HomeMy WebLinkAboutHealth Department Septic Approval (2) PERMIT #:56-SF-1730589
APPLICATION #:AP 1269783
STATE OF FLO IDA
DEPARTMENT OE HEALTH DATE PAID:
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID:
CONSTRUCTION PERMIT RECEIPT #:
DOCUMENT #:PR1044688
CONSTRUCTION PERMIT FOR: O TDS New
APPLICANT: Justine Sigel(772-359-7920 call for pick up)
PROPERTY ADDRESS: 11700 Appaloosa Ct Port Saint Lucie,FL 34987
LOT: 15BLOCK: A SUBDIVISION: Pony Pines
A-PROPERTY ID #: 3309-605-0018-000-3 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
[OR TAX ID NUMBER]
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION'
381.0065, F.S., AND CHAPTER 64E-6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE
SATISFACTORY PERFORMANCE Fol, ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS,
WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE
_ PERMIT APPLICATION. SUCH 40DIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID.
ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL,
STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY.
SYSTEM DESIGN AND SPECIFICATIONS
T [ 1,200 l GALLONS / GPD Septic new CAPACITY
A [ ] GALLONS / GPD N/A CAPACITY
N [ ] GALLONS GREASE INrERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:.1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ]
D [ 767 ] SQUARE FEET Drainfield new SYSTEM
R [ ] SQUARE FEET N/A SYSTEM
A TYPE SYSTEM: [ ] STANDARD [ ] FILLED [x] MOUND [ ]
I CONFIGURATION: [ ] TRENCH [xl BED [ 1
N
nail in ab a palm SE of system
I ELEVATION OF PROPOSED SYSTEM SITE [ 20.00 ] [ INCHES FT ] [ABOVE BELOW BENCHMARK/REFERENCE .POINT
E BOTTOM OF DRAINFIELD TO BE [ 18.00 ] [ INCHES FT ] [ABOVE BELOW BENCHMARK/REFERENCE POINT
L
-- •-D FILL REQUIRED: [20.001 IN 2HES EXCAVATION REQUIRED: [ ] INCHES
The system is sized for 3 bedrooms with a maximum occupancy of 6 persons(2.per bedroom),for a total estimated flow
O of 460 gpd.
T The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance with
H s.64E-6.013(3)(0,FAC.
E
R OF
SPECIFICATIONS BY: Brian J Ingram TITLE: Environmental Specialist II
APPROVED BY: TITLE: Environmental Specialist II St.Lucie CHD
Brian J Ir g;afi
DATE ,ISSUED: 01/09/2017` EXPIRATIO14 DATE: 07/09/2018
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC Page 1 of 3
1.1.4 AP1269783 SE1016814
NOTICE OF RIGHTS
A party whose substa itial interest is affected by this order may petition for an
administrative hearing pursuant to sections 120.569 and 120.57, Florida Statutes. Such
proceedings are governed by Rule 28-106, Florida Administrative Code. A petition for
administrative hearing must be in writing and must be received by the Agency Clerk for the
Department,within twenty-on (21) days from the receipt of this order. The address of the
Agency Clerk is 4052 Bald C1 press Way, BIN A-02, Tallahassee, Florida 32399. The
Agency Clerk's facsimile num ber is 850-413-8743.
Mediation is not avail c ble as an alternative remedy.
Your failure to submit a petition for hearing within 21 days from receipt of this order
will constitute a waiver of you,right to an administrative hearing, and this order shall become
a'final order.
Should this order become a final order, a party who is adversely affected by it is
entitled to judicial review pur1]ant to Section 120.68, Florida Statutes. Review proceedings
are governed by the Florida ules of Appellate Procedure. Such proceedings may be
commenced by filing one cop of a Notice of Appeal with the Agency Clerk of the
Department of Health and a'e cond copy, accompanied by the filing fees required by law,
with the Court of Appeal In th.appropriate District Court. The notice must be filed within 30
days of rendition of the final c rder.
STATE OF FLORIDA PERMIT J PPLICATION TO CONSTRUCT, ` J Y l -73 K
REPAIR;MODIFY,OR ABAND ON A WELL Permit No.
❑Southwest Florida Unique ID,�-a 5q 4 9
v PL SE FILL OUT ALL APPLICABLE FIELDS
❑Northwest ( enotes Required Fields Where Applicable) Permit Stipulations Required(see Attached)
9
❑St.Johns River
?'.., The:aferwellcontractorfs respantible/arcomplehng
South Florida
this mm fonvarding the permit mita application 62-524 Quad No. Delineation No.
'^a:,_E •*
❑Suwannee River app priatedelegatedauthority where applicable.
❑DEP CUP/WUP Application No.
❑Delegated Authority(If Appli able)
ABOVE THIS LINE-FOR OFFICIAL USE ON Y
1,Justine Sigel 11691 Appal osa Court,PSL,FL 34987 772-359-7920
Owner,Legal Name if Corporation Ac dress City State ZIP Telephone Number
2.11700 AppMoosa CourtPSL FL 34987
Well Location-Address,Road Name or Number.Cl
3. 3309-605-0018-000-3 15 A 1
Parcel ID No.(PIN)or Alternate Key(Circle One) Lot Block Unit
4.09 36S 39E St Lucie Pony Pines Check If 62-5240Yes❑No
Section or Land Grant Township Range County Subdivision
5•Scott's Drilling,Inc. 11213 772-489-6117 scottsdrilling@bellsouth.net
Water Well Contractor LicE nse Number Telephone Number E-mail Address
6.5014 Palm Drive Fort Pierce FL 34982
Water Well Contractor's Address City State ZIP
7. Type of Work: ❑✓ Construction ❑ Repair ❑ Modification[:]Abandonment
8. Number of Proposed Wells ONE Reason for Rep.r uon ofwa*4-5134 WD
9. Specify Intended Use(s)of Well(s): ate 5 amp
❑✓ Domestic. Landscape Irrigation Agricultural Irrigation ❑ Site Investigations
Bottled Water Supply 8 Recreation Area Irrigs ion H Livestock ❑ Monitoring Ip ^O��
H Public Water Supply(Limited Use1DOH) ❑ A11
Nursery Irrigation ❑ Test
❑ Public Water Supply(Community or Non-Communit/DEP) Commercial/Industrial Earth-Coupled Geothermal
F1Class I Injection H Golf Course Irrigation HVAC Supply
u HVAC Return
Class V Injection:❑ Recharge ❑ commercial/Ind istrial Disposal ❑ Aquifer Storage and Recovery❑ Dra)n�c_� in St Lucie COU
Remediation:C] Recovery❑ Air Sparge ❑ Other iDescribe) _ ENVI 0NP&W1A6,HEA TH
❑ Other (Dexnbe) —
10.Distance from Septic System if 5 200 ft. 'i) 11.Facility Descdption ing a Family Residence 12.Estimated Start Date
13.Estimated Well Depth 120 ft. Estimated Casing Depth 100 ft. Primary Casing Diameter 2 in. Open Hole: From To fL
14.Estimated Screen Interval:From 100 To 120 it.
15.Primary Casing Material: Black Steel Galvanized PVC Stainless Steel
Not Cased Other
16.Secondary Casing: Telescope Casing Lir er Surface Casing Diameter in.
17.Secondary Casing Material: Black Steel G Ivanized PVC Stainless Steel Other
18.Method of Construction,Repair,or Abandonment: Auger Cable Tool Jetted Rotary Sonic
Combination(Two or More Methods) Hand Driven(Well Point,Sand Point) Hydraulic Point(Direct Push),
Horizontal Drilling Plugged by Approved Method Other(Describe)
19.Proposed Grouting Interval for the Primary,Seconds ,and Additional Casing:
From 0 To 100 Seal Material( Ben onite ,/Neat Cement Other )
From To Seal Material( Ben onite Neat Cement Other )
From To Seal Material( Ben onite Neat Cement Other )
From To Seal Material( Ben onite Neat Cement Other )
20.indicate total number of existing wells on site List number of existing unused wells on site
21.Is this well or an existin well or water withdrawal •s o 1EemIt
or pp Icatlon es ,/ No I yes,complete the follow ng:C P/WUP No. District Well ID No.
22.Latitude Longitude
23.Data Obtained From: GPS Map 3urvey Datum: NAD 27 NAD 83 WGS 84
I Mrebycerwow[w3cm0ywiU,aaappli ba.-mlesef Tata46.Floida AdmiosVelm Codo.eM)halawater I eerily eat lam pa—,of Me Wpedy.Nal me mkrms6a,p.,Wtei b aoM .a.l pat l am aware of my
use pen]aaaieaw rMAarpe pemu6 if nee".ha3 bear)or w91 be o 166 priorWc en 'o1wea MSPomibiliks under chooler 373.Florida Slatelos.Wmanlain a pfopery abandon ibisxe0:or,I WIVY mat I em
WnatNCaWI.INnher xrefy Nat all lnfomabon proaide<I HI Nrs appheltimbnreumteo tnatIwjobNn Nx:genlior Nn armar,Nal lha mfanla0ca prWidMls araamla.and alAtlhavo hdolmsd 0,e awnnr pf Ne'a
wrMioaryappmval fron oNor federal,state,Ulertl povammen15,8appdra0la lapraot p,midea xan to:po,96iaasa rog I. amve.Banc pak.m sw i wbp parsonmment t w-d by mos of Aua,rnly across
o+aWbtiotrepM to meautrid wYJlhl3a days oMrcanplsdpr,MU,e CansWCV•r.,Wpair, i!mn,a IO Na wa75Aa E0M7Ir1e mnatruc0an,repai,mpLE(21gn,or aaandMmanl euthx,zad by mos parm:t
1=0 pIVM11e0 aa0oop veanM
171T3/161R27pMFST• 17r1W 611 nm EST
cvrvK� Nframanwtdllvv13 6xa2-eNMYayT•14rZ
Signature of Contractor icense No. Signature of Owner or Agent 7 Date
BELOW THISMNE-FOR OFFICIAL USE ONLY
Approval Granted By Issue Date Expiration Date /Hydrologist Approval
INtia a
Fee Received $ Race!3t No. Check No.
THIS PERMIT IS NOT VALID UNTIL PROPERLY SIGNED BY I N AUTHORIZED OFFICER OR REPRESENTATIVE OF THE WMD OR DELEGATED AUTHORITY.THE
PERMIT SHALL BE AVAILABLE AT THE WELL SITE DURING CONSTRUCTION,REPAIR,MODIFICATION,OR ABANDONMENT ACTIVITIES.
DEP Form:62532.900(1) Incorporated in 62-532.400(1),F.A.C. Effective Date:October 7,2010 Page 1 of 2
a
Pb St. Lucie County Health Department
FR
��: z 5150 NW Milner Dr Port Saint Lucie, FL 34983
HEALTH
PAYING ON: PERMIT*.5E-SF-1730589 BILL DOC#:56-BID-3328183 CONSTRUCTION APPLICATION#:AP1269783
RECEIVED FROM: All Count Septic AMOUNT PAID: $ 515.00
PAYMENT FORM: CHECK 42 PAYMENT DATE: 01/05/2017
MAIL TO: Justine Sigel (772-359 7920 call for pick up)
FACILITY NAME :
PROPERTY LOCATION:.
11700 Appaloosa Ct
Port Saint Lucie, FL 34987
Lot: 15 Block: A
Property ID: 3309-605-001 E-000-3
EXPLANA ION or DESCRIPTION: QUANTITY FEE "
-1 - OSTDS Construction Applicat on and Plan Review,New 1 $ 100.00
123-OSTDS Construction Site Evaluation 1 $ 115.00
126-OSTDS Construction Permi (New or Mod, Amendment) 1 $ 55.00
127-OSTDS Construction Systern Inspection 1 $ 75.00
128-OSTDS Construction Systern Inspection Research Fee 1 $ 5.00
133-OSTDS Construction Reinspection 1 $ 50.00
-1 - Surcharge(All) 1 $ 15:00
-1 -OSTDS New Permit Surcharge 1 $ 100.00
RECEIVED BY: VanceMH AUDIT CONTROL NO. 56-PID-3165981
STATE OF F ORIDA PERMIT NO.,T - 505SI
DEPARTMENT OF HEALTH DATE PAID
p ONSITE SEW GE TREATMENT AND DISPOSAL FEE PAID: {e;^ (}�
{f��+*`sSYSTEM RECEIPT #:
APPLICATION FOR CONSTRUCTION PERMIT C
APPLICATION FOR:
New System [ ] Existing System L 7 Holding Tank [ ] Innovative
[ ] Repair [ ] Abandonment [ ] Temporary [ 7
APPLICANT: C 5-
AGENT: `
TELEPHONE:
AGENT: do
MAILING ADDRESS:
TO BE COMPLETED BY APPLICANT- OR APPLICANT'S AUTHORIZED AGENT. SYSTEMS MUST BE CONSTRUCTED
BY A PERSON LICENSED PURSUNNT TO 489.105(3) (m) OR 489.552, FLORIDA STATUTES. IT IS THE
APPLICANT'S RESPONSIBILITY TO PROVIDE DOCUMENTATION OF THE DATE THE LOT WAS CREATED OR
PLATTED (MM/DD/YY) IF REQ STING CONSIDERATION OF STATUTORY GRANDFATHER PROVISIONS.
PROPERTY INFORMATION
� t1
LOT: 1,5 BLOCK: SUBDIVISION: Pong Psn] tj PLATTED:
PROPERTY ID #: 00( . 3 ZONING: i'.S I/M OR EQUIVALENT: [ Y / N ]
PROPERTY SIZE: ACRES, WATER SUPPLY: PRIVATE PUBLIC [ ]c=2000GPD [ 1>2000GPD
.r
IS SEWER AVAILABLE AS PER 81.0065, FS? [ Y /�] DISTA�NgCE TO SEWER: FT
PROPERTY ADDRESS: l
DIRECTIONS TO PROPERTY: _jjS`!
tSOLO
r ti
P
Q
BUILDING INFORMATION [)4 RESIDENTIAL [ ] COMMERCIAL
Unit Type of No. of Building Commercial/Institutional System Design
No Establishment Bedrooms Area Sgft Tabblleg 1, Chapter 64E-6, FAC
vrr
3
4
[ ] Floor/RuAipment Draii Other (Specify)
SIGNATURE: L7
DATE:
DH 4015, 08/ (Obsoletes previous editions which may not be used)
Incorporated 64E-6.001, FA Page 1 of 4
' STATE OF FLORIDA APPLICATION # AP1269783
y DEPARTMENT 0 HEALTH PERMIT # 56-SF-1730589
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM DOCUMENT #
SE1018814
SITE EVALUATION AND SYSTEM SPECIFICATION
APPLICANT: Justine Sigel(772-359-7920 call for pick up)
CONTRACTOR / AGENT: All County Septic
LOT: 15 BLOCK: A
SUBDIVISION: Pony Pine ID#: 3309-605-0018-000-3.
TO BE COMPLETED' BY ENGINEER, HEALTH DEPARTMENT EMPLOYEE, OR OTHER QUALIFIED, PERSON. ENGINEERS MUST
PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS.
PROPERTY SIZE CONFORMS TO SITE LAN: [X]YES [ ]NO NET USABLE AREA AVAILABLE: 2,00 ACRES
TOTAL ESTIMATED SEWAGE FLOW: 460 GALLONS PER DAY [ RESIDENCE S-TASLEI / OTHER-TABLE 2 ]
AUTHORIZED SEWAGE FLOW: 3000.00 GALLONS PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE ]
S
UNOBSTRUCTED AREA AVAILABLE: 1300.00 SQFT UNOBSTRUCTED AREA REQUIRED: 1150.00 SQFT
BENCHMARK/REFERENCE POINT LOCAT ON: Orange painted nail in cabbage palm SE of system
ELEVATION OF PROPOSED SYSTEM SI 20.00 [ INCHES / FT ] [ ABOVE / BELOW ] BENCHMARK/REFERENCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES
SURFACE WATER: FT DITCHES/SWALES: FT NORMALLY WET: [ ]YES [X]NO
WELLS: PUBLIC: FT LIMITED USE: FT PRIVATE: 75 FT. NON-POTABLE: FT
BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: 5 FT POTABLE WATER LINES: 10 FT
SITE SUBJECT TO FREQUENT FLOODING? [ ]YES [X]NO 10 YEAR FLOODING? [ ]YES [X]N01
10 YEAR FLOOD ELEVATION FOR SI FT [ MSL / NGVD ] SITE ELEVATION: FT [ MSL / NGVD
SOIL PROFILE INFORMATION SITE 1 SOIL PROFILE INFORMATION SITE 2
USDA SOIL SERIES:Nettles sand USDA SOIL SERIES:Nettles sand
Munsell#/Color Texture Depth Munsell#/Color Texture, Depth
I OYR 4/1 Sand 0 To 6 1 OYR 5/1 Sand 0 To 5
1 OYR 4/4 Sand 6 To 16 1 OYR 4/3 Sand 5 To 15
1 OYR 6/3 Sand 16 To 20 invp Ain Rand is TO 9n
1 OYR 6/2 Sand 20 To 30 10YR 6/2 Sand 20 To 30
1 OYR 4/2 Sand 30 To 41 10YR 4/2 Sand 30 To 42
1 OYR 2/1 Spodic Material 41 To 46 10YR 312 Sand 42 To 48
"2.5Y 4/2 Loamy Sand 46 To 60 2,5Y 4/2 Loamy Sand 48 To 58
2.5Y 4/3 Sandy Loam 60 To 72
2.5Y 4!3 Sandy Loam 58 To 72
'OBSERVED WATER TABLE: 68,00 INCHES [ ABOVE /EEI EXISTING GRADE TYPE: [ PERCHED / APPARENT ]
ESTIMATED WET SEASON WATER TABLE ELEVATION: 22 INCHES [ ABOVE / BELOW ] EXISTING GRADE
HIGH WATER TABLE VEGETATION: [ ]YES [X ]NO MOTTLING: [X]YES [ ]NO DEPTH: 22.00 INCHES
SOIL TEXTURE/LOADING RATE FORS STEM SIZING: Sand/0.60 DEPTH OF EXCAVATION: INCHES
DRAINFIELD CONFIGURATION: [ ] TRENCH [X] BED [ ] OTHER (SPECIFY)
REMARKS/ADDITIONAL CRITERIA
WSWT determined using USDA WSS and so 1 borings. `
10YR712 stripping In 10YR6/2 matrix 10%wit h diffuse boundaries starting@ 22"In S132.
SBI 17"below RP.SB2 20"below RP. `�
SITE EVALUATED BY: / DATE: 01/06/2017
lng!arr,Brian( e:Environmental Specialist 11)(ENVIRONMENTAL HEALTH)
DH 4015, 08/09 (obsoletes previous edit'ons which may not be used) Incorporated: 64E-6.001, FAC Page 3 of 4
AP1269783 EID1730589 v 1.0.2