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HomeMy WebLinkAboutHealth Department Septic Approval (2) PERMIT #:56-SF-1739183 STATE OF FLORIDA APPLICATION #:AP 1275419 DEPARTMENT OF HEALTH DATE PAID: ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID: t SYSTEM RECEIPT #: DOCUMENT #: PR1051079 CONSTRUCTION PERMIT FOR: OSTDS New APPLICANT: Joseph&Tracy Fersch PROPERTY ADDRESS: 4820 Southwind Tri -Fort Pierce,FL 34950 T LOT: BLOCK: SUBDIVISION: PROPERTY ID #: 1418-133-0015-000-3 [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 FOR 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 MODIFICATIONS 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 [ 900 ] GALLONS / GPD. SeDtic new CAPACITY A [ ] GALLONS / GPD N/A CAPACITY N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ] , D [ 500 ] SQUARE FEET Drainfield new SYSTEM R [ ] SQUARE FEET N/A SYSTEM A TYPE SYSTEM: [ ] STANDARD [ ] FILLED [x] MOUND [ ] I CONFIGURATION: [ ] TRENCH [X] BED [ ] N F LOCATION OF BENCHMARK: site BM Nail in tree TBM in 21"pine W of,system I ELEVATION OF PROPOSED SYSTEM SITE [ 36.00 ] [ xNCHEs FT ] [ABOVE BELOW BENCHMARK/REFERENCE POINT `' [ 32.00 ] [ INCHES FT ] [ABOVE BELOW BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE �L D;FILL REQUIRED: [22.001 INCHES 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 of O 300 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 SPECIFICATIONS BY: Brian J Ingram TITLE: Environmental Specialist II APPROVED BY: LE: Environmental Specialist II St:Lucie CHD Brian J Ingr DATE ISSUED: 02/24/2017 EXPIRATION DATE: 08/24/2018 DH 4016, 08/09 (Obsoletes all previous editions. which may not be used) R /j Incorporated: 64E-6.003, FAC of 3 i.i.4 rn1275419 SE1024448 E 1� NOTICE OF RiGHA A party whose substantial 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-one (21) days from the receipt of this order. The address of the Agency Clerk is 4052 Bald Cypress Way, BIN A-02, Tallahassee, Florida 32399. The Agency Clerk's facsimile number is 850-413-8743. Mediation is not available 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 your 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 pursuant to Section 120.68, Florida Statutes. Review proceedings are governed by the Florida Rules of Appellate Procedure. Such proceedings may be commenced by filing one copy of a Notice of Appeal with the Agency Clerk of the Department of Health and a second copy, accompanied by the filing fees required by law, with the Court of Appeal in the appropriate District Court. The notice must be filed within 30 days of rendition of the final"order. h F I St. Lucie County Health Department - t HEALTH 5150 NW Milner Dr Port Saint Lucie, FL 34983 PAYING ON: PERMIT W 56-SF-1739183 BILL DOC#.56-BID-3345728 CONSTRUCTION APPLICATION#.AP1275419 RECEIVED FROM: Joseph &Tracy Fersch AMOUNT PAID: $ 515.00 c PAYMENT FORM: CREDIT CARD PAYMENT DATE: 02/10/2017 MAIL TO: Joseph &Tracy Fersch FACILITY NAME : PROPERTY LOCATION: 4820 Southwind Trl Fort Pierce,FL 34950 Lot: Block: Property ID: 1418-133-0015-000-3 EXPLANATION or DESCRIPTION: QUANTITY FEE -1 -OSTDS Construction Application and Plan Review,New 1 $ 100.00 123- OSTDS Construction Site Evaluation 1 $ 115.00 126-OSTDS Construction Permit(New or Mod,Amendment) 1 $ 55.00 127-OSTDS Construction System Inspection 1 $ 75.00 128- OSTDS Construction System 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-3183056 �1-2400 STATE OF FLORIDA PERMIT NO. DEPARTMENT OF HEALTH DATE PAID: ONSITE SEWAGE TREATMENT AND DISPOSAL, FEE PAID. SYSTEM RECEIPT #: APPLICATION FOR CONSTRUCTION PERMIT APPLICATION FOR: [ 7 . New System' _ [ 7 Existing System [ 7 Holding Tank j ] Innovative [ ) Repair [ ] Abandonment �[ •-] Temporary q [ ] APPLICANT: AGENT: TELEPHONE: 1 0 MAILING ADDRESS: F6 x 2-5 11 V-e ro 5e 0.C—k TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. SYSTEMS MUST BE CONSTRUCTED BY A PERSON LICENSED PURSUANT TO 489.105(3) (m) OR 489.S52, FLORIDA STATUTES. ' IT IS THE APPLICANT'S RESPONSIBILITY TO PROVIDE DOCUMENTATION OF THE DATE THE LOT WAS CREATED OR PLATTED (MK/DD/YY) IF REQUESTING CONSIDERATION OF STATUTORY GRANDFATHER PROVISIONS. -------------------- PROPERTY INFORMATION LOT: BLOCI{: SUBDIVISION: PLATTED: PROPERTY ID #: 00C) ZONING: I/M OR EQUIVALENT: [ Y / N 7 PROPERTY SIZE: 1 ,(4 ACRES WATER SUPPLY: { PRIVATE PUBLIC [ J<=2000GPD [ 1>2000GPD IS SEWER AVAILABLE AS PER 381.0065, FSY [ Y / DISTANCE TO SEWER: FT PROPERTY ADDRESS s 2-G �J�� is11 a��( � Y �.• �" ' �--I ' DIRECTIONS TO 'PROPERTY: BUILDING. INFORMATION 14 RESIDENTIAL [ J COMMERCIAL fi Unit Type of No. of Building Commercial/Institutional System Design No Establishment Bedrooms Area Sgft Table 1, Chapter 64E-6, PAC J y0 2 3 4 [ ) Floor/Equipme'n�ta Drains [ ] Other (Specify) SIGNATURE: �y1 �� DATE: DH 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated 64E-6.001, FAC Page 1 of 4 STATE OF FLORIDA APPLICATION # AP1275419 DEPARTMENT OF HEALTH 56-SF-1739183 ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM PERMIT # DOCUMENT # SE1024448 SITE EVALUATION AND SYSTEM SPECIFICATION APPLICANT: Joseph&Tracy Fersch CONTRACTOR / AGENT: Joseph&Tracy Fersch LOT: BLOCK: SUBDIVISION: ID#: 1418-133-0015-000-3 =TO BE COMPLETED BY ENGINEER, EALTH 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 PLAN: [X]YES [ ]NO NET USABLE AREA AVAILABLE: 1.16 ACRES TOTAL ESTIMATED SEWAGE FLOW: 300 GALLONS PER DAY [ RESIDENCES-TABLEI / OTHER-TABLE 2 ] AUTHORIZED SEWAGE FLOW: 1740.01 GALLONS PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE ] UNOBSTRUCTED AREA AVAILABLE: 750.00 SQFT UNOBSTRUCTED AREA REQUIRED: 750.00 SQFT BENCHMARK/REFERENCE POINT LOCATION: site BM Nail in tree TBM in 21"pine W of system ELEVATION OF PROPOSED SYSTEM SITE 36.00 [ 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: 30 FT NORMALLY WET: [ ]YES [X]NO WELLS: PUBLIC: FT LIMITED USE: FT PRIVATE: 100 FT NON-POTABLE: FT BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: 35 FT POTABLE WATER LINES: 75 FT SITE SUBJECT TO FREQUENT FLOODING? [ ]YES [X]NO 10 YEAR FLOODING? [ ]YES [X]NO) 10 YEAR FLOOD ELEVATION FOR SITE: FT [ MSL / NGVD ] SITE ELEVATION: FT [ MSL / NGVD 'SOIL PROFILE INFORMATION SITE 1 SOIL PROFILE INFORMATION SITE 2 USDA SOIL SERIES:Myakka fine sand USDA SOIL SERIES:Myakka fine sand Munsell#/Color Texture Depth Munsell#/Color Texture Depth 1 OYR 5/1 Sand 0 To 15 1 OYR 5/1 Sand 0 To 15 1 OYR 6/1 Sand 15 To 31 1 OYR 6/1 Sand 15 To 30 1 OYR 7/1 Sand 31 To 37 1 OYR 7/1 Sand 30 To 37 1 OYR 3/1 Sand 37 To 43 1 OYR 3/2 Sand 37 To 47 1 OYR 3/2 Sand 43 To 54 1 OYR 4/2 Sand 47 To 57 1 OYR 4/3 Sand 54 To 67 1 OYR 5/2 Sand 57 To 72 1 OYR 5/2 Sand 67 To 72 OBSERVED WATER TABLE: 72.00 INCHES [ ABOVE / BELOW ] EXISTING GRADE TYPE: [ PERCHED / APPARENT ] ESTIMATED WET SEASON.WATER TABLE ELEVATION: 20 INCHES [ ABOVE / BELOW ] EXISTING GRADE HIGH WATER TABLE VEGETATION: [ ]YES EX]NO MOTTLING: [X]YES [ ]NO DEPTH: 20.00 INCHES SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: Sand/0.60 DEPTH OF EXCAVATION: INCHES DRAINFIELD CONFIGURATION: ( ] TRENCH EX] BED [ ] OTHER (SPECIFY) REMARKS/ADDITIONAL CRITERIA WSWT determined using"USDA WSS and soil borings. 10YR7/1 stripping In 10YR6/1 matrix>10%with diffuse boundaries starting at 20"In SB1 SB1 36"below BM.SB2 34"below BM. SITE EVALUATED BY: �'_. DATE: 02/24/2017 Ingram,Bria tle:Environmental Specialist 11)(ENVIRONMENTAL HEALTH) DE 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated: 64E-6.001, FAC Page 3 of 4 AP1275419 EID1739183 v 1.0.2 Florida's Leading Engineering Source n mental•Geotechnical•Construction Materials Testing•Threshold and special Inspections•Plan Review&Code Compliance ,�TFRNATtiO�Py March 18, 2014 GHO Homes Corporation 1775 SW Gatlin Blvd#206 Port St. Lucie, Florida 34953 RE: Soil Exploration-Proposed One-Story. Residence NE of Southwind Trail and Indrio Rd (Parcel ID#1418-133-0015-000-3), Ft. Pierce, Florida GFA Project# 14-0613:00 GFA International -performed soil testing with three auger borings with hand cone penetrometers at the above referenced project. Based on the test results, the soil on which the referenced structure is to rest is capable of sustaining a safe bearing capacity of .2,500 psf. The subsurface exploration activities were performed in accordance with Section 1818.2 of the Florida Building Code (latest addition) and applicable ASTM and AASHTO standards. For detailed information on subsurface conditions encountered, please refer to the logs attached to this letter. We recommend that.the bottom-of the footings be founded at a depth of at least 12 inches below finish grade. The depth shall be measured from the lowest adjacent grade. We also recommend a minimum footing width of 18 inches for spread footings and 16 inches for monolithic footings, but not less than 8 inches more than the width of the imposed wall. This report does not state or imply that the foundation soils at the bearing level will remain in the original condition in which they were found during the subsurface exploration activities. Exposure to the environment may weaken the foundation soils at the bearing level if the foundation excavations remain open for a long period of time;or if the foundation soils are.exposed to rainfall. Consequently, it is recommended that the excavations for the wall and column footings be.performed to final grade and footings constructed as soon as possible to minimize potential damage of the bearing soils. GFA estimates that 2 to 3 feet of fill will be required to bring the foundation pad to design grade. It is also recommended that the 2 feet below existing grade, the bottom of all new footing excavations and slabs, and all fill material, be compacted to a minimum density of 95% of the Modified Proctor(ASTM D-1557), prior to the placement of the concrete for the footings. Sincerely, GFA Intergplidhicillinp. F13PEe4A 49 RMOCF��i�� .•.•GE N Oro .. • I�W. Molq*, P.E. :w ' Craig A. Hampy, E.I. Ses�ior,Geotechn abRnginaM Staff Engineer FIcTj%'Regisfr��i n Nat:6�S .�LOF��O.�C�. Attachflrs'f '�ip4b`n Plan, Auger Boring(AB)Logs (3), Notes Related to Test Borings Copies, 521 NW Enterprise Drive Port St.Lucie,Florida 34986 • (772)924-3575 (772)924.3580(fax) www.teamgfa.com OFFICES THROUGHOUT FLORIDA r iY' j:tF. ^�thcuto!d* • • • • . • ' . I 1 1 1 1 • Zi - • 1 11 1.7,-Y� 4 j 'T '1 ! �1i l�'�\�S• a.. t '�.i�k V Fes' -, 1 1^,F;�'"1 ry.. �' t AIM& N pw Ci�h L" >•+,.-t d'.u.l ;�p,--a r � }T��1•� } t'`''+ • - � ,r5c.:, S 1''s t'7',r,'.vFit4 !' tiJr. �i� ��; �_ { .Yi-4•t•ti r^'r�3^.r, ` t7la at' J r. `�Yd3 -"•' a .X .d��`"'� �-a? r'a r� . Q� f if'n y � •, ti 44, .-..�' ` '�R~1Lr7' �t�l:.h�C. � ;` + ` •' 1 C �h r r 4 ,iC '( :t TF• ��rA•-r ;ir t r� S cC.`yp '4t�: U J't•�.1. 1F � � S t y •• U t• h �w�i. f- �71t 1 } *` _ t�1 1U,17 CinttglP •,. , ,Li '^.. �` ! CF1 C�fjl0,,Dp(j j�;t 1sstInnycry UateN�J,3/d�l`� la[,;17�SZ19�3° lc�n -5(1373309� elc\ Il k: All AUGER BORING LOGS WITH HAND CONE PENETROMETER (HCP) TESTS Client: GHO Homes Corporation Project No: 14-0613.00 Project: Proposed One-Story Residence Lab No: NE of Southwind Trail and Indrio Road Test Date: 3/15/2014 (Parcel ID#1418-133-0015-000-3) Ft. Pierce, Florida Elevation: Existing Site Grade Technician: PMNVN TEST LOCATION: AB— 1 N27.52244° W80.37356' HCP Depth(feet) Description (color,texture,consistency,remarks) Depth Reading 0- 1 Brown fine sand trace roots SP 1 30 1 -2 Light gray fine sand SP 2 80+ 2—3%2 Brown fine sand trace roots SP 3 80+ 3Y2—5 Brown fine sand SP 4 40 5-7 Light brown fine sand SP 5 20 7— 10 Light 2ray fine sand SP 6 40 7 80+ 8 30 9 20 10 20 Water table at 3'/4 feet below round surface TEST LOCATION: AB—2 N27.52229' W80.37353° HCP Depth(feet) Description (color,texture, consistency,remarks) Depth Reading 0-1 Light_gray fine sand trace roots SP 1 20 1 -2 Light gray fine sand SP 2 80+ 2-3 Brown fine sand SP 3 80+ 3-5 Dark brown fine sand SP 4 60 5-5%2 Brown fine sand SP 5 80+ 5'/2—7 Light brown fine sand SP 6 40 7—10 Light gra fine sand SP 7 60 8 70 9 40 10 20 Water table at 3%feet below ground surface .:Erii"i�,St.= .. 2...,si;.9 :'=3 g".'''i.t?.+i..•"::i'f}'w �C:�.•,`t"•.^.i; iyr�RfYA���aPv AUGER BORING LOGS.WITH'HAND CONE PENETROMETER (HCP) TESTS Client: GHO Homes Corporation Project No: 14-0613.00 Project: Proposed One-Story Residence Lab No: NE of Southwind Trail and Indrio Road Test Date: 3/15/2014 (Parcel ID#1418-133-0015-000-3) Ft. Pierce, Florida Elevation: Existing Site Grade Technician PM/WN TEST LOCATION: AB—3 N27.52245° .W80.37340' HCP Depth(feet) Description (color,texture,consistency,remarks) Depth Reading 0-1 Gray and brown fine sand trace roots SP 1 40 1 -2 Gray fine sand SP 2 30 2—3'/2 Dark brown fine sand SP 3 80+ 3%2—5%z 'Brown fine sand SP 4 80+ 5%2—7 Light brown fine sand SP 5 80+ 7—10 Light gray fine sand SP 6 60 7 40 8 80+ 9 50 10 30 Water table at 3'/_e feet below ground surface 1 NOTES RELATED TO RECORDS`OF TEST BORING AND —$r• !75 GENERALIZED SUBSURFACE PROFILE ' 1. Groundwater level was encountered and recorded(if shown)following the completion of the soil test boring on the date indicated,Fluctuations in groundwater levels are common;consult report text for a discussion. 2. The boring location was identified in the field by offsetting from existing reference marks and using a cloth tape and survey wheel. 3. The borehole was backfilled to site grade following boring completion,and patched with asphalt cold patch mix when pavement was encountered. 4. The Record of Test Boring represents our interpretation of field conditions based on engineering examination.of the soil samples. 5. The Record of Test Boring is subject to the limitations,conclusions and recommendations presented in the Report text. 6. "Field Test Data"shown on the Record of Test Boring indicated as 1116 refers to the Standard Penetration Test (SPT)and means I I hammer blows drove the sampler 6 inches.SPT uses a 140-pound hammer falling 30 inches. 7. The N-value from the SPT is the sum of the hammer blows required to drive the sampler the second and third 6- inch increments. 8. The soil/rock strata interfaces shown on the Records of Test Boring are approximate and may vary from those shown.The soil/rock conditions shown on the Records of Test Boring refer to conditions at the specific location tested;soil/rock conditions may vary between test locations. 9. Relative density for sands/gravels and consistency for silts/clays are described as follows: SPT CPT SANDS/GRAVELS SPT CPT SILTS/CLAYS BLOWS/FOOT KG/CM- RELATIVE DENSITY BLOWS/FOOT KG/CM- CONSISTENCY 0-4 0-16 Very loose 0-1 0-3 Very soft 5-10 1740 Loose 2-4 4-6 Soft 11-30 41-120 Medium Dense 5-8 7-12 Firm 31-50 121-200 Dense 9-15 13-25 Stiff . 50+ over 200. Very Dense 16-30 25-50 Very stiff >30 1 >50 Hard 10. Grain size descriptions are as follows: NAME SIZE LIMITS Boulder 12 Inches or more Cobbles 3 to 12 Inches Coarse Gravel Y4 to 3 Inches Fine Gravel No,4 sieve to Y.inch Coarse Sand No.10 to No.4 sieve Medium and No.40 to No.10 sieve Fine Sand No.200 to No.40 sieve Fines Smaller than No.200 sieve 11. Definitions related to adjectives used in soil/rock descriptions: PROPORTION ADJECTIVE APPROXIMATE ROOT DIAMETER ADJECTIVE <5% Trace Less than 1132" Fine roots 5%to 12% Little 1132"to W' Small roots 12%to 30% Some %s"to I" Medium roots 30%to 50% And Greater than V Large roots Organic Soils:Soils containing vegetable tissue in various stages of decomposition that has a fibrous to amorphous texture, usually a dark brown to black color,and an organic odor. Organic Content<25%:Slightly to Highly Organic;25%to 75%:Muck;>75%:Peat 1 f 'roperty Card Page 1 of l 56-sr_ . 173 WS Michelle Franklin, CFA--Saint Lucie County Property Appraiser--All rights reserved. Property Identification Site Address:Southwind Parcel ID: 1418-133-0015- Account#:7896 Sec/Town/Range: TRL 000-3 18/34S/40E Map ID: 14/18N Zoning:AR-1 Use Type:0000 Jurisdiction:Saint Lucie County Ownership Legal Description Joseph W Fersch 18 34 40 N 1/2 OF NW I/4 OF SW 1/4 OF SW 1/4 OF NE Tracy J Fersch 1/4-LESS W 30 FT-(1.16 AC)(OR 3865-3) 2135 SW 18th SW AVE Vero Beach,FL 32962-7938 Current Values Historical Values 3-year Just/Market: $24,400 Assessed: $24,400 Year Just/Market Assessed Exemptions Taxable Exemptions: $0 Taxable: $24,400 2016 $24,400 $24,400 $0 $24,400 2015 $27,600 $27,600 $0 $27,600 2014 $28,900 $24,200 $0 $24,200 Sale History Date Book/Page Sale Code Deed Grantor Price 05-02-2016 3865/0003 0001 WD Mitchell Michael T $34,000 02-05-2014 3604/0407 0001 WD Jones,Michael S $27,500 08-27-2009 3122/2786 0338 DE Faurot,Michael $154,900 Primary Building Information Finished Area of this building:0 SF Gross Area of this building:0 SF • Exterior Data View: Roof Cover: Roof Structure: Building Type: Year Built:N/A Frame: Grade: Effective Year:2014 Primary Wall: Story Height: No.Units:0 Secondary Wall: Interior Data Bedrooms:0 A/C%:0% Electric: Primary Int Wall: Full Baths:0 Heated%:N/A% Heat Type: Avg Hgt/Floor:0 Half Baths:0 Sprinkled%:0% Heat Fuel: Primary Floors: Total Areas Finished/Under Air 0 (SF): Gross Area(SF): 0 Land Size(acres): 1.16 - ' Land Size(SF): 50,530 y Total Building Count: 1 Special Features and Yard Items Type Qty Units Year Blt This information is believed to be correct at this time but it is subject to change and is not warranted. ©Copyright 2017 Saint Lucie County Property Appraiser.All rights reserved. ttp://www.paslc.org/RECard/ 2/22/2017 : L� , 4.�•iAF^���`t'e'er "",®'�"�,^^'-.'i GsS +G y, • , �Fes- y-,:. -`.-,-;r„_..�-...-,_. .,,� ., �.—`�,. ,,. }� ,rF''"�'r,•; - .. _ � C yr u 1'1 '�.. °l F� f..-�a a W5 � ��"�}`.,rC u, -. 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'� ,a" T �' 4 �� '. ....r-.F oil GAN ,� " ' • Y TM - -• 1 1 1 11 11 11 1 1 1 1 1 1 1 a - 1 sue. /739��3 i STATE OF FLORIDA PERMIT APPLICATION TO CONSTRUCT, - - REPAiR,MODIFY,OR ABANDON A WELL Permit No. '/ :_)Southwest Florida Ufnquo IDS _� `/' PLE,ah I�ux.cu•1 ALL nfrPL.iC!ar+;r.s:r��ns Northwest ('Denotes Required Fields Where Applicabie) F'ermil Supulmifim,Required(See Attached) St.Johns River 7r 'qouth Florida '/'e"rt:rreelh'antruttorr,respuluioh'lru.nnlpt<rn,: __ _____ U:rsnurnarvirnr•vw„Lu:N+�n�+nlr'appk:(10or,rofill, G2524 Quad No. Delineation No. I Suwannee River epee}prartv0e1 YWC-0oulnu,l(ywhemapr+L'abiz — f'i DEP r-UP.,VVUP Application No. Delegated Authority(If Applicable) i — ABOVE THISLINE,FOR OFFICIAL USE ONLY — 1 . !-, t-f?.,� 135 1rW �''_�+cvt- Ye11b Owner,il gal Name if Corporation 'Address- 'City State ZiP Telephone Number, Well 1.0ation-Address,Road Name or Number,City .Parcel IQ No.(PING or Alt`errnnal Rey(Circle Onei - -Lot - - Block -- �- Unit 4 -- ✓ .. u _ Check if 62-524:© Yes[j No `Section•or Land Grant 'Township 'Range —'County Subdivision _Scott's rifling Inc. -` _ _ 112'13_ _ 772-489-6117 iLnq @bellsouth.net scottsdril @bellsouth.net _ 'iNater lrjlell Contractor - - -License NumberV"Telephone Number- E-mail Address 6.5..0 PI i1 m Drive Fort Pierce FL 34982 ^Water Ve11 Contractor's Address City Slaw ZIP 7. 'Type of Work: it Construction`A(] Repair Ej Modification[] Abandonment _ S. 'Number of Proposed Wells ilX! Itcaoo l nor i eplcr,!:k•4`c2aon.or AWl ,I :auani 9 -Specifyllntended Use(s)of Welf(s): /A l D a9 O D Domestic Landscape irriyatior• Agriculturat Irrigation Site Investigations lr� (] Bottled Water Supply [] Recreation Area Irrigation Livestock [' monitoring Public Water Supply(Limited Use/DOH) [] Nursery Irrigation F] Test Public aler Supply(Gommunily or Non-CommunilyiDEP) Conlrriercial/industrial f Earth Coupled Geothermal MAR - 3 2017 (- Class 1 I ejection Gott Course Irrigation HVAC Supply HVAC Return Class V Injebon:[] Recharge (] CommerciaUlndustrial Disposal C] Aquifer Storage and Recovery( ' i)rainage OH in St!ueie Cou ty Remediatio :[] Recovery❑ Air Sparge ❑ Gther (ars�nb�, TH Other ({`Iatam :) 10'Distancel from Septic System if <_200 ft. _ 11.Facility Description! - 12.Estimated Start Date 18.-Estimateld Well Depth l�ft. -Estimated CasingDepth 43i. Primary Casing Diameter.--�-,rin. ripen Hole: From To rt. 14.Estimated Screen Interval'From�_To_� _ _ r ___ i&'Primary Pasing Material: Black Steel Galvanized --FV_C _1 Stainless Steel Not Cased Other:_. 16.Seconda Casing. Telescope Casing Liner Surface Cesiny DiamLaer in. 17.Seconda Casing Material: Black Steel Galvanized PVC, Stainless Steal Other• 1S.-Method df Construction,Repair,or Abandonment: Auger Cable Too) .lettel' ary Sonic C atnbination(Two or More Method,,,) Hand Driven(Well Point,Sand Point) Hydraulic ou heel Push) +i,izantal DiAling Plugged by Approved klelnod Other ictoymuni 19.Proposer uting Interval for the Primary. Socondary,and Additional Casing. From To 1 Seal Material( Bentonile Neal Cement Other From- To _ Seal Material( 9enlonile Neat Cement Other From i-t-� To - Seal Material( Bentonite Neat Cement Other.W� 1 From--I—. To _-,_• Seat Material( Eentonite Neat Cement Other w�__•_ _—�) 20. Indicate total number of existing wells on site _ List number of existing unused wells on site 21,1s this W)iI or any existingwell or water withctf r the owner's contiguous property covered'under a ConsurnptiveA4'ater.Use Permit(CUPjWUP) or CUPP?VUP Application. Yes No es,complete the fopt)wrrtg:CUPIINUP iJo,_____•-_._�_ District Well iD No. 22.Latitude 23.Data Ob(ained From: GPS Map Survey Daturn; _NAD 27 _NAD 83 Vl/GS 84 Il7C'r,py[ntrlyl^:1 AY'ahl;:yaL't the n�p•sr.�s qc:a Stxi,�FYlre:AM!ar.•al:A re:,.ae a•a:l:_:•.,.•a,Sn• Iv.-n•1;•hdl!a^r'.Fu fa:•.+ll!ira rvearrr.�s�.ace•G,411fOn�••(a0'a!id41JS-.I(.:lO.d'[:U:,1:IT.:Xf:.Pu 91:.., . mw tvvnq r tAG A roJurga parts 4'd W 1,.:^al tern w n{-:•mt;r^.��:i,o l•..^+'^.•..r'::ro-nr,ce nn l en ^s'aq[n a,.' L",n(l,r 3.r!ct,ta 5l�IutE�.Ya rnd�rl.vr:+r inczw..,y&IrcG.ins:oII.W.I W W'-I"A fir+, rTJI.•.'_R•Cign.lL;U'•[nyR,l•rAlfl•.�If.'UL'IGY Aros7..^:n:ll'rA Ap;:.cAlrnr:a•..`l•r,!n•�:•i that i:,•17•.I.+r• {:nnL;M•:fp•Pl••T:'-:R'.l1:,11-a�1�::n,.f.Vi'i.,yY'llVi;:A��;/arC.A'O UrAlrr�tg u11CIT.yIOli;i\t'r10tG11�U•' rxF.avr eppmra:m!n orII,u itwrn!,Sf8117.a:!fit9•q(eCra•MaaM 1:9Y::raT,r.la.,no to nWr 9p naa�' •na;ahem{�{';.54:1:C wmm.t?M.^h•'A^jq+IC In Yr,„1.egC.?R,y+na7 d tl,.a VF.,D or D"A!miLxNn•iyu We ! awl^}..-nW1 , t lha-hi In wylyr.�r'(Iegs rhar p,IrNEM1':dlrr.rtr;SU,.dQn.N'p+:•.:(.*}L,n;a:'v tyl'lu tW..{F91 Ci9:;V 1".•nrrs:•,Gb;lr'A:W1r^Ubd:,Cti`n._+.itsir'Y!^1_•fldann�nu oy l.`.e f%a:n.l ,Dd:lou.:ntia l'r�..Ka;l>tlh:^^.(lvn,:'v!ru Fhrhl erp:w+a'•a'or•wre••rc.n 5rot. 11213 'Signature of �g� ure o Orrner orAgent-` —� — 'Date ArlpNval Graf led By. _-_•____•_ --_—.._- - _.. Issue Onto..3. 3 l7• Expiration Date 0 _ y Hydrologist Approval Foe ReceivedI$ - h'ere:pt No. ...._......-.- - ---..-•-.-• Check No._—.---....._ ..___..__-----.-_-.-• THIS PERA11111S NOT VALID UNTIL PROPERLY SIGNED BY AN AUTHORIZED OFFICE:OR REPRESENTATIVE OF THE Wkl.D OR DELEGATED AUTHORITY. THE ' PERMIT SHA I BE AVAILA6LE AT THE WELL SITE DURING ALL CONSTRUCTION.REPAIR.-MODIFICATION.OR ABANDONMENT ACTIVITIES. OF?P Fnr p:62!32.900(1) Incorporated in(i2-532.400i1)•F.A.C. I:f/ectr+e date:October 7 2010 Page i of 2 C� FND CAP CuX.) oz�. '�' % 302.17• zoo �M �'� '-- --+„� OF' ,W. F4 or w.>5 - Y OF N.E. 3' OF SECTION l8.345. 40E� 4• CLF I I ttF o nnn a . ,37• 0.5' EA5 qQ•t Q¢2 _ Iz1al LESS TIVE 5,7wEST j. I I Tin 50.0' ti\24.5 n.,. •.�n,,v. t I UlI � 4 PROP. Sf1EV O PROP. l=.F•.EL.=25.5• WELL .a +'N::�Y _ �~^� tit I / f•d'yrV1, 27.3' ..1,•.•.!.+;� �1<•.o'r:✓..,..4wrt.; r•rti1,,•,wr.�.v+.,•, ../... �•:.• + N PROP. N 2 AAiT tmvr w N• I 1418-133-0015-0 —3 i r�� �.,,��O`P��ECf`'...,... .WIIN-%• 4 +s.""",f,3 vAcanr M, �,,;r m ° ° 1 5TORY tj 4� ti�3I ".� ' Q ti F.F.EL.�LrD.U•j SET T,B.M.E S �I ..._. ......._- r- b 'a^^'► PRIE TREE 5 t� b � t 27.3 100.0 f II WELL PUMP 4 � � � ��/ 179AB9FIELD WOOD 750 SOFT. ." 1 i a5T EVE �I� GON. A/G I PAD �L.=25.7'19 LEs3om�>�t-wT�sT I vo 4�. 5ET GAP --- _ LNE OF HA 34 OF S.W. 34 off',N.E.Y4 OF SECTION 19, 345. 40E tii1:T CAP l r 4 f f t ''aa,� *•^. �,, YN.� .,��**< a re�u.,�� y� '#: -.:;i'�l'f"-�^��.y,��€sua;��K��..f-+�.y.m"�,a"�?`�:,�s€_,�+-�:�.,�.���-^;�...c-s+F.:-..�'�"Fx�.-.>�.,•,.F.;x..4. nbr�'5� t,7. nS¢1 Gs`+�v nsy i t F�ro� '•1 �'' ,�'r''S+.