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HomeMy WebLinkAboutHealth Department Septic Approval �P aa �� PERMIT #:56-SF-2182977 APPLICATION #:AP1582559 STATE OF FLORIDA '�. DEPARTMENT OF ,HEALTH DATE PAID: y ONSITE SEWAGE TREATMEN DISPO AL FEE PAID: SYSTEM RECEIPT #: 0. w DOCUMENT #:PR1495809 CONSTRUCTION PERMIT FOR: OSTDS New APPLICANT: Charlotte Stahlberg PROPERTY ADDRESS: 1316 Copenhaver Rd For:Pie ce, FL 3494 LOT: BLOCK: SUE DIVISION: [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] PROPERTY ID #: 2313-123-0003-000-6 [OR TAX ID NUMBER] SYSTEM MUST BE CONSTRUCTED IN ACC RD CE WITH SPECIFICATIONS AND STANDARDS OF SECTION 381.0065, F.S., AND CHAPTER 64E-6, F. .0 DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECrFIC PERIOD �OF TIME. ANY CHANGE IN MATERIAL FACTS, WHICH SERVED AS A- BASIS FOR ISSUANC, F THIS ERMIT, REQUIRE .THE APPLICANT TO MODIFY THE PERMIT APPLICATION. SUCH MODIFICATION MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID. ISSUANCE OF THIS PERMIT DOES NOT E EMP THE A PLICANT FROM COMPLIANCE WITH OTHER FEDERAL, STATE, OR LOCAL PERMITTING REQUIRED FOR DE LO ME] OF T IS PROPERTY. SYSTEM DESIGN AND SPECIFICATIONS T [ 900 ] GALLONS / GPD Sei itic lew CAPACITY A [ ] GALLONS '/ GPD N/Al CAPACITY N [ ] GALLONS GREASE INTERCEPTOR CILACIITY [MAXI CAPACITY SINGLE TANK:1250 GALLONS] K [ ] GALLONS DOSING TANK CAPACITY [ ]G LONS @[ ]DOSES PER 24 HRS #Pumps [ ] i D [ 500 ] SQUARE FEET drainfield SYSTEM R [ ] SQUARE FEET N/A SYSTEM A TYPE SYSTEM: [ ] STANDARD [ ] L D [X] MOUND [ ] I CONFIGURATION: [ ] TRENCH [X] BE [ ] N F LOCATION OF BENCHMARK: site BM nail in disk 2 St qide of road C nter of property I ELEVATION OF PROPOSED SYSTEM SITE [. 2.0 ] [ INCHE FT I ABOVE BELOW BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 5.0 ] [ INCBE FT ] [ ABOVE BELOW]BENCHMARK/REFERENCE POINT L D FILL REQUIRED: [25.001 INCHES ' X VATION RE�UIRED: [ ] INCHES The system is sized for 3 bedrooms with a maximum occt pancy of 6 p rsons(2 per bedroom),for a total estimated flow of 0 300 gpd. T H E R SPECIFICATIONS BY: g a J n ram TITLE: Environmental Specialist II APPROVED BY: IT Env ental Manager St.Lucie CHD Victor Faconti DATE ISSUED: 12/28/2020 EXPIRATION DATE: 06/28/2022 DH 4016, 08/09 (Obsoletes all previous edit'on which may not be used) Incorporated: 64E-6.003, FAC Page 1 of 3 v 1.1.A F.Y1�82559 S�14Fi�o'7.3 i i i NO ICE OF IGHTS A party whose substantial interest is a ected 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 FI rida Admi istrative Code. A petition for administrative hearing must be in writing a id must be rec ived by the Agency Clerk for the Department, within twenty-one (21) days from he receipt of this order. The address of the Agency Clerk is 4052 Bald Cypress Way, IN -02, Tallahassee, Florida 32399. The Agency Clerk's facsimile number is 850-413-8743. Mediation is not available as an alt' rn tive remedy. Your failure to submit a petition for hearing within 1 days from receipt of this order will constitute a waiver of your right to an admi nist,ative 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. 8, lorida Stat tes. Review proceedings are governed by the Florida Rules of AppellateProcedure. Such proceedings may be commenced by filing one copy of a Notice of Appeal wit i th 3 Agency I Jerk of the Department of Health and a second copy, accompanied by the filing fe s required by law, with the Court of Appeal in the appropriate District Court. The notice mus be filed within 30 days of rendition of the final order. y W IV { St. Luck County Health Department � a 5150 NVV IV ilner Dr, _, ort Saint Lucie, FL 34983 HEALTH PAYING ON: #:56-SF-2182977 BILL D C#: 6-BID-50 5099 CONSTRUCTION APPLICATION#:AP1582559 RECEIVED FROM: Charlotte Stahlberq AMOUNT PAID: $ 545.00 PAYMENT FORM: CHECK 1435 PAYMENT DATE: 10/05/2020 MAIL TO: Charlotte Stahlberg FACILITY NAME : PROPERTY LOCATION: 1310 Copenhaver Rd Fort Pierce, FL 34945 Lot: Blo k: Property ID: 2313-123-0003-000-6 EXPLANATION or DES RI TION: QUANTITY FEE 128 -OSTDS Construction System Inspection Research Fee 1 $ 5.00 -1 -Surcharge (All) 1 $ 45.00 -1 -OSTDS New Permit Surcharge 1 $ 100.00 -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 Mo , A endment 1 $ 55.00 127-OSTDS Construction System Inspection 1 $ 75.00 133-OSTDS Construction Reinspection 1 $ 50.00 ioh u "wmfwj�+ - RECEIVED BY: WhighamJL .AUDIT CONTROL NO. 56-PID-4743782 1 { 4 i �rtes PERMIT NO. STATE OF FLORIDA `•,.5 DATE PAID /7[)'Lc� �•�, DEPARTMENT OF� HEALTH L ��5 ONSTTE SEWAGE TREAT M NT AND DI OSAL FEE PAID; I RECEIPT $ SYSTEM : y`°°" '`�• APPLICATION FOR CONSTRUCTION PERMIT APPLICATION FOR: New System [ ] Existing System ( Holding Tank [ ] Innovative [ ] Repair [ ] Abandonment [ Temporary [ ] °sue I APPLICANT: �61�p ""' • AGENT. C ��� TELEPHONE:�'l Z TZ Gy%- !� � MAILING ADDRESS: 510 o.-, e_er `l TO BE COMPLETED BY APPLICANT OR APPLIC AUT90RI ED AGENT.r SYSTEMS MUST BE CONSTRUCTED BY A PERSON LICENSED PURSUANT TO 489.1015(3 (m) OR 4•19.552, FLORIDA STATUTES. IT IS THE APPLICANT'S RESPONSIBILITY TO PROVIDE DQCU IENTATIONIIOF THE DATE THE LOT WAS CREATED OR PLATTED (MM/DD/YY) .IF REQUESTING CONSIDERATION OF STATUTORY GRANDFATHER PROVISIONS. PROPERTY INFORMATION=== �^ram •� LOT: BLOCK: SUBDIVISION; PLATTED: 5, �-orJt,;�3'' "ZOE S - I/M OR EQUIVALENT: [ /N ] PROPERTY ID #: �D.% � �� � ZONING: a PROPERTY SIZE: Q. ACRES' WATER SUPP Y: [ ] PRI.rE PUBLIC [�]<=2.000GPD [ ]>20000PD IS SEWER AVAILABLE AS PER 381.0065, FS? [ / ] � DISTANCE TO SEWER: FT PROPERTY ADDRESS: l� I bf' - �GI I DIRECTIONS TO PROPERTY: Lo BUILDING INFORMATION [ RESID NT AL j [ ] COMMERCIAL Unit Type of 'No. of Buil4ind CQif_mmereial/Institutional System Design No Establishment Bedrooms re S f:t T4.ble 1, Chapter 64E-t, PAC 2 - --- 3 4 [ ] Floor/Equipment Drains [ ] Othe (Specify) zo �. "1 SIGNATURE: , DATE.:. DH 4015, 08109 (Obsoletes previous- editio s hich mayllnot be used) Incorporated 64E-6.001, FAC { Page 1 of 4 f � I G i STATE OF FLORIDA APPLICATION # AP1582559 DEPARTMENT OF HEALTH PERMIT # 56-SF-2182977 ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATION DOCUMENT # SE1453613 APPLICANT: Charlotte Stahlberg CONTRACTOR / AGENT: Charlotte Stahlberg LOT: BLOCK: SUBDIVISION: ID#: 2313-123-0003-000-6 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 PLAN: [X]YES [ ]NO NET USABLE AREA AVAILABLE: 2.01 ACRES TOTAL ESTIMATED SEWAGE FLOW: 300 GALLONS PER DAY [ RESIDENCES-TABLET / OTHER-TABLE 2 ] AUTHORIZED SEWAGE FLOW: 5025.02 GALLONS PER DAY [ 1500 GPD/ACRE OR 1 2500 GPD/ACRE ] UNOBSTRUCTED AREA AVAILABLE: 800.00 SQFT UNOBSTRUCTED AREA REQUIRED: 500.00 SQFT BENCHMARK/REFERENCE POINT LOCATION: Site BM nail in disk east side Of road Center Of property ELEVATION OF PROPOSED SYSTEM SITE 2.00 [ 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 [ ]NO WELLS: PUBLIC: FT LIMITED USE: FT PRIVATE: FT NON-POTABLE: FT BUILDING FOUNDATIONS: 8 FT PROPERTY LINES: 50 FT POTABLE WATER LINES: 60 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:Pineda sand USDA SOIL SERIES:Pineda sand Munsell#/Color Texture Depth Munsell#/Color Texture Depth 10YR 5/3 Fill-Sand 0 To 4 10YR 5/2 Sand 0 To 3 10YR 3/2 Sand 4 To 6 10YR 3/2 Sand 3 To 6 10YR 5/1 Sand 6 To 16 10YR 311 Sand 6 To 12 10YR 5/2 Sand 16 To 31 10YR 5/1 Sand 12 To 25 10YR 5/6 CMN/PRM RF 21 To 31 10YR 6/1 Sand 17 To 25 10YR 4/4 Sand 31 To 37 10YR 4/3 Fine Sand 25 To 36 10YR 5/2 Sandy Clay Loam 37 To 57 10YR 4/4 Sandy Clay Loam 36 To 38 10YR 5/2 Loamy Fine Sand' 57 To 65 10YR 5/2 Sandy Clay Loam 38 To 49 10YR 5/2 Loamy Sand 65 To 72 10YR 5/2 Loamy Sand 49 To 60 HOLE CAVING Refusal 60 To 72 OBSERVED WATER TABLE: 30.00 INCHES [ ABOVE / BELOW ] EXISTING GRADE TYPE: [ PERCHED / APPARENT ] ESTIMATED WET SEASON WATER TABLE ELEVATION: 17 INCHES [ ABOVE / BELOW ] EXISTING GRADE HIGH WATER TABLE VEGETATION: [ ]YES [X ]NO MOTTLING: [X]YES [ ]NO DEPTH: 17.00 INCHES SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: Sand/0.60 DEPTH OF EXCAVATION: INCHES DRAINFIELD CONFIGURATION: [ ] TRENCH [XI BED [ ] OTHER (SPECIFY) REMARKS/ADDITIONAL CRITERIA WSWT determined using USDA WSS and soil borings.10YR 611 stripping in 10YR 5/1 matrix.>10%with diffused boundaries starting at 17"inches in S132. SB 10"above and SIB 2 2"below BM Continued On The Following Page. . . AP1582659 EID2182977 v 1.0.2 STATE OF FLORIDA APPLICATION # AP1582559 DEPARTMENT OF HEALTH PERMIT # 56-SF-2182977 ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM DOCUMENT # SE1453613 SITE EVALUATION AND SYSTEM SPECIFICATION SITE EVALUATED BY: DATE: 12/08/2020 Ingram,Bria itle:Environmental Specialist II)(ENVIRONMENTAL HEALTH) DH 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated: 64E-6.001, FAC Page 3 of 4 AP1582559 EID2182977 v 1.0.2 APPLICANT'S NAME: LEGAL DESCRIPTION: .�-3�✓?��z3 4f�3�'G —'� SC z ��F t PROPDSEDSEPTICSYSTE�SIT'�INFOR`�f4Tl®1��- `R� � I certify that there are no potable private wells within 75 feet of the available area for the proposed septic system, that there are no non-potable wells within 50 feet of the available area for the proposed septic system, that there are no wells within 25 feet of a pesticide-treated building foundation, that there are no public.wells that serve less than 25 people or less than 15 homes or businesses within 100 feet of the proposed septic system, that there are no public wells that serve more than 25 people or more than 15 homes or businesses within 200 feet of the proposed septic system, that the water line from the water meter or well to the structure is at least 10 feet from the available area for the proposed septic system unless the plans show the line to be double sleeved, that there is not a gravity sewer line, low pressure sewer line or vacuum sewage line in a public easement or right-of-way that abuts the property, that there are no lakes, streams, wetlands,.or surface water within 75 feet of the available area for the proposed septic system unless the property was created prior to 1972, that the septic system is proposed on the side of the lot farthest from surface water, that all private wells, septic systems and surface water on adjacent or contiguous land within 75 feet of the applicant's lot are shown on the site plan, that all public wells within 200 feet of the applicant's lot are shown on the site plan, and that the location of building or residences, swimming pools, recorded easements, paved areas or driveways, sidewalks, the general slope of the property, filled areas, drainage features, and surface waters such as lakes, ponds, streams, canals, or wetlands are shown on the applicants lot. The natural grade elevation in the area of the proposed septic system and the benchmark must be shown on the site plan. Please locate the benchmark within 200 feet of the proposed septic system. %`�����ini�r�i 4971 '�,,��•• ......• •, �•; NOTE: MUST BE CERTIFIED BY A FLORIDA CERTIFIED BY:��S I^liJ REGISTERED SURVEYOR OR ENGINEER. FLORIDA ROF SSIONAL NO.: - DATE: JOB NO.: Z:2-512�) dues.fonim'septi es;Sept icApppPa e207 APPLICANT'S NA`IE: �'cdYge �Tc��1l�CYQ LEGAL DESCRIPTION: Y-: 'ROOSE,Z> SP�'1 �'ST15i ' JNF(JRIITIQN` I certify that there are no potable private wells within 75 feet of the available area for the proposed septic system, that there are no non-potable wells within 50 feet of the available area for the proposed septic system, that there are no wells within 25 feet of a pesticide-treated building foundation, that there are no public.wells that serve less than 25 people or less than 15 homes or businesses within 100 feet of the proposed septic system, that there are no public wells that serve more than 25 people or more than 15 homes or businesses within 200 feet of the proposed septic system, that the water line from the water meter or well to the structure is at least 10 feet from the available area for the proposed septic system unless the plans show the line to be double sleeved, that there is not a gravity sewer line, low pressure sewer line or vacuum sewage line in a public easement or right-of-way that abuts the property, that there are no lakes, streams, wetlands, or surface water within 75 feet of the available area for the proposed septic system unless the property was created prior to 1972, that the septic system is proposed on the side of the lot farthest from surface water, that all private wells, septic systems and surface water on adjacent or contiguous land within 75 feet of the applicant's lot are shown on the site plan, that all public wells within 200 feet of the applicant's lot are shown on the site plan, and that the location of building or residences, swimming pools, recorded easements, paved areas or driveways, sidewalks, the general slope of the property, filled areas, drainage features, and surface waters such as lakes, ponds, streams, canals, or wetlands are shown on the applicants lot. The natural grade elevation in the area of the proposed septic system and the benchmark must be shown on the site plan. Please locate the benchmark within 200 feet of the proposed septic system. Nub •• `\<r NOTE: MUST BE CERTIFIED BY A FLORIDA CERTIFIED BY:��S REGISTERED SURVEYOR OR ENGINEER. FLORIDA 17OF` SIONAL NO.: -jAEZZ DATE: '? JOB NO.: does.fonns,scpucs,Srp1irApppPage_07 APPLICANT'S NAME: 4�;�!2ZSe �Tq`jl,DeY4 LEGAL DESCRIPTION: PROS`DSEI�SE�'TI�SYS?L�1�S.�1'L�tN�'41TIf�N`��' � �= I certify that there are no potable private wells within 75 feet of the available area for the proposed septic system, that there are no non-potable wells within 50 feet of the available area for the proposed septic system, that there are no wells within 25 feet of a pesticide-treated building foundation, that there are no public.wells that serve less than 25 people or less than 15 homes or businesses within 100 feet of the proposed septic system, that there are no public wells that serve more than 25 people or more than 15 homes or businesses within 200 feet of the proposed septic system, that the water line from the water meter or well to the structure is at least 10 feet from the available area for the proposed septic system unless the plans show the line to be double sleeved, that there is not a gravity sewer line, low pressure sewer line or vacuum sewage line in a public easement or right-of-way that abuts the property, that there are no lakes, streams, wetlands, or surface water within 75 feet of the available area for the proposed septic system unless the property was created prior to 1972, that the septic system is proposed on the side of the lot farthest from surface water, that all private wells, septic systems and surface water on adjacent or contiguous land within 75 feet of the applicant's lot are shown on the site plan, that all public wells within 200 feet of the applicant's lot are shown on the site plan, and that the location of building or residences, swimming pools, recorded easements, paved areas or driveways, sidewalks, the general slope of the property, filled areas, drainage features, and surface waters such as lakes, ponds, streams, canals, or wetlands are shown on the applicants lot. The natural grade elevation in the area of the proposed septic system and the benchmark must be shown on the site plan. Please locate the benchmark within 200 feet of the proposed septic system. StAn OF NOTE. MUST T BE CERTIFIED BY A FLORIDA CERTIFIED BY:��S REGISTERED SURVLYOR OR ENGINEER. FLORID—�7�OF SIOi`IAL�t0.: .. T— DATE: '7 7�� !OB NO.: docs fiimis,scptics,ScpticApppPggc_i)7 I Date: ' Approved: .D Florida Depa f Heal i C�kee `LP.m\.ry�nman�•- a County _— 33NVLT�G<mra,TmlGivm,0.3L59-f//31 LSi-lii3 DP1LRTlORCMDlMI.6wTJOt9LLM X5aLIILGi[O.�SCR. 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N NJ. l r D 1 1 I 1 �11 © 1CJQS 11//• O = —LI 1 Mfwtvnn _ I I ;•. O� C W. r--------- TABULATION I i o 0 I - I I _ O u•G -��-- Ca [pr, m¢roxce Ln• 3L I 1 ❑ L L-__ _ I I ®� O �L � r�, LL+`. 6VtPY R I •© - . a 9Q o ac R,[ra1L in'nj ° CWW SCH CCf N gvv N a Pml WINDOW DOOR C'DULL' fA .GrL EDCQLL ILxfYYYx q ----- MII s;o•.••Im.�� �] W IA Ih[iNv`i rW�i. O 1.11' f4'-O $:n' S`->' Z'-0' 4�3• 7�-� S'.m• 4'•0• 4'•U' L'./i_ yJ FLOOR PLAN BEIdOflMARK ENGINEETtWG - BOWDOIN G.HUFOWASON M 670878