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HomeMy WebLinkAboutHealth Department Septic Permit I � �p STATE OF FLORIDA PERMITAP�LI��Urfv F�Nb 1 2017 ;1n1Si.� IFY N A WELL Permit No. �.r , ti� REPAIR, ,.'• ° 'p+� Florida Unique ID est SE FILL OUT ALL APPLICABLE FIELDS f i(. .; F) 11 North t enotes Required Fields Where Applicable) Permit Stipulations Required(See Attached) ' r TheyrarerlveUmmrattoritresponslhle�orcompkHng ,4 uth Florida thisfomiandfofyiordi*ogtliepermlrappfrcutiantothe 62-524 Quad No. Delineation No. i D• ';: �° ❑Suwannee River approptiateaalegatedaluhwh1-whereapplfca6le. lr e:•.. ❑DEP CUP/WUP Application No. O Delegated Authority(If Applicable) ABOVE TH15 LINE-FOR OFFICIAL USE ONLY 1 RJ Newman Enterprises LLC 5410 Myrtle Drive, Fort Pierce,FL 34982 ?71 20! 7?17 1 "Owner,Legal Name if Corporation i `Address ,City *State 'z1P - ale-phone Numbe i*, 2 Bmcksmjth Road Fort Pierce FL 34945 -Well Location-Address,Road Name or Number,City i 3.2320-501-0018-000-8 2&3 2 1 *Parcel ID No.(PIN)or Altemate Key'.(Circle One) Lot Block Unit 4.20 358 i 39E St Lucie Check if 62-524:❑ Yes❑ No 'Section or Land Grant `Township "Range "County Subdivision 5.Scott's Drilling,inc. 11213 772-48"117 scottsdrilling@bellsouth.net 11 'Water Well Contractor 'License Number &Telephone Number E-mail Address 6.5014,Palm Drive Fort Pierce FL 34982 `Water Well Contractor's Address City state ZiP f 7. 'Type of Work: ❑✓ Construction ❑ Repair ❑ Modification[—] Abandonment ` 8.'`Number of Proposed Wells ONE 'Reason far Repak. Moth D p n e ed Use(s)of Well(s): ' �MR,, ul Domesti Landscape Irrigation Agricultural Irrigation Site Investigations ottied water Supply ®Recreation Area irrigation � Livestock IH Monitoring ❑ Public Water Supply(Limited Use/DOH) Nursery Irtigation Test APR 12 2017 � Public Water Supply(Community or Non-CommunityfDEP) CornmerciaUindustrio Earth-Coupled Geothermal . Class I Injection Golf Course irdgationH HVAC Supply HVAC Return H In St�t�9 Coil Class V Injection,❑ Recharge [] CommerniaUlndustria)Disposal ❑ Aquifer Storage and Recovery❑ DrainagPE IRONMENTAL HEA► Remediatlon:[] Recovery❑ Air Sparge ❑ Other (Desafie) Official Use only C..EsdOther (Do a) timatedl istence from Septic System if _9 200 ft, 11.Facility Description trig a aml y an am f12,Estimated Start Date Y-2-Zo)h Well Depth 120 ft '=Estimated Casing Depth 100 fL Primary Casing Diameter 2 in. Open Hole: From To fit. 14.Estimated Screen Interval:From 100 To 120 fL I5.=Primary Casing Material: Black Steel Galvanized�+'� Stainless Steel Not Cased Other. 16.Seco` ary Cos Teles pe C in Liner^ Sulfa Caging Maprinter 17.Seconds asing Mate Blacdc St Galvan. d PVC Stainless Ste�f'�`` OUrer`. 18.'Method of Construction,Repair,or Atiandonrrient Au Cable Tool Jetted ./ Rotary Sonic Combination(Two or More Methods) Hand Driven(Well Point,Sand Point) rau 1e75-1ntt((Direct Push) Horizontal Drilling Plugged by Approved Method Other (oescriba) 19.Proposed Grouting Interval for the Primary,Secondary,and%Additions ng: From 0 To 100 Seal Material( Ben to ire eat Cement Other ) From To Seat Material( Berta • errrent Other ) 'From To Seal Material( Bentonits Neat Cement Other ) From To Seal Material( Bentonite Neat Cement Other 1 2D.Indicate total number of existing wells'on site List number of existing unused wells on site 21."Is this well or any existing we)l.or water drawal'bn the owner's contigfuous property covered under a ConsumptivelWater Use Permit(CUPIWUP� or CUPMUP Application. Yes, ,/ No ,)f yes,complete the ellowing:CLIPANUP No. District Well iD No. 22.Latitude ongltude 23.Data Obtained From: GPS I Map Survey Datum: NAD 27 NAD 83 WGS 84 I Iteraby=IBy 1hW 1 W0 cmy*wah tha appyenka nine of70a 40!Florida AdreinhMe ive Coda,aria Thal a ti-mar t eertl(y mac 1 atnlha aerttarotthe prapotty,tb6 rife humnoflan pmided 6 aeevate.and thotf am n•.rare of my tsollstmitarntbdaitadtmgepmlri.breaded,Msbetmmei7hoaNaNadpdabeamnraaementahvtll mspan5ah�0nanderCh2 379.F1arlWstawas.torwlnlainmpopadyabafWantaswcd:a.lcs41y01atlam eanshuetion.I fudhara*fy dW d fafotrntft pvddet intl1s appiteagan is amrato midWdl w&obadn tfe ages tor0m a=ar.mat toe Wmmmfian pmWad B acamle.and tut l hava faramtod t e avmaraf the& namssmyamfmad hum afherr�oial.aLla.orlaealpavemmanls.tfappgp4la.lagfantoptovidaaweg ids paaslUyg�Saeslaledbbave.a+rtlMCmtSmdetaalhlrlhlgaadalmlalOi0d6:16W0or0a1ageldAuliwfdya w Wtlsnropatlolha0lsuicrtvMn31,daysatlarcompktlanol0iecorl,UUCka,rnui.madVietUaa.ar totfecvdisgadaanglhaunsaaGFon.TePAmodificagan, tdmndonmentwAarlmdbyftpuml abandanminrlud by gee pmmil,nrtha pumh osplrsgan.vd i o'rer owes Wri 11213 1 "sibrAre of Contractor °License No. "Signature of Owner or Agent 'Date Approval Granted By Issue Date VZ e9tration Date 7 L Hydrologist Approval lawn, Fee Received S A ell Receipt No. Check No. ` THIS PERMIT IS NOT VALID UNTIL PROPERLY SIGNED BY AN AUTHORIZED OFFICER OR REPRESENTATIVE OF THE WMD OR DELEGATED AUTHORITY.THE PERMIT SHALL BE AVA(LABLE AT THE WELL SITE DURING ALL CONSTRUCTION,REPAIR,MODIFICATION,OR ABANDONMENT ACTIVITIES. DEP Form:62-632.900(1) Incorporated in e2-532.400(1),FA.C. Ettecilve Date:October 7,2010 Page 1 of PERMIT NO. STATE OF FLORIDA DEPARTMENT OF HEALTHDATE PAID: P ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID: � a SYSTEM RECEIPT /7�i N PERMIT O APPLICATION FOR CONST RUCTION i APPLI.CA.TION FORS [ I 1-rdw $yetem 1 3 Existing System [ I Holding Tatak [ 3 Sanovative [ 1 Repair' [ 3 Abandonment [ I Temporary [ ] APPLICANT: ] f l.tl.yV�G,r1 L h 4 r-r ge i C-e-5 L - AGENT: Ii��rl�ahc�fsCo Ca 4-- VvJar '�� �VhTC6-d- Dirmw(YSk�)TELEP HONE: 772- `�0�-7'79`7 zanING .ADDRESS: g$uo 1 u,Y.,i r m t a2 jrm� ` )t L FT aacccc�acec==a_c.a.e=eeaeeo-en.=c=_ec=eaneocea=ca===_=cam ecaaaaaean:ceoises=earl=-ca=a=a TO BE CMIr-ETED BY APPLICANT OR A£PLZMM'S AUTRORIZED AGENT. SYSTEMS MUST BE CONSwRlymn BY A PERSON LICENSED PURSUANT TO 489.10S(3) (m) OR 489.552, FLORIDA STATUTES. IT IS TEE A'PPI,TCnT'8 BESPONSISILITT TO PROVIDE DOCUMENTATION OF THE DATE THM LOT WAS MATED DR PLATTED JXK/DD/Vy) IF REQUESTING CONSIDERATION OF STATUTORY i#RA'NDPATAER PRM—MON3I. PROPERTY 3NFOMZTXON . LOT:lQnd 3 . mocx: PIrATTED: PROPERTY ID ;ZQ '51)1 ZONING: I/X OR EQUIVALENT: [I Y / N 3 PROPERTY SZZE: ACRES WATER SUPPLY: [ p-j PRIVATE PUBLIC [ 3<=2000GPD [ I>Z000GPD ZS SEWER AVAILABLE AS PER 3ai.0065, FS? [ Y /a] DISTANCE TO SEWER: PROtAkft RD Pr �;`ere,e �`vfi• 3�syf DIREC'TIOX6 Tn PROPERTY: )(Mech�a3Be a ro ff D Nxt t 'l �n aDprax 4 mr!•tS ors l��'C al[.- t oFr 6, 'DjE"LeSta �,STn,et"A 5;4 go 'F� ``a +{ 6,dr Se a�� Ocerv� are r. dr,rdill 0f SUILD= MORNATIQN [t/1 RESIDENTIAL [ 3 COMMERCIAL unit Typs Of NO. Of Building Commercial/Institutional System Design No x6t0lisbmwit Bedrooms Area 9gft Table 1, Chapter 64E.6, FAC 1 Sm6It Gay Ly �tSdcQ{.rEFik _ oZ°i3 2 3 4 [ 3 FivoV/Ec,S,tiipment Drains [ ] Other (Specify) 4. DATE: . SIGNATURE: ©� ..- PH 4015, Q4/09 (Obsoletes previous editions which may not' e u = u.t'C'- ; Incorpdrat,ed $4E-6.001, PAC Page 1 of 4 APR 2 u 0 ,r s PERMIT #:56-SF-1751360 APPLICATION #:AP 1283521 STATE OF FLORIDA ' DATE PAID: DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID: SYSTEM RECEIPT #: Documm #:PR1056862 CONSTRUCTION PERMIT FOR: OSTDS New - � I APPLICANT: (RJ Newman Enterprises LLC) Y PROPERTY ADDRESS: 2275 Brocksmith Rd Fort Pierce,FL 34945 LOT: 2&3 BLOCK: 2 suBDmsxoN: McHurlen Farms [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] PROPERTY ID #: 2320-501-0018-000-6 [OR TAR ID NUMBER] I 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 TME PERMIT APPLICATION. SUCH MODIFICATIONS MAX 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. i SYSTEM DESIGN AND SPECIFICATIONS T [ 1.050 ] GALLONS / GPD Seotic new CAPACITY A [ ] GALLONS / GPD N/A CAPACITY N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAMMUM CAPACITY SINGLE TANK:1250 GALLONS] K [ 300 ] GALLONS DOSING TANK CAPACITY [67.00 ]GALLONS @[ 6 ]DOSES PER 24 HRS #Pumps [ 1 ] D [ 667 ] 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: orange spot top of 6"90degree well elbow N side.S of system I ELEVATION OF PROPOSED SYSTEM SITE [ 24.00 ] [ INCHES FT ] [ABOVE BELOW BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 17.00] [ INCHES FT ] [ABOVE iBELOW BENCHMARK/REFERENCE POINT L D FILL REQUIRED: [25.001 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 0 400 gpd. T Performing Lift Dosing. H Pumps must be certified as suitable for distributing sewage effluent. The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance with E s.64E-6.013(3)(0, FAC. R SPECIFICATIONS BY: Bri an In TIC' Environmental Specialist II XPPROVED BY: F I -TITLE: Environmental Specialist II St.Lucie CHD i Brian J inasam QATE ISSUED: 04/07/2017 EXPIRATION DATE: 10/07/2018 6H 4016, 09/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E-6.003, PAC Page 1 of 3 v 1.1.4 ar1283521 sE1029716 i i