HomeMy WebLinkAboutHealth Department Septic Approval ' PERMIT #: 56-SF-1 605525
t APPLICATION #:AP 1275056
STATE OF FLORIDA
DEPARTMENT 'OF HEALTH DATE PAID:
ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID:
SYSTEM RECEIPT #:
r DOCUMENT #: PR1061174
i
CONSTRUCTION PERMIT FOR: ;OSTDS New
I
APPLICANT: (Grande Construction)
PROPERTY ADDRESS: 17900 Wagonwheel Ln Fort Pierce, FL 34987
LOT: 4 BLOCK: SUBDIVISION: Carlton Country Estates
PROPERTY ID #: 3211-701-0006-000-1 [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 vOF 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 ] GALLONS / GPD Seotic 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 [ 767 ] SQUARE FEET i 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: BM no 1 fnd pk nail and disk stamped"pcp 2391"elev 23.69
I ELEVATION OF PROPOSED SYSTEM SITE [ 13.00 ] [ INCHES FT ] [ ABOVE BELOW BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 6.00 ] [ INCHES FT ] [ ABOVE BELOW BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: [25.001 INCHES EXCAVATION REQUIRED: [ ] INCHES
The system is sized for 5 bedrooms with a maximum occupancy of 10 persons(2 per bedroom),for a total estimated flow of
0 460 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
SPECIFICATIONS BY: Brian J Ingram TITLE: nv 1 ci" II
APPROVED BY: TITLE: Environmental Specialist II St. Lucie CHD
Brian iJ Iq am
DATE ISSUED: 02/27/2017 EXPIRATION DATE: 08/27/2018
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, PAC Page 1 of 3
v 1,1,4 AP1275056 SE1024526
NOTICE OF RIGHTS
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 twentyone (21) days from the receipt of this order. The address of the
Agency Clerk is 4052 Baldl 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.
t
STATE OF FLORIDA PERMIT APPLICATION TO CONSTRUCT,
REPAIR,MODIFY,OR ABANDON A WELL Permit No. �—
x` I OSouthwest Florida Unique ID
c PLEASE FILL OUT ALL APPLICABLE FIELDS
❑Northwest (*Denotes Required Fields Where Applicable) Permit Stipulations Required(See Attached)
DSt.Johns River
The water well contraaoris responsible forcompleting
❑South Florida. this form andforwardingthepermit application tothe 62-524 Quad No. Delineation No.
0Suwannee River appropriate delegated authority whereopprmbla
:., .Qn�M�•���• ❑DEP
CUPMNP Application No.
❑Delegated Authority(If Applicable) $
1. ANGevYt.�,. rfALD Ct 13'taotJCA f T•1�lb�is6 > L �7?J.3,3 12-y0
`Owner,Legal Name if Corporation Address *City `State *ZIP Telephone Number
2. Fr- )O)b12LG C,0eLT0,J Gal�..r,✓iy �S7'nTb$
*Well Location—Address,Road Name or Number,Ci
3. 3zll — 70l — OOOG 0007 it
*Parcel ID No.(PIN)orAlternate Key(Circle One) / Lot Block Unit
— Check if 62-524:0 Yes❑ No
`Section or Land Grant 'Township *Range *County Subdivision
-7 �Co3Y�9-7_ f�{13
'Water Well Contractor *License Number
i� -c `Telephone Number E-maitAddress
6- 3590 ti uv /,2-
otC z ;e.�-6<-, •e X16 3
"Water Well Contractor's Address City State ZIP
7. *Type of Work Construction ❑ Repair ❑ Modification❑ Abandonment
8. *Number of Proposed Wells�_ 'Reason for Repair. Modification.or Abandonment
9. 'Specify Intended Use(s)of Well(s): Date stamp
❑ Domestic Landscape irrigation ❑ Agricultural Irrigation ❑ Site Investigations
❑ Bottled Water Supply Recreation Area Irrigation ❑ Livestock ❑ Monitoring D D D O D
❑ Public.WaterSupply(Limited Use/DOH) ❑ Nursery irrigation Test ���® �®
❑ Public Water Supply(Community orNon-Community/DEP)❑ CommercialAndustrial Earth-Coupled Geothermal
❑ Class i Injection ❑ Golf Course irrigation HVAC Supply HVAC Return F E® 2 7 2019
Class V Injection:❑ Recharge ❑ Commerciai/lndustrial Disposal Aquifer Storage and Recovery❑ Drainage
Remediation:❑ Recovery❑ Air Sparge ❑ Other (Describe) Official Use Only
❑ Other (Describe) I
ty
n
10.*Distance from Septic System if 5 200 ft 11.Facility Description -f r �/ 12-Estimate LT H
13.*Estimated Well Depth-nP ft. -Estimated Casing Depth/ S ft. Primary Casing Diameter n. Open Hole: From• To ft.
14.Estimated Screen Interval:From /U STo 6c ft.
15.*Primary Casing Material: Black Steel Galvanized PVC Stainless Steel
Not Cased Other.
16.Secondary Casing: Telescope Casing Liner Surface Casing Diameter In.
17.Secondary Casing Material: Black Steel Galvanized 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,Secondary,and Additional Casing:
From To Seal Material( Bentonite Neat Cement Other )
From To Seal Material( Bentonite Neat Cement Other )
From To Seal Material( Bentonite Neat Cement Other- )
From .To Seal Material( Bentonite Neat Cement Other )
20.Indicate total number of existing wells on site List number of existing unused wells on site
21.1s this well or any existing well or water withdrawal on the owner's contiguous propertyy covered under a Consumptive/Water Use Permit(CUP/WUP)
oir CUPIWUP Application. Yes No if yes,complete the following:CUP/WUP'No. District Well ID No.
22.Latitude , Longitude
23.Data Obtained Froth: GIPS Map Survey Datum: NAD 27 NAD 83 WGS 84
l hereby cer"ithat l wil wavywoh the applicable rufes of Tide da,Florida Adndnlstrative,Code,ono lnata water leeray Hallam theMiner of the property,that the information provided is_accurate,and that lama+rare otmy
.se ponnd'oraAifirialreehugepermit.ifeaotlad,has tfoon orveilldo obtained pricrtommmoneement otweg resp..'Wires under Chapter 373,Florida Statutes,io maintaNpr property abandon fir the perimit MkIltiort vfiicheveraccur vaiiyell;or,I�My that l am
cadsWgtom Ifurther earbry that nornfamialiao provided In d fa
,this application is accurate and drat l ivia obtain the agent the Omar. mr that the lnfoatten"video baowrate,and that l have Wow`' lhaawnrroruteb necessary oppronlrrom othvfederal•sbito,or lord gnvemmi'nts;'Af apptirabfe lagreotobravrieavien responsibailiesasstateilabove,Owner=%ants to aibivina porsonnal ofmis WMD orDdeghten Authdnty access
wrt�leaon«part to the District within 30 days after comp!oUon ofthe construction,repair,madirlwiton.or to the well sla dining the constru « m
ction, pair,modification,or abandonent aulhor¢ed by this pemut.
-ebeotlonmerA aathorkeedbyy Untsp7 Crst.
,, ptmtt,
*Signattreof Conl ctor License No. _-�Si6ntIlure of Owner orAgent -Dale
Approval Granted By Issue Date Z 'v 7 ��Expiration Date �� / Hydrologist Approval
Fee Received,S Receipt No. Check No.
tnliais
THIS PERMIT IS NOT VALID UNTIL PROPERLY SIGNED BY AN AUTHORIZED OFFICER OR REPRESENTATIVE OF THE WMD OR DELEGATED AUTHORITY. THE
PERMIT SHALL BE AVAILABLEAT THE WELD SITE DURING ALL CONSTRUCTION,REPAIR,MODIFICATION,OR ABANDONMENT ACTIVITIES.
I
I
St. Lucie County Health Department
5150 NW Milner Dr Port Saint Lucie, FL 34983
HEALTH
PAYING ON: PERMIT#:56-SF-1605525 BILL DOC#:56-BID-3344099 CONSTRUCTION APPLICATION#:AP1275056
RECEIVED FROM: Grande Construction AMOUNT PAID: $ 515.00
PAYMENT FORM: CHECK 3050 PAYMENT DATE: 02/08/2017
i
MAIL TO: (Grande Construction)
I
FACILITY NAME :
PROPERTY LOCATION:
i
17900 Wagonwheel Ln
Port Saint Lucie, FL 34987
Lot: 4 Block:
Property ID: 3211-701 10006-000-1
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
I
-1 -Surcharge (Ali) 1 $ 15.00
-1 - OSTDS New Permit Surcharge 1 $ 100.00
I
I
I
RECEIVED BY: VanceMH AUDIT CONTROL NO. 56-PID-3182119
PERMIT' NO.
STATE OF FLi�RI�A -•
{ DEPARTMENT OF HEALTH. DATE PAID:
p ONSITE' SEWAGE TREATMENT AND. DISPOSAL FEE
SUTA14 R�c� Px #:cx—JV5-T .
•ty`°°" ``�• APPLICATION. FOR "CONSTRUCTION PERMIT
APPLICATION IOR:
[v Neer systsm [ 1', ] Existing System [ J Holdsng- Tank ] Iiiao rat3ve
C } ReFair C .7 Abando=eiit [ ] Temporary C ].
APPLICANT': �-t 5Z' C�J s xw�r��•- c,J L
'1 e.1:on�L .I c��( l , �7.0 3, TELEPHONE: Z Z� 33 -���(
_AGENT: 'zl2�Cg lJ
b%-XLXNG ADDRESS: �.0 • 1��C ��' 1 7Ch5� "F�n,z'3�•LUe,le'� L ��9a
-cacao:c,�a��a4aa6�Sa=a aaaL'L'sCarsaaaaaasaaaaa__aaaa___assaaa�a-a=aa�aa=aEs�'R:J�,+= z;ca::aa�cca a
TO BE COMPLETED' .BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT: SYSTEMS MUST BE CONSTRUCTED
BY A PERSON -LICENSED :PURSUANT TO 4.89.105(,.3) (m) OR 4:89.552, FLORIDA STATIITES. IT IS THS
APYL•ICANT'0 RESPONSY$ILITY TO PROVIDE DOCUMENTATIOX OF THE :DATE TgE LOT' WAS CREATED OR
PLATTED (MM/DDfYY) IF REatIESTING CONSIDERATION OF STATUTORY GRANDFATHER $ROVxgIONS:
a=ca�� era:a:a-• t �� :a� = oaa:�:.:a�o�a=�ars_�=. _ae�:�=as"a==...,a.::���=_=a_-.o..=o_�pa-'�c���:a=a
PROPERTY INFORMATION
LOT: _ BLOCK SUBDIVISION: C/-lYLL-td^b. C-OVIV W ff$T6 rS'S FL13'1"rED.s
PROPERTY ID #: 21 7a l 8 bO(o— 090/1 . ZONING.: I/M OR EQtTIVAL=T-; .[ Y
I.
PROPERTY SIZE: ~ ACRES WATER SUPPLY: [ '- PR2VATE PUBLIC [ 7<=2OOOGPD [ 1>2'000G3?D
IS SEWER AVAILABLE AS PER 381.0065, PS? C Y / DISTANCE TO SEWER: FT
PROPERTY ADDRESS: t '19 O O l hJ of 6 O 14 W W 5 q5 L Lj j. , F7• p► dtC.G' -
DIRECTIONS TO PROPERTY: 'ro t Dc;a - H o Lb j n1 L9 S .(5 e v-n-j� T v
W•�(,_o+v�.✓�!bsL L,.1 . �ASr `To prz'o-pco-!- 4 f)rJ /V. S6 vC byl�' M4AD.
+ //
5)b r1 O� t-a-•f �°�
BUILDING INFORMATION IV-'] RESIDENTIAL C COMMERCIAL
Unit Type of -No. of Building CbnUerci•al/73ist :tutional Syolmip Design
No. ES�abliohmdnti Bedrooms Area S:gft Table 1, Chapter 64Et6, FAG
i
2
3 I
4
( 7 Floor/Equipment Drains C 7 Other (SPecity.)
SIGNATURE: �1 S. DATE s 1 1 7
DH 4Q15, 08/09 (Obaolates V3�4v9.ous editions which may not be used)
2neorpora"ed 64E-6..001, FAC Page 1 of 4
a E STATE OF FLORIDA APPLICATION # AP1275056
y: ;' •- DEPARTMENTI OF HEALTH PERMIT # 56-SF-1605525
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
DOCUMENT # SE1024526
SITE EVALUATION AND SYSTEM SPECIFICATION
virt
APPLICANT: Grande Construction
CONTRACTOR / AGENT: Grande Construction
LOT: 4 BLOCK:
SUBDIVISION: Carlton Country Estates
xD#: 3211-701-0006-000-1
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: 5.23 ACRES
TOTAL ESTIMATED SEWAGE FLOW: ; 460 GALLONS PER DAY [ RESIDENCES-TABLET / OTHER-TABLE 2 ]
AUTHORIZED SEWAGE FLOW: 7845.01 GALLONS PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE ]
UNOBSTRUCTED AREA AVAILABLE: 40000.00 SQFT UNOBSTRUCTED AREA REQUIRED: 1300.00 SQFT
BENCHMARK/REFERENCE POINT LOCATION: BM no 1 fnd pk nail and disk stamped"pcp 2391"elev 23.69
ELEVATION OF PROPOSED SYSTEM SITE 13.00 [ 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: 100 FT NORMALLY WET: [ ]YES [X]NO
WELLS: PUBLIC: FT LIMITED USE: FT PRIVATE: 85 FT NON-POTABLE: 100 FT
BUILDING FOUNDATIONS: 51 FT PROPERTY LINES: 70 FT POTABLE WATER LINES: 50 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:Unkown USDA SOIL SERIES:Unkown
Munsell#/Color Texture Depth Munsell#/Color Texture Depth
1 OYR 5/1 Sand 0 To 7 1 OYR 3/2 Organic Soil 0 To 1
1 OYR 5/2 Sand 7 To 21 1 OYR 5/1 Sand 1 To 10
1 OYR 6/2 Sand 21 To 33 1 OYR 4/4 Sand 10 To 27
10YRA/2 Sand 33 To 63 1 OYR 3/2 Sand 27 To 32
1 OYR 5/1 Sand 63 To 72 1 OYR 2/1 Sand 32 To 36
1 OYR 3/1 Sandy Clay 36 To 47
1 OYR 4/2 Sandy Clay Loam 47 To 65
1 OYR 5/2 Very Coarse Sand 65 To 72
OBSERVED WATER TABLE: 50.00 INCHES [ ABOVE / BELOW ] EXISTING GRADE TYPE: [ PERCHED / APPARENT ]
ESTIMATED WET SEASON WATER TABLEiELEVATION; 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: [ I ] TRENCH [X] BED [ ] OTHER (SPECIFY)
REMARKS/ADDITIONAL CRITERIA
WSWT determined using USDA WSS and;soil borings.
Stripping in 10YR5/2 matrix>10%with diffuse boundaries starting at 30"in SB1.
SB1 and SB213"below BM.
SITE EVALUATED BY:
DATE: 02/15/2017
Ingram,Brian(Ty e: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
AP1275056 EID1605525 v 1.0.2