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HomeMy WebLinkAboutHealth Department Septic Approval -f File 'C PY PERMIT 56-SF-1738221:A'. C)b]5 APPLLCATION'#t gP1274.7.:92` 5'- C pv 4n STATE or, FLORIDA DEPARTMENT OF HEALTH DATE PAID Z: •ONSITE SEWAGE T_REATN NT AND DISPOSAL FEE PAID `STY x:• SYSTEM RECEIPT $ �r rr ry.' �`�� nocuMENT PR1050$09 CONSTRUCTION PERMIT FOR: OST:DS NeW; APPLICANT:. William Diaz _ PROPERTY ADDRESS: Palmetto-,,Dr Fort Pierce,;FL 3--4082. LOT: 57&58 BLOCK: 5 SUBDIVISION: ;Indian RiverEstates '[SECTION, TOWNSAilp,;:RANGE•, :PARCEL NUMBER] PROPERTY ID #:: 3402-606-005MOO-3 [OR'.TAX`ID"NUMBER] I SYSTEM MUST BE CONSTRUCTED IN .ACCORDANCE WITH SPECIFICATIONS' AND STANDARDS OF SECTION' 381.0065,• F.S., AND CHAPTER 64E-6, F.'A.•C. DEPARTMENT APPROVAL OF .SYSTEM DOES NOT GUARANTEE" SATISFACTORY PERFORMANCE 'FOR. ANY SPECIFIC PERIOD .09 TIME.. ANY: CHANGE; IN MAT99ZALz FACTS; . WHICH SERVED, AS A BASIS FOR. ISSUANCE OF ,THIS PERMIT', REQUIRE:, THE APPLICANT TO MODIFY THE' PERMIT APPLICATION. SUCH MODIFICATIONS ',MAY RESULT 'IN THIS PERMIT BEING MADE NULL,AND vOID:' ISSUANCE OF THIS PERMIT DOES NOT ,EXEMPT THE APPLICANT FROM _CO2�LIANCE WITH -OTHER FEDERAL,, STATE, OR LOCAL PERMITTING'REQUIRED FOR DEVELOPMENT OF`T$IS PROPERTY, SYSTEM DESIGN AND SPECIFICATIONS T [ 1;050 ] GALLONS /.GPD - - Sebticnew CAPACITY A [ ] GALLONS / GPD _ -N/A CAPACITY N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:125;0 GALLONS] y K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS' @[' ]DOSES=PER 24 URS O.P. [ ] D [ 667 ] SQUARE FEET Drainfieid<new SYSTEM R [ ] SQUARE- FEET N/A SYSTEM A TYPE SYSTEM: [ ] STANDARD [ ] FILLED [ix] MOUND [' I CONFIGURATION: [ ] TRENCH (,X] 'BED [ ] N Site BM Oran. a painted X in jntersection.of howard and"p.a hetto F LOCATION OF BENCHMARK: g • I I 'ELEVATION OF PROPOSED SYSTEM SITE. [ 12.00]'L .INCHES;, FT ],['-ABOVE :BELOW' BENCRx;mK-/REFERENCE ;POI27T'' E BOTTOM OF DRAINFIELD TO BE r 9:00 ][ INCHES; ET It 06v-E- 'BELOW: BENCHMARK/REFERENCE POINT' L D: FILL REQUIRED`: [21..001 INCHES EXCAVATION:REQUIRED:- ;[ 58.00 ]- INCHES The'system is.sized for 4'bedmoms with a maximum occupancy Of 8 persons:(2,per:bedroom),fora total-estimated flow'of 0 400.9pd. - T The licensed contractor installing the system is responsible"for installing the minimum category of tank m accordance with H, s.64E-6.013(3)(f),.FAC. E. R ' SPECIFICATIONS BY:, Brian J',In TITLE: 9zd� Environmental Specalist.,II APPROVED BY: TITLE:: Environmental Specialis;t:, II St.LUCie CH6 - Brian 'J Ingy6o ,- DATE ISSUED: O2%22/2017 EXPIRATION SATE;: 0,8/22120.19 ' DH 4016, 09109 (Obaoletes, s11 previous editions which may not be.used) Incorporated: 64E-6.003, FAC Page•1 of ,3 v 1.1A "1274792 SE1024644' - 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 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 ofthis 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. of ei �* STATE OF FLORIDA PERMIT, NO. 5�:=5e l�382 2-1 DEPARTMENT .OF HEALTH DATE PAID: ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID: Sys-E9 I RECEIPT #: ~CQp ST • APPL=.CATION FOR CONSTRUCTION PERMIT " APPLICATION,FOR:, [ New System [ ]- Existing System [ ] Holding Tank j ] Innovative [ ] Repai-r^� [ ] Abandonment 1/ [ ] Temporary APPLICANT: J I<a."Z �XC?f /Q 036 AGENT: _ -��t, �ta I .G,1all- G v iG TELEPHONE': 77Z MAILING ADDRESS: —12C)'l C>)t I qV „/A L'P 99y3 TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. SYSTEMS MUST BE CONSTRUCTED BY A PERSON'LICENSED PURSUANT TO 489.10.5(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 REQUESTING CONSIDERATION OF STATUTORY GRANDFATHER PROVISIONS. -4 PROPERTY INFORMATION LOT: ,4; BLOCK: SUBDIVISION: / (�/1�h {CZ/ � PLATTED PROPERTY ID #: Yjq(jZ- L.OG, ' 7 ZONING: � I/M OR EQUIVALENT: [ Y / N ] PROPERTY SIZE: ACRES WATER SUPPLY: [ ] PRIVATE PUBLIC &I<=2000GPD [ J>2000GPD IS SEWER AVAILABLE AS PER 381.0065, FSP [ Y /ON ] DISTANCE TO SEWER: FT PROPERTY ADDRESS:TT� DIRECTIONS TO PROPERTY:,, BUILDING INFORMATION [ � RESIDENTIAL [ J COMMERCIAL Unit Type of No. of Building Commercial/institutional System Design NO Establishment Bedrooms Area Sq£t Table 1, Chapter.64E-6, PAC 2 ��✓ t b _ 3 4 [ ] Floor/Egufpment Drains [ J • Other (Specify) S IGNATURE: _ DATE: L J, / /-7 DH 4015, 08/09 =-tes — vious editions which may�note urea) Incorporated 64E-6.001., FAC Page 1 of 4 �L� a6 J- 17_-3 �y STATE OF FLORIDA APPLICATION # AP42741,92' 'DEPARTMENT OF HEALTH PERMIT # 56 SF=1738221 `f ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM DOCUMENT # SE1024044 SITE EVALUATION AND SYSTEM SPECIFICATION 17 APPLICANT: William Diaz CONTRACTOR / AGENT: Atlantic Lafnd Design _ LOT': 57&58 BLOCK: 5 • suBDIVISION: -,Indian River Estates. ID#,:3402,606=0055-000-3 TO BE COMPLETED BY ENGINEER, HEALTH DEPARTMENT EMPLOYEE, OR OTHER QUALIFIED -PERSON. ENGINEERS MUST PROVIDE. i REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE. OF SUBMITTAL.'COMPLZTE ALL-ITEMS. PROPERTY SIZE CONFORMS TO SITE PLAN: [X]YES [ ]NO NET USABLE AREA AVAILABLE: 0.91 ACRES TOTAL ESTIMATED SEWAGE FLOW: 4,00, GALLONS PER DAY [ RESIDENCES-TABLEI< •J 6T39ER=TABLE' 2 '] AUTHORIZED SEWAGE FLOW: 2275.02 GALLONS PER DAY [ 1500 GPD%ACRE OR 2500- GPD/ACRE '] UNOBSTRUCTED AREA AVAILABLE: 1000.00 SQFT UNOBSTRUCTED AREA REQUZR$ID: 1000.00_ SOT BENCHMARK/REFERENCE POINT LOCATION: Site BM Orange painted X in intersection of howard,and palmetto ELEVATION OF PROPOSED SYSTEM SITE 12.00 [1 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: 26 FT NORMALLY WET: `[ -]YES [.X]NO WELLS: PUBLIC: FT LIMITED USE: FT PRIVATE: 1,00 FT NON-POTABLE: FT BUILDING FOUNDATIONS: 11 FT PROPERTY LINES: 25 FT POTABLE WATER LINES': 1.0 FT SITE SUBJECT TO,FREQUENT FLOODING? [ ]YES Ex]NO 10 YEAR FLOODING? 1 ]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:Lawnwood sand USDA SOIL SERIES:Lawnwood sand Munsell#/Color Texture Depth Munsell.-#/Color; Texture Depth 1 OYR-6/1 Sand 0 To 25 1 OYR 51Z Sand O To_15, -1 OYR 711 Sand- 25 To 35 10YR.5/1 Sand` 15 To 25, 10YR 211 Spodic Material 35 To 38 1 OYR'7/1 Sand 25 To 35.. 7.5YR 3/2 Spodic Material 38 To 58 1 OYR 211 Spodic';Material 35 To 39 10YR 4/1 Sand 58:To 63 7.6YR 3/2' Spodic Material 39 To 43 10YR 5/3 Sand 63 To.72 10YR 261 Sp,odic Material 43 To 55 10YR 513 Sand 55 To 72 OBSERVED WATER TABLE: 72.00 INCHES [ ABOVE / BELOW ] EXISTING GRADE TYPE-:. [ PERCHED / '.APPARENT ]., ESTIMATED WET SEASON WATER TABLE ELEVATION: 21 INCHES [ ABOVE / BELOW ] EXISTING GRADE HIGH WATER TABLE VEGETATION: [ ]YES [X]NO MOTTLING: [X]YES [ ]NO DEPTH:. 21.00' INCHES SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: Sand/ DEPTH OF EXCAVATION': 58 INCHES DRAINFIELD CONFIGURATION: [ ] TRENCH I] 'BED [ ] OTHER ('SPECIFY) REMARKS/ADDITIONAL CRITERIA i WSWT determined using USDA WSS and soil borings. 10YR7/1 stripping in 10YR6/1 matrix>than 10%with diffuse boundaries starting at 21"in SB'I.No observed water table. SB1 and SB2 12"below BM SIB EVALUATED BY: DATE:' 0211412017 Ingram,Bri (Title:Environmental Specialist 11)(ENVIRONMENTAL HEALTH) DR 4015, 08109 (obsoletes previous editions which may not be used) Incorporated: 64E-6.001, PAC, Page 3' of 4 ^r AP1274792 EID1738221 v 1.0.2 9 STATE OF FLORIDA PERMIT #.56, - -DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM h SITE EppVALUATION AND SYSTEM // SPECIFICATIQNS APPLICANT�I c ? ✓"�9Sc�c.ts1 .�C�. f� � IVl L. AGENT,:._.✓!fI>r r LOT:j • 0 BLOCK: SUBDIVISION: � �. 5- L) PROPERTY ID #:_36Z'l, j ,•oaSS* -3 [Section/Township/Parcel No. or Tax ID Number] TO BE COMPLETED BY ENGINEER, HEALTH DEPARTMENT EMP,LOYEE,OR­OTHER QUAL2FIED PERSON. ENGINEERS MUST PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL: COMPLETE ALL_ITEMS. PROPERTY SIZE CONFORMS TO SITE PLAN: C{] YES [ ] NO NET USABLE AREA AVAILABLE,: . d. - _ ACRES TOTAL ESTIMATED SEWAGE, FLOW: GALLONS PER DAY [RESIDENCES-TABLE 1/6THER- ABLE2] AUTHORIZED SEWAGE FLOW: GALLONS PER DAY [1500 GPD/ACRE OR 250,0 'GPD/ACRE] UNOBSTRUCTED AREA AVAILABLE: SQFT UNOBSTRUCTED AREA REQUIIRED: S_QFT BENCHMARK/REFERENCE POINT LOCATION: /Yt�Y4� tY Oa 7'G�1ttPTfV / �,li t ry, ELEVATION OF PROPOSED SYSTEM SITE IS [INCHES/FT] [ABOVE/BELOW] ENCHMARK/REFERENCE POINT THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES SURFACE WATER: 1G O FT DITCHES/SWALES: f�� FT. NORMALLY WET? [ ] YES ..NO WELLS: PUBLIC: Z—' an FT LIMITED USE: IO'O, FT PRIVATE: `7s - FT NON-POTABLE: �p FT BUILDING FOUNDATIONS: 71 FT PROPERTY LINES: 11 FT POTABLE WATER LINES: 16C- 'FT SITE SUBJECT TO FREQUENT•FLOODING: [ ] YES ] NO 10 YEAR FLOODING? [ ] YES V] ,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 - MUNSELL #/COLOR TEXTURE: DEPTH MUNSELL 4/COLOR _ TEXTURE DEPTH. TO TO. TO - - -TO- TO TO: . TO TO' .. - TO TO TO TO TO TO TO _ TO TO USDA SOIL SERIES: USDA SOIL SERIES: OBSERVED WATER TABLE: INCHES [ABOVE / BELOW] EXISTING GRADE. TYPE: [PERCHED / APPARENT] ESTIMATED WET SEASON WATER TABLE ELEVATION: INCHES [ABOVE / BELOW] EXISTING GRADE HIGH WATER TABLE VEGETATION: [ ] YES [ ] NO MOTTLING: [ ] YES [ ] NO DEPTH: _ INCHES SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: DEPTH OF EXCAVATION: INCHES DRAINFIELD CONFIGURATION: [ ] TRENCH [ ] BED [ ] OTHER (SPECIFY) REMARKS/ADDITIONAL CRITERIA: SITE EVALUATED BY:, DATE': DH 4015, 08109 (obsoletes Previous editions which may not be used) Incorporated: 64E-6.001,FAC Page 3 of 4 i 71 •) �Zjoacj[Ie. Maps 4 ' U1'.CSSitrP•LD+. 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S ?ir � '+r"S"�r•:s# 4'' V� 'lky } �:h is S; �:, �. ..y: sa .�r � "��'!"'� �.,�4' �_.+���. :;j- 3, x y4,• •r� ,.:•3 1t} F. f�6 ��}��fY"r^': .' , i-i I "•6 I. :ate£ i(t l ,4i�. 4 �r 46j �+ r �.-eb f` , �, L:. jSR > .'. 1 Al?,l,�' .07' rw,•" } 9 Y Y S= C yJ •i'd fff 1 F iV 1Y.IP.Y'PIinDDlrcSZ O jyll V34..{Y� 1 { y�� t 1I x kk .19 llrcl PttrO 'f�',Ve"cc@fl ahl It' U'UiIlJ: Uu}.ItRc��{'t r 'j t' i J . `�C 1', •�.a Q § a C. }I..1 0 7 Q... .. tlr rr i 5r � ♦ N3 � 4� - . o r¢( \rtpo Ls Yi t,JYpRMfI PYf4n� .a,Jylrch OYFn ,:ynll +� ( � f '� I � � ..t _ -� � Csor c.::�', t � Ir.n.W.cv r,.......c.a �.....�. ...,.. .. •�d _ E- ...:'..R.w, t.us 1 Map data.©2017 Goo,gle 500 it ,,,. 4 M � ' dE APPLICATION '#:AP1274792 STATE -OF FLORIDA PERMIT #:56=SF-17-38221 DEPARTMENT OF HEALTH c 'L' ONSITE SEWAGE TREATMENT AND :DI-SPOSAL SYSTEM_ DOCUMENT #:FI1154498 CONSTRUCTION INSPECTION AND FINAL, APPROVAL -DATE PAID:02/07/20.17 WE FEE PAID':515.00 RECEIPT #:56-PID,31.81409 APPLICANT: William Diaz AGENT: Atlantic Land Design PROPERTY:ADDRESS: Palmetto Dr For Pierce, FL 34982 LOT: 57&58 BLOCK: 5 SUBDIVISION: Indian River Estates ID#s .3402-606-0055-000-3" CHECKED [X]; ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED., TANK INSTALLATION SETBACKS [ ] [01] TANK 'SIZE [1] 1050.00 (2]. [ ] [27,] SURFACE WATER- FT [ 1 [021 TANK MATERIAL Concrete [ ] [26'] DITCHES FT [ 1 [031 OUTLET DEVICE [ ], [29•J PRIVATE•WELLS FT [ 1 [04`1 MULTI "CHAMBERED. [ Y N" ] [, ] [301 PUBLIC WELLS FT [ ] [05] OUTLET FILTER PolylOk PL=122 [ 1 [311 IRRIGATION.'WELLS FT [ ] [06] LEGEND 1,, 01-011=09DC3' 2. ( ] [32] POTABLE'WATER 45 FT [. .] (07] WATERTIGHT ( ]. [33.] BUILDING FOUNDATIONS 5 FT [ ] t.08] LEVEL. [ ] 134.]. PROPERTY LINES 21 FT [ ], ;[091 DEPTH'TO LID [ ] [35] OTHER FT- DRAINFIELD INSTALLATION" FILLED /MOUND SYSTEM [ ] [10] AREA [1]. 672 [2] SQFT [ ] [36] DRAINFIELD COVER [ ] [11] DISTRIBUTION BOX HEADER X ( ] 1371 SHOULDERS [' ] [12] NUMBER OF DRAINLINES 1, TO& 2. [. 1 [381 SLOPES [ ] (13] DRAINLINE SEPARATION [ ] [.39] STABILIZATION: ;01/2W01$ [. ] [14,1 DRAINLINE SLOPE [ l [15] DEPTH•OF COVER ADDITIONAL INFORMATION' [ J [-16]- ELEVATION [ ABOVE / BEIOW •]BM 9.00 [ ] [40] UNOBSTRUCTED 'AREA .[ ] [17] SYSTEM LOCATION [ ] [411 STORMWATER. RUNOFF (. 1 [18] DOSING PUMPS I 1 [421 ALARMS [ ] [191 AGGREGATE SIZE [ ] [431 MAINTENANCE AGREEMENT [ ] [201 AGGREGATE EXCESSIVE FINES [ ] 1441 BUILDING AREA [ 1 [211 AGGREGATE DEPTH [ ] [95] LOCATION CONFORMS WITH SITE PLAN FILL / EXCAVATION MATERIAL; [ ] (40] FINAL SITE' GRADING' [ ] [221 FILL 'AMOUNT [. ] ['47] CONTRACTOR David Whiteside-(Accurate Se [ ] [231 FILL TEXTURE C 1 [48.1 OTHER INFILTRAT0R-Quick4 EQ36(single c . [ ] [24] EXCAVATION DEPTH ABANDONMENT [ ] [25] AREA REPLACED [ ] [49,1 TANK PUMPED.' [ ] [261, REPLACEMENT MATERIAL [ 1 [50,1 TANK CRUSHED & ..FILLED Comments: Comments are on, page 2: CONSTRUCTION [ .APEROVED / t. LUCIe CHD DATE,: 09/29/2017 DISAPPROVED' ]""Enviro mental Specialist 11 Bri ingram(ENVIRONMENTAL,HEALTH) FINAL SYSTEM [ APpROVED / DISAPPROVED J i t. Lucie, CHD DATE: '01/26/2019 - Environmental Specialist 11 BriaK Ingram`.(ENVIRONMENTALMEALTH). (Explanation of Violations on following page) DH 4016., O8/09 (Obsoletes all previous editions which may not-be used) Incorporated: 64E-6.03, FAC 'Page 2 of 3 I EH Dalabase v 1.9.1 AP1274792 EI151,738221 I ak APPLICATION #:.AR1274792 r r STATE OF FLORIDA y.:, •• PERMIT #.:56-SF-1738221 DEPARTMENT OF HEALTH DOCUMENT #':F1:1154498 c 't* ONSITE SEWAGE TREATMENT, AND :DI`SPO.S.AL SYSTEM CONSTRUCTION INSPECTION AND' `FINAL, APPROVAL DATE PAID.:02/07/2017 FEE PAilj 59 5:00 RECEIPT. #:5:.0-PI,Q-3181409 Violation-Number Comment Comments The system,is sized for 4 bedrooms with a maximum occupancy of.8 persons(2,per•bedroom);.fora total estimated flow-of-400 gpd.New ST and 7x8 long DF. No violations;system ok to cover..Contractor notified,onsite.:Needs final inspection:for mound:system.and.final.grading. Final-system approved.Contractor-and'building department emailed final approval. DH 4016; 08/0;9 (Obsoletes .all previous editions which may not be used)' Incorporated: 64E-6..003, FAC Page- 2 of- 3 EN:Database w 1.0.1 01274792• EID1738221 • l