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HomeMy WebLinkAboutHealth Department Septic Permit (2) i PERMIT #:66-SF-179394E APPLICATION #:AP1309898 STATE OF FLORIDA DEPARTMENT OF HEALTH DATE PAID: ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID SYSTEM �� [!�,p,p"' •niYf: � +i9.ie RECEIPT #: ®V 0 $ 2 �� DOCUMENT #: PR1079480 CONSTRUCTION PERMIT FOR: OSTDS New PERrAl TIF]G St. Lucie County, FL APPLICANT: Karen Gorden PROPERTY ADDRESS: TBD Yucca Dr Fort Pierce, FL 34982 LOT: BLOCK: SUBDIVISION: PROPERTY ID #: 3402-610-0608-000-8 [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 [ 375 ] SQUARE FEET Drainfield new SYSTEM R [ ] SQUARE FEET N/A SYSTEM A TYPE SYSTEM: [ ] STANDARD [ ] FILLED [x] MOUND [ ] I CONFIGURATION: [x] TRENCH [ ] BED [ ] N F LOCATION OF BENCHMARK: Orange X CL of rd NW property Corner I ELEVATION OF PROPOSED SYSTEM SITE [ 11.00 ] [ 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: [23.001 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 0 300 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 Inqpgm TITLE: Environmental Specialist II APPROVED BY: TITLE: Environmental Sp B.' ecialist II St. Lucie CHD an J Ingr DATE ISSUED: 10/13/2017 EXPIRATION DATE: 04/20/2019 DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E-6.003, FAC Pa e 1 of 3 v 1.1.4 AP1309898 SE1050888 File, C®�� 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 Clerks 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. I i � I 1 St. Lucie County Health Department `O 5150 NW Milner Dr Port Saint Lucie, FL 34983 HEALTH PAYING ON: PERMIT#:56-SF-1793945 BILL DOC#:56-BID-3605380 CONSTRUCTION APPLICATION#:AP130 I898 RECEIVED FROM: K. Gordon Construction DBA Paradise H AMOUNT PAID: $ 515.00 PAYMENT FORM: CHECK 14646 PAYMENT DATE: 10/06/2017 :MAIL TO: Karen Gorden CaA }�. V 2 rA �✓ U� 3 �y 7Z FACILITY NAME : PROPERTY LOCATION: TBD Yucca Dr Fort Pierce, FL 34982 Lot: Block: Property ID: 3402-610-0608-000-8 i EXPLANATION or DESCRIPTION: QUANTITY FEE 128-OSTDS Construction System Inspection Research Fee 1 $ 1 5.00 -1 -Surcharge (All) 1 $ 15.00 -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 Mod, Amendment) 1 $ 55.00 127-OSTDS Construction System Inspection 1 $ 75.00 I 133- OSTDS Construction Reinspection 1 $ 50.00 i I I I RECEIVED BY: VanceMH AUDIT CONTROL NO. 56-PID-3406425 i i ?� STATE OF FLORIDA PERMIT NO. A,-5 r, 17 3 1 DEPARTMENT OF HEALTH DATE PAID $ ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID: 3/- ;� c' SYSTEM RECEIPT #: APPLICATION FOR CONSTRUCTION PERMIT APPLICATION FOR: �- Iv 1 New System [ ] Existing System [ ] Holding Tank [ ] [ ] Repair F-11 Abandonment [ ] Temporary APPLICANT: Karen Gordon nIV335Z AGENT: K. Gordon Construction DBA Paradise Homes Group TELEPHONE: - MAILING ADDRESS: 575 NW Mercantile Place #109 34986 -7 TO BE COMPLETED BY APPLICANT OR APPLICANTfS AUTHORIZED AGENT YSYSTEMS MUS BY A PERSON LICENSED PURSUANT TO 489.105(3) (m) OR 489.552, FLORIDA STATUTE APPLICANTS RESPONSIBILITY TO PROVIDE DOCUMENTATION OF THE DATE THE LOT PLATTED (MM/DD/YY) IF REQUESTING CONSIDERATION OF STATUTORY GRANDFATHER PROVISIONS. PROPERTY INFORMATION LOT: n/a BLOCK: n/a SUBDIVISION: n/a PLATTED: n/a PROPERTY ID #: 3402-610-0608-000-8 ZONING: RS-4 I/M OR EQUIVALENT: [ Y /', N ] PROPERTY SIZE: •23 ACRES WATER SUPPLY: PRIVATE PUBLIC ✓ <=2000GPD [ ]>2000GPD IS SEWER AVAILABLE AS PER 381.0065, FS? [ Y / N ] DISTANCE TO SEWER: 1000 FT PROPERTY ADDRESS: Parcel Control Number 3402-610-0608-000-8 DIRECTIONS TO PROPERTY: Take Bartow Street east to Yucca Drive and go south II� BUILDING INFORMATION RESIDENTIAL [ ] COMMERCIAL Unit Type of No. of Building Commercial/Institutional System Design No Establishment Bedrooms Area Sqft Table 1, Chapter 64E-6, FAC 1 New SFR 3 1885uv1n9 2 3036 Total 3 4 [ ] Floor/E ipment Drains [ ] Other (Specify) SIGNATURE: DATE: 1 0/04/1 7 DH 4015, 08/09 (Obsoletes previous��Iitions which may not be used) Incorporated 64E-6.001, FAC Page 11of14 i STATE OF FLORIDA APPLICATION # AP1309898 DEPARTMENT OF HEALTH PERMIT # 56-SF-1793945 ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM c� q SITE EVALUATION AND SYSTEM SPECIFICATION DOCUMENT # SE1050888 APPLICANT: Karen Gorden CONTRACTOR / AGENT: K. Gordon Construction DBA Paradise Homes Group LOT: BLOCK: SUBDIVISION: ID#: 3402-610-0608-000-8 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: 0.23 ACRES TOTAL ESTIMATED SEWAGE FLOW: 300 GALLONS PER DAY [ RESIDENCES-TABLET / OTHER-TABLE 2 ] AUTHORIZED SEWAGE FLOW: 575.01 GALLONS PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE ] UNOBSTRUCTED AREA AVAILABLE: 1000.00 SQFT UNOBSTRUCTED AREA REQUIRED: 750.00 SQFT BENCHMARK/REFERENCE POINT LOCATION: orange x CL of rd NW property corner ELEVATION OF PROPOSED SYSTEM SITE 11.00 [ 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: 15 FT NORMALLY WET: [ ]YES [X]NO WELLS: PUBLIC: FT LIMITED USE: FT PRIVATE: 75 FT NON-POTABLE: FT BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: 5 FT POTABLE WATER LINES: 10 , 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 i SOIL PROFILE INFORMATION SITE 1 SOIL PROFILE INFORMATION SITE 2 USDA SOIL SERIES:Wabasso sand USDA SOIL SERIES:Wabasso sand Munsell#/Color Texture Depth Munsell#/Color Texture Depth 1 OYR 4/2 Sand 0 To 7 1 OYR 4/2 Sand 0 To 6 10YR 5/2 Sand 7 To 23 10YR 5/2 Sand 6 To 24 1 OYR 6/2 Sand 19 To 38 1 OYR 6/2 Sand 19 To 38 10YR 2/2 Spodic Material 38 To 45 10YR 2/1 Spodic Material 38 To 47 10YR 3/3 Sand 45 To 52 1 OYR 4/4 Sand 47 To 55 HOLE CAVING Refusal 52 To 72 HOLE CAVING Refusal 55 To 72 OBSERVED WATER TABLE: 13.00 INCHES [ ABOVE / BELOW ] EXISTING GRADE TYPE: [ PERCHED / APPARENT ] ESTIMATED WET SEASON WATER TABLE ELEVATION: 19 INCHES [ ABOVE / SELOW ] EXISTING, GRADE HIGH WATER TABLE VEGETATION: [ ]YES [X]NO MOTTLING: [X]YES [ ]NO DEPTH: 19.00 INCHES SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: Sand/0.80 DEPTH OF EXCAVATION: INCHES DRAINFIELD CONFIGURATION: [X] TRENCH [ ] BED [ ] OTHER (SPECIFY) REMARKS/ADDITIONAL CRITERIA WSWT determined using USDA WSS and soil borings. 10YR612 stripping in 10YR5/2 matrix>10%with diffuse boundaries starting at 19"In both SBs. SB1 and SB211"below BM. SITE EVALUATED BY: DATE: 10/131/201:7 Ingram,Brian(Title:E (ronmental 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 AP1309898 EID1793946 v 1.0.2 5 I ;roperty card Page 1 of I e-S�- k-?g3 �y Michelle Franklin, CFA--Saint Lucie County Property Appraiser--All rights reserved. Property Identification Site Address:Yucca DR Parcel ID:3402-610-0608- Account#:38695 Sec/Town/Range: 000-8 12/36S/40E Map ID:34/12S Zoning:RS-4 Use Type:0000 Jurisdiction:Saint Lucie County Ownership Legal Description Kurt R Boller INDIAN RIVER ESTATES-UNIT-09-BLK 91 LOT 3(MAP Linda L Boller 34/12S)(OR 3990-179) 7701 Silver Oak DR Port St Lucie,FL 34952-2892 Current Values Historical Values 3-year Just/Market: $16,400 Assessed: $12,947 Year Just/Market Assessed Exemptions Taxable Exemptions: $0 Taxable: $12,947 2017 $16,400 $12,947 $0 $12,947 2016 $12,500 $11,770 $0 $11,770 2015 $10,700 $10,700 $0 $10,700 Sale History Date Book/Page Sale Code Deed Grantor Price 04-26-2017 3990/0179 0001 WD Hill(TR)Lillian H $21,000 12-11-1998 1191/0292 XX01 WD $100 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 • t Finished/Under Air 0 (SF): Gross Area(SF): 0 Land Size(acres): 0.23 MEN=- Land Size(SF): 10,000 Total Building Count: I 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/ I10/6/2017 i i APPLICANT'S NAME: Kurt Boller PERMIT #: A-5F-17737g3 LEGAL DESCRIPTION: Parcel Control Number 3402-610-0608-000-8 PROPOSED SEPTIC SYSTEM SITE INFORMATION 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 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 or constructed of a minimum of 40 schedule PVC pipe, 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 or structure 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. File, Copy NOTE: MUST BE CERTIFIED BY A FLORIDA CERTIFIED BY: REGISTERED SURVEYOR OR ENGINEER. FLORIDA PROFESSIONAL NO.: z DATE: JOB NO.: docs(fonns/septics/SepticApppPage2 022014.doc 1 APPLICANT'S NAME: Kurt Boller PERMIT #: 54'-Sr- 17 LEGAL DESCRIPTION: Parcel Control Number 3402-610-0608-000-8 PROPOSED SEPTIC SYSTEM SITE INFORMATION T 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 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 or constructed of a minimum of 40 schedule PVC pipe, 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 or structure 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 waters such lakes, ponds, streams canals or wetlands are shown on the surface wa.t s as a , p , 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. i i NOTE: MUST BE CERTIFIED BY A FLORIDA CERTIFIED BY: REGISTERED SURVEYOR OR ENGINEER. FLORIDA PROFESSIONAL NO.: DATE: JOB NO.: docslfonnslseptics/SepticApppPage2 022014.doc I Rictc Scott Mission: Govemor To protect promote&improve the health k. of all people in Florida through integrated =, John H.Armstrong,NIO, PACE state,county&community efforts. j State Surgeon General&Secretary C~j f JI H Vision:To he the Healthiest State in the Nation OWNER AUTHORIZATION PRINT Name of Owner authorize Paradise Homes Group PRINT Name of Agent(s) to apply for an Onsite Sewage Treatment and Disposal System Permit from the Florida Department of Health in St Lucie County on my behalf for the property with the address of: Parcel I D: 3402-610-0608-000-8 Signature of Owner Date 1���1 � o l l.:e. ►2 ' PRINT Name of Signatory