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HomeMy WebLinkAboutSewage PermitR6cEIVED MAR 2 3 7.0L1 Permitter. St 9 Dai)artmc ,. Lucie Ccu,F. STATE OF E'LORIDA e DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM "`'"�• APPLICATION FOR CONSTRUCTION PERMIT P ICATION FOR: PERMIT NO. �(Q DATE PAID: FEE PAID: ,DU RECEIPT #: [�C] New System [ ] Existing System r ] Abandonment [ ] -Repair � Holding p Tank [ ] Innovative u APPLICANT: AGENT: TELEPHONE ' / ! J MAILING ADDRESS: s oSCafl 1� � _ 01lot 1 TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. SYSTEMS MUST BE CONSTRUCTED BY A PERSON LICENSED PURSUANT TO 489.105(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: BLOCK: SUBDIVISION: PLATTED: S PROPERTY ID #: p06 j,% —©� " ZONING: I/M OR EQUIVALENT: [ Y PROPERTY SIZE: ON`V v ACRES WATER SUPPLY: []� PRIVATE PUBLIC [ ]<=2000GPD [ 1>2000GPD IS SEWER AVAILABLE AS PER 381.0065, FS? [ Y / N ] DISTANCE TO SEWER: FT PROPERTY ADDRESS: DIRECTIONS TO PROPERTY: Q BUILDING INFORMATION Unit Type of No ^Establishment t4u, de- 2 3 4 [ ] Floor/Equipment Drai SIGNATURE: DH 4015, 08/09 (Obs'oletes "pre Incorporated 64E-6.001, FAC �P���alde e P � .`ice ca-, qw Ile r ( +ice ra-4 [ ] RESIDENTIAL [ ] COMMERCIAL i i No. of Building Commercial/Institutional System Design Bedrooms Area Sqft Table 1, Chapter 64E-6, FAC l 41(AF [..."_...'].. Other (8` cif y DATE: M - `% /} -.,-Jill/ vious editions which may not be useAL E COPY Page 1 of 4 I STATE OF FLORIDI DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM SITE EVALUATIONIAND SYSTEM SPECIFICATION APPLICANT: Kylie Fasnacht CONTRACTOR / AGENT: LOT: SUBDIVISION: BLOCK: ID# : 3234-231-0001-000-5 APPLICATION # AP1606194 PERMIT # 56-SF-2211896 DOCUMENT # SE1482549 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: TOTAL ESTIMATED SEWAGE FLOW: 300 AUTHORIZED SEWAGE FLOW: UNOBSTRUCTED AREA AVAILABLE: EX ]YES [ ]NO NET USABLE AREA AVAILABLE: 20.03 ACRES GALLONS PER DAY [ RESIDENCES -TABLET / OTHER -TABLE 2 ] GALLONS PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE ] SQFT UNOBSTRUCTED AREA REQUIRED: 750.00 SQFT BENCHMARK/REFERENCE POINT LOCATION: 1 Orange Paint nail in W side of post near SE corner of property 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: 75 FT DITCHES/SWALES: FT NORMALLY WET: [ ]YES [X]NO WELLS: PUBLIC: 1125 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 SOIL PROFILE INFORMATION SITE 1 SOIL PROFILE INFORMATION SITE 2 USDA SOIL SERIES: Munsell #/Color Texture Depth 10YR 4/3 Sand 0 To 14 10YR 6/1 Sand 14 To 24 10YR 6/1 Sand 14 To 24 10YR 7/8 CMN/PRM RF 14 To 24 1 OYR 6/8 Sand 18 To 24 N 6/ Sandy Clay Loam 24 To 30 10YR 6/2 Sand 30 To 36 N 6/ Sandy Clay Loam 34 To 44 N 6/ MARL 44 To 49 HOLE CAVING Refusal j 49 To 72 USDA SOIL SERIES: .Munsell #/Color Texture Depth 10YR 4/2 Sand 0 To 13 10YR 6/2 Sand 13 To 18 10YR 6/8 Sand 18 To 22 10YR 7/1 Sandy Clay Loam 22 To 27 10YR 7/3 Sand 27 To 36 10YR 3/2 Sand 30 To 36 5GY 511 Sandy Clay Loam 34 To 43 REFUSAL Refusal 43 To 72 OBSERVED WATER TABLE: 32.00 INCHES [ ABOVE / BELOW ] EXISTING GRADE TYPE: [ PERCHED / APPARENT ] ESTIMATED WET SEASON WATER TABLE ELEVATION: 14 INCHES [ ABOVE / BELOW ] EXISTING GRADE I HIGH WATER TABLE VEGETATION: [ YES [X]NO MOTTLING: [X]YES [ ]NO DEPTH: 14.00 INCHES SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: Fill - Sand/0.60 DEPTH OF EXCAVATION: 30 INCHES DRAINFIELD CONFIGURATION: [ ] TRENCH [X ] BED [ ] OTHER (SPECIFY) REMARKS/ADDITIONAL CRITERIA WSWT determined using USDA WSS and soil borings. 10YR718 CMN PROM RF mottling in 10YR6/1 matri?c >2% starting at 14" in SB1. SB1 10" below BM. SB211" below BM. l SITE EVALUATED BY: Ingram, Briar{ (Tj,t.J(a: Environmental Specialist II)) (ENVIRONMENTAL HEALTH) DR 4015, 08/09 (Obsoletes previous emay not be used) Incorporated: 64E-6.001, FAC V AP1606194 EID2211896 DATE: 02/12/2021 Page 3 of 4 v 1.0.2 STATE OF FLORIDA PERMIT APPLICATION TO CONSTRUCT, REPAIR, MODIFY, OR ABANDON A WELL Permit No. Southwest Florida Unique ID I PLEASE FILL OUT ALL APPLICABLE FIELDS rr�t� 59-31 ❑ 1,401 Inwest ('Denotes Required Fields Where Applicable) Permit Stipulations Required (See Attached) ❑St..Johns River IJSouth Florida Ma:varenvelicnnrracrorisrespumiblefor camplerrrg OU form and lonvar fina;he permit rrpplFcarion ro,hr. 82-524 Quad No, Delineation No. El Suwannee River appr�p:ialrrktrJnredrrurhurityl Lereu/�pfiraGle. 0 DEP Delegated Authority Of Applicable) CUPIWUP Application No. Kylie & Christopher Fasnacht 89A2 Carlton Road, Fort Pierce, FL 34987 772-216-4456 "Owner, Legal Name if Corporation "Address -City "State "ZIP Telephone Number 2. _ �'2D Carlton Road Fort Pierce FL 34987 "Well Location - Address, Road Name or Number, City 3.3234-231-0001-00 0-5 'Parcel ID No. (PIN) or Alternate Key (Circle One) 4,34 36S 38e St Lucie +.e Lot Block Unit Check if 62-524:0 Yes ❑ No .,echon or Land Gral it Township 'Range 'County Subdivision ,. Scott's Drilling, Inc. 11213 772-489-6117 scottsdrilling@bellsouth.net '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 7. 4Type of Work: 0 Construction ❑ Repair ❑ Modification❑ Abandonment S. "Nutnber of Proposed Wells ONE 'Reason for Repair. Moditit2tion,orAbandonment 9. 'Specify Intended Use(s) of Well(s): Domestic Landscape Irrigation pp St mow ow ] Bottled Water Supply [IIrrigation Recreation Area Irrigation El ❑ Agricultural Irrigationp H Site Investigations L"1 ] Public Water Livestock Monitoring Supply (Limited Use/DON) ❑ Nursery Irrigation ❑ Test ]Public Water Supply (Community or Non-Community/DEP) Class ❑ Commercial/industrial El Earth -Coupled Geothermal F E B 1 0 2021 I Injection Golf Course Irrigation HVAC Supply ❑ HVAC Return Class V Injection: ❑ Recharge ❑ Cormme�cial/Industrial Disposal ❑ Aquifer Storage and Recovery ❑ Drainage Remediation: Recover Air 5 a e ) DOH in St Lucie Cou ❑ y ❑ p r9 ❑ 'Other {Describe ❑ Other (Describe) i1j IO.`Distance from Septic System if 5 200 ft.%1_b F-1 i. Facility Description 12. Estimated Start Date 13.'•'Estimated Wail Depth 7 o ft. 'Estimated; Casing Depth i W ft. Primary Casing Diameter I-• in. Open Hole: From To ft. '14. Estimated Screen Interval: From WC, To It DD ft. 15."Primary Casing Material: Black Steel Galvanized PVC Stainless Steel Not Cased Other: �—'"" '16. Secondary Casing: Telescope Casing i Liner Surface Casing Diameter in. 17. Secondary Casing Material: Black Steel Galvanized PVC Stainless Steel Other •I0.'Nlelhod of Construction, Repair, or Abandonment: Auger Cable Tool Jetted Rotary Sonic Combination (Two or More Methods) Hand Driven (Well Point, Sand Point) yy i (Direct Push) Horizontal Drilling Pit gged by Approved Method Other (Describe) 19. Proposed Grouting Interval for the Primary, Secondary, and Ad ' ' From_0 To 100 Seal Material ( Sentonite ,/ Neat Cement Other 1 From To _ Seat Material (I Bentonite ement Other ) From To _ Seal Material (i Bentonite Pleat Cement Other ) From To Seal Material ( Bentonite Neal Cement Other ) 20. Indicate total number of existing wells an site List number of existing unused wells on site h 211s this well or any existing well or water veil f the owner's contiguous propertyY covered tinder a Consumptive/Water Use Permit (CUPIWUP) or CUP/WUP Application. Yes / No yes, complete the following: CUPMUP No. District Well ID No. 22. Latitude _ Longitude 23. Data Obtained From: GPS Map I Survey I limelu reify lout 1 xall ramp i- :. N ilT agpprw1b10 rules Of TAIL 40, Flatida A0.:1lala1n5sn Code, and that o Later as, pcmil at affucial reeilw9v pr:nrii if noedad, has bvrw o: rnrf Lis ohlaamd'pflor to ceirsimitcnnr-ritorviell canstn¢pnn. I fanhcf millti Matau mlunrnlian pn vldad in Ibis appl!ra5on 1s mcmata ant ilat I c.10 ounln uaresxafy appravat ham a0m: ledeial. slate, ar vocal 0aemnarrfw it aptdicetJa. I aspen la prrf•Aaa a well canractlen ropmt la Ihn Gstrlu eri;lan 30 &iy.; nl1n, nmrnplefiun er 1ha aanslrito�ion. mFa'r. rr,r9Ecallm, or nbro„rnnfsrt ietlinni,raf by IMs parnk or the penal expir..hen. wlddmurr ncecre rust I 11213 Sigi amre of Conliactor -license No. Approval Granted by Datum: ` NAD 27 _ NAD 83 VdGS 84 1 cor0ly, flat I am Ilia a:•mer of Ilan l.:ope4y, that fit, infmmarion rvo:ldod as a=afflo, affd thvl 1 am armlis of ury reslwnslb:TiG,s under Chapter 273, I'lonaa S:Lfhs, to inrJninin nr prupofly abandon thls:•m;h or. I r„mty ihal I and Iho adenl fv Wa caner, th:d the inlonna0al Iav:Ided a uanote. and Utaa hdra Inlolmed Um a:•mor or the it responsidhlles as cialed aLc:a. t-�vnnr cansanlsm:alnrirq pufawrnd ottbls Vfld nr Onlr.Oa,ed Aunrutily nccoss lathe. trefl die dinic0l•fe wnsbf�r, rapmh, m,nllliagiyn. ,„ abamtannrent avllmia7o b/ INs pamU. or Agent Issue Date A 1v7 w�l Expiration Date 0112/ 11�"( Hydrologist Approval Fee P,r_-reived $ U Receipt No. r harah ! Check No. 'rl-ils PERN11T IS NOT VALID UNTIL PROPERLY SIGNED BY AN AUTHORIZED OFFICER OR REPRESENTATIVE OF THE VWD OR DELEGATED AUTHORITY. THE PERMIT SHALL BE AVAILABLE AT THE uVELL SITE DURING ALL CONSTRUCTION, REPAIR, MODIFICATION, OR ABANDONMENT ACTIVITIES. DEP Form: 62-532.900(1) Incorporated in 62-532.400(1), F.A.C. Effective Date: October 7, 2010 Page 1 of C 0 i STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT FOR: OSTDS New APPLICANT: Kylie Fasnacht I PROPERTY ADDRESS: TBD Carlton Rd Port Saint Lucie. FL 34987 LOT: BLOCK: SUBDIVISION: PERMIT #:56-SF-2211896 APPLICATION #: AP1606194 DATE PAID• FEE PAID: RECEIPT #: DOCUMENT #: PR1515002 PROPERTY ID #: 3234-231-0001-000-5: [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 Septic 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 [ 500 ] SQUARE FEET Drainfield new SYSTEM R [ ] SQUARE FEET N/A SYSTEM A TYPE SYSTEM: [ ] STANDARD, [ ] FILLED [X] MOUND [ ] I•CONFIGURATION: [ ] TRENCH j [X] BED [ ] N F LOCATION OF BENCHMARK: Orange Paint nail in W side Of post near SE corner Of property I ELEVATION OF PROPOSED SYSTEM SITE [ 11.001 INCHES FT ] [ABOVE= BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 1.00 ][INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT L D FILL REQUIRED: [28.001 INCHES EXCAVATION REQUIRED: [ 30.001 INCHES 1The system is sized for 2 bedrooms with' a maximum occupancy of 4 persons (2 per bedroom), for a total estimated flow of 300 gpd. T IM!nimum 225 gal dosing tank required if;gravity flow to drainfield cannot be achieved. H E IR SPECIFICATIONS BY: Brian J Ingram TITLE: Environmental Specialist III APPROVED BY: TITLE: Environmental Specialist III St. Lucie CHD Brian J In am DATE ISSUED: 02/15/2021 EXPIRATION DATE: 08/15/2022 DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E-6.003, FAC Page 1 of 3 v 1...4 AP160,6194 SE1482549 v# DOOIL t, `qJ3 i/v UAj 10 j-t,,I,fr5 -- FDOH in St. Lucie CBi3* . Environmental`* -Health Site Plan Approved for Construction, Supersedes All Previous Site Plans for OSTDS #56-5r-221 9%* & Well # I Date: Z I h Reviewer: /\` DIKE MARK' W:;TEEP..E' f PROFESSIONAL.,(;ANCI'S RVEYOR FLORIDA REGISTRATION NUMBER #4811 I ER I -POLE NAIL .` 291.01 LEOP.L DESCRIPTION I THENORT'H 342.99 FEET OFTHE SOUTH 376825 FEET OF THE WEST ONE-HALF OF SECTION 34, TOWNSHIP 36 SOUTH, RANGE 38 EAST, LESS THE WEST 000 FEETTHEREOF; SAID LAND LYING IN ST LUCIE COUNTY, FLORIOK PARDELM'234-231.0001-000-5 SURVEY NOTES: 1. SURVEY OF DESCRIPTION AS FURNISHED BY CLIENT; LANDS SHOWN HEREON WERE NOT ABSTRACTED FOR EASEMENTS AND/OR RIGHT-OF-WAYS OF RECORD. 2.-IHISSURVEY DOES NOT MAKE ANY ATTEMPT TODELINEATE ORDEFINE AREAS OF ENVIRONMENTAL CONCERN OTHER THAN PROVIDED AND SHOWN HEREON. THERE NAY BE AREAS OF ENVIRONMENTAL CONCERN ON THIS SITE NOT NOTED OR MAPPEE ON THIS SURVEY. 3. UNLESS OTHERWISE STATED THE BASIS OF BEARINGS AND DISTANCES ARE IN ACCORDANCE WITH THE RECORD PLAT AND HAVE BEEN VERIFIED BY FIELD NEASUREMENTS. . 4. ALL MEASUREMENTS SHOWN HEREON ARE IN FEET. _ 5. ALLELEVATIONSSHOWN HEREONARE SASEDON -- --- - - — THE NORTH AMERICA}1 VERTICAL DATUM OF I W8 (NAVD68). 6. 'IHISSURVEYMEETS OREXCEEDS APPLICABLE ACCURACY REQUIREMENTS AND IS .PREPARED ACCORDING TO THE STANDARDS OF PRACTICE SET FORTH BY THE FLORIDA ADMINISTRATIVE CHAPTER 6J•17 AS CODE, ADOPTED BY THE BOARD OF PROFESSIONAL SURVEYOR AND MAPPERS. 7. W13RTEN DIMENSIONS TAKE PRECEDENT OVER SCALED DIMENSIONS AND SYMBOLS OF FEATURES ARE NOT TO SCALE AND ARE ONLY A REPRESENTATION OF LOCATION INTHE FIELD• S. THIS SURVEY ISNOTV/WDwaHOUTTHEORIGINAL SIGNATURE AND EMBEDDED SEAL OF THE SURVEYOR IN RESPONSIBLE CHARGE. THIS -SURVEY CANNOT BE ' TRANSFERRED Oil ASSIGNED WBIHOUTTHE SPECIFIC WRITTEN PERMISSION OF THE SURVEYOR HEREON, AND IT IS A VIOLATION OF CHAPTER 5.1-17, FLORIDA ADMINISTRATIVE CODE TO ALTERTHIS SURVEY WITHOUTTHE EXPRESS PRIOR WRITTEN CONSENT OFTHESURVEYOR ADDITIONS AND/OR DELETIONSMADE TO. . THIS SURVEY IN ANY FORM.RENDERS•THIS SURVEY INVALID. S. NO UNDERGROUND IMPROVEMENTS HAVE BEEN LOCATED AS PART OFTHE SURVEY. 10. BY ACCEPTING THIS SURVEY, ALL PARTIES AGREE THAT THE SIGNINGSURVEYOR•S LIABILITY IS LIMBED TO THE AMOUNT PAID FOR SAID SURVEY. 11. NO OWNERSHIP OF FENCE LINES HAS BEEN DETERMINED AS PART OF THIS SURVEY. 12. THIS SURVEY IS INCOMPLETE WHEN ALL SHEETS IN THE SET ARE NOT SHOWN IN THEIR ENTIRETY. 13. THE LAST FIELD DATE OF THIS SURVEY WAS: ZI 2 I 14. FLOOD ZONE INFORMATION: l' j�v- I'0?, HOL� 115;E L, FLOODZONE:-*,MAP:12111CO250JI f l�'�1� DATED: 02H8f12 e4fl!-To 14 20,W LEGEND L -MCuTIDTN cm -CONCRrFE -RTEV -OBw- -4XSRNGo R -RM ODNoxulexi Fn -HN91 rUX ELEVARON CORNERSTONE SURVEYING -a -x- REF -MG50 e C RE FENCE -ENSM aANRa RT/a P NO Fn -HQI PPE -HAL h em CR m -aTxuO RECORD Booty -OnCta RE LB# 7941 - D- -DO51H0 WOW OFENCEFEN FENCE -CUM EY Poe MM -PMT CF O MONUMENT - EF COMMENCEMENT Bff pe PB BB -PENT BOCK BJQC -PAC INE PEN WT -POINT OFT RWNNO PC E Bw -w�art�oF�ivnv P� -PERMANENT REFrneEc,: uaDMNr FxD -Paw -MN 326 SW SOUTH QUICK CIRCLE rCONr c , euw FRAME PCP -PExBAN w CONTROL. POW t�xwoWM-WAIL. T1P -TTAGL MPORT ST. LUCIE, FLORIDA 34853 PT -PaM OF TANIENNCY LP+IE�oL.ST -PIATITB OISTANf£hBENtlNb asrANa N: Ti[IN70FH NTORANi `PC 772418-2376 PRO CH -POHf OF CURVAiORE -POINT aF REYFRSE aNAtIRE -0laaa -G4aRATm -DEEDED oISTARCE t �JWP/o -PRaESSONK SRtl:YOR NO "PER BLp P ,•U PamTEL: -UllITT Pas COANERSTONESURVEYING®HOTMAILCOM Ca ID -LICENSED mmms RLS -MASTERED LAND SURIEVON --CHORD ANUENo B BOUNDARY SURVEY PREPAID ON THE GVER OR sum • PACE BATE. 2/mil �I