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HomeMy WebLinkAboutSewage & Well Water ApplicationSTATE OF FLORIDA RECEIVED DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISP%n 9 202, SYSTEM CONSTRUCTION PERMIT FOR: OSTDS New APPLICANT: KaGsanrtra Facnnrht PROPERTY ADDRESS: LOT: PROPERTY ID #: Permitting Department St. Lucie Ccunty 8932 Carlton Rd Fort Pierce, FL 34987 BLOCK: SUBDIVISION: 3234-231-0002-000-2 PERMIT #:66-SF-2239686 APPLICATION # : AP 1629374 DATE PAID: FEE PAID: RECEIPT #: DOCUMENT #: PR1616344 [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 Seotic new CAPACITY A [ ] GALLONS / GPD N/A CAPACITY N [ J 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 [XI BED [ ] N F LOCATION OF BENCHMARK: Nail in N side gate post, near SE property corner I ELEVATION OF PROPOSED SYSTEM SITE [ 17.00][ INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 3.00 ][ INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT L D E O T H' E R ILL REQUIRED: i,JY.UUJ INCHES EXCAVATION REQUIRED: L JD.UUJ INCHES The system is sized for 2 bedrooms with a maximum occupancy of 4 persons (2 per bedroom), for a total estimated flow of 300 gpd. SPECIFICATIONS BY: A Brian J Ingram TITLE: Environmental Specialist III APPROVED BY: TITLE: Environmental Specialist III St. Lucie CHD Brian J I r am DATE ISSUED: 02/17/2021 V EXPIRATION DATE: 08/17/2022 DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E-6.003, FAC Page 1 of 3 v 1.1.4 AP1629374 SE1482969 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 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. HEALTH St. Lucie County Health Department 5150 NW Milner Dr Port Saint Lucie, FL 34983 PAYING ON: #: 56-SF-2239686 BILL Doc 4:56-BID-5179855 CONSTRUCTION APPLICATION #: AP1629374 RECEIVED FROM: Atlantic Land Desiqns of the TC AMOUNT PAID: $ 660.00 PAYMENT FORM: CREDIT CARD 01011 D PAYMENT DATE: 02/10/2021 MAIL TO: Kassandra Fasnacht FACILITY NAME: PROPERTY LOCATION: 8932 Carlton Rd Port Saint Lucie, FL 34987 Lot: Block: Property ID: 3234-231-0002-000-2 EXPLANATION or DESCRIPTION: 128 - OSTDS Construction System Inspection Research Fee -1 - Surcharge (All) -1 - OSTDS New Permit Surcharge -1 - OSTDS Construction Application and Plan Review,New 123 - OSTDS Construction Site Evaluation 126 - OSTDS Construction Permit (New or Mod, Amendment) 127 - OSTDS Construction System Inspection 133 - OSTDS Construction Reinspection -1 -Well Construction. QUANTITY FEE 1 $ 5.00 1 $ 45.00 1 $ 100.00 1 $ 100.00 1 $ 115.00 1 $ 55.00 1 $ 75.00 1 $ 50.00 1 $ 115.00 RECEIVED BY: AdamsC AUDIT CONTROL NO. 56-PID-4883214 Note: New w/ well 59-31504 RECEIVED MAR 19 2021 STATE OF FLORIDA DEPARTMENT OF HEALTH PermittiP.g Deaartr7tent St Lucie Ccu ttV PERMIT NO. DATE PAID: ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID: .� SYSTEM RECEIPT #: APPLICATION FOR CONSTRUCTION PERMIT APPLICATION FOR: [,,(] New System [ ] Existing System [ ] Holding Tank [ ] Innovative [ ] Repair [ ] Abandonment I ] Temporary [ ] APPLICANT: Fasnacht AGENT: Atlantic Land Designs of the Tc, Inc. TELEPHONE: 772-398-4290 MAILING ADDRESS: PO Box 1421 Jensen Beach, Florida' 34958 Email - ALD5543aa,Gmail.com 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. PROPERTY INFORMATION LOT: BLOCK: SUBDIVISION: Fractional Section 34 PLATTED: 1860 PROPERTY ID #: 23343234-231-0002-000-2 ZONING: AG-2.5 C I/M OR EQUIVALENT: [ No ] PROPERTY SIZE: 20 ACRES WATER SUPPLY: [v/] PRIVATE PUBLIC [ ]<=2000GPD [ 1>2000GPD IS SEWER AVAILABLE AS PER 381.0065, FS? [ No ] DISTANCE TO SEWER: N/A FT PROPERTY ADDRESS: 8932 Carlton Road DIRECTIONS TO PROPERTY: See attached BUILDING INFORMATION Unit Type of No Establishment 1 Residential 2 3 4 [ ] Floor/Equipment Drains SIGNATURE: [✓] RESIDENTIAL [ ] COMMERCIAL No. of Building Commercial/Institutional System Design Bedrooms Area Sqft Table 1, Chapter 64E-6, FAC 2 1416 [ ] Other (Specify) DH 4015, 08/09 (ObsoK-t6 apevious editions which may not be used) Incorporated 64E-6.00, DATE: 02/04/21 Page 1 of 4 e STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATION APPLICANT: Kassandra Fasnacht CONTRACTOR / AGENT: Atlantic Land Designs of the TC LOT: BLOCK: SUBDIVISION: ID#: 3234-231-0002-000-2 APPLICATION # AP1629374 PERMIT # 56-SF-2239686 DOCUMENT # SE1482969 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: 20.00 ACRES TOTAL ESTIMATED SEWAGE FLOW: 300 GALLONS PER DAY [ RESIDENCES -TABLET / OTHER -TABLE 2 ] AUTHORIZED SEWAGE FLOW: 30000.00 GALLONS PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE ] UNOBSTRUCTED AREA AVAILABLE: 2000.00 SQFT UNOBSTRUCTED AREA REQUIRED: 750.00 SQFT BENCHMARK/REFERENCE POINT LOCATION: ELEVATION OF PROPOSED SYSTEM SITE Nail in N side gate post, near SE property corner 17.00 [ INCHES / FT ] [ ABOVE / HEL01 BENCHMARK/REFERENCE POINT THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES SURFACE WATER: 100 FT DITCHES/SWALES: 15 FT NORMALLY WET: [ ]YES [X]NO WELLS: PUBLIC: FT LIMITED USE: FT PRIVATE: 86 FT ' NON -POTABLE: FT BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: FT POTABLE WATER LINES: 75 FT SITE SUBJECT TO FREQUENT FLOODING? E. ]YES [X]NO 10 YEAR FLOODING? [ ]YES [X]NO] 10 YEAR FLOOD ELEVATION FOR SITE: FT[ MSL / NGVD ] SITE ELEVATION: FT [ MSL / NGVD RATT. DPe)WTT.F. TV7nRMDTTOW RTMW. 9 RnTT. Dl2n7TT.7. TN7nRMDTTAN RTMM 9 USDA SOIL SERIES: Munsell #/Color Texture Depth 1 OYR 5/2 Sand 0 To 25 1 OYR 6/8 CMN/PRM RF 10 To 25 5G 6/2 Sandy Clay Loam 25 To 30 1 OYR 3/2 Sand 30 To 32 1 OYR 5/1 Sand 30 To 32 5G 6/2 Sandy Clay Loam 32 To 41 HOLE CAVING Refusal 41 To 72 USDA SOIL SERIES: Munsell #/Color Texture Depth 10YR 5/3 Sand 0 To 9 1 OYR 5/2 Sand 9 To 25 1 OYR 5/8 CMN/PRM RF 10 To 25 1 OYR 4/3 Sandy Clay Loam 25 To 35 1 OYR 4/3 Sand 35 To 41 5GY 6/1 Sandy Clay Loam 41 To 46 HOLE CAVING Refusal 46 To 72 OBSERVED WATER TABLE: 20.00 INCHES [ ABOVE / EEI EXISTING GRADE TYPE: [ PERCHED / APPARENT ] ESTIMATED WET SEASON WATER TABLE ELEVATION: 10 INCHES [ ABOVE / BELOW ] EXISTING GRADE HIGH WATER TABLE VEGETATION: EX ]YES [ ]NO MOTTLING: [X]YES [ ]NO DEPTH: 10.00 INCHES SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: Sand/0.60 DEPTH OF EXCAVATION: 35 INCHES DRAINFIELD CONFIGURATION: [ ] TRENCH [XI BED [ ] OTHER (SPECIFY) r- REMARKS/ADDITIONAL CRITERIA WSWT determined using USDA WSS and soil borings. 10YR518 CMN PROM RF mottling in 10YR5/2 matrix >2% starting at 10" in SB2. SB1 and SB2 17" below BM. .117 SITE EVALUATED BY: Ingram, Brian (TI e: Environmental Specialist III) (ENVIRONMENTAL HEALTH) DH 4015, 08/09 (Obsoletes previous editions w oh may not be used) Incorporated: 64E-6.001, FAC AP1629374 EID2239686 DATE: 02/12/2021 Page 3 of 4 v 1.0.2 M STATE OF FLORIDA DEPARTMENT OF HEALTH p. ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS APPLICANT: Fasnacht PERMIT #. AGENT: Altnatic Land Designs of the TC, Inc. LOT: BLOCK: SUBDIVISION: Fractional Section 34 PROPERTY ID # : 3234-231-0002-000-2 [ Section/Township/Parcel No. or Tax ID Number 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: [✓] YES [ ] NO NET USABLE AREA AVAILABLE: 12.1 ACRES TOTAL ESTIMATED SEWAGE FLOW: GALLONS PER DAY [RESIDENCES -TABLE VOTHER-TABLE2 ] AUTHORIZED SEWAGE FLOW: GALLONS PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE ] UNOBSTRUCTED AREA AVAILABLE: 1,300+ SQFT UNOBSTRUCTED AREA REQUIRED: SQFT BENCHMARK/REFERENCE POINT LOCATION: Nail and Disk Stamped MAGA45 in CL or road near west property line ELEVATION OF PROPOSED SYSTEM SITE IS [INCHES/FT ] [ABOVE/BELOW] BENCHMARK/REFERENCE POINT THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES SURFACE WATER:100 FT DITCHES/SWALES:15 FT NORMALLY WET? [ [ YES [✓] NO WELLS: PUBLIC:200 FT LIMITED USE:100 FT PRIVATE:75 FT NON—POTABLE:50 FT BUILDING FOUNDATIONS:? FT PROPERTY LINES:11 FT POTABLE WATER LINES:100 FT SITE SUBJECT TO FREQUENT FLOODING: [ ] YES [✓] NO 10 YEAR FLOODING? [ ] YES [✓] NO 10 YEAR FLOOD ELEVATION FOR SITE: FT MSL/NGVD SITE ELEVATION: FT MSL/NGVD SOIL PROFILE INFORMATION SITE 1 MUNSELL #/COLOR TEXTURE DEPTH TO TO TO TO TO TO TO TO TO USDA SOIL SERIES: SOIL PROFILE INFORMATION SITE 2 MUNSELL #/COLOR TEXTURE DEPTH USDA SOIL SERIES: TO TO mn TO TO mn OBSERVED 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, 08/09 (Obsoletes previous editions which may not be used) Incorporated: 64E-6.001, FAC Page 3 of 4 2/5/2021 8932 Carlton Rd - Goog le Maps Google Maps 8932 Carlton Rd Map data ©2021 2000 ft■ ■ https:/Am&w.google.conilmaps/placet8932+Carlton+Rd,+Fort+Pierce,+FL+34987/ _27.3290903; 80.5216428,14z/data=!4m5!3m4!ls0)S8de94l4Od24fb81:0xc5f290elfa23600!8rrO3d27.303286!4d-80.525842 1/2 Mission: To protect, promote & improve the health of all people in Florida through integrated state, county & community efforts. HEALTH Vision: To be the Healthiest State in the Nation Ron DeSantis Governor Scott A. Rivkees, MD State Surgeon General Florida Department of Health in St. Lucie County Conditions for Issuance of Water Well Permits Effective July 24, 2017 • Contact the Florida Department of Health in Saint Lucie County (FDOH — St. Lucie) prior to constructing or abandoning any well. a. Call the FDOH — St. Lucie Well Line at 772-873-4936 or email SLCDOH-WELLS(&,FLHEALTH.GOV b. Provide the following information: i. Permit number ii. Driller name iii. Address iv. Date and time to begin construction/abandonment • A minimum of 24 hours' notice is required before constructing any public water supply wells. Please call our main office at 772-873-4931 and speak with Environmental Health Staff or provide notification by email to SLCDOH-WELLS(a)-FLHEALTH.GOV • Submit revisions to permit and/or site map and associated fee within 48 hours of well construction or abandonment. Florida Department of Health St. Lucie County Accredited Health Department 5150 NW Milner Drive • Port St Lucie, FL 34983 :Public Health Accreditation Board PHONE: 772962-3800 • FAX: 772l871-5360 StLucieCountyHealth.com STATE OF FLORIDA PERMIT APPLICATION TO CONSTRUCT, REPAIR, MODIFY, OR ABANDON A WELL ❑ Southwest ❑ Northwest PLEASE FILL OUT ALL APPLICABLE FIELDS ("Denotes Required Fields Where Applicable) ❑ St. Johns River .[]St. outh Florida ing wateform ctin ❑Suwannee River ndfcannactorrsresponAopplicble to the this form and forwarding tlrepemrif applirntion to the this approptiatedelegatedouthnritywliereapplicable. ❑ DEP ❑ Delegated Authority (if Applicable) Permit No. Florida Unique ID 59-31504 Permit Stipulations Required (See Attached) 62-524 Quad No. Delineation No. CUP/WUP Application No, 1. Kassandra/Christopher Fasri 8932 Carlton Road, Fort Pierce, FL 34987 '.',p_-ems.' 16--=ymy. *Owner, Legal Name if Corporation `Address *City 'State "ZIP Telephone Number 2.8.932 Carlton Road, Fort Pierce FL 34987 Well Location -Address, Road Name or Number, City 3. 3234-231-0002-000-2 `Parcel ID No. (PIN) or Alternate Key (Circle One) Lot Block Unit 4.34 36S 38E St Lucie Check if 62-524:❑ Yes ❑ No 'Section or Land Grant 'Township "Range "County Subdivision 5. Scoots 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, `Type of Work: ❑✓ Construction ❑ Repair ❑ Modification❑ Abandonment 8. 'Number of Proposed Wells ONE 9. 'Specify Intended Use(s) of Well(s): 'Reason for Repair, ✓ Domestic Landscape Irrigation Agricultural irrigation Site Investigations Bottled Water Supply 8 Recreation Area Irrigation ® Livestock ® Monitoring ❑ Public Water Supply (Limited Use/DOH) ❑ Nursery Irrigation Test f E B 1 7 2021 ❑ Public Water Supply (Community or Non-Community/DEP) ❑ Commercial/Industrial Earth -Coupled Geotherrhal ❑ Class I Injection ❑ Golf Course Irrigation 8 HVAC Supply WAG Return lass V Injection: ❑ Recharge ❑ Commercial/Industrial Disposal ❑ Aquifer Storage and Recovery ❑ DrainageF OH in St Lucie Count Remediation: ❑ Recovery ❑ Air Sparge ❑ Other (oesaitie) iRoWA@NTAQMEq U er (Describe) 10'Di an from Septic System if <_ 200 ft. 11. Facility Description ing a Family Residence 12. Estimated Start Date stimated Well Depth 120 ft. "Estimated Casing Depth 100 ft. Primary Casing Diameter 2 in. Open Hole: From To ft. 14. Estimated Screen Interval: From 100 To 120 ft. 15'Primary Casing Material: Black Steel Galvanized ✓ PVC Stainless Steel Not Cased Other: 16. Secondary Casing: Telescope Casing Liner Surface asing Diameter in. 17. Secondary Casing Material: Black Steel Galvanized PVC Stainless Steel ter 18.'Method of Construction, Repair, or Abandonment: Auger Cable Tool Jett r ✓ Rotary Sonic Combination (Two or More Methods) Hand Driven (Well Point, Sand Point) lie in (Direct Push) Horizontal Drilling Plugged by Approved Method Other (Describe) 19. Proposed Grouting Interval for the Primary, Secondary, and Pddit onal Casing. From o To 100 Seal Material ( Bentonii ✓ Neat Cement Other ) From To Seal Material ( Benton'r,> �: errc 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.'Is this well or any existing well or water raw, o e owner's contiguous property covered under a Consumptive/Water Use Permit (CUP/ WUP) or CUP/WUP Application? Ye ✓ No If y s, propertyyy complete the following: CUP/WUP No. District Well ID No. r 22. Latitude ZeRgilu 23. Data Obtained From: GPS Map Survey Datum: NAD 27 ______PAD 83 WGS 84 I heteby cent y Ihal I An comI4 with the applicable rules of trda 40, F oddaAdidnistmbve Cade, and that a water I eeNty thus I am the ovatur of the property, that the Informabun provided Is aacutata, and lhur I avt aware of my use permit or arliddal mahume penrut It needed, hart bean onwb hd obtattwd prior to comnwnwmerd of well respotWtlridae under Chaldor373, FWda Statutes, to matnialn or properly abandon INsweti: ar.I cortcry that I am construction. I further codify that all Intanmbon provided In this app9radon is accurate and that I will ohtaln the agent for bre awnar, that We.lnfermetian p ad is accurate, and that I have Intomtad Lae =nor of their necessary approval from other federal, auto. at Iecal Dovemments, it app9a+Wa. I agree to provide a wen 4,,fim atova Oa g porsarini of this M or D 1. atad Authority accessw30 days n0m eomphtion at the canshuoutin, repair modl9cation, or r alrudlorobardonmenta by Ws parmT. or:the permit expiration, whichaver acaas first 11213Slanatn Contractor `License No. wner or 'Date Approval Granted By l ec—�� t 71M^"/� Issue Date L fZ_ Expiration Date &M %# Hydrologist Approval Iddais Fee Received $ V 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 AVAILABLE AT THE WELL SITE DURING ALL CONSTRUCTION, REPAIR, MODIFICATION, OR ABANDONMENT ACTIVITIES. DEP Form: 62-532.900(1) Incbrporated in 62-532.400(1), FA.C. Effective Date: October 7, 2010 Page 1 t 9 .TAIL SCALE 1 STORY FETAL BLDG. diantic Land Designs of the Treasure Coast, LB7468 8932 CARLTON ROAD LAST FIELD DATE:1 27 21 BOUNDARY SURVEY Certified to: Christopher W. Fosnocht and Kasandro L. Fasnacht Geneva Financial LLC First American Title Insurance Company St. Lucie County Health Department 5150 NW Milner Dr Port Saint Lucie, FL 34983 HEALTH PAYING ON: #: 56-SF-2239686 BILL Doc #:56-BID-5179855 CONSTRUCTION APPLICATION #: AP1629374 RECEIVED FROM: Atlantic Land Desiqns of the TC AMOUNT PAID: $ 660.00 PAYMENT FORM: CREDIT CARD 01011 D PAYMENT DATE: 02/10/2021 MAIL TO: Kassandra Fasnacht FACILITY NAME: PROPERTY LOCATION: 8932 Carlton Rd Port Saint Lucie, FL 34987 Lot: Block: Property ID: 3234-231-0002-000-2 EXPLANATION or DESCRIPTION: 128 - OSTDS Construction System Inspection Research Fee -1 - Surcharge (All) -1 - OSTDS New Permit Surcharge -1 - OSTDS Construction Application and Plan Review,New 123 - OSTDS Construction Site Evaluation 126 - OSTDS Construction Permit (New or Mod, Amendment) 127 - OSTDS Construction System Inspection 133 - OSTDS Construction Reinspection -1 - Well Construction 1 1 1 1 1 1 1 1 1 QUANTITY FEE $ 5.00 $ 45.00 $ 100.00 $ 100.00 $ 115.00 $ 55.00 $ 75.00 $ 50.00 $ 115.00 RECEIVED BY: AdamsC — AUDIT CONTROL NO. 56-PID-4883214 Note: New w/ well 59-31504 dPJ ��®�FDOH in St. Lucie County Environmental Health Site Plan Approved for Construction Supersedes All Previous Site Plans for OSTDS 76,Sf ZZ3g(ps6 & We414 3l --- ,Date: ?�-f 7 Revie er: N a4 11,59 M