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HomeMy WebLinkAboutSewage & Well WaterSTATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT FOR: OSTDS New APPLICANT: Rodolfo Vega PROPERTY ADDRESS: 1950 S Brocksmith Rd Fort Pierce, FL 34945 LOT: BLOCK: PROPERTY ID #: 2317-422-0000-000-5 SUBDIVISION: PERMIT #:56-SF-2243868 APPLICATION #: AP1632490 DATE PAID: FEE PAID: RECEIPT #: DOCUMENT # : PR1548614 [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 [ 1,500 ] 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 [ 875 ] 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: Site BM, red capped set IR, elev 21.03 I ELEVATION OF PROPOSED SYSTEM SITE [ 1.00 ][ INCHES FT ][ ABOVE BELOW] BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 11.00][ INCHES FT ][ ABOVE BELOW] BENCHMARK/REFERENCE POINT L D I O T H E R 'ILL REQUIRED: [ G2S.UU] INCHES EXCAVATION REQUIRED: [ bU.UU ] INCHES The system is sized for 7 bedrooms with a maximum occupancy of 14 persons (2 per bedroom), for a total estimated flow of 700 gpd. , . SPECIFICATIONS BY: 01 Brian J Ingram TITLE: Environmental Specialist III APPROVED BY: eM" TITLE: Environmental Specialist III St. Lucie Brian J Otgram CHD DATE ISSUED: 04/19/202, EXPIRATION DATE: 10/19/2022 DR 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 AP1632490 SE1505891 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. 0 St. Lucie County Health Department 5150 NW Milner Dr PortSaint Lucie, FL 34983 HEALTH PAYING ON: #: 56-SF-2243868 BILL DOC #:56-BID-5187460 CONSTRUCTION APPLICATION #: AP1632490 RECEIVED FROM: Alexander J. Piazza PSM, Inc AMOUNT PAID: $ 545.00 PAYMENT FORM: CREDIT CARD 002174 PAYMENT DATE: 02/22/2021 MAIL TO: Rodolfo Vega FACILITY NAME: PROPERTY LOCATION: 1950 S Brocksmith Rd Fort Pierce, FL 34945 Lot: Block: Property ID: 2317-422-0000-000-5 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 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 RECEIVED BY: VanceMH AUDIT CONTROL NO. 56-PID-4891375 d E � P o� STATE OF FLORIDA PERMIT NO. DEPARTMENT OF HEALTH DATE PAID: ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID: :. SYSTEM RECEIPT # : cy `COp WE� APPLICATION FOR CONSTRUCTION PERMIT APPLICATION FOR: New System [ ] Existing System [ ] Holding Tank [ ] Innovative [ ] Repair [ ] Abandonment [ ] Temporary [ ] APPLICANT: Rodolfo Vega & Cannen Hernandez AGENT: Alexander J. Piazza PSM, Inc. TELEPHONE: MAILING ADDRESS: 619 SW Biltmore Street, Port St. Lucie, Florida 34983 772-340-7770 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: - PLATTED: - PROPERTY ID # 2317-422-0000-000-5 ZONING: R I/M OR EQUIVALENT: [ No ] PROPERTY SIZE: 20.513 ACRES WATER SUPPLY: [,(] PRIVATE PUBLIC [ ]<=2000GPD [ ]>2000GPD IS SEWER AVAILABLE AS PER 381.0065, FS? [ No ] DISTANCE TO SEWER: FT PROPERTY ADDRESS: 1950 S. Brocksmith Road, Fort Pierce, FL 34945 DIRECTIONS TO PROPERTY: SEE MAP BUILDING INFORMATION Unit Type of No Establishment 1 RESIDENCE K 3 4 [✓] RESIDENTIAL [ ] COMMERCIAL No. of Building Commercial/Institutional System Design Bedrooms Area Sqft Table 1, Chapter 64E-6, FAC 8 6,590 [ ] Floor/Equipment Drains [ ,/ ] Other (Specify) GARBAGE GRINDERS / DISPOSALS N0111y siPcd ny Af—dn d Piu Alexander J Piazza DN:c-Cs.o UmM)Imud.m-AO1410D OOD0tl25GC22ra3000167rA,m-,%Icxominl SIGNATURE : o°+o±1.w.unx:osos-0sW DATE: 2-12-21 DH 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated 64E-6.001, FAC Page 1 of 4 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATION APPLICANT: Rodolfo Vega CONTRACTOR / AGENT: Alexander J. Piazza PSM, Inc LOT: BLOCK: SUBDIVISION: ID# : 2317-422-0000-000-5 APPLICATION # AP1632490 PERMIT # 56-SF-2243868 DOCUMENT # SE1505891 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: 20.51 ACRES TOTAL ESTIMATED SEWAGE FLOW: 700 GALLONS PER DAY [ RESIDENCES -TABLET / OTHER -TABLE 2 ] AUTHORIZED SEWAGE FLOW: 30765.01 GALLONS PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE ] UNOBSTRUCTED AREA AVAILABLE: 10000.00 SQFT UNOBSTRUCTED AREA REQUIRED: 1313.00 SQFT BENCHMARK/REFERENCE POINT LOCATION: Site BM, red ELEVATION OF PROPOSED SYSTEM SITE 1.00 11 set IR, elev 21.03 1/ 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: 100 FT NORMALLY WET: [ ]YES [X]NO WELLS: PUBLIC: FT LIMITED USE: FT PRIVATE: 100 FT NON -POTABLE: 100 FT BUILDING FOUNDATIONS: 30 FT PROPERTY LINES: 100 FT POTABLE WATER LINES: 100 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 TNFORMATTON STTF. 2 USDA SOIL SERIES: Munsell #/Color Texture Depth 10YR 5/2 Sand 0 To 9 10YR 5/3 Sand 9 To 14 10YR 5/2 Sand 14 To 20 10YR 5/8 CMN/PRM RF 15 To 20 10YR 5/6 Sand 20 To 26 10YR 6/6 Sand 26 To 31 10YR 5/1 Sandy Clay 31 To 48 5GY 5/1 Loamy Sand 48 To 72 USDA SOIL SERIES: Munsell #/Color Texture Depth 10YR 3/1 Loamy Sand 0 To 4 10YR 5/2 Sand 4 To 23 10YR 5/8 CMN/PRM RF 14 To 23 10YR 7/6 Sand 23 To 34 10YR 4/2 Sandy Clay 30 To 50 10YR 5/2 Loamy Sand 50 To 72 OBSERVED WATER TABLE: 64.00 INCHES [ ABOVE / BELOW ] EXISTING GRADE TYPE: [ PERCHED / APPARENT ] ESTIMATED WET SEASON WATER TABLE ELEVATION: 14 INCHES [ ABOVE / BELOW ] EXISTING GRADE HIGH WATER TABLE VEGETATION: [ ]YES [X]NO MOTTLING: [X]YES [ ]NO DEPTH: 14.00 INCHES SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: Sand/0.80 DEPTH OF EXCAVATION: DRAINFIELD CONFIGURATION: [X ] TRENCH [ ] BED [ ] OTHER (SPECIFY) r REMARKS/ADDITIONAL CRITERIA WSWT determined using USDA WSS and soil borings. 10YR5/8 CMN PROM RF mottling in 10YR512 matrix > 2% starting at 14" in SB2. SB1 and SB2 1" above BM. SITE EVALUATED BY: Ingram, Brian (}tie: Environmental Specialist III) (ENVIRONMENTAL HEALTH) DH 4015, 08/09 (Obsoletes previous editions w ich may not be used) Incorporated: 64E-6.001, FAC 50 INCHES DATE: 04/19/2021 Page 3 of 4 AP1632490 EID2243868 v 1.0.2 �ET�w STATE OF FLORIDA PERMIT #. DEPARTMENT OF HEALTH t.. '��• ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS APPLICANT: Rodolfo Vega & Carmen Hernandez AGENT: Alexander J. Piazza PSM, Inc. LOT: - BLOCK: - SUBDIVISION: - PROPERTY ID # : 2317-422-0000-000-5 [ 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: 20.513 ACRES TOTAL ESTIMATED SEWAGE FLOW: 1166 GALLONS PER DAY [RESIDENCES -TABLE T/OTHER-TABLE2 ] AUTHORIZED SEWAGE FLOW: GALLONS PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE ] UNOBSTRUCTED AREA AVAILABLE: 1749 SQFT UNOBSTRUCTED AREA REQUIRED: 1749 SQFT BENCHMARK/REFERENCE POINT LOCATION: ELEVATION OF PROPOSED SYSTEM SITE IS34 [INCHES/FT 1 [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? [ I YES [✓] NO WELLS: PUBLIC:200 FT LIMITED USE:100 FT PRIVATE:75 FT NON—POTABLE:100 FT BUILDING FOUNDATIONS:5 I FT PROPERTY LINES:10 FT POTABLE WATER LINES: FT SITE SUBJECT TO FREQUENT FLOODING: [ ] YES [✓] NO 10 YEAR FLOOD ELEVATION FOR SITE: FT MSL/NGVD SOIL PROFILE INFORMATION SITE 1 MUNSELL #/COLOR TEXTURE USDA SOIL SERIES: nFpmH TO TO TO TO TO TO TO TO TO 10 YEAR FLOODING? [ ] YES [✓] NO SITE ELEVATION: FT MSL/NGVD SOIL PROFILE INFORMATION SITE 2 MUNSELL #/COLOR TEXTURE DEPTH TO TO TO TO TO TO TO TO TO USDA SOIL SERIES: OBSERVED WATER TABLE:40+ INCHES [BELOW T] 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: [VI TRENCH [ ] BED [ ] OTHER (SPECIFY) REMARKS/ADDITIONAL CRITERIA: igi a ysign y eaan er wua Alexander J Piazza WN:[=L.. d=Una% aced. A0141000000017356C13F43000167FA m=Alexander) Plaua SITE EVALUATED BY: Date: 2021.02.1209U4:51-05'00' DATE: 2-12-21 DH 4015, 12/11 (obsoletes previous editions which may not be used) Incorporated: 64E-6.001, FAC Page 3 of 4 APPLICANT'S NAME: Rodolfo Vega & Cannen Hernandez LEGAL DESCRIPTION: PARCEL ID: 2317-422-0000-000-5 F, 7 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 wells within 25 feet of a pesticide -treated building foundation; 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,. 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 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 andthe benchmark must be shown on the site plan. Please. locate the benchmark within 200 feet of the proposed septic system. NOTE: MUST BE CERTIFIED BY A FLORIDA REGISTERED SURVEYOR OR ENGINEER. oiyieany slped W Atewnd,d rya A6410D00000I7756C77F43000167FA. Alexander J Piazza WN CERTIFIED BY: ,A 2022r7 0B.-D435 Dae—A7.17iam W-05'00' FLORIDA PROFESSIONAL NO.: 6330 DATE: 02/12/21 JOB NO.: 20-5963 docs/rorms/septics/SepticApppPage207 Page 4 of 4 1/21/2021 1980 S Brocksmith Rd - Google Maps �A 1980 S Brocksmith Rd S!. Luoe G NUWay LoOr..Gr,5'Oesl lndust;ies .. ,- - ,'•,�S}, DJlUnccd \Later' ,Y ` -- ^ "' intr!fnUlltlilai r^ r� rSr:n FI;1Y® e _ and OrJfll SerY1Cl'a tt .miler£, Hamner Calk ,• 7 , FSp_r:lnl�':'IdC i)'/�j. (�-;1' Burn ed Truc6in3 -V' ':Ldvroy Uetermnry(r� 4' ' Uranga ,Svenue Destiny Bound v� R�nm Horn259 `JenuC '= ' Agrr rWc a! at;utge. 7! "Depust Church Ysrrshyc Serace ,eevl 4Y!nnn Best Cnnne Peaxlnr�- Siab!ee aOd VHospiW! ez Intcrha(ional sCrutt%S e•c�q!•fan ca r,gmf— vld CO CUr!slNCiien� `Jain Carus E L D. FABRIC!,-T!OH Q ® ec+mp:ard -- - _ r'•-Naturn's Keep:•: Inc - .- - A Windows De -Light I_'�•'` ' Ci k xcnPlaterondliwlml Sun Ccasi (h'� - _ F.1cFarland Fsrnily ®_ - - 'Y -_ Painllruf Sen ices II!` • Chrislinas Tice's - - Helena Chemical Draxen Fauns .= ;r r - - ? 1080 S Drocksmilh Rd. �Fcrt 0 _ - _ - `�: •- .. ... _ _ _ ,- Pieice. FL 34945 - ro✓ _ O Robert OueRfur^'od ar/ - Map data ©2021 1000 ft r -- i https://www.google.com/maps/place/1980+S+Brocksmith+Rd,+Fort+Pierce,+FL+34945/@27.4368176,-80A537887,15z/data=!4m5!3m4!1sOx88de8d4b2f828063:Ox9900bde2f3674cB1!8m2!lrl9749444 ��� Mission: To protect, promote & improve the health of all people in Florida through integrated state, county & community efforts. I 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(a-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(aD.FLHEALTH.GOV • Submit revisions to permit and/or site map within 48 hours of well construction or abandonment. Florida Department of Health -St Lucie County Division of Disease Control and Health Protection Bureau of Environmental Health Location: 3855 S US Highwayl, Fort Pierce, FL 34982 Mailing: 5150 NW Milner Drive, Port St Lucie, FL 34983 Phone 772-873-4931 Fax 772-595-1306 FloridaHealth.gov Accredited Health Department Public Health Accreditation Board STATE OF FLORIDA PERMIT APPLICATION TO CONSTRUCT, 6 ta_. REPAIR, MODIFY, OR ABANDON A WELL PennitNo._ 59-31586 ❑Southwest Florida Unique ID ❑ Northwest PLEASE Denotes Required Fie ds Whereas O St. Johns River ApPiicabie) Permit Stipulations Required (See Attached) El South Florida The water well contladarts responsible tbrcomplefing this Ibna and forwarding the permit application to the 62-524 Quad No. ❑ Suwannee River appropriate delegated authority whore applicable Delineation No. ❑ DEP ❑ Delegated Authority (If Applicable) Application 'Owner, Le' al Na if Corporation Address City 'State 'ZIP 'Telephone Number 2. L °Well Locatron -Address, Road Name or Number, City 3. � A` 4C,27 odcb0-15raf9 Parcel ID No. (PiN) orAltem to Key (Circle One) Lot Block Unit 4. '1. -� L IL *S 0 or nit G`rant'�, 'Township Range 'Conn S bdivision Check if 62-524: _Yes �No 5. • e hq�, .�i t&,d• t1 1���►�'-� �l� 77L-�(�f '®.���9� cN ( '-•! `Water Well Co tractor `License Number 'Teleph Number E-mail Address 6. `�`� �� \�t�l ,i u � � "fit, _ ,TV ?V 'Water WelllContractor's Address i State ZIP 7. `Type of Work: Construction._Repair —Modification Abandonment 8. `Number of ,Proposed WellsReeson for Repair. Modficahon, argbandonment 9. *Specify Intended Use(s) of Well(s): � � 'nJ[��e,�t��S�� n D Domestic' ___-Landscape Irrigation Agricultural Irrigation Bite Investigation L� L! U v Bottled Water Supply —Recreation Area Irrigation Livestock _Monitoring _Public Water Supply (Limited Use/DOH) —Nursery Irrigation Test Public Water Supply I (Community or Non-Communi /DEP—Commercial/Industrial —Earth-Coupled Geothermal ) _Golf Course Irrigation —HVAC Supply A P R 19 2021 Class (Injection —HVAC Return Class V injection: —Recharge CommercialAndustrial Disposal Aquifer Storage and RecoveryDrainage Remediation: _Recovery Air Sparge —Other (oesabbe) DOH in St Lucie Cou VtRGPW&A£�NTAMIIH Other (Oasaibe) (Note: Not all types of wens are permitted by a given permitting authority) 10 :Distance from Septic System if s200 It $' 11. Facility Description _r AAkA--A— 12. Estimated Start Date 13 `Estimated Well Depth lO ® fL `Estimated Casing Depth420_R *Primary Casing Diameter :;' in. Open Hole: From To ft. 14. Estimated Screen Interval: From—LO -To floft. 15.'Pdmary Casing Material: Black Steel Galvanized ZPVC Stainless Steel NotCased 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, orAbandonment Auger Cable Tool Jetted �otary Sonic Combination (rwo or More Methods) Hand Driven (Well Point, Sand Point) Hydraulic Point (Direct Push) Horizontal Drilling Plugged by Approved Method Other (Desclibe) 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 m ) FroTo Seal Material �Bentonite Neat Cement Other ) From To Seal Material ( Bentonite Neat Cement Other ) 20. Indicate total numberof existing wells on site List number of existing unused wells on site 21 °Is this well or any existing well orwaterwithdrawal on the owner's contiguous property covered under Consumptivraterse Permit (CUP/WUP) or CUP/WUP Application? Yes No If yes, complete the following: CUP/WUP No. Well ID No. 22. Latitude Longitude 23. Data Obtained From: GPS Map Survey I bembyceiW oat I wW canVywlth tha appUmNe ndas of rftre 4a, FbrtdeAdadrdstr&m Code, mid that a water use pamdt ar er0chd redmrya peaM4 f needed, hasbeen cram M obtalned prior to a nunencmu n! alwdi mnstuftiL I fuMercaft frdeg hdwmallan prodded In M application lsa=rala and DWI coal obtain Approval Granted Fee Received $_ 0!3=/3 'License No. Receipt No, Datum: NAD 27 NAD 83 WGS 84 1 mdtfy that I am the awnerofthe properly, tire! Itm Wannalfan pmWded Is acwate, and fret lam wane of my f spmwIM= under Chopter3r3. Ftodda Sbnufae, to malntln or pmpedyaWndon INswet m,Ice" fret l am the agenlforlhe owner. Uralthe ftbmaftan PuMed Is aenuete, and that 1 have bdb med the owneroimeir resWstblydias as sfatedabom Owner toallowuppers=nNafMYYMDorDdegdWAuthcoyeccros to Me wen site during the mnstmNan, repat, =0 11an, ar ebandoommd auawdad by#& pemdL 'Signature of Owner crAgdnt 'Date Issue Da 1a1 840 Expiration Check No. InNals THIS PERMIT IS NOT VAUD UNTIL PROPERLY SIGNED BYAN AUTHORIZED OFFICER OR REPRESENTATIVE OF THE WMO OR DELEGATED AUTHORITY. THE I PERMIT SHALL BEAVAILABLE AT THE WELL SITE DURING ALL CONSTRUCTION, REPAIR, MODIFICATION, ORABANDONMENTACTMTIES. DEP Form: 62-532.900(1) Inc6rporated in 62-532A00(1). F.A.C. Effective Date: October 7,2010 Page 1 of 2 I �ND II 5' "RECORNER I ELEV= 11.U3 NAVU 196b k0t.A: INU t3A"J I GCFV* ZF-r V CE NAIL I �0.3'N, 15.5'E N89 38 23 E 1290.90 iC I I N 0 Ix W\ X / \ I J•� I X 1 102.19' I x \ 21.72 2 07 + 21.38 1 x O I x �I 200.00' I 3• x PTV d w W O O r- IN' x 215.15 O x z o I OD OD I x w OD W x 5' WIRE FE CE CORNER FENCE CORNER 1.4'N OF PL 1.39 0. 'N 16.1'E 21. 5 OR poe S89'38'23"W 435.60' BUIL LC 1 I L22100 NAIL I \ WETLAND LIMITS \ p BY OTHERS"\ V NOT PLATTED FND IRC "ILLEGIBLE" ` FENCE ECORNER / x 2.7'S, 22.WE I OF PCOR � 11 A-z—B Aff". BOUNDARY SURVEY 1950 SOUTH BROCKSMITH ROAD s:c 17. RU 3m Rcc 32E RODOLFO VEGA & CARMEN HERNANDEZ 9, .. . . . ..... St. Lucie County Health Department 5150 NW Milner Dr Port Saint Lucie, FL 34983 PAYING ON: #: BILL DOG #:56-BID-5188926 RECEIVED FROM: Coastal Waterworks AMOUNT PAID: $ 230.00 PAYMENT FORM: CHECK 1891 PAYMENT DATE: 02/24/2021 MAIL TO: Coastal Waterworks Fort Pierce FL 34951 FACILITY NAME: Coastal Waterworks PROPERTY LOCATION: Fort Pierce FL 34951 Lot: Block: Property ID: EXPLANATION or DESCRIPTION: -1 - Well Construction 2 QUANTITY FEE $ 230.00 RECEIVED BY: WhighamJL AUDIT CONTROL NO. 56-PID-4893000 Note: 59-31585 Sultan Dr & 31586 Osceola I _Property Card 51-3159C& Michelle Franklin, CFA -- Saint Lucie County Property Appraiser -- All rights reserved. Property Identification Site Address: 1950 S Parcel ID: 2317-422-0000- Account #: 138258 Sec/Town/Range: BROCKSMITH RD 000-5 17/35S/39E Map ID: 23/17S Zoning: AG-5 Count Use Type: 6000 Jurisdiction: Saint Lucie County Ownership Legal Description Rodolfo Vega 17 35 39 COMM AT SW COR OF SE 1/4 RUN N 00 DEG 21 Carmen Hernandez MIN 37 MIN W ALG 1/4 LI 1497.50 FT, TH N 89 DEG 38 904 Osceola DR MIN 23 SEC E 43.5 FT TO POB, TH N 00 DEG 21 MIN 37 Fort Pierce, FL 34982 SEC W ALG E R/W BROCKSMITH RD 560 FT, TH N 89 DEG 38 MIN 23 SEC E 1290.94 FT, TH S 00 DEG 16 MIN 46SEC E 760 FT, TH S 89 DEG 38 MIN 23 SEC W 854.27 FT, TH N 00 DEG 21 MIN 37 SEC W 200 FT, TH S 89 DEG 38 MIN 23 SEC W 435.6 FT TO POB (20.55 AC) Current Values Historical Values 3-year Just/Market: $244,400 Assessed: $5,651 Year Just/Market Assessed Exemptions Taxable Exemptions: $0, Taxable: $5,651 2020 $244,400 $5,651 $0 $5,651 2019 $244,400 $5,651 $0 $5,651 2018 $154,612 $5,651 $0 $5,651 Sale History Date Book/Page Sale Code Deed Grantor Price 08-28-2020 4468 / 1986 0001 WD Lantigua Rolando $100,000 09-30-2002 1602 / 1910 XX00 WD Smith Mildred K $145,000 12-14-1995 0989 / 2604 XX00 DE Branscomb Robert E $74,500 Primary Building Information Finished Area of this building: 0 SF Gross Sketched Area: 0 SF View: Year Built: N/A Primary Wall: Bedrooms: 0 Full Baths: 0 Half Baths: 0 Roof Cover: Frame: Story Height: A/C %: 0% Heated %: N/A% Sprinkled %: 0% Exterior Data Roof Structure: Grade: No. Units: 0 Interior Data Electric: Heat Type: Heat Fuel: Building Type: Effective Year: N/A Secondary Wall: Primary Int Wall: Avg Hgt/Floor: 0 Primary Floors: Total Areas Finished/Under Air 0 (SF): Gross Sketched Area 0 (SF): Land Size (acres): 20.55 Land Size (SF): 895,158 Total Building Count: 1 Special Features and Yard Items Type Qty Units Year Blt Page 1 of 1 All information is believed to be correct at this time, but is subject to change and is provided without any warranty. © Coovrieht 2021 Saint Lucie Countv Prooertv Aonraiser. All riehts reserved. https://www.paslc.org/RECard/ 2/24/2021