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HomeMy WebLinkAboutHealth Dept Permit - TzimenatosSTATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: OSTDS New APPLICANT: Lesley Tzimenatos PROPERTY ADDRESS: 7848 Carlton Rd Port Saint Lucie, FL 34987 LOT: 1 BLOCK: SUBDIVISION: PROPERTY ID #: 3228-600-0001-000-8 PERMIT #: 56-SF-2268948 APPLICATION #: AP1653671 DATE PAID: FEE PAID: RECEIPT #: DOCUMENT #: PR1581621 [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 [ 1,050 ] GALLONS / GPD Seotic 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 [ 667 ] SQUARE FEET Drainfield New SYSTEM R [ ] SQUARE FEET N/A SYSTEM A TYPE SYSTEM: [ ] STANDARD [ ] FILLED [X] MOUND [ ] I CONFIGURATION: [ ] TRENCH [X] BED [ ] N F LOCATION OF BENCHMARK: ORANGE BM NAIL IN E SIDE OF RD S OF PROPERTY I ELEVATION OF PROPOSED SYSTEM SITE [ 17.00][ INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 14.00][ INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT L D FILL REQUIRED: [21.00] INCHES EXCAVATION REQUIRED: [ ] INCHES 0 T H E R system is sized for 4 bedrooms with a maximum occupancy of 8 persons (2 per bedroom), for a total estimated flow of gpd. SPECIFICATIONS �Y: Nicole Montanez TITLE: Environmental Specialist II APPROVED BY: W E: Environmental Specialist II St. Lucie CHD NiC01 Mo ane. DATE ISSUED: 06/17/2021 EXPIRATION DATE: 12/17/2022 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 AP1653671 SE1537084 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. STATE OF FLORIDA PERMIT APPLICATION TO CONSTRUCT, REPAIR, MODIFY, OR ABANDON A WELL �Op KFiE SraTF Y s•i r :_i Southwest PLEASE FILL OUT ALL APPLICABLE FIELDS l Northwest ('Denotes Required Fields Where Applicable) ° '-I St. Johns River The water well contractor >� ryco, is South Florida is responsible for completing this form and forwarding the permit application td the River appropriate delegated authority where applicable J'� b lyr'Cn O DEPannee ❑ Delegated Authority (If Applicable) Permit No. -- 59-31789 Florida Unique ID Permit Stipulations Required (See Attached) Quad No. Delineation No Application NO. ...__._._._,,I ,. �ji lmtx�a oS.._......4Qq.. NE:f _.�aald(e_.t�t. 1�S� _... �-.._.. �31to 3 77a-873-(Q?o; caner, Le al Name if Corporation 'Address *City 'State ZIP 'Telephon Number 2. --rS+ .1 ui Ft- 3gg4_?. _.. � 84 $. Well Location - Address. Road Name or Number. City 3 •21,-7-0000 7.0001 - 000- � � 'P�r_cel lg`No. (PIN) orAltern to Ke (Cir I ne Lot Block Unit 4. _ 1 `� �_ri• �t�1Gt _der 'Section or Land Grant 'Townsh'p 'Ran 'Count Y -� ck if 62-524: Yes No Subdivision t -- 1 I r "Water Well Contract r 'License Number •Telephone Number E-mail Address 6 � _ Water Well Contractors Aess - -_-' OA City Stale ZIP 7. 'Type of Work: __)C Construction _Repair Modification ___Abandonment 8. 'Number of Proposed Wells 'Reason for Repair. Modification or Abandonment 9. 'Specify Intended Use(s) of Well(s): K1)5pRQVgt Domestic _ landscape Irrigation _Agricultural irrigation _Site Investigation __.Bottled Water Supply ^Recreation Area Irrigation _livestock _Monitoring Public Water Supply (Limited Use/DOH) _Nursery Irrigation Test Public Water Supply (Community or Non-Community/DEP) Commercial/Industrial _ ^Earth -Coupled Geothermal Golf Course Irrigation _.-_-HVAC Supply JUN 17 2021 Class 1 Injection — _ HVAC Return Class V Injection: _Recharge _Commercial/Industrial Disposal Aquifer Storage and Recovery Drainage Remedtalion. _ Recovery _•_.-Air Sparge _ Other (Describe) Olhef (Describe) _ In. "AMMIMAWIRM __ ,Note Not ali types of weds are permitted by a`� van permilling autho 10.'Distance from Septic System if ,200 fl. !'�r 11. FacilityDescription , j �,5�`� yl� 12. Eslirnated Start Date $1)-P 13 'Estimated Welf Depth .13.0ft. -Estimated Casing Depth V..V ft. -Primary Casing Diameter _ in Open Hole: From _ TOft. 14. Estimated Screen Interval. From. TO—. _ ft. 15.-Primary Casing Material: __Black Steel 2C Galvanized PVC Stainless Steel _. • Not Cased ---Other: , I 16. Secondary Casing: Telescope Casing Liner Surface Casing Diameter in. E 17. Secondary Casing Material: Black Steel Galvanized -. PVC •- Stainless Steel Other, 18.'Method of Construction, Repair, or Abandonment: Auger Cable Tool Jetted . • Rotary Sonic, Combination (Two or More Methods) Hand Driven (Well Point. Sand Point) Hydraulic Point (Direct Push) _____Horizontal Drilling Plugged by Approved Method Other (oesenhe) 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 - From _ ) _•. , ,. To••_ _...._,.Seal Material (- Bentonite..., . Neat Cement. Other From_ - _ - To______Seal Material ( _ Bentonite. ,. ... Neat Cement _ .Other_-.. ...... .,_.�� j 20. Indicate total number of existing wells on site C2 List number of existing unused wells on site 21.'Is this well or any existing well or water withdrawal on the owner's contiguous properly covered under a Consumptive/Water Use Permit (CUP/WUP) or CUPlWUP Application? . . -. Yes X No If yes, complete the following. CUP/WUP No. • ..,.., District Well ID No. 22. Latitude Longitude _ 23. Data Obtained From: GPS Map -Survey Datum: NAD27 _ NAD 83 WGS 84 i herany apmly final f l re GWrply wnn In8 appllWWa faiL'S u1 TIR qU. fldrma AOm.rndlydartl Coua. Jpa ills: a wJior I LOrhty ihdl I inn inc 0wnm 01 Me p101-1y. 0-01 M. ,nlarmJha•i pro�,da0 4 a0LWJ10. and plat I.au dwdrtl of n,y I�Sq ppnn : fn aIINr..nl fgCha,is pgrmll. d needed. had Dean 0, wa no Dora— pon/ r0 Lmmn,anLadtanl prw N a drlrintJHl.ligs undal Chaplar 17.1 FlMlea standes. In miomaul N propany ahl,ldn:l m.s ,lad. a. I Wlry:ful 1011, ,J„apaL4W1 I lur{iial Cafhty Thal atl In10InIJaW1 prOV.dail to Ih:Y app:ICaUan S :1LWra7a AnO ilia(1 will IMlar,i tlw agwn! Iru tno owner. that pie nnprinairon urowded,d aceur010. and that 1 I:avu 11om d rllp Dena, Jr eia r ,lirppSS,iry ap1110va1 if I Oillpi tprlgral. Slalff. nr Mr_li aovpmman:fi iI dnla,r+nhlp I a9fon In prov,de a wqa resnanw.,- s n5 1orea ntldva Ow rgnsR,11S la allnwnlg pa,aO,MBr nt I,,,S whip or eMJgn41d nVMO/ 1, arr.lsc CMldlla0n ,apen161 D,518L1 wllNn JO Days aher LOmplgaWl d the rA031ruL1,M, rap0n. nl<a1.pfdUOn. n' I„ Iha w6 d du 9 pia COnS p0 ropm, 1.0ddiLiLar, or aWndOMlOnt ilulhOn:rld py •S pOm l .1h ..l non' ua)w eM tly mrA pMm� r pip pa�rml! gep�llatmn, ,rlt•p,W vnr nff1a51atrr _ 70 'Sign a of Contract r 'License No. 'Sign re of Owner or Agent ate Approval Grante By -. �Qxi R U=OURING Issue Date I. 1 . . Expiration Oatel.d 1.1-,_ 1, F Hydrologist Approval Poo Received $1 .5- (56 Receipt o ` �� �- pf 9ILLI' - Check No. THIS PERMIT IS NOT VALID UNTIL PROPEUT ORIZEO OFFICER OR REPRESENTATIVE OF THE WMO OR DELEGATED AUTHORITY, THE PERMIT SHALL BE AVAILABLE AT THE WELL NSTRUCTION, REPAIR, MODIFICATION. OR ABANDONMENT ACTIVITIES. St. Lucie County Health Department ' 5150 NW Milner Dr Port Saint Lucie, FL 34983 HEALTH PAYING ON: #: 56-SF-2268948 BILL DOC #:56-BID-5244727 CONSTRUCTION APPLICATION #: AP1653671 RECEIVED FROM: Homecrete Homes AMOUNT PAID: $ 660.00 _ PAYMENT FORM: CREDIT CARD 05227G PAYMENT DATE: 04/06/2021 MAIL TO: Lesley Tzimenatos FACILITY NAME: PROPERTY LOCATION: __"'I' r,,�TBD Carlton Rd Port Saint Lucie, FL 34987 1 Lot: Property ID: 3228-600-0001-000-8 EXPLANATION or DESCRIPTION: Block: 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 1 1 1 1 1 1 1 1 1 FEE $ 5.00 $ 45.00 $ 100.00 $ 100.00 $ 115.00 $ 55.00 $ 75.00 $ 50.00 $ 115.00 RECEIVED BY: AdamsC ry AUDIT CONTROL NO. 56-PID-4938210 Note: W/ Well#59-31789 �E Wett Igo . 5�-31�`6�i STATE OF FLORIDA PERMIT NO. Sr- ZZ /4Ej DEPARTMENT OF HEALTH DATE PAID: O 21 ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID: :�.� SYSTEM RECEIPT #: Q�jZZ,� Cn APPLICATION FOR CONSTRUCTION PERMIT APPLICATION FOR: New System [ ] Existing System [ ] Holding Tank [ ] Repair [ ] Abandonment [ ] Innovative [ ] Temporary [ ] APPLICANT: Lesley Tzimenatos AGENT: Melissa Showman 1pPr 1rQ .e �i bYYtP 1'L� TELEPHONE: 772-873-6707 MAILING ADDRESS: 2162 NW Reserve Park Trace, Port St Lucie, FL 34986 -------------------------------------------------- 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: 1 BLOCK: SUBDIVISION: Serenity at the Preserve PLATTED. Y PROPERTY ID #: 3228-600-0001-000-8 ZONING: AG-5 I/M OR EQUIVALENT: [ No ] PROPERTY SIZE: 5.26 ACRES WATER SUPPLY: [,/] PRIVATE PUBLIC [ ]<=2000GPD [ 1>2000GPD IS SEWER AVAILABLE AS PER 381.0065, FS? [ No ] DISTANCE TO SEWER: NA FT PROPERTY ADDRESS: To be detennined ('6��V\) � DIRECTIONS TO PROPERTY: Start at the intersection of Glades Cut OFF and Carlton Road. Follow Carlton Road north. Keep on it as it bends to the west and then to the north again then go 0.9 miles and the property is on the right (east) side of the street. BUILDING INFORMATION Unit Type of No Establishment 1 Single Family 2 3 4 [ ] Floor [ ✓ ] RESIDENTIAL [ ] COMMERCIAL No. of Building Commercial/Institutional System Design Bedrooms Area tS��gft Table 1, Chapter 64E-6, FAC 4�P�4r� NA SIGNATURE: / DATE: 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: Lesley Tzimenatos CONTRACTOR / AGENT: HOmeCrete Homes LOT: 1 BLOCK: SUBDIVISION: ID# : 3228-600-0001-000-8 APPLICATION # AP1653671 PERMIT # 56-SF-2268948 DOCUMENT # SE1537084 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: 5.26 ACRES TOTAL ESTIMATED SEWAGE FLOW: 400 GALLONS PER DAY [ RESIDENCES -TABLET / OTHER -TABLE 2 ] AUTHORIZED SEWAGE FLOW: 7890.01 GALLONS PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE ] UNOBSTRUCTED AREA AVAILABLE: 1716.00 SQFT UNOBSTRUCTED AREA REQUIRED: 1000.00 SQFT BENCHMARK/REFERENCE POINT LOCATION: ORANGE BM NAIL IN E SIDE OF RD S OF PROPERTY ELEVATION OF PROPOSED SYSTEM SITE 17.00 [ 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: FT DITCHES/SWALES: 100 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: 40 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 STTF. 1 USDA SOIL SERIES: Munsell #/Color Texture Depth 10YR 4/1 Sand 0 To 24 10YR 5/1 Sand 21 To 24 10YR 4/1 Sand 24 To 52 10YR 7/3 MARL 52 To 72 REFUSAL Refusal 63 To 72 CCITT. PROFTT.R TNFORMATTON STTE 2 USDA SOIL SERIES: Munsell #/Color Texture Depth 10YR 4/1 Sand 0 To 26 10YR 5/1 Sand 23 To 26 10YR 4/1 Sand 26 To 54 10YR 7/3 MARL 54 To 72 REFUSAL Refusal 65 To 72 OBSERVED WATER TABLE: 31.00 INCHES [ ABOVE / BELOW j 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 DRAINFIELD CONFIGURATION: [ ] TRENCH r REMARKS/ADDITIONAL CRITERIA Sand/0.60 DEPTH OF EXCAVATION: INCHES [X] BED [ ] OTHER (SPECIFY) WSWT determined using USDA WSS and soil borings. 10YR5/1 stripping in a 10YR4/1 matrix > 10% with diffuse boundaries starting at 21" in S131. SB1 17" below BM. SB2 15016 below BM. SITE EVALUATED BY: DATE Montane' Nicol (Title Environmtlsed) Specialist 11) (Florida Department of Health in S DH 4015, 08/09 (obsoletes previous editions which may not Incorporated: 64E-6.001, FAC 06/10/2021 Page 3 of 4 AR1653671 EID2268948 v 1.0.2 Michelle Franklin, CFA -- Saint Lucie County Property Appraiser -- All rights reserved. Property Identification Site Address: TBD Parcel ID: 3228-600-0001- Account #: 189028 Sec/Town/Range: 27/36S/38E 000-8 Map ID: 32/27X Zoning: AG-5 Count Use Type: 6000 Jurisdiction: Saint Lucie County Ownership Legal Description Lesley Tzimenatos SERENITY AT THE PRESERVE (PB 91-3) LOT 1 (5.26 AC - 624 NE Bent Paddle LN 229,126 SF) Port St Lucie, FL 34983 Current Values Historical Values 3-year Just/Market: Assessed: Year Just/Market Assessed Exemptions Taxable Exemptions: Taxable: Sale History Date Book/Page Sale Code Deed Grantor Price 02-05-2021 4555 / 1425 0001 WD Osco Holdings Inc $129,000 Type Total Areas Finished/Under Air 0 (SF): Gross Sketched Area 0 (SF): Land Size (acres): 5.26 Land Size (SF): 229,126 Total Building Count: Special Features and Yard Items Qty Units Year Blt All infonnation is believed to be correct at this time, but is subject to change and is provided without any warranty. © Copyright 2021 Saint Lucie County Property Appraiser. All rights reserved.