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HomeMy WebLinkAboutOSTDS NewSTATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT FOR: OSTDS New APPLICANT: Thomas Montana PERMIT #:66-SF-2218623 APPLICATION #: AP1611048 DATE PAID: FEE PAID: RECEIPT #: DOCUMENT #: PR1518417 PROPERTY ADDRESS: TBD Tranquility Base Ln Port Saint Lucie, FL 34986 LOT: 4 BLOCK: 3 SUBDIVISION: Aero Acres PROPERTY ID #: 3215-801-0057-000-2 [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 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 [ 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: Site BM, NA S side of Rd, E PL extended S I ELEVATION OF PROPOSED SYSTEM SITE [ 2.00 ][ INCHES FT ][ ABOVE BELOW] BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 13.001 INCHES FT ][ ABOVE BELOW]BENCHMARK/REFERENCE POINT L D E O T H E R ILL REQUIRED: [ Z9.UU] INCHES EXCAVATION REQUIRED: t 'IU.UU J 114UAkSb The system is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total estimated flow of 400 gpd. SPECIFICATIONS BY: Brian J I ram TITLE: Environmental Specialist III APPROVED'BY: TITLE: Environmental Specialist III St. Lucie CHD Brian J ngram DATE ISSUED: 03/03/201 EXPIRATION DATE: 09/03/2022 DH 4016', 08/09 (Obsoletes.all previous editions which may not be used) Incorporated: 64E-6.003., FAC ' Page 1 of 3 I v 1.1.4 AP1611048 SE1486050 • ~n 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. I e, OHM HEALTH PAYING ON: RECEIVED FROM: PAYMENT FORM: St. Lucie County Health Department 5150 NW Milner Dr Port Saint Lucie, FL 34983 #: 56-SF-2218623 SILL DOC #:56-BID-5148052 CONSTRUCTION APPLICATION #: AP1611048 Alexander J Piazza PSM Inc. AMOUNT PAID: $ 430.00 CHECK 1315 PAYMENT DATE: 01/06/2021 MAIL TO: Thomas Montana FACILITY NAME: PROPERTY LOCATION: TBD Tranquility Base Ln Port Saint Lucie, FL 34986 Lot: 4 Block: 3 Property ID: 3215-801-0057-000-2 EXPLANATION or DESCRIPTION: QUANTITY FEE 128 - OSTDS Construction System Inspection Research Fee 1 $ 5.00 -1 - Surcharge (All) 1 $ 45.00 -1 - OSTDS New Permit Surcharge 1 $ 100.00 -1 -'OSTDS Construction Application and Plan Review,New 1 $ 100.00 126 - OSTDS Construction Permit (New or Mod, Amendment) 1 $ 55.00 127 - OSTDS Construction System Inspection 1 $ 75.00 133 - OSTDS Construction Reinspection 1 $ 50.00 RECEIVED BY: AdamsC AUDIT CONTROL NO. 56-PID-4851264 E o� STATE OF FLORIDA PERMIT NO --'y 1 ` �a� DEPARTMENT OF HEALTH DATE PAID: 41::5117 Lp 2 �p ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID: `ti,�e tam` SYSTEM RECEIPT #: APPLICATION FOR CONSTRUCTION PERMIT APPLICATION FOR: [./I New System [ ] Existing System [ ] Holding Tank [ ] Innovative [ ] Repair [ ] Abandonment [ ] Temporary [ ] APPLICANT: Thomas & Elizabeth Montana AGENT: Alexander J. Piazza PSM, Inc. TELE PHONE : 772-340-7770 MAILING ADDRESS: 619 SW Biltmore Street, Port St. Lucie, Florida 34983 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: 4 BLOCK: 3 SUBDIVISION: 'Aero Acres PLATTED: 1989 PROPERTY ID #: 3215-801-0057-000-2 ZONING: R I/M OR EQUIVALENT: [ No ] PROPERTY SIZE: 1.224 ACRES WATER SUPPLY: [�/] PRIVATE PUBLIC [ ]<=2000GPD [ ]>2000GPD IS SEWER AVAILABLE AS PER 381.0065, FS? [ No ] DISTANCE TO SEWER: -W:K-FT PROPERTY ADDRESS: TBD Tranquility Base Lane, Port St. Lucie, Florida 34986 DIRECTIONS TO PROPERTY: SEE MAP BUILDING INFORMATION Unit Type of No Establishment 1 RESIDENCE 2 3 4 [,(] RESIDENTIAL [ ] COMMERCIAL No. of Building Commercial/Institutional System Design Bedrooms Area Sqft Table 1, Chapter 64E-6, FAC 3 2,733 [ ] Floor/Equipment Drains [ v/ ] Other (Specify) GARBAGE GRINDERS / DISPOSALS D1&11y.ipW by Al...&,J Ph — Alexander J Piazza DA: c•US, o-UnaTaliatW, A01J10D00[N101 PiLQIFd7000167PA.—Ak .JM J SIGNATURE : Ww:2020.11.02 13:29:59-05W DATE: 11-02-20 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: Thomas Montana CONTRACTOR / AGENT: LOT: 4 Alexander J Piazza PSM Inc. BLOCK: 3 SUBDIVISION: Aero Acres ID#: 3215-801-0057-000-2 APPLICATION # AP1611048 PERMIT # 56-SF-2218623 DOCUMENT # SE1486050 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: 1.23 ACRES TOTAL ESTIMATED SEWAGE FLOW: 400 GALLONS PER DAY [ RESIDENCE S—TABLEI / OTHER —TABLE 2 ] AUTHORIZED SEWAGE FLOW: 1845.01 GALLONS PER DAY [ 1500 GPD/ACRE I OR 2500 GPD/ACRE ] UNOBSTRUCTED AREA AVAILABLE: 1000.00 SQFT UNOBSTRUCTED AREA REQUIRED: 1000.00 SQFT BENCHMARK/REFERENCE POINT LOCATION: Site BM, NiD, S side of Rd, E PL extended S ELEVATION OF PROPOSED SYSTEM SITE 2.00 [ 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: 44 FT NORMALLY WET: [ ]YES [X]NO WELLS: PUBLIC: FT LIMITED USE: FT PRIVATE: 75 FT NON —POTABLE: FT BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: 50 FT POTABLE WATER LINES: 42 FT SITE SUBJECT TO FREQUENT FLOODING? [ ]YES EX ]NO 10 YEAR FLOODING? [ ]YES [X]NO) 10 YEAR FLOOD ELEVATION FOR SITE: FT MSL / NGVD ] SITE ELEVATION: FT ( MSL / NGVD ROTT. AROWTTR TNFORMATTOW RTW.. 1 SOIL PROFILE INFORMATION SITE 2 USDA SOIL SERIES: Munsell #/Color Texture Depth 10YR 4/2 Fill - Sandy Clay 0 To 9 10YR 6/2 Sand 9 To 22 1 OYR 5/8 CMN/PRM RF 13 To 22 1 OYR 6/4 Sand 22 To 32 1 OYR 4/3 Sand 32 To 45 1 OYR 6/2 Sand 45 To 54 HOLE CAVING Refusal 54 To 72 USDA SOIL SERIES: Munsell #/Color Texture Depth 1 OYR 4/2 Fill - Sandy Clay Loam 0 To 10 I OYR 5/2 Sand 10 To 25 10YR 6/1 Sand 15 To 25 10YR 6/3 Sand 25 To 33 1 OYR 4/2 Sand 33 To 44 1 OYR 6/2 Sand 44 To 57 HOLE CAVING Refusal 57 To 72 OBSERVED WATER TABLE: 44.00 INCHES [ ABOVE / BELOW ] EXISTING GRADE TYPE: [ PERCHED / APPARENT ] ESTIMATED WET SEASON WATER TABLE ELEVATION: 13 INCHES [ ABOVE / BELOW ] EXISTING.GRADE HIGH WATER TABLE VEGETATION: [ ]YES [X]NO MOTTLING: [X]YES [ ]NO DEPTH: 13.00 INCHES SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: Sand/0.60 DEPTH OF EXCAVATION: 10 INCHES DRAINFIELD CONFIGURATION: [ ] TRENCH EX BED [ ] OTHER (SPECIFY) REMARKS/ADDITIONAL CRITERIA WSWT determined using USDA WSS and soil borings. 10YR5/8 CMN PROM RF mottling In 10YR6/2 matrix >2% starting at 13" In SB1. SB1 and SB2 2" above BM. SITE EVALUATED BY: DATE: 03/02/2021 Ingram, Brian (71 : Environmental Specialist III) (ENVIRONMENTAL HEALTH) DH 4015, 08109 (Obsoletes previous editions which may not be used) Incorporated: 64E-6.001, FAC Page 3 of 4 AP1611048 EID2218623 v 1.0.2 • •r �E� STATE OF FLORIDA PERMIT 2 Z] 1 DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS APPLICANT: Thomas & Elizabeth Montana AGENT: Alexander J. Piazza PSM, Inc. LOT: 4 BLOCK: 3 SUBDIVISION: Aero Acres PROPERTY ID # : 3215-801-0057-000-2 [ 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: 1.224 ACRES TOTAL ESTIMATED SEWAGE FLOW: 667 _GALLONS PER DAY [ ENCES-TABLET/OTHER-TABLE2 ] AUTHORIZED SEWAGE FLOW: 1% C6 GALLONS PER DAY [ 500 PD/ACRE OR 2500 GPD/ACRE ] UNOBSTRUCTED AREA AVAILABLE: 1000 SQFT UNOBSTRUCTED A REQUIRED: 1000 SQFT BENCHMARK/REFERENCE POINT LOCATION: ; 5� ^y���5� S �`�' of S;k [t/ "klgc�s+ (� M ELEVATION OF PROPOSED SYSTEM SITE IS$* b7 [ _ p� C S/FT ] [ O E/BELOW ] BEN/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: 100 FT BUILDING FOUNDATIONS:5 FT PROPERTY LINES: 10 FT POTABLE WATER LINES: FT SITE SUBJECT TO FREQUENT FLOODING: [ ] YES [✓] NO 10 YEAR FLOODING? [ ] YES [✓] NO 10 YEAR FLOOD ELEVATION FOR SITE: VA FT MSL/NGVD SITE ELEVATION: U]-A FT MSL/NGVD SOIL PROFILE INFORMATION SITE 1 SOIL PROFILE INFORMATION SITE 2 MUNSELL #/COLOR M YQ / to Y R �� 3 o y R?i 3 ]d� P- 5" Z. Ioy2 S-Iz- DEPTH 6 TO )D 10 TO'24 z TO 3/ S I TO 4-L 4 7— TO 11- TO TO TO TO USDA SOIL SERIES: __ j A� �►L,C TEXTURE SANS) Q �f�3a1 MUNSELL #/COLOR la Q R ,aYR tb yR ]ti YQ TEXTURE SA14k S `0 Re. -sal USDA SOIL SERIES: -fA ►dT1 LE DEPTH 6 TOII I] TO U Z.0 T031 31 TO'yX yZ TO 'tz TO mn TO rrn OBSERVED WATER TABLE:40* INCHES [BELOW 1] EXISTING GRADE. TYPE:[P R D/APPARENT ] ESTIMATED WET SEASON WATER TABLE ELEVATION: 16 INCHES [.ABOVE/ EL W EXISTING GRADE HIGH WATER TABLE VEGETATION: [ ] YES [,A] NO MOTTLING: [XI YES [ ] NO DEPTH: 10 'SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZIN9: Sow DEPTH OF EXCAVATION: DRAINFIELD CONFIGURATION: [X] TRENCH [Y] BED [ ] OTHER (SPECIFY) REMARKS/ADDITIONAL CRITERIA: 'o INCHES igi y,gn ikFe er iaua Alexander J Piazza —D Al S.o=Una1 lialM, au=A01410D000001725fiQ2F43000167FA cn=Ale. inderJ flaria ' SITE EVALUATED BY: Date. 2020.11.0213:30:15-05'00' DATE: 11-02-20 DH 4015, 12/11 (obsoletes previous editions which may not be used) Incorporated: 64E-6.001, FAC Page 3 of 4 9r APPLICANT'S NAME: Thomas & Elizabeth Montana 7i Z ( p7, LEGAL DESCRIPTION: Lot 4, Block 3 of Aero Acres (PB 27, PG 14, PGS 14A-14D) 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 1.O0-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 apublic 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 and. the 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. Dig, W ly signed by Alexander 7 Plaw Prha USo=Unaflll ie4 Alexander J Piazza..AA019�1gdD00POWD177S6CZZFe700b167FA. .PJeCERTIFIED BY: DA.2020AU'13v3trJ1.°''°° FLORIDA PROFESSIONAL NO.: 6330 DATE: 11 /02/20 JOB ND.: 20-5580 does/ Forms/septics/SepticApppPage207 2-2(�O Michelle Franklin, CFA -- Saint Lucie County Property Appraiser -- All rig is reserved. Property Identification Site Address: TBD Parcel ID: 3215-801-0057- Account#: 127345 Sec/Town/Range: 15/36S/38E 000-2 Map ID: 32/15X Zoning: AG-5 Count Use Type: 0000 Jurisdiction: Saint Lucie County Ownership Thomas Montana Elizabeth Montana 557 SW New Castle CV Port St Lucie, FL 34986 Legal Description AERO ACRES BLK 3 LOT 4 (1.223 AC) Current Values Historical Values 3-year Just/Market: $105,100 Assessed: $100,540 Year Just/Market Assessed Exemptions Taxable Exemptions: $0 Taxable: $100,540 2020 $105,100 $100,540 $0 $100,540 2019 $91,400 $91,400 $0 $91,400 2018 $76,000 $76,000 $0 $76,000 Sale History Date Book/Page Sale Code Deed Grantor Price 10-03-2018 4192 / 0618 0001 WD Moore Roger H $95,000 07-03-2000 1314 / 1542 XX00 WD McCreesh Margaret $35,000 07-17-1990 0703 / 0206 XX00 WD Walker David $33,000 Primary Building Information Finished Area of this building: 0 SF Gross Sketched Area: 0 SF Exterior Data View: Roof Cover: Roof Structure: Building Type: Year Built: N/A Frame: Grade: Effective Year: N/A 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 k Finished/Under Air 0 (SF): Gross Sketched Area 0 (SF): {� s Land Size (acres): 1.23 Land Size (SF): 53 722.548 Total Building Count: 1 Special Features and Yard Items Type Qty Units Year Blt All information 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. Mission: To protect, promote & improve the health of all people in Florida through integrated state, county & community efforts. 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(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 6150 NW Milner Drive • Port St Lucie, FL 34983 :Public Health Accreditation Board PHONE: 7721462-3800 - FAX: 7721871-5360 StLucieCountyHealth.com SF_ -Z2-� augz3 STATE OF FLORIDA PERMIT APPLICATION TO CONSTRUCT, REPAIR, MODIFY, OR ABANDON A WELL �fit, ..o Southwest PLEASE FILL OUTALL APPLICABLE FIELDS w. = Northwest (*Denotes Required Fields Where Applicable) D St. Johns River (c ' D South Florida The water well contractor Is responsible for completing _Suwannee River this form and forwarding the permit application to the appropriate delegated authority where applicable. �i DEP D Delegated Authority (If Applicable) s�z 1.'r u 14-M.11 1�)r) *Owner, Legal Name-tfCorporation, z. 1'Gb 'T' 40.6G1r4;/,"f Well Location -Address, Road -Name or -city .. 59-31372 Permit No. Florida Unique ID Permit Stipulations Required (See Attached) 62-524 Quad No. Delineation No. CUPNWP Application No. "State _'ZIP ... 'Telephone Number "Parcel ID No. (PIN) orAltemaat'te''__Keey ircle One Lot Block Unit 4 {s ?� Sr' L�r-1G/ Check if62-524: Yes No `Section or Land Grant Township `Range •C3r1,,, Subdivision Q Q, — — 5. -3as L.e_ollAf JS to—ed 11r:err 63 623 9 /n3 •Water Well Contractor License G-mber "Telephone Number E-mail Address 6. �i 7a_� Q. pj�Let.t� t2(�ePc-a�h� I•-^L �fg7!S/ "Water We I C7 ontractor's Address city State ZIP 7. *Type of Work: =Construction —Repair —Modification —Abandonment 8. • Number of Proposed Mlls —I 'Reason for Repair, Modification, or Abandonment 9. •Spedfy Intended Use(s) of VIlf:ll(s): � ��St�pU �� XDomestic 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 MAR 3 2021 Class I Injection HVAC Return Class V Injection: —Recharge —Commercial/industrial Disposal Aquifer Storage and Recovery —Drainage Remediation: _Recovery —Air Sparge —Other (Describe) 0iiOMc§1&V " yCOW _Other (Describe) (Note: Not all types of wells are permitted by a given permitting authtafi 10'Distance from Septic System if s 200 ft. 3'5 } 11. Facility Description S F (Z 12. Estimated Start Date 1 WEstimated Well Depth J 3 0 ft. -Estimated Casing Depth lt�ft. -Primary Casing Diameter 2 in. Open Hole: From To ft. 14. Estimated Screen Interval: From To ft. � 15`Primary Casing Material: Black Steel Galvanized PVC Stainless Steel NotCased Other: 16. Secondary Casing: Telescope Casing Liner Surface Casing Diameter I r in. 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 (Describe) 19. Proposed Grouting Interval for the Primary, Secondary, and Additional Casing: From To Seal Material L_Bentonite Neat Cement Other ) From To Seal Material L_Bentonite Neat Cement Other ) From To Seal Material L__Bentonite Neat Cement Other ) From To Seal Material L—Bentonite Neat Cement Other 20. Indicate total number of existing wells on site _� List number of existing unused wells on site lJ 21 'Is this well or any existing well or waterwithdrawal on the owner's contiguous property covered under a Consumptive/Water Use Permit (CUP/WUP) or CUP/WUP Application? Yes _I/No If yes, complete the following: CUP/1NUP No. District Well ID No. 22. Latitude Longitude 23. Data Obtained From: GPS Map Survey Datum: NAD 27 NAD 83 WGS 84 t hereby cemfy that I unit comply with the apptcalie rules of Title 40. Flo da Adrtumstratian Code. and mat a water I cemfy tiff I am me owner of me property, that the mfom+atron provded rs accurate. and mat I am avlare of my use permit or aroflea it recharge permif needed. has been or vwa be obtained prior to commencement of well respome titres order chapter 3n Florrda statutes, to maintain or property abandon this well. or 1 cemly that; an construction. I further certify thatatl unfomrahon provided In this application s aecwate and that I von obtain :he agent for me ownw that the tntormation provided is accurate, and that I have unformed me corner of his necessary approvai from outer federal, state. or local governments, If applicable, I agree toprovide provide a well r axim 5 as stated above Owner consents to allowing personnel of ins W MD or Delegated Aumomy access to amplebon report to me District within 30 days after completion of me ccnstnrcdon. repair. modification or weer duntg die oorsbuct4m. repair, modripbon, or ablmdonment authdr@ed by the be=t abn andoumor¢ad by this Pamir.er. the cermit emlraaon Whichever occurs first. *Siaodure of Contractor *License No. •S cnature of Owner or Aaent •ate Approval Granted By . Issue Date /3 /ZF'Z / Expiration Date1 Hydrologist Approval f � l IllinoisFee Received S 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. FORM LEG-R.040.01 (6110) This permit is valid for 90 days from the date of issue. Rule 40D-3.101 (1), F.A.C. r TAXIWAY TRACT 2 KlQa•r,1'2r,"1= man nn' 5 D.E. 0 o (A 0 0 o c m 30.00' 40.39' _ 20.20' 59.41' S 60.00' o / to BY OTHERS N 1i N 14.67' 15.08' 0 0 � FUTURE o a COVEREDfO / o CONC APRON o HANGER c FFE=25.00 \ PORCH J 12.33' 14.00' 15.67' / COVERED o PORCH 14.00' 5' aim �iZ� 50.00, 60.00' 20.20' PROPOSED ago I r� CBS RESIDENCE oaza o FFE=25.00 ate. PROµPEOSED N O m� Op O I 15.08' oo ^� 20.33' 1 LOT 4 BLOCK 3VACAN J 2� PROPOSED h ^ a. DRIVE - FUTURE DRIVE / \ / 30.00' 24.00' FD \ Er I4 im St. Lucie Cou vir. nmental'Healt ty m d PROPOSED Site Plan pprpved-for Cons r6tio 1" WATER SERVICE t rsede AII'Previ qWSffe� ians ir o OSTDS #5L2.,1z S 2 3 & Well 51-31. 2- ,s.00' 0 12.00' Date: / 2: 1. Reviewer: rRIC 6' U.L 23.19 s7651 S8 '51'25IV 260.00' 0 0 ti~j� M r TRANQUILITY BASE LANE ►RY I PLOT PLAN U C TIE .0 1 9-02-20 SIONS. BY: A� 260.00, S89'51'25"W 2866.68' TRANQUILITY BASE LANE 60' R/W - 2Q' ASPHALT ROAD AL ITOPOGIRAPHIC ALEXANDER J. PIAZZA PSM, INC. Surveying • Mapping • Consulting 619 SW 811tmore Street ® Port St. Lucie. Florida 34983 Phone: (772) 340-7770 LBJ7280 Fa)c (772) 340-2250 SITE BENCHMARK G SET NAIL�� ELEV= 23.21 NAVD 1988 LAST FIE CAD K:\9UILDERS\DWG2020\20-5580 REF K:\ FLD CJM / RP FB. 000 PG. OFF CJM CKD AJP SHEET 1 OF Awg, 1/14/2021 3:59:35 PM 56-.5r-• 2,w5*?3 51-X372- Michelle Franklin, CFA -- Saint Lucie County Property Appraiser -- All rights reserved. Property Identification Site Address: TBD Parcel ID: 3215-801-0057- Account #: 127345 Sec/Town/Range: 15/36S/38E 000-2 Map ID: 32/15X Zoning: AG-5 Count Use Type: 0000 Jurisdiction: Saint Lucie County Ownership Legal Description Thomas Montana AERO ACRES BLK 3 LOT 4 (1.223 AC) Elizabeth Montana 557 SW New Castle CV Port St Lucie, FL 34986 Current Values Historical Values 3-year Just/Market: $105,100 Assessed: $100,540 Year Just/Market Assessed Exemptions Taxable Exemptions: $0 Taxable: $100,540 2020 $105,100 $100,540 $0 $100,540 2019 $91,400 $91,400 $0 $91,400 2018 $76,000 $76,000 $0 $76,000 Sale History Date Book/Page Sale Code Deed Grantor Price 10-03-2018 4192 / 0618 0001 WD Moore Roger H $95,000 07-03-2000 1314 / 1542 XX00 WD McCreesh Margaret $35,000 07-17-1990 0703 / 0206 XX00 WD Walker David $33,000 Primary Building Information Finished Area of this building: 0 SF Gross Sketched Area: 0 SF Exterior Data View: Roof Cover: Roof Structure: Building Type: Year Built: N/A Frame: Grade: Effective Year: N/A 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: �l~ TotalAreas Finished/Under Air 0 ( Gross SketchedA Area 0 (SF): Land Size (acres): 1.23 Land Size (SF): 53,722.548 Total Building Count: 1 Type Special Features and Yard Items Qty Units Year Blt All information is believed to be correct at this time, but is subject to change and is provided without any warranty. 0 Copyright 2021 Saint Lucie County Property Appraiser. All rights reserved. L rev ;§ < St. Lucie County Health Department 5150 NW Milner Dr Port Saint Lucie, FL 34983 HEALTH PAYING ON: #: BILL DOG #:56-BID-5148056 RECEIVED FROM: PLM Construction AMOUNT PAID: $ 115.00 PAYMENT FORM: CHECK 1315 PAYMENT DATE: 01/06/2021 MAIL TO: PLM Construction 542 NW Mercontile PI Port Saint Lucie FL 34986 FACILITY NAME: PLM Construction PROPERTY LOCATION: 542 NW Mercontile PI Port Saint Lucie FL 34986 Lot: Block: Property ID: EXPLANATION or DESCRIPTION: QUANTITY FEE -1 - Well Construction 1 $ 115.00 RECEIVED BY: AdamsC AUDIT CONTROL NO. 56-PID-4851267 Note: 59-31372 Tranquility Base Lane