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STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
PERMIT #:56-SF-1351662
APPLICATION # : qP 1036808
DATE PAID: I
FEE PAID:
RECEIPT #:
DOCUMENT #: PR847027
CONSTRUCTION PERMIT FOR: OSTDS New 11 1 1 . L . t., 1 1 0
APPLICANT: George and Susan Pantuso
PROPERTY ADDRESS: 3415 S. Indian Romer pr Fort Pierce, FL 34979,
LOT: 3 BLOCK: SUBDIVISION:
PROPERTY ID #: 2426-133-0001-000-0 [SECTxON, TOWNSHIP, RANGE, PARCEL NUMBER]
[OR TAX ID NUMBER]
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECT1
381.0065, F.S., AND CHAPTER 64E-6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANI
SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACT
WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY 7
PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND V01
ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERP
STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY.
SYSTEM DESIGN AND SPECIFICATIONS
T [ 1,500 l GALLONS / GPD Septic 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 l SQUARE FEET SYSTEM
R [ ] SQUARE FEET N/A / SYSTEM
A TYPE SYSTEM: [X] STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [X] TRENCH [ ] BED [ ]
N
F LOCATION OF BENCHMARK: TOP OF IRON ROD EL 42.22 NAVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 22.001E INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 52.0011 INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: [ 0.001 INCHES EXCAVATION REQUIRED: [ ] INCHES
The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance with
s. 64E-6.013(3)(0, FAC.
T Not to have more than 18" cover over top of drainfield
H
• E
R I
• SPECIFICATIONS BY: James C Duncan TITLE: Environmental Specialist II
i APPROVED BY: TITLE,: Environmental S ecialist II
P St. Lucie c:
DATE ISSUED: 06/09/20 EXPIRATION DATE: 12/09/2012
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 AP1036808 SE845910
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STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
•�`°O"E''� APPLICATION FOR CONSTRUCTION PERMIT
APPLICATION FOR:
[ ✓] New System [ J Existing System [ ] Holding Tank
[ ] Repair [ ]. Abandonment [ ] Temporary
APPLICANT: (�eo rqe Q qc( 3U6 GtA -b•
AGENT: i►Zala5k f orKes the. / 61-u6r. A
i
PERMI NO o `�'
DATE PAID:
FEE PAID: i
RECEIPT #:
[ ] Innovative
[ ]
TELEPHONE : -S(v/- T %/ -
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MAILING ADDRESS : I3 bD /� . �/ ✓ / C1 / "C �`� ✓ �/ ' `- �`�
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TO BE COMPLETRD BY'APPLICANT OR APPLICANT'S AUTHORIZED AGENT. SYSTEMS MUST BE CONSTRUCTE
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.
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PROPERTY INFORMATION ry,/
LOT: 3 BLOCK: 3 6 SUBDIVISION: PLATTED: / 7"9
PROPERTY ID #: , YI & - /33 - DOD - 000- O ZONING: I/M OR EQUIVALENT: [ Y / N ]
q. otl2592
PROPERTY SIZE: ACRES WATER SUPPLY: [V/1 PRIVATE PUBLIC [ I<¢2000GPD [ ]>200`0GPD
IS,SEWER AVAILABLE AS PER 381.0065, FS? [ Y / N ] DISTANCE TO SEWER: 7J FT
PROPERTY ADDRESS: 3��� J. 3Y9-/9
DIRECTIONS TO PROPERTY:
BUILDING INFORMATION [ V] RESIDENTIAL. [ ] COMMERCIAL
Unit Type of
No Establishment
2.
3
4
[ ] Floor/Equ
SIGNATURE:
DH 4015, 08/09 (Obsoletes P.
Incorporated 64E-6.001, FAC
No. of Building Commercial/Institutional, System Design
Bedrooms Area Sqft Table 1, Chapter 64E-6, FAC
17
[ ] Other (Specify) (�
'�- DATE:
6-us editions which may not be used)
Page 1 of 4
a
STATE . OF FLORIDA APPLICATION # AP1036f
DEPARTMENT OF HEALTH PERMIT # 56-SF-1351
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM DOCUMENT # .SE845910
SITE EVALUATION AND SYSTEM SPECIFICATION
APPLICANT: George and Susan Pantuso
CONTRACTOR / AGENT:
LOT: 3
Dave M. Jones
BLOCK:
SUBDIVISION: ID# : 2426--133-0001-000-0
TO BE COMPLETED BY ENGINEER, HEALTH DEPARTMENT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEERS Mt
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: 4.06 ACRE:
TOTAL ESTIMATED SEWAGE FLOW: 700 GALLONS PER DAY [ RESIDENCES-TABLEI / OTHER -TABLE 2
AUTHORIZED SEWAGE FLOW: 6090.01 GALLONS.PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE
UNOBSTRUCTED AREA AVAILABLE: 1860.00 SQFT UNOBSTRUCTED AREA REQUIRED: 1750.00 SQF4
BENCHMARK/REFERENCE POINT LOCATION: TOP OF IRON ROD EL 42.22 NAVD
ELEVATION OF PROPOSED SYSTEM SITE 22.00 [ INCHES / FT ] [ ABOVE / BELOW ] BENCHMARK/REFERENCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES
SURFACE WATER: 600 FT DITCHES/SWALES: N/A FT NORMALLY WET: [ ]YES [X]1`
WELLS: PUBLIC: N/A FT LIMITED USE: N/A FT PRIVATE: 177 FT NON -POTABLE: N/A I
BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: 5 FT POTABLE WATER LINES: N/A I
SITE SUBJECT TO FREQUENT FLOODING? [ ]YES [X]NO 10 YEAR FLOODING? [ ]YES [X]N
10 YEAR FLOOD ELEVATION FOR SITE: FT[ MSL / NGVD ]' SITE ELEVATION: FT [ MSL / NGVL
SOIL PROFILE INFORMATION SITE 1 SOIL PROFILE INFORMATION SITE 2
USDA SOIL SERIES:St.
Munsell #/Color
Lucie sand'
Texture
Depth
1OYR 4/1
Fine Sand
0 To 10
1 OYR 7/1
Sand
10 To 40
1 OYR 7/1
Sand
40 To 60
1 OYR 8/6
Sand
60 To 72
USDA SOIL SERIES:St.
Munsell #/Color
Lucie sand
Texture
Depth
1 OYR 5/1
Fine Sand
0 To 8
1 OYR 7/1
Sand
8 To 36
1 OYR 8/1
Sand
36 To 72
OBSERVED WATER TABLE: 72.00 INCHES [ ABOVE / BELOW ] EXISTING GRADE TYPE: [ PERCHED / APPARENT
ESTIMATED WET SEASON WATER TABLE ELEVATION: 72 INCHES [ ABOVE / HELOW ] EXISTING GRADE
HIGH WATER TABLE VEGETATION: [ ]YES [X]NO MOTTLING: [ ]YES [ ]NO DEPTH: INCHE
•SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: Sand/0.80 DEPTH OF EXCAVATION: INCHE
• DRAINFIELD CONFIGURATION: [X] TRENCH [ ] BED [ ] OTHER (SPECIFY)
.r REMARKS/ADDITIONAL CRITERIA
SITE EVALUATED BY:
DATE: 05/31 /2011
Duncan, Jarltef(Title Env lonkfen'tal Sp cS list II) (St Lucie County Environmental Health)
DH 4015, 08/09 (Obsoletes previous editions whic may not be used) Incorporated: 64E-6.001, FAC
Page 3 of 4
LOT: BLOCK: SUBDIVISION:
PROPERTY ID'#? 2426 1.33 00001-000-0:. [Section%TowashWParcel:No or.Tax' ID Number]`:
TO BE' COMPLETED-'HY ENGINEER ,`HEALTH''DEPARTEMENT EMPLOYEE`,bX.OTHER'QUALIFIED PERSON 'INGINNEERS
MUST`"PROVIDE'';.REGISTRATION,.NUMBER AND-'SIGN.AND`:'SEAL•;EACH`,PAGE'.OF;.'SUBMIT TAL:,.'COMPLETE- ALL- .ITEMS ,
PROPERTY SIZE:,CONFORMS, TO SITE PLAN: [ `YES [ ] NO': NET..USABLE AREA'AVAILABLE U ACRES
TOTAL ESTIMATED SEWAGE FLOW %C)Ci GALLONS PEIf DAY [RESIDENCES TABLE 1/.OTHER-TABLE2]
AUTHORIZED SEWAGE FLOWG1'Coi� GALLONS PER DAY`: [15U0 GPD%ACRE; OR 2500 GPD/ACRE']
UNOBSTRUCTED:"AREA'AVAILASLE j i sD ..' 3QFT UNOB TRUCTED;-AREA REQUIRED• $QFT'.
(,� ! ii' dl✓Ci"S ll
BENCFII+IARK/REFERENCE POINT` LOCATION: /1/.Ini Y2'. ZZ1i/�.�7
ELEVATION OF, -PROPOSED SYSTEM: -SITE -IS [INCHES/•FT]r [ABOVE/BELOW] ' „NC ,:- /REFERENCE, POINT t;
s "
THE MINIMUM, -SETBACK WHICH CAN, BE MAINTAINED FROM THE 0 iSED`SYSTEM TO THE FOLLOWING'FEATURES
SURFACE WATER tJ FT DITCHE8/SWALES _ FT --"NORMALLY. .WETS [ ]''YES
WELLS: VbBLIC• FTC LIMITED IISE FT` PRIV_ATEs G► FT NON POTABLE: Z:- FT
BUILDING FOUNDAT. ONS S FT . PRO{ ERTY' LINES S FT POTABLE WATER' LINES
SITE SUBJECT TO "'FREQUENT'- FLOODING.; [A' ICES, _ [ XJ: NO 1O' • YEAR<. FLOODING? [ ] YES [ X] NO
10 'YEAR FLOOD=ELEVATION'°FOX-SITE.'•'.•. =• -:FT,SITE:.ELEVATION: FT' MSL/,NGVD
_t y
SOIL PROFILE INFORMATION SITE 1 SOIL .PROFILE INFORMATION SITE.;2
MUNSELL #/COLOR' TEXTURE DEPTH „' .,' .MUNSE=L;'#/COLOR TEXTURE DEPTH
2/2 "FS: "`: "p :T0',8" 10,' YR :;"•'S/1 FS 0 TO',?10"
lO. YR. ' T/2 FS A`, T0 22" 10' YR 7/?. FS 1U TO 24" ,
10 'YR 8/1 . - FS 22 ,To
24 TO`120"
TO
TO. _ TO
To
9,
TO , TO
TO
USDA SOIL -SERIES: 42-St:"'Lucie-Sarid USDA SOIL SERIES 42- Lucie Sarid'
OBSERVED WATER,TABLE. 12~0+. INCHES [ABOVE /BELOW]'; EXISTING GRADE TYPEajPERCHED /`APPARENT)
ESTIMATED WET ---SEASON, TABLE ELEVATION. 120+ } `.INCHR [A80VE /."BELOW EXISTING`GRADE }.
HIGH :WATER TABLE. VEGETATION .;[ ] YES [X,] NO ' ;MOTTLING [ '>] YES [X] 'NO DEPTH INCHES r
SOIL,TEXTURE/.LOADING RATE FOR SYSTEM"SIZING DEPTH OF `EXCAVATION: INCHES �`
DRAINFIELD CONFIGURATION'e [ ]:'"'TRENCH 's ''`[ l4 BED I ' I OTHER `(SPECIFY)
a
77,
REMRRKS/ADDITIONAL CRITERIA
'r 7
SITE EVALUATED BY D TE Ma '2' 201L! fir
to Paul'C MartinEA Y '
/• ' ♦ t
r.44GaiS,_:oe/o9 (oba'vyJw/lotus previous.editions-which:roar aotba A. '+ncarporated 64E6001,.FAC F Page 3 of 4
s PERMIT APPLICATION TO
CONSTRUCT REPAI:RMODIFY,
M. OR ABANDON A WELL
St. Lucie County Health Department This form must be completed by the
Environmental Health - Water Programs certified well contractor for approval
5150 NW Milner Drive Port St. Lucie, FL 34983 prior to well construction. .
Phone: (772) 873-4931 Fax: (772) 873-4893
9. Imo' eb✓q c '- a ja( Musa PL 7
Owner or Legaf Name of Pro erty gqwner //��
2. .5415 g - lh di k& Ki ve
Well Permit #:t
OSTDS Permit
Fee Amount
Date Paid:
WUP #:
��n-luso Po%�a� /1/0Al9 �r�
r Bailing
✓/ Vi✓
Well Location (Street Address and Directions)
3. 24 35
City / State Zip
AeaCe-, Al- 24479
Owner Phone No. -
City/ Zip
or 4d V toR'6 410S FEc
A2,4�/ HP -AS Aweift RlurD
Well Drilling Contractor Driller Mailing Address I 'City/State Zip Driller Phone No. Driller Fax No.
..................................................................................................................................................................................................
5. PROPOSED WELL:: New ❑ Replacement ❑ Abandonment ❑ Repair ❑ Other:
.........................................................................................................
...................................................
6. WELL TYPE: ®Single Family Drinking ❑ Single Family Irrigation
❑ DOH Public Drinking (> Duplex) < 15 Service Connections/Serves less than 25 people/ or no oral consumption) - WUP Required, Duplex N/A
DEP Public Drinking (> 15 Service Connections or Serves 25 people or more) - WUP Required
❑ Commercial Irrigation - WUP Required ❑. Monitor-Qry • ❑ Other (Explain):
..........................................................................................................................................................
7. SITE IS ON: ❑ SEWER ZNJ SEPTIC PROPOSED DISTANCE TO CLOSEST SEPTIC OR PUBLIC SEWER LINE: 7�
8. CUP/WUP: Is a Water Use Permit (WUP) required? ❑ YES ONO (If YES WUP must be attached)
9. CONSTRUCTION METHOD: 19 Rotary ❑ Cable Tool ❑ Other (Explain):
10. GROUTING METHOD: IRBentonite 19cement ❑ Other (Explain):
11. WELL CONSTRUCTION: FYfPVC ❑ Blk-Steel ❑ Galvanized ❑ Other (Explain):
12. CASING DIAMETER (SIZE): 3!�f 13. ESTIMATED: TOTAL DEPTH SCREEN INTERVAL FROM TOO
..................................................................................................................................:................................................................
14. PERMIT CONDITIONS:
♦ Contact St. Lucie County Health Department (SLCHD) the day before initiating drilling or abandonment operations and provide the driller name,
permit number, and estimated time drilling or abandonment will begin (Please contact an inspector directly 24 hours prior to drilling all public drinking
water wells). If construction does not occur and SLCHD is not notified and an SLCHD inspector visits the site on or after the estimated time, a reinspection
fee will be assessed.
♦ Detailed Site plan must be attached and show the proposed well location and distances to onsite building structures, property lines, all onsite and
neighboring septic systems and/or sewer lines or sewer systems, and all other applicable setbacks per Florida Statutes and Florida Administrative Code.
♦ This permit must be available at the well site during drilling or abandonment operations
..................................................................................................................................................................................................,
15. WELL CONTRACTOR PERMIT AGREEMENT: ; OWNER/AGENT PERMIT AGREEMENT:
I herby certifyihat I will comply with the applicable rules of Title 40, Florida Administrative Code, and that I certify that I am the owner of the property, that.the information
a water use permit or artificial recharge permit, if needed, will be obtained prior to commencement of well provided is accurate, and that I am aware of my responsibilities under
construction. I also certi that backs referenced in Rule 40E-3, Florida Administrative Code (FAC), ; Chapter 373, Florida Statutes, to maintain or properly abandon this
64E-8; FAC, and 2-5 , F , will a maintained. If above setbacks cannot be maintained a variance well; or, I clarify that I am the agen the owner, that the information
application wi a ie for and ned prior to drilling. I further certify that all information provided on , provided is urate, and that I ve in need the owner of his
this appli ati cu to nd at I ill obtain necessary approval from other federal, state, or local ; respons' Ilities as sta bov . Owner rise is to personnel of the
govegimen eli c do repo must be submitted to the District and the delegated ency w' In DOH a r r sent ive ce s to the I site.
30 da r rillin r the mtit iration, w ich er cc rs first.
' G(
Signature of Well Contractor License No. Date Owners or.Age nature Date
.......o............................DO NOT WRITE BELOW THIS LINE - FOR OFFICIAL USE ONLY ............................................
THIS PERMIT IS NOT VALID UNTIL PROPERLY SIGNED BY AUTHORIZED OFFICER OR REPRESENTATIVE OF THE ST. LUCIE COUNTY HEALTH DEPARTMENT.
PER IT IS VALID FOR 180 DAYS FRO DAT OF ISSUANCE
1.
Rgrmit Approved By: n, 1
PRINT A _ _._._._._ _ _ _ME SIGNATU_
_.. Issue Date:. ..
Distance to closest septic system or sewer line: Well Construction Method: Grout Material:
Inspectors Comments:
Approved By: Date:
�\SLCHD Rev 7/13/07 SIGNATURE
ct toJZavrenQ QGvtPtnr.