HomeMy WebLinkAboutAPPROVED Health Dept. PermitSTATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION PERMIT FOR: OSTDS NBW
APPLICANT: (Port St Lucie Properties)
PROPERTY ADDRESS: 7702 Hibiscus Rd Fort Pierce. FL 34951
LOT: 1Fi BLOCK: 4R SUBDIVISION: lakawnnrl Park
PERMIT #:56-SF-2350819
APPLICATION #:AP1714041
DATE PAID:
FEE PAID:
RECEIPT #:
DocUMENT #: PR1649644
PROPERTY ID #: 1301-605-0216-000-1 [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-61 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
T [
1,050 ] GALLONS / GPD
SBDfIC 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
[ J SQUARE
FEET
N/A
SYSTEM
A
TYPE SYSTEM:
[ ]
STANDARD [
] FILLED
[x] MOUND [ ]
I
CONFIGURATION:
[ ]
TRENCH [x]
BED
[ ]
N
F LocATION of BENCHMARK: NID SW OF PROPERTY EDGE OF ROAD
I ELEVATION OF PROPOSED SYSTEM SITE [ 8,00 ][ INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 11.00][ INCHES FT ][ABOVE BELOW] BENCHMARK/REFERENCE POINT
L
D ]
0
T
H
E
R
REQU11tEU: L 3/.UV] INCHES EXCAVATION REQOIRED: f J 1NCMEu
system is sized for 4 bedrooms with a maximum occupancy of 8 persons (2 per bedroom), for a total estimated flow of
9pd•
SPECIFICATIONS BY: Matthew S Vajanyi TITLE: Environmental Specialist I
APPROVED BY: TITLE: Environmental Specialist I
Matthew S Va7an I
DATE ISSUED: 09/22/2021 EXPIRATION DATE:
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC
St,
Lucie cxD
03/22/2023
Page 1 of 3
v 1. 1.4 AP1714041 SE1596025
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 28A 06, 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 850413-8743.
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 APPLICATION # AP1714041
DEPARTMENT OF HEALTH
PENT # 56-SF-2350819
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATION DOCUMENT # SE1596025
APPLICANT: Port St LUCIe
CONTRACTOR / AGENT:
K(IS[en
MOntal[O
LOT: 16
BLOCK: 48
SUBDIVISION:
Lakewood
Park
ID#:t301-605-0216-000-1
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: 0,38 ACRES
TOTAL ESTIMATED SEWAGE FLOW:
400
GALLONS
PER DAY [ RESIDENCES -TABLET /
OTHER -TABLE 2 ]
AUTHORIZED SEWAGE FLOW:
570,01
GALLONS
PER DAY [ 1500 GPD/ACRE OR
2500 GPD/ACRE ]
UNOBSTRUCTED AREA AVAILABLE:
1000,00
SQFT
UNOBSTRUCTED AREA REQUIRED:
1000,00 SQFT
BENCHMARK/REFERENCE POINT LocAT2ON: NID SW OF PROPERTY EDGE OF ROAD
ELEVATION OF PROPOSED SYSTEM SITE 8.00 C 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: FT
NORMALLY WET: [ ]YES
[ ]NO
WELLS: PUBLIC: FT
LIMITED USE: FT PRIVATE: 85
FT NON -POTABLE:
FT
BUILDING FOUNDATIONS: 8
FT PROPERTY LINES: 11 FT
POTABLE WATER LINES:
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 INFORMATION SITE 2
USDA SOIL SERIES:
Munsell #/Color Texture Depth
1OYR 3/1 Sand 0 To 11
1OYR 4/1 Sand 11 To 17
10YR 5/1 Sand 11 To 22
10YR 6/1 Sand 17 To 22
1 OYR 6/3 Sand 22 To 39
REFUSAL Refusal 39 To 72
USDA SOIL SERIES:
Munsell #/Color Texture Depth
10YR 3/1 Sand 0 TO 11
10YR 5/1 Sand 5 TO 11
10YR 6/1 Sand 5 To 11
2.5Y 4/2 Sand 11 To 16
2.6Y 5/3 Sand 16 To 25
REFUSAL Refusal 25 To 72
OBSERVED WATER TABLE; 6.00
USDA SOIL SERIES:
Munsell #/Color Texture Depth
10YR 3/1 Sand 0 TO 11
10YR 5/1 Sand 5 TO 11
10YR 6/1 Sand 5 To 11
2.5Y 4/2 Sand 11 To 16
2.6Y 5/3 Sand 16 To 25
REFUSAL Refusal 25 To 72
OBSERVED WATER TABLE; 6.00
OBSERVED WATER TABLE; 6.00
INCHES [ABOVE
EXISTING GRADE
TYPE;
[ PERCHED / APPARENT ]
ESTIMATED WET SEASON WATER TABLE
ELEVATION: $
INCHES [ABOVE
/ BELOW ]
EXISTING GRADE
HIGH WATER TABLE VEGETATION:
[ ]YES [X]NO
MOTTLING: [X]YES
[ ]NO
DEPTH: 5,00 INCHES
30IL TEXTURE/LOADING RATE FOR SYSTEM SIZING:
Sand/0.60
DEPTH OF EXCAVATION:
SWT determined using USDA WSS and soil borings. 10YR611 stripping in a 10YR5/1 matrix > 10 % with diffuse boundaries starting
5" in 8132. 861 2" below BM. SB2 8" below BM.
SITE EVALUATED BY:
U y.(31fre: [
OH 40150 OB/09 (Obeoletes previous editions which may not be used) Incorporated: 64E-6.001, FAC
AP1774041 EID2350819
INCHES
DATE: 09/20/2021
Page 3 of 4
v 1.0.2
/ BELOW j
SITE EVALUATED BY:
U y.(31fre: [
OH 40150 OB/09 (Obeoletes previous editions which may not be used) Incorporated: 64E-6.001, FAC
AP1774041 EID2350819
INCHES
DATE: 09/20/2021
Page 3 of 4
v 1.0.2
/ BELOW j
AP1774041 EID2350819
INCHES
DATE: 09/20/2021
Page 3 of 4
v 1.0.2
/ BELOW j
_ St. Lucie County Health Department
5150 NW Milner Dr Port Saint Lucie, FL 34983
HoIAUTH
PAYING ON: #:56-SF-2350819 BILL ooC#:56-13I1]1-5530443 CONSTRUCTION APPLICATION#: AP1714041
RECEIVED FROM: Kristen Montalto AMOUNT PAID: $ 545.00
PAYMENT FORM: CREDIT CARD 000884 PAYMENT DATE: 08/13/2021
MAIL TO: (Port St Lucie Properties)
FACILITY NAME
PROPERTY LOCATION:
7702 Hibiscus Rd
Fort Pierce, FL 34951
16
Lot:
Property ID:
1301-605-0216-000-1
EXPLANATION or DESCRIPTION:
48
Block:
128 - OSTDS Construction System Inspection Research Fee
-1 - Surcharge (All)
-1 - OSTDS New Permit Surcharge
A - 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
RECEIVED BY: AdamsC _
Note: Well from Down the Hole being sent separately
QUANTITY FEE
1
$
45.00
1
$
100.00
1
$
100.00
1
$
115.00
1
$
55,00
1
$
75,00
1
$
50,00
AUDIT CONTROL NO. 56-PID-5157790
� IE
T STATE OF FLORIDA
r' w DEPARTMENT OF HEALTH
�c> ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
APPLICATION FOR CONSTRUCTION PERMIT
APPLICATION FOR:
PERMIT NO. ��2�` 02)lC
DATE PAID: �j 'Z'
FEE PAID: --
RECEIPT #: C))0)03
(✓] New System [ ] Existing System ( ] Holding Tank [ ] Innovative
( ] Repair [ ] Abandonment [ ] Temporary [ ]
APPLICANT : Port St Lucie Properties Inc.
AGENT: Kristen Montalto TELEPHONE: (772)281-8584
MAILING ADDRESS: 201 SW PSL Blvd. PSL, Fl. 34984
---------------------------------------------------------------------------------------
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.
i•���Fi9\LaC�IiuY�i{�1�1
LOT: 16
BLOCK: 48 SUBDIVISION: Lakewood Parlc Units
PLATTED:
Y
PROPERTY
ID #: 1301-605-0216-000-1 ZONING: RS-4
I/M OR EQUIVALENT:
[ No ]
PROPERTY
SIZE: 0.34 ACRES WATER SUPPLY: [ ✓] PRIVATE
PUBLIC [ ]<=2000GPD [
1>2000GPD
IS SEWER
AVAILABLE AS PER 381.0065, FS? [ No ]
DISTANCE TO SEWER:
NA FT
PROPERTY ADDRESS : 7702 Hibiscus Road, Fort Pierce, F134951
DIRECTIONS TO PROPERTY: Northwest comer of the intersection of Hibiscus Road and Fort Pierce Boulevard.
BUILDING
Unit Type of
No Establishment
1 Single Family
2
3
4
[ ✓ ] RESIDENTIAL [ ] COPII9ERCIAL
No. of Building Commercial/Institutional System Design
Bedrooms Area Sqft Table 1, Chapter 69E-6, FAC
4 1799,000
[ ] Floor/Equipment Drains [ ] Other (Specify)
SIGNATURE
DH 4015, 08/09 (Obsoletes previous editions which may not be used)
Incorporated 64E-6.001, FAC
Page 1 of 9
Michelle
Franklin, CFA -- Saint Lucie County
Property Appraiser -- All
rights reserved.
Property Identification
Site Address: 7702
Parcel ID: 1301-605-0216-
Account ff: 1245
Sec/Town/Range: 11/34S/39E
HIBISCUS RD
000-1
Map ID: 13/1IN
Zoning: RS-4 Count
Use Type: 0000
Jurisdiction: Saint Lucie
County
Ownership Legal Description
Sabrina Parker Cooper LAKEWOOD PARK -UNIT 5- BLK 48 LOT16 (MAP 13/11N)
194 Spivey Ridge CIR
Jonesboro, GA 30236
Current Values
Historical
Values 3-year
Just/Market: $19,800 Assessed: $13,930 Year
Just/Market
Assessed
Exemptions
Taxable
Exemptions: $0 Taxable: $13,930 2021
$19,800
$13,930
$0
$13,930
2020
$13,000
$12,664
$0
$12,664
2019
$13,800
$11,513
$0
$11,513
Date
04-07-2021
08-26-2014
01-01-1900
View:
Year Built: N/A
Primary Wall:
Bedrooms: 0
Full Baths: 0
Half Baths: 0
Sale History
Book/Page Sale Code Deed Grantor
4591 / 2458 0001 WD Ragan 11 Harry E
3673 / 1925 0119 PR Ragan (EST) Marguerite S
Primary Building Information
Finished Area of this building: 0 SF
Gross Sketched Area: 0 SF
Roof Cover:
Frame:
Story Height:
Heated %: N/A
Sprinkled %: 0%
Exterior Data
Roof structure:
Grade:
No. Units: 0
Interior Data
Electric:
Heat Type:
Heat Fuel:
Total Areas
Price
$35,000
$0
$0
Building Type:
Effective Year: N/A
Secondary Wall:
Primary Int Wall:
Avg H5UFloor: 0
Primary Floors:
Finished/Under Air 0
(SF):
Gross Sketched Area 0
(SF):
Land Size (acres): 0.38
Land Size (SF): 16,516
Total Building Count: I
Special
Features
and Yard
Items
Type
Qty
Units
Year Blt
All inforntation is believed [o be correct at [his [itne, but is subject to change and is provided without any warcanty.
® Copyright 2021 Saint Lucie County Property Appraiser. All rights reserved.
STATE OFFLORIDA PERMITAPPLICATIONT000NSTRUCT, — _235D r1 /
REPAIR, MODIFY, OR ABANDON A WELL LPormhS9puIaVon:9A:aquIrad
59.32428
OSoulhwest pLEASEPILLOUTAILAPPLICneLEFIEL03 Floridato
❑ Northwest (Denotes Required Flelde Wnere Applicable)ns RagfdreJ (sae Allaalled)
❑SL Johns klver .IlJatlninte RirharamlandranvnfJlupllmpim1It#MPmadn to rho o,Dalfnoellon No,
le
OSuwanneaRlver ODEPlca0on No,
O Delegated Authority (If Applicable)
2"77 Hibiscus Road Ft Pierce FI 34951 "' Omra nr Telephone Number
'W011 Locallcm dA ress, Road Nenlo or Number, ol(y
3,1301-605-0216-000-1 �_ 48
4 ' Qa1cal ID No, (PIN) or Ailamata Key (Circle one) Lot Block Vnll
3 39E St Lucie Check If62-624:❑ Yes0 No
'SecllonorLandGrant Township 'Range County Subdivision 61 James Paul Tyson 11362 964.618.4269 downthehofe@att.net
r Water vvell unniromor 'License Number Telephona Number E•mall Address
6, PO BOX 881496 Port St, Lucia FI 34988
Walar Woll Contra ar's Address city stole ZIP
7. 'TypeorWorlc CConstnmt�n [j Repair ❑ MDdifIcadon❑ Abandonment
0, 'Number of Proposed Wells 'Hvmonrernopoir, modia"O or d nrae o o �%/� j
a, 'specify Intended Use(s) of W011(s): d o m V L
Domestic ® Landscape Irrigation ® Agioulluml Irrigation SI10 Investigations
Bottled Water Supply Racreallon Area letgatlon Livestock Monitoring
Public WnrorSupply(Llmtled Use/DOH) Nureary irrigation Test SEP ?_ 8 2021
Public Water Supply (Community or Non•Cammunfty/0EP)� Oommorclalllndusiriol Eanh-Caupletl Geothermal
Class I Injection (act(' lrcigellan HVAC Supply
PP Y
Class V Injactlom ❑ Recharge Commercrelllndusldal Dis oe01 HVAC Reluf
❑ P ❑ AqulferStorage and Recovery] Drainage FDOH In St Lu le County
Remedlalion:❑ Recovery❑ AlrSparge ❑ Other (D000boll F�ayai�� EN 4LHEALTH
Other (Dds<(Ibo)
10.•Dtelence from Septa System If 5 200 A, 75+ 11. Faclllly Description KeSIdOn0O 12, Estimated start Dale
13.'EaUmated Well Depth 120 g, •Eallmoted Oesing DepIh100 R. Primary Cearng Dlameler 2 In. Opsn Hole: From__To �_8,
14. Estimated Screen Interval: From 100 To 120 ft.
lb.'Pdmary Casing Material: Black$lost Galvanized Stainless Steel
Not Cased Other:
16. Secondary Casing: Telescope Casing Linar SurfactrCeatng Dlamohrr_ln.
17. Secondary Casing Material; Black Steel Galvanized PVC Stainless61001 Olhcr
I B.'Melhad of Conslmollon, Repair, or Abandonment Auger Cable Toot Jetted q&st Sonic
Combination (Two or More Methods) Hand Driven (Well Point, Sand point) Hydraulic polm (Direct push)
Horizontal Drilling Plugged by Approved Method Other (Dm4dbd)
106 Proposed Grouting In arval forthe Primary, Secondary, and Ad ofng:
From n ,,, 70 9� Seal Materiel ( Bentonlfe a enl Other )
FrOIIL_ To _ Seal Materiel ( Banlonlle eo amen! Other_ )
From To _ 'East Materiel ( 6onlonlla Neat Cement Other. )
From To Seal fvlefedal( Bonlanlle Neat Cement Other. 1
20. Indicate (star number ofexlating walls on alto 0 List number of existing unused walls on site 0
216'1e1 le we�llpqrenyexlsllnppwell orwalerwilhdrtNNaaNUwwYYYVaLLL000nthe Dwnefe conllpuppuspprapQQ��yyc�ppv�gqrepd Under Consumpllve/Waler Use permit (CUPIWUP)
OaC PMIUP Application Yee �a fyes, complete the 0110winOovUl'/WUP No, Dlstict Well lD No,
22, Latitude Long e
23, Dale Ohl0lned From: OPS Mop Survey Dalum __NAD 27 __NAD 03 _WG3 84
Inu,eveerAmmvu e,mdr,anm..ae,.a„1e,,,,,,,11.......................' —... _. _
11362
'Llconro No.
Approval Granted
Faa Racolvod 8_
Exnlrnllon I
Check
THIS PERMIT 19 NOT VALID UNTIL PROPERLY 31aNfip DV AN AUTHORI2E0 OFFICER OR nGPRESENTATIVa OF THE WMD OR DELEOATEO AUTHORITY, THE PERMIT SHALL BE AVAIIAaLEAT THE VJELLBITE DURINOALL CONSTRUOTION, REPAIR. MDOIFICATION. nR nnnrdnnue,cem
REFERENCE POINT:
NID SW OF PROPERTY EDGE OF ROAD.