HomeMy WebLinkAboutHealth Department Septic Approval C r Z3.�SZ3 Y
STATE OF FLORIDA PERMIT APPLICATION TO CONSTRUCT, 5 -
•, Tilt ril�� REPAIR,MODIFY,OR ABANDON A WELL Perrnd No. 59.324 6
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t i+r• �; •' 'a PLEASE FILL CUT ALL APPLICABLE FIELDS Florida Unique ID I
❑Northwest (•Denotes Required Fields Where Applicable). Permit Stipulations Required(See Attached)
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DUth FIOfi d-alp/ tlds='. dfiemanfngthepermirapplicatrontothe 62-S24 Ouad No. - Delineation No.
``�4litislt���, '-GadwametrRIver approprlate4olegdtedouthodtywhereapplicabla
{ 3 DEP CUPMlUA Application No.
k - 17 Delegated Authority(If Applicable) ,
i.Marvin Watson Elizabeth Sca 3605 Wilderness Drive East Fort Pierce FL 34982 .
i 'Owner,Legal Name-if Corporation "Address -city "State 'ZIP Telephone Number
2. 1305 Lone Pine Drive Fort Pierce FL 34982
i 'Well Location-Address,Road Name or Number,City
3.3409-505.0028-000-6 22/23
%Parcel lD No.(PIN)or Alternate Key(Circle One) Lot Block Unit
4.09 368 40E St Lucie Lone Pine S/D Check If 62-524:❑ Yes❑No
Section or Land Grant 'Township *Range *County Subdivision
P 5.Scottfs Drilling, Inc. 11213 772-489-6117 scottsddlling@belisouth.net
'Water Well Contractor 'License Number 'ratephone Number E-mail Address
'6;5014 Palm Drive Fort Pierce FL 34982
"Water Well Contractor's Address City State ZIP
( 7. `Type of Work: [0 construction [] Repair ❑ Modification❑ Abandonment
8. 'Number of Proposed Wells ONE 'Reason for Repatr,Modincefbn,or abandonment -
j 9. *Specify Intended Uses)of Well(s): D
i ❑ Domestic 8 Landscape Irrigation ® Agricultural Irrigation 8 Site Investigations
❑ Bottled Water Supply Recreation Area Irrigation Livestock Monitoring
j Public Water Supply(Limited Use/DOH) Nursery irrigation Test
Public Water Supply(Community or Non-Community/DEP) CommerciainndusMal Earth-Coupled Geothermal S E Q 2021
Class I Injection Golf Course Irrigation HVAC Supply
j HVAC Return
Class V Injection:❑ Recharge [] Commerclaillndustrial Disposal ❑ Aquifer Storage and Recovery❑ Drainage .
Remedlation:❑ Recovery❑ Air Sparge ❑ Other (Descrme) F OH 1n St Lucie Coun
t n }�
❑ Other Poserihe)
10.'Distance from Septic System If 5 200 ft f 11.Facility DesalptionSingle Faml y .Residence 12.Estimated Start Date
b( 13"Estimated Well Depth 120 ft, -Estimated Casing Depth 100 g, Primary Casing Diameter 2 tn. Open Hole: From To A
14.Estimated Screen Interval:From 100 To 120 fL
15."Primary casing Material: Black Steel Galvanized 4�1
Stainless Steel
Not Cased Other._ _
16.Secondary Casing: Telescope Casing Liner Surface Casing Diameter In.
11 17.Secondary Casing Matedef: Black Steel Galvanized PVC Stainless Steel r
4 18'Method of Construction.Repair,or Abandonment: Auger Cable Tool Jetted a;P�oint
otSonic
Combination-(Two or More Methods) Hand Driven(Well Point,Sand Point) (Direct Push)
Horizontal Drilling Plugged by Approved Method Other (Describe)
19.Proposed Grouting Interval for the Primary,Secondary,anqVNeat
nal Casin
I From o To 100 Seal Material( Bentonite _C(!Se t' Other )
Front - To Seal Material( Bentonite ement OtherFrom To Seal Material( Bentonitet Cement Other )
From To Seat Material( Bentonite Neat Cement Other )
I20.Indicate total number of existing wells on site List number of existing unused wells an site
21-Is this well or any existingg well or waterCL
rawa n the owner's contiguous property covered under a ConsumpttvelWater Use Pen P(WUP)
f or CUPMNP Application? Yes ,/ No f yes,complete the following:CUP/WUP No. District Wel!I Na.
22.Latitude o ude
I
23.Data Obtained From: GPS Map Survey Datum: NAD 27 NAD 83 84
l hereby dersry W I win WM*wo the,oppncnble rhlea of Tel■ap,Fladda Admfnistra lw Code,and Wni a water 1 eWj that I nm the mar of Cis property,fhat the lerarmattan piaAded Ls e,and plat I un aware otmy
teopafmHofaNndarrecitetpepamlLLffn6eded,has bcanarwlq�ablaNadprforlaoommaneaaptatt'tell taapansmtpl4sunderChaptar973,F1ottdaSlalulea,tamaNtalnorptopMtyaha Ihlsrwaar,IeaNrylMllam
I camWctlon.IraM■r eenty-thaldfnrmmogon tuer{pedNads application Is era rala and mellwfaarwn Ina sO■nl rorth.wnror,hattnehfamurlen pmv dedh■aurala sna tn■tlhave fekrrnedw ownoratnetr
I nacrosaty■ppruvalsumaaKrfedaN:alai".arbutpavmmnaniti,Mapplcatia.lapreotopmHdaawe9 nsponslhtinasas ledobovo,orrnerconsafdstosumMpp■rsannifoflhbWAlOorUt�ledAuprorayoao■aa
eomptalan ropod to the OFSM wnHn Se days amw eorrilation or the eonsfmcuon,mpaV■modJaopon,or tbwewonaEa aW cwrsvuafan.repaU,rmdlaratbn,of 4"odarlawt"artmd IN Nis pamdL
ahardoomer dby dtb pooh.or the pmrO ozptrallan,whteheverocan tusl.
11213,
�l 'Sign re of Contractor aUcense No. �*Slgnatklea_f Owner or Agent *Date I`
Approval Otanlyd 8 Issue Date Expiration Date Hydrologist Approval 'rodsro I
Fee Received $ Receipt No. Check No.
k THIS PERMIT IS NOT VALID UNTIL PROPERLY SIGNED BY AN AUTHORIZED OFFICER OR REPRESENTATIVE OF THE VVMD OR DELEGATED AUTHORITY. THE
PERMIT SHALL BE AVAILABLE AT THE WELL SiTE DURING ALL CONSTRUCTION,REPAIR,MODIFICATION,OR ABANDONMENT ACTIVITIES.
DEP Fonn:92-532.e00(1) Incorporated In 82-532.400(1),F.A.C. Effective Date:October 7,2010 Page 1 of 2
STATE OF FLORIDA PERMIT NO.
DEPARTMENT OF- HEALTH DATE PAID: V-Z712-(
ONSITE SEWAGE TREATMENT
REATMENT AND DISPOSAL FEE PAID:
SYSTEM RECEIPT #:
APPLICATION FOR CONSTRUCTION PERMIT
APPLICATION FOR:
[v/] New System Existing System Holding Tank f I Innov'Ative
f I Repair Abandonment Temporary . . C I
APPLICANT: ftcb&A,
AGENT: &) TELEP!iONE:_772. _,2ol
MAILING ADDRESS.,
TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. SYSTEMS- MUST BE CONSTRUCTED
BY A PERSON LICENSED PURSUANT TO 489.103(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 .
ATTED (MM/DD/YY.) .IF REQUESTING CONSIDERATION OF STATUTORY GRANDFATHER PROVISIONS.
----------- --------- - - ------------
PROPERTY -INFORMATION
1. 2-1 .
LOT. BL.00R, SUBDIVISION- PLATTED: pg.j
PROPERTY ID #: 3�aci 5'o5 M,_y (2 a 6 b ZONING: I/M OR EQUIVALENT. [ PIN ]
74 . ]-�=2.000GPD E 1>2000GPD
PROPERTY SIZE.; ACRES WATER SUPPLY. [V PRIVATE PUBLIC
IS SEWER AVAILABLE AS PER 381.0063,- FS? r Y/& I DISTANCE TO SEWER: FT
PROPERTY ADDRESS:
DIRECTIONS TO PROPERTY:
19) tz.T OV4 Ia,.e pl'n-
.RuILDING INFORMATION V1 RESIDENTIAL COMMERCIAL
IAL
Unit Type of 'No,. of Bui2gin4 CoMMeeceial/*3:iiEit.i.tuti.bnal System Design
NO Establishment.
'Bedrooms Area Sqk.t Table I, Chapter 54S-4, FAC
Gl'n )t 3;4 4
2
3
4
1 Floor/Equ
ipment Drains Other (Specify)
SIGNATURE: DATE...
DH 40I5, 08'I09 (Obsoletes previous' editions which may not be iised).
incorporated 64E-6.001, FAC Page 1 of 4
PERMIT #:56-SF-2355234
STATE OF FLORIDA APPLICATION #:AP1717076
DEPARTMENT OF HEALTH DATE PAID:
ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID:
SYSTEM
RECEIPT #:
a%WMZI DOCUMENT #:PR1650431
CONSTRUCTION PERMIT FOR: OSTDS New
APPLICANT: Marvin Watson
PROPERTY ADDRESS: 1305 Lone Pine Dr Fort Pierce, FL 34982
LOT: 22-23 BLOCK: SUBDIVISION: Lone Pine
PROPERTY ID #: 3409-505-0028-000-6 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
[OR TAX ID NUMBER]
I
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 Septic New CAPACITY
A, [ ] GALLONS / GPD N/A CAPACITY
N! [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
Ki [ ] 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: PAINTED NID NW OF PROPERTY CL OF RD
I ELEVATION OF PROPOSED SYSTEM SITE [ 4.00 ] [ INCHES FT ] [ ABOVE BELOW]BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 10.00 ] [ INCHES FT ] [ ABOVE BELOW]BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: [24.00] INCHES EXCAVATION REQUIRED: [ ] INCHES
The system is sized for 3 bedrooms with a maximum occupancy of 6 persons(2 per bedroom),for a total estimated flow of
0 400 gpd.
T
H
E
R
SPECIFICATIONS BY: Matthew S Vajanyi TITLE: Environmental Specialist I
APPROVED BY: � --IMTLE: Environmental Specialist I St. Lucie CHD
Matt ew S Vajanyi
DATE ISSUED: 09/28/2021 EXPIRATION DATE: 03/27/2023
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 AP1717076 SE1596883
STATE OF FLORIDA APPLICATION # AP1717076
DEPARTMENT OF HEALTH PERMIT # 56-SF-2355234
;.. c
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATION DOCUMENT # SE1596883
%W"Vz� .
APPLICANT: Marvin Watson
CONTRACTOR / AGENT: DiFrancisco Construction Inc.
LOT: 22-23 BLOCK:
SUBDIVISION: Lone Pine ID#: 3409-505-0028-000-6
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: 0.76 ACRES
TOTAL ESTIMATED SEWAGE FLOW: 400 GALLONS PER DAY [ RESIDENCES-TABLET / OTHER-TABLE 2 ]
AUTHORIZED SEWAGE FLOW: 1140.01 GALLONS PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE ]
UNOBSTRUCTED AREA AVAILABLE: 1000.00 SQFT UNOBSTRUCTED AREA REQUIRED: 1000.00 SQFT
BE ICHMARK/REFERENCE POINT LOCATION: PAINTED NI NW OF PROPERTY CL OF RD
ELEVATION OF PROPOSED SYSTEM SITE 4.00 [ INCHES / FT ] I ABovE / BELOW ] BENCHMARK/REFERENCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES
S ACE WATER: 160 FT DITCHES/SWALES: FT NORMALLY WET: [ ]YES [ ]NO
WELTS: PUBLIC: FT LIMITED USE: FT PRIVATE: 90 FT NON-POTABLE: FT
BUILDING FOUNDATIONS: 10 FT PROPERTY LINES: 54 FT POTABLE WATER LINES: FT
SITE SUBJECT TO FREQUENT FLOODING? [ ]YES EX]NO 10 YEAR FLOODING? [ ]YES [X]NO]
10 TEAR FLOOD ELEVATION FOR SITE: FT [ MSL / NGVD ] SITE ELEVATION: FT [ MSL / NGVD
SOIL PROFILE INFORMATION SITE 1 SOIL PROFILE INFORMATION SITE 2
i
USDA SOIL SERIES: USDA SOIL SERIES:
Munsell#/Color Texture Depth Munsell#/Color Texture Depth
10YR 3/1 Sand 0 To 20 1 OYR 3/1 Sand 0 To 18
10YR 5/2 Sand 20 To 46 1 OYR 5/1 Sand 18 To 27
10YR 6/2 Sand 20 To 46 1OYR 6/1 Sand 18 To 27
10YR 4/2 Loamy Sand 40 To 46 10YR 3/3 Sand 27 To 42
10YR 4/2 Loam 46 To 52 1 OYR 4/2 Sandy Clay Loam 42 To 62
REFUSAL Refusal 52 To 72 10Y 5/1 Sandy Clay Loam 60 To 62
REFUSAL Refusal 62 To 72
OBSERVED WATER TABLE: 33.00 INCHES [ ABOVE / BELOW ] EXISTING GRADE TYPE: [ PERCHED / APPARENT ]
ESTIMATED WET SEASON WATER TABLE ELEVATION: 18 INCHES [ ABOVE / BELOW ] EXISTING GRADE
HIGI WATER TABLE VEGETATION: [ ]YES [ ]NO MOTTLING: [X]YES [ ]NO DEPTH: 18.00 INCHES
SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: Sand/0.60 DEPTH OF EXCAVATION: INCHES
DRAINFIELD CONFIGURATION: [ ] TRENCH [X] BED [ ] OTHER (SPECIFY)
REMARKS/ADDITIONAL CRITERIA
WSWT determined using USDA WSS and soil borings.10YR6/1 stripping in a 10YR5/1 matrix>10%with diffuse boundaries starting
at 18"in S62.SB1 2"above BM. SB2 4"above BM.
SITE EVALUATED BY: y?/ DATE: 09/27/2021
-T� Vajanyl,Matthew(T Ironmental Specialist 1)(Florida Department of Health in S
DH 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated: 64E-6.001, FAC Page 3 of 4
AP1717076 EID2355234 v 1.0.2