HomeMy WebLinkAboutSewageSTATE OF FLORIDA
" DEPARTMENT OF HEALTH
�a. ONSITE SEWAGE TREATMENT AND DISPOSAL
„�1�j4`' SYSTEM!
APPLICATION FOR CONSTRUCTION PERMIT
• APPLICATION FOR:
r3' New System I ] Existing System [ ] holding Tank
[t''] -Repair [ ] Abandonment [ ] Temporary
PERMIT NO.
DATE PAID: ? 2-
FEE PAID:
RECEIPT #:
[ ] Innovative
APPLICANT: , A A
slit, TELEPHONE: %L/
�y
MAILING ADDRESS: 4J1 ,bV Pi if iree.0
TO BE COMPLETED BY APPLICANT OR APPLICANTS AUTHORIZED AGENT. 'SYSTEMS MUST BE.CONSTR:IICTED
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
LOT: BLOCK: 1 7 SUBDIVISION: Ui1.� PLATTED:
PROPERTY ID # : _ � 301 �o o S -- ()qdO Oct - C ZONING : I /M OR EQUIVALENT.- [ Y& ]
PROPERTY SI'ZE: .�� ACRES WATER SUPPLY: // PRIVATE PUBLIC ]mac]'<=2000GPD [ ]>2000GPD
IS SEWER AVAILABLE AS PER 381.00'69,. FS? [ Y (9 ] DISTANCE TO SEWER: FT
PROPERTY ADDRESS: qoo 7 4't�j �,SC �G S ��1// Gl
DIRECTIONS TO PROPERTY: Pad ln1 eS--r Mkki n
r i �� i-osn } i� e r c e �� i v��l -r C i r n 1N es� o n I�. ,10i S C -k.5, ��t L C.'s 1-
F. ,SP(iii,noj e �4<x
BUILDING INFORMATION ,LNeRESIDENTIAL [ ] COMMERCIAL
Unit Type of No. of Building Commercial/Institutional System Design
No Establishment Bedrooms Area Sqft Table 1, Chapter 64E-6, PAC
1 ' I
2
3
4
i
[ ] Floor/Equipment ,Drains [ I Other (Specify)
RE
SIGNATURE:
W
DATE: 1 S
DH 4015, 08/0.9 (Obsol•etes previous editions which may nob be used)
Incorporated 64E-6.001, FAC Page 1 of 4
Y`
St. Lucie County Health Department
5150 NW Milner Dr Port Saint Lucie, FL 34983
HEALTH
PAYING ON: #: 56-SF-2350643 BILL Doc #:56-BID-5523331 CONSTRUCTION APPLICATION #: AP1713927
RECEIVED FROM: Ashton AMOUNT PAID: $ 660.00
PAYMENT FORM: CREDIT CARD 012225 PAYMENT DATE: 08/12/2021
MAIL TO: (St Lucie Habitat for Humanity)
FACILITY NAME:
PROPERTY LOCATION:
8007 Hibiscus Rd
Fort Pierce, FL 34951
22
Lot:
Property ID: 1301-605-02000-000-6
Block: 47
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
123 - OSTDS Construction Site Evaluation
1
$
115.00
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
-1 - Well Construction
1
$
115.00
AS
RECEIVED BY: AdamsC AUDIT CONTROL NO. 56-PID-5157135
Note: Well#59-32383
AUTHORIZED SEWAGE FLOW:
UNOBSTRUCTED AREA AVAILABLE:
BENCHMARK/REFERENCE POINT LOCATION:
ELEVATION OF PROPOSED SYSTEM SITE
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATION
APPLICANT: St Lucie Habitat for H
CONTRACTOR / AGENT: Ashton
LOT: 22
BLOCK: 47
APPLICATION # AP1713927
PERMIT # 56-SF-2350643
DOCUMENT # SE1595916
SUBDIVISION: Lakewood Park ID#: 1301-605-02000-000-6
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:
TOTAL ESTIMATED SEWAGE FLOW: 300
420.01
818.00
[X]YES [ ]NO NET USABLE AREA AVAILABLE: 0.28 ACRES
GALLONS PER DAY [ RESIDENCES -TABLET / OTHER -TABLE 2 ]
GALLONS PER DAY [ 1500 GPD/ACRE I OR 2500 GPD/ACRE ]
SQFT UNOBSTRUCTED AREA REQUIRED: 750.00 SQFT
PAINTED LARGE NAIL ON CORNER OF BEND BTWN HIBISCUS AND SEMINO
0.00 [ INCHES / FT ] [ ABOVE / BELOW ] BENCHMARK/REPERENCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES
SURFACE WATER: 90 FT DITCHES/SWALES: 20 FT NORMALLY WET: [ ]YES [ ]NO
WELLS: PUBLIC: FT LIMITED USE: FT PRIVATE: 84 FT NON -POTABLE: FT
BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: 7 FT POTABLE WATER LINES: 25 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
RATT. PROFTT.F. TNFnRMATTON RTTF. 1 ROIT. PROFTT.E TNFORMATTAN RTTE 2
USDA SOIL SERIES:
Munsell #/Color
Texture
Depth
I OYR 5/1
Sand
0 To 17
10YR 6/1
Sand
17 To 23
1 OYR 7/1
Sand
17 To 23
10YR 6/2
Sand
23 To 36
1OYR 2/2
Spodic Material
36 To 44
5Y 6/2
Silty Clay Loam
44 To 45
REFUSAL
Refusal
45 To 72
USDA SOIL SERIES:
Munsell #/Color
Texture
Depth
1 OYR 5/1
Sand
0 To 19
10YR 6/1
Sand
14 To 24
10YR 6/2
Sand
19 To 42
5Y 6/2
Sandy Loam
42 To 43
REFUSAL
Refusal
43 To 72
OBSERVED WATER TABLE: 24.00 INCHES [ ABOVE / HELOW ] EXISTING GRADE TYPE: ,[ PERCHED / APPARENT ]
ESTIMATED WET SEASON WATER TABLE ELEVATION: 14 INCHES [ ABOVE / HEIAW ] EXISTING GRADE
HIGH WATER TABLE VEGETATION: [ ]YES [X]NO MOTTLING: [X]YES [ ]NO DEPTH: 14.00 INCHES
SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: Sand/0.60 DEPTH OF EXCAVATION: INCHES
r DRAINFIELD CONFIGURATION: [ ] TRENCH [XI BED [ ] OTHER (SPECIFY)
I 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 14" in SB2. SB1 1.5" above BM. 8132 0" below BM.
SITE EVALUATED BY: DATE: 09/20/2021
Vajanyl, Matthew (Title: E16Won al Specialist 1) (Florida Department of Health in S
DR 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated: 64E-6.001, FAC Page 3 of 4
AP1713927 EID2350643 v 1.0.2
4.
• ��
STATEOFFLORIDAPERMIT�APPLICATIONTQCQNSTRUCT
_
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o•oa,r�e
REPAIR,MODIFY,ORABANDONAVVELL
jpermitNo 59�32383i i ;
a•:
QSDUtlIWEst L '
PL'EASE�FILLOUTALL,3PPLICAB EFIELDS
Florida UntriLIOD
try
�
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❑Nortfiwestt (Denotes Required Fields Wnere.Appiii:able)tjPermit
sbp(jtations Required lSeeAllacht;d)
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Mt. Johns River.
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❑SDUth•Florida thisfofrtJundfonvcrdrngthcpsniranl:Lcc.ton^cthe
�62-52dQuadNo.. Delineation. No. I '
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�DEP'•
iCUPMIUPApplication No.
(If Applicable) Authority, uABOVETH
- " -
fit. J-cl)nL LU.Lte;r dundt'IuC,tlul- flU 0,0LI.CSL.
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_
;i Owner. Legal, Name if Corporation Address
City State
_
ZIP Telephone Number
2. 0007 HIBISCUS RD . :• _
;
Well Location -:Address. Road Name or Number. City
A3; 1301.605.0200-000.6`
22
47 5
• Parcel ID No. ` Q,(PIN) or Q•klternate Ke
i) Lakewaotl Paik
- Lot
L
Block U it
7
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Cheek,if 62-524i D yes o,
Section or L nd Grant Township Range Countv
5 1 �L( c�L, �1<<�Ct:c�t S. t.
Subdivision
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so
i, Wa`erWell Co tractor License hiber
C LCI. ?
' Telepho a umber
�7� Q.t
E-mail Address
((� (a- (w a.f
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5
_Water Well Contra,�ct
. 's Address -
City
State Z IP
}7. - Type of Work: L'TLonslruction Q Repair E] Modification ❑'Abandonment
3 Number of Proposed Wells I Reason fa R4:pa,r t11 'tilt opo �u . nfi?^
['
D
. .
9 Specify Intended Use(s) of Well(s):
r omesttc_ ❑;Landscape'Imgation ❑A ricultural'Irri anon o
4 ❑ g g ❑Site-dnvestigationsi
?'
Bo131ed Water Supply Recreation Area Imgation ❑ Livestock ❑ Monitoring; 4
G ❑Publ a Water;Supply,(Limited.UseIDOH) ❑ Nursery Irrigation ❑Test' i• $LP 2' 202-1z
❑Public Water Supply,(Community;or Norr:Cbrrimuniry/DEP) ❑ Commercialfindustrial. ❑ Earth -Coupled Geothermal
,, ❑Classy In)ection ❑ Golf Course Irrigation ❑ HVAC Supply 4� .
lass V:Injectlon ❑ Recharge OCommeecial/Industrial Disposal - DAgwfer Storage❑a d Recovery Return,HVAC C]prainage B t 1 n
F OH i S Luce Cou
2emediatlont E]Recovery LA¢•Spargei pother (Desodbo) ENLIRONMEN 4HEAOffiral.use Only
H'
1' D.Qther; tDea'criber)'• '- - - - .. _ _- _ _ _ -. _ .. _
0 Distance from Septic System if 5;200 ft. t,1;•Facility Description !t .12 EstimatedSiart Date
1 3 EstimatedWell Depth_ft. Estimated Casing Depth �'6 ft: Pnlna"ry,„Casing Diameter_In. Open Hole: From To, ft.
14. Estimated'Sueen-Interval: Froml(� To 5 fC
i5. PrimaryCasing'Material: ❑BI'ackSteel, O'Galvanlzed 6c ❑Stainless.Steel'
❑;Not Cased DOtherc
16. Secondary Casing: ❑Telescope -Casing ,pluner []'Surface Casing- Diameter In., i
17. Secondary Casing,Material ❑Black Steel [3Galvanrzed, ❑PVC. - []Stainless Steel C Other
18. Method dConstrurtion. Regain or Abandonment: , ❑Auger ❑CahleTool Jetted 6�0ry El8onid
[],Combination (Tvro or Moire Methods) Hand Dnven'(Well ?oinl. Sand Point) Hydraulic Point-(DireU Push)
[];Horizontal Drilling, ❑P_lugged by,Approved Method E)Other or—,rhe
9, Proposed Grouting Interval for the Primary. Secondary. and Additional Casing:
From' To. Seal -Material (❑Ben'tonite, ❑Nest Cement, []Other ) t
From ~To^ Seal Material (E]b❑ entonite- ❑Nest Cement Other, ): "
From To. Seal Material-..(OBentonite: ElNest Cement ❑Other )
Frnm To Seaf Material (1313entonite ENeat Cement QOther
20; Indicate total number of existing wells on site' List number of existing; unused wells on site
21: Is,lhis well or any existing wall or water withd I on the owners contiguous property covered under a Consumptive/Water Use -Permit (CUPlWUP) t
or CUPMIUP Application? Yeso If yes. complete the following: CUP.NVUP No. District Well ID'No.
2a. Latitude- Longitude:
23. Data Obtained From: ElGPS, CTMap ❑Survey. Datum: - NAO'27- NAD'83 WGS 84 3
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r'•:tm-pq-e L•ctthr::,6,•^=t:+rl..r..ktrr%n,r,ed•nl^.a irr4s rouc.r: re4 r'vl+ha•IRi,,.t':rr _ .IF,a�.ar.r lei...SmK.•ry••-^h'crrSrlrvjt(NR'+IisJtaPtl're'FI'11III:Y.l4Vtfr•WASRc oAT1T (/P)•J 9 ,
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.Y c R R Yn m. e j r'J' • • ,
Sig tore o Cpntractur r .. License. No. Styria ure.of Uwnor or Agent, Date ,
,, �._ --._, � _ _ .._ __ - _. � ._ • , ... - _- ,- '` . :BELOWTHISLINE FOROFFIGALUSEONLV' - - _ - ,
AppigvalGrantefBv' ` Issue Dale r°Expvatlon,Dat H,drolotgistApproval ;
L h,•
EceRecraived c zi. eceiptNo Check No-_
711III PERFIIT IS'NOT VALID UNTIL P-RCPERU(SiGNEU 9Y AN AUTI'IORIZED OFFICER OR REPRESENTATIVE OF THE Wrffi OR DELEGATED AUTHORIT". THE
IPEPjhiITSHALL 13E AVAILABLE AT THE, WELL: SITE•DURING'ALL-CONSTRUC IION. REP,\IR.. MODIFICATION. OR ABANDOWIENT ACTIVITIES
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