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HomeMy WebLinkAboutHealth Department Septic Approval 441 PERMIT #:56-SF-1794341 APPLICATION #:AP 1310085 STATE OF FLORIDA RECEIVED DATE PAID: i DEPARTMENT OF HEALTH + ; ONSITE SEWAGE TREATMENT AND DISPOSAL FEB I,2 2614 FEE PAID: SYSTEM pemt,�ti Department RECEIPT #: SG DOCUMENT #:PRID79618 CONSTRUCTION PERMIT FOR: OSTDS New APPLICANT: Daniel Hernandez PROPERTY ADDRESS: 10105 Muller Rd Port Saint Lucie, FL 34987 LOT: 2 BLOCK: SUBDIVISION: [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] PROPERTY ID #: 2334-700-0003-000-2 [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 Se[3tiC 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 @[ IDOSES PER 24 HRS #Pumps [ ] D [ 667 ] SQUARE FEET Drainfield New SYSTEM R [ ] SQUARE FEET N/A SYSTEM A TYPE SYSTEM: [ ] STANDARD [ ] FILLED [XI MOUND [ ] I CONFIGURATION: [ ] TRENCH [X] BED [ ] N F LOCATION OF BENCHMARK: Orange painted"X"CL of road @ driveway I ELEVATION OF PROPOSED SYSTEM SITE [ 13.001 [ INCHES FT ] [ABOVE BELOW BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 2.00 ] [ INCHES FT ] [ ABOVE BELOW]BENCHMARK/REFERENCE POINT L D FILL REQUIRED: r 33.001 INCHES EXCAVATION REQUIRED: t 52.001 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 The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance with H s,64&6.013(3)(f),FAC. E R SPECIFICATIONS BY: Dianna S May TITLE: Environmental Specialist I APPROVED BY: �� -�>- i �.�r TITLE: Environmental Specialist I St.Lucie CHD Dianna 3 May DATE ISSUED: 02/1 212 0 1 8 EXPIRATION DATE: 04/23/2019 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 AP1310005 SE106A090 NOTICE OF RIGHTS A art whose substantial interest is affected by this order may petition for an party 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. STATE OF FLORIDA APPLICATION # AP1310085 DEPARTMENT OF HEALTH PERMIT # 56-SF-1794341 ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATION DOCUMENT # SE1064040 APPLICANT: Daniel Hernandez CONTRACTOR / AGENT: Atlantic Land Design LOT: 2 BLOCK: SUBDIVISION: ID#: 2334-700-0003-000-2 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: 2.50 ACRES TOTAL ESTIMATED SEWAGE FLOW: 400 GALLONS PER DAY [ RESIDENCES-TASLEI / OTHER-TABLE 2 ] AUTHORIZED SEWAGE FLOW: 3750.00 GALLONS PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE ] UNOBSTRUCTED AREA AVAILABLE: 1300.00 SQFT UNOBSTRUCTED AREA REQUIRED: 1000.00 SQFT BENCHMARK/REFERENCE POINT LOCATION: Orange painted"X"CL of road @ driveway ELEVATION OF PROPOSED SYSTEM SITE 13.00 [ 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: 100 FT NORMALLY WET: [ ]YES [X]NO WELLS: PUBLIC: FT LIMITED USE: FT PRIVATE: 75 FT NON-POTABLE: FT BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: 16 FT POTABLE WATER LINES: 25 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:Winder loamy sand USDA SOIL SERIES:Winder loamy sand Munsell#/Color Texture Depth Munsell#/Color Texture Depth 1 OYR 3/1 Loamy Sand 0 To 5 10YR 3/1 Loamy Sand 0 To 5 10YR 4/2 Loamy Sand 5 To 20 10YR 4/2 Sand 5 To 20 10YR 5/6 CMN/PRM RF 9 To 40 10YR 5/6 CMN/PRM RF 9 To 40 1 OYR 5/2 Sandy Clay Loam 20 To 38 1 OYR 5/2 Sandy Clay Loam 20 To 38 10YR 611 Sandy Clay Loam 38 To 52 10YR 6/1 Sandy Clay Loam 38 To 52 1 OYR 6/2 Loamy Sand 52 To 56 1 OYR 6/2 Loamy Sand 52 To 56 10YR 6/2 Sand 56 To 62 1OYR 6/2 Sand 56 To 62 HOLE CAVING Refusal 62 To 72 HOLE CAVING Refusal 62 To 72 OBSERVED WATER TABLE: 39.00 INCHES [ ABOVE / HOW ] EXISTING GRADE TYPE: [ PERCHED / APPARENT ] ESTIMATED WET SEASON WATER TABLE ELEVATION: 9 INCHES [ ABOVE / BELOW ] EXISTING GRADE HIGH WATER TABLE VEGETATION: [ ]YES [X ]NO MOTTLING: [X ]YES [ ]NO DEPTH: 9.00 INCHES SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: Sand/0.60 DEPTH OF EXCAVATION: 52 INCHES DRAINFIELD CONFIGURATION: [ ] TRENCH [X] BED [ ] OTHER (SPECIFY) REMARKS/ADDITIONAL CRITERIA WSWT determined using USDA WSS and soil borings. 10YR5/6 CMN PRM RF>2%in a 10YR4/2 matrix starting @ 9". SB1 and SB213"below BM. SITE EVALUATED BY. (��i�v �,, �y DATE: 02/09/2018 May,Dianna(Title: Environmental Specialist 1)(Florida Department of Health in St Luc DH 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated: 64E-6.001, FAC Page 3 Of 4 AP1310085 EID1794341 v 1.0.2 l7 J r • (-Jq'yi �Tt+E APPLICATION #-.AP131®085 STATE OF FLORIDA PERMIT #:.56-SF-1794341 DEPARTMENT OF HEALTH DOCUMENT #:F11.193246 ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM ;Y y� CONSTRUCTION INSPECTION AND FINAL 'APPROVAL DATE PAID:02/08/2018 "" uv FEE 'PAID.1 40.00 RECEIPT #:56-PID-3478684 APPLICANT: Daniel Hernandez AGENT: Atlantic Land,Design PROPERTY ADDRESS: 10105 Muller Rd Port Saint Lucie, FL34987 LOT: 2 BLOCK.: SUBDIVISION: ID#`: 2334=7004003-000-2 CHECKED [XI ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE. CORRECTED. TANK INSTALLATION SETBACKS [ ] [01] TANK SIZE [1] 1090.00 [2] [ ] [27] SURFACE'. WATER FT [02] TANK MATERIAL Polyethylene [, ] [28] DITCHES FT [ ] [031 OUTLET 'DEVICE [ ] [29.1 PRIVATE WELLS 86. FT [ ] [04] MULTI-CHAMBERED [ Y N .] [ ] [30] PUBLIC .WELLS FT [ ] [05] OUTLET FILTER Polylok PL-68 [ ] [ill IRRIGATION WELLS FT [ ] [661 LEGEND 1. 70-143-11DC3 2. [ ] [32]. POTABLE WATER 17 FT' [ ] [071 WATERTIGHT [ ] [33.]' BUILDING FOUNDATIONS 7 FT [ } [0.8] LEVEL [ ] [341 PROPERTY LINES 25 FT [ ] [09] DEPTH TO LID [ ] [35.]'. OTHER FT' DRAINFIELD INSTALLATION FILLED / MOUND SYSTEM. [ ] [101 AREA [1] 672 [21 SQFT [ ] [361 DRAINFIELD. COVER [ ] [11.] DISTRIBUTION BOX HEADER X [ ] [371 SHOULDERS, [ ] [12] NUMBER OF DRAINLINES 1.. 7.00 2. [ ] [38], SLOPES i [ ] [13] DRAINLINE SEPARATION [ ] [39] STABILIZATION 06/25%2018 1 ( ] (r141 DRAINLINE SLOPE [ ] [15] DEPTH OF COVER ADDITIONAL INFORMATION [ ] [16] ELEVATION [ ABOVE / BELOW ]BM 2.00 .- L ] [40.] UNOBSTRUCTED AREA [ ] [17] SYSTEM LOCATION [ ] (41] S'TORMWATER RUNOFF [ ] [18] DOSING PUMPS [ ] [4.2'] ALARMS f`I [ ] [19] AGGREGATE SIZE [ ] [43] MAINTENANCE AGREEMENT ! [ ] [201 AGGREGATE 'EXCESSIVE VINES [ ] [441 BUILDING AREA [ ] [21] AGGREGATE .DEPTH [ ] [4'5'] LOCATION CONFORMS WITH SITE PLAN FILL / EXCAVATION MATERIAL I ] [461 FINAL SITE GRADING. [ ] [22] FILL AMOUNT. I ] [471 CONTRACTOR Jeff Hedgepeth'(POrts Of Call 4 [ ] [23] FILL TEXTURE [ ' ] [48] OTHER , INFILTRATOR Quick4 EQ36(single c # [ ] [241 EXCAVATION .DEPTH ABANDONMENT i [ ] [,25] AREA REPLACED [ ]' [491- TANK PUMPED [ ] (26] REPLACEMENT MATERIAL [ ] [501] . TANK CRUSHED & FILLED Comments: Comments are on page 2: i - I CONSTRUCTION ( APPROVED / St:Lucie CHD DATE: 05/09/201-8: ]DISAPPROVED " ifriviro ental Speciallst,ll B 0 ngram-(ENVIRONMENTAL HEALTH) it FINAL SYSTEM ( APPROVED / DISAPPROVED ]: Sf.;LUCie CHD DATE: O6I25/IO1S j Environmental Speclaftt11 BSI J.Ingram(ENVIRONMENTAL HEALTH) i (Explanation of Violations on following'page) DH 4016, 08/0.9 (Obso'letes all previous editions which may not be used) Incorporated- 64E-6.003, FAC Page 2 of 3 EH Database v 1:0.1 AP1310085 ElD1794341 i APPLICATION #:01 39.00.8 5 STATE OF FLORIDA. PERMIT #:.56-S.F-1794341 `. 5 DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL :SYSTEM "DOCUMENT #:0 /2/08/20/2018 6 CONSTRUCTION INSPECTION AND FINAL APPROVAL DATE PAID: FEE, PAID:140.00 RECExPT #:56-PID-3478684 Violation Number Comment Comments 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. New ST and 7x8 long DF installed.No violations,system ok to cover.Contractor notified onsite;Needs final inspe..ction for mound system-and grading,Final system approved.Contractor and building department emailed final approval i i I I DH 4016, 08/09 (Obsol'etes all previous editions which may .not be used)' Incorporated: 64E-6'.'003, .FAC_ .Page 2 of 3 EH DaWb'asc v 1.0.1 AP1310095 EIR1794341 I T Ok APPLICATION #:APT-3'10085 r STATE OF FLORIDA. . PERMIT # 56-SF-1704841 DEPARTMENT OF HEALTH. DOCUMENT # F11:193246 ONSITE- SEWAGE TREATMENT: 'AND DISPOSAL SYSTEM CONSTRUCTION I-NSPECTION AND FINAL APPROVAL DATE PAID.;62/08/20'18 ycgyW6Ya+s' FEE `PAID,140.00 RECEIPT: #:56-PID--3478684 APPLICANT: Daniel Hernandez rjI �- AGENT:. Atlantic Land.Design C PROPERTY ADDRESS: 1.0105. Muller Rd Port Saint Lucie, FL 34987 L07:' 2 BLOCK: ST. Lucie County, Permittinq SUBDIVISION: . ID#: .2334=7000003:000-2 CHECKED [XI ITEMS ARE NOT IN. COMPLIANCE, WITH STATUTE OR RULE AND MUST BE' CORRECTED:. TANK INSTALLATION SETBACKS [ ] [01] TANK SIZE [11 1090.00 [7] [ j [271 SURFACE. WATER. FT [ ] [02] 'TANK MATERIAL Polyethylene [. ] [28] DITCHES FT [ ] [031 OUTLET 'DEVICE [ ] [29] PRIVATE WELLS 86 FT [ ] [04] MULTI--CHAMBERED [ Y N ] [ ] [30] PUBLIC .WELLS FT [ ] [051 OUTLET FILTER f OIyIOk PL-68 [ ] [31] IRRIGATION WELLS FT [ ], ['06] LEGEND 1, 70-143-11DC3 2. [ ] [92]. .POTABLE WATER 1.7 FT [ ] [0.7] WATERTIGHT [ ] [33] BUILDING,FOUNDATIONS: 7 FT [ ]- [0.8] LEVEL. [ ] [341 PROPERTY. LINES 25 FT [ ] [0'9] DEPTH TO LID [ ] [35]' OTHER' FT` DRAINFIELD INSTALLATION FILLED. / MOUND SYSTEM .[ ] [101 AREA Ill 672 [2] SQFT [ ] [:361 DRAINFIELD COVER [ ] [11] DISTRIBUTION BOX HEADER X [ ] [371 SHOULDERS [ ] [121 NUMBER OF DRAINLINES 1. 7.00 2. [ '] [38] SLOPES [ ] [13.] DRAINLINE SEPARATION [ ] [3'9] STABILIZATION 06/25/2018. [ ] [14] DRAINLINE SLOPE [ ] [15] DEPTH OF COVER ADDITIONAL ;INFORMATION [ ] [16.] ELEVATION [ ABOVE / BELOW ]BM 2.00 , I, ] [40.] UNOBS±RUCTED. AREA [ ] ['I7] SYSTEM LOCATION [ ] [41] $TORMWATER RUNOFF [ ] [181 DOSING PUMPS I ] [,42] ALARMS. [ ] [191 AGGREGATE SIZE [ ] [43] MAINTENANCE AGREEMENT [ ] [20] AGGREGATE 'EXCESSIVE' VINES [ ] [44.1 BUILDING AREA ] [21] AGGREGATE .DEPTH [ ] [45] LOCATION CONFORMS WITH SITE .PLAN FILL / EXCAVATION MATERIAL [ ] [46] FINAL SITE, GRADING [ ] [22] FILL AMOUNT, [ ] [97] cONTRAcTOR Jeff Hedgepeth(Ports of Call. [ ] [23] FILL TEXTURE. [ ] [48] OTHER' 'INFILTRATOR Quick4 EQ36(single c; [ ] [24] EXCAVATION DEPTH ABANDONMENT [ .j [25] AREA REPLACED [ ] [491' TANK PUMPED [ ] [261 REPLACEMENT MATERIAL [ ] [50'] TANK ,CRUSHED & FILLED Comments: Comments are on page .2. CONSTRUCTION [ APPROVED St Lucie - - - . DATE: 05/09/2018 ( DISAPPROVED ]= nvlrq enI is pecialistdl B. ngram(ENVIRONMENTAL HEALTH) I FINAL SYSTEM [ APPROVED / DI,SAPPROVED ']: St.Lucie CHD DATE: 06/25/2018 Environmental Speclal)stll BFi il Ingram(ENVIRONMENTAL HEALTH) (Explanation of-Violations on following page) DH 4016., 08y0.9 (Obso'letes all previous editions which may not be used) Incorporated: 64E-6.603,_ FAC Page 2 of 3 EH Database v1.0.1 AP1310085 EID1794341 I T APPL.ICATION _#:.PI 310085 STATE OF' FLORIDA. PERMIT '# :556-S:F-1794341 DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM. Docuc�NT #.FI 93246 CONSTRUCTION INSPECTION AND FINAL APPROVAL" DATE PAID2l08/2018 WE 140.00 FEE PAID.. RECEIPT #:56=P]D-3478684 Violation Number Comment Comments- _ The system is sized for 3 bedrooms with a maximum occupancy of 6 persons(2 per bedroom),for a`tota[estimafed flow'of 400 gpd. New ST and 7x8 long DF installed.No violations,system ok to:cover.Contractor notifietl onsite.Needs final inspection.for mound system and grading,Final system approved.Contractor.and building,'department eroailed final approval i I I I DH 4016, 08/09 (Obsoletes all previous editions which may ,not be used) i Incorporated: :64E-:6._003', FAQ Page 2 of ,3 EH Datab.aso.v:1.0.1. AP1310Q85, EIR1794341 t PERMIT #:56-SF-1794341 STATE OF FLORIDA APPLICATION #:AP 1310085 DEPARTMENT OF HEALTH DATE PAID: ONSITE SEWAGE TREATMENT AND DISPOSAL ^� FEE PAID: SYSTEM 0-0:0 DOCUMENT #:PR1079618 4 CONSTRUCTION PERMIT FOR: OSTDS New APPLICANT: Daniel Hernandez PROPERTY ADDRESS: TBD Muller Rd Port Saint Lucie, FL 34987 ^LOT: 2 BLOCK: SUBDIVISION: -� PB'AhB12TX'ID #: 2334-700-0003-000-2 [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, REQU3RE 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] 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 [ ] -wI CONFIGURATION: [ ] TRENCH [x] BED [ ] F LOCATION OF BENCHMARK: orange.painted x CL of rd @ driveway \I ELEVATION OF PROPOSED SYSTEM SITE [ 5.00 ] [ INCHES FT ] [ABOVE BELOW BENCHMARK/REFERENCE POINT BOTTOM OF DRAINFIELD TO BE [ 9.00 ] [ INCHES FT ] [ ABOVE BELOW]BENCHMARK/REFERENCE POINT L ILL REQUIRED: [32.003 INCHES EXCAVATION REQUIRED: [ 41.001 INCHES The system is sized for 3 bedrooms with a maximum occupancy of 6 persons(2 per bedroom),for a total estimated flow of O 400 gpd. T The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance with H s.64E-6.013(3)(0, FAC. E R SPECIFICATIONS BY: Brian J Ingr TITLE: Environmental Specialist II APPROVED BY: TITLE: Environmental Specialist II St. Lucie CHD Brian J Ingram"/ DATE ISSUED: 10/23/2017 EXPIRATION DATE: 04/23/2019 DH 4016, 08/09 (Obsoletes all previous editions which.may not be used) Incorporated: 64E-6.003, PAC File C opyage 1 of 3 v 1.1.4 AP1310085 SE1051046 1 ' t NOTICE OF RIGHTS A party whose substantial interest is affected by this order may petition for an administrative hearing pursuant to sections 120.669 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 govemed 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. �L' STATE OF FLORIDA PERMIT APPLICATION TO CONSTRUCT, rRofido REPAIR,MODIFY,OR ABANDON A WEELL G7$OUttIWBSt ue IDQ So t hwe t PLEASE FILL OUT ALI.APPLICABLE FIELDS Q ('Denotes Required Fields Where Applicable) lations Required(See Attached) rar CISL Johns River 17ISouth Florida fhfsrnrmarktforwardNryrhepemrlrapp&avonrorhe 62-524 Quatl No. Delineaton No. 111Suwannee River appropnatedekrtaledaurborltywhereapplkabte [b DEP ICUPAIVUP Application No. w O Delegated Authority(if Applicable) ABOVE THIS LINE-FOR OFFICIAL USE ONLY ,. 4- 3 w ) Own eryLegal arrefif Corpo i t n ress City "State "ZIP Telephone Number 2 'We0 cation AdIJ(OSS.Road Na or b City- 3. — •ParcelI (PIN)or Altemate (Cy r Lot Bloch nit 4 ki n �t A o p j Check if 62-524:❑ IS tion or d Grunt T s Ip apge r o�ln S ivis' , j' s. t 1 - (] t Con Or "Lic nse Number T I h tie m r , i'I Address 6. *Water I Cont actor's Address ily State IP 7. 'Type of Work-20 Construetlof ❑ Repair ❑ Modification❑ Abandonment 8. 'Number of Proposed Wells -Reason for Repair,14 D 'Specify Intended Uie(s)of Well(s): Domestic 8 Landscape Irrigation ® Agricultural Irrigation ❑ Site Investigations Bottled Water Supply Recreation Area irrigation Livestock ❑ Monitoring Public Water Supply(Umited Use1DOH) Nursery Irrigation Test OCT 2 3 2017 Public Water Supply(Community or Non-CommunitylDEP) CommerciaYindus(rial Earth-Coupled Geothermal Class I injection Golf Course irrigation HVAC Supply HVAC Return F OH to St Lucre Coun Class V injection:[] Rechar()e ❑ CommerciaUMdustrial Disposal ❑ Aquifer Storage and Recovery❑ Drain RONMENTAL HEAL H Remedtation:❑ Recovery❑ Air Sparge ❑ Other (oecaibo) Ofrsiel use Only ❑ Other (Ddflcribe) 10'Dlstartce from Septic System if 5 200 ft. 11.Facility-Description 12.Estimated Start Date 13'Estimated Well Depth_1'0 ft. -Estimated Casing Depth F ._ft. Primary Casing Diameter in. Open Hole: From To (L j 14.Estimated Screen Interval:From�To AaQft. IVPrimary Casing Material: Black Steel Galvanized PVC Stainless Steel Not Cased Other: 16.Secondary Casing Telescope Casing Liner Surface Casing Diameter' in. 17,Secondary Casing�alerial: Black Steel Galvanized PVC Stainless Steel Other 18,'Method of Construction.Repair,br Abandonment: Auger Cable Tool Jetted Rotary Sonic ~ Combination(Two or More Methods) Hand Driven(Weil Point,Sand Point) Hydrau (Direct Push) Horizontal Drilling Plugged by Approved Method Other (oescnbe) Is.Proposed'pMubng;Interval for the Primary,Secondary,and AT.-t tng:, From To;�._ Seal Material( Bentonite Cement ) Other ) From To; Seal Material( Bentonite l ent Other ) From To! Seal Material( Bentonite Neal Cement Other ) From To; Seal Material( Bentonite Neat Cement Other } 20.Indicate total number of existing wells on site List number of existing unused wells on site 21.'Is this well or any;existirti�well or water with wal the owner's contiguous property covered under a Consumptive/Water Use Permit(CUPiWUP) i or CUPMMP App$cation Yes No yes,complete the following:CUPMNP No. District Well ID No. 22.Latitude I 23.Data Obtained From: GPS Map Survey Datum: NAD 27 NAD 83 WGS 84 IntdelrytatoytnuIy4Gt t 1*t.WWAblenrfo.ofTIW AI. I Mot nmllimd,. xna.rthep, p.tn.rdwifform.11o.pawdwk.u�,.1..oadu,.stomamvbr,ny use psmita tgidrd reMw9.p.�mr arredad.tua fraen orNvlb.ab!•rrud prior la wtenranesnoect at axe wpprN0lfaa Ur4V Chap4r 373.riaids 9tabars.m rrratntaN a pvaperiy abanrhv tlrY w.R a,iee.Aty coat I ono eomtuLft.IMe"mirr float qil YrWmallon prowled in oft rppluoan 4.canh W"i two obtain me agmr tot Ina ounce.flat tv infomWon pmvidad h.ecutm.wd lMtl nwt hhrm.dthe oxrur of dark naousary appwal rttan oYtu t♦,Yait,a bat riovan.rr4s,e.ppYeage,I,,pros b provide.xd r u stated wham. rcramb b alaatn9 pmomal of ft intlty vOaMgssed Fttrrarily access Ntt0latiett olfbiho OlahIka e1 30dly.9W cortgkeat crew eohscudiao,cep*,nvdkxwn.or a1M dw kv W. Dalr,modFaUm,ar.hmdavnontaWgf.ad b7 flda prrM. ararodaW ivy sr4 of psadon, roeeura wet Sig re f Ifect 'Llcensa No. i er or A an 'Date tented By Issue Date Expiration Date 9 R Hydrologist Approval t ae.s Fee Received 3 Receipt No. Check No. THIS PERMIT IS NOT VALiD UN17L PROPERLY SIGNED BY AN AUTHORIZED OFFICER OR REPRESENTATIVE OF THE VYMD OR DELEGATED AUTHORITY, THE PERMIT SHALL BE AVNLABLE AT THE WELL SITE DURING ALL CONSTRUCTION.REPAIR,MODIFICATION,OR ABANDONMENT ACTIVITIES. DEP Form 62.532.80011) IrrcoMomted In 62-532-400(i),F.A.C. Etfscdva Dzte:October 7,2010 pope 1 of 2 � d St. Lucie County Health Department HEALTH 5150 NW Milner Dr Port Saint Lucie, FL 34983 PAYING ON: PERMIT#: - BILL DOC#: - RECEIVED FROM: Atlantic Land Desiqn AMOUNT PAID: $ 515.00 PAYMENT FORM: CREDIT CARD PAYMENT DATE: 10/09/2017 MAIL TO: Daniel Hernandez FACILITY NAME : PROPERTY LOCATION: TBD Muller Rd Port Saint Lucie, FL 34987 Lot: 2 Block: Property ID: 2334-700-0003-000-2 EXPLANATION or DESCRIPTION: QUANTITY FEE 128- OSTDS Construction System Inspection Research Fee 1 $ 5.00 -1 -Surcharge (All) 1 $ 15.00 -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 9 127- OSTDS Construction System Inspection 1 $ 75.00 133- OSTDS Construction Reinspection 1 $ 50.00 V RECEIVED BY: VanceMH AUDIT CONTROL NO. 56-PID-3408164 STATE OF FLORIDA APPLICATION # AP1310085 DEPARTMENT OF HEALTH PERMIT # 56-SF-1794341 ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM DOCUMENT # SE1051046 SITE EVALUATION AND SYSTEM SPECIFICATION APPLICANT: Daniel Hernandez CONTRACTOR / AGENT: Atlantic Land Design LOT: 2 BLOCK: SUBDIVISION: ID#: 2334-700-0003-000-2 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: 2.50 ACRES TOTAL ESTIMATED SEWAGE FLOW: 400 GALLONS PER DAY [ RESIDENCES-TABLET / OTHER-TABLE 2 ] AUTHORIZED SEWAGE FLOW: 3750.00 GALLONS PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE ] UNOBSTRUCTED AREA AVAILABLE: 1300.00 SQFT UNOBSTRUCTED AREA REQUIRED: 1000.00 SQFT BENCHMARK/REFERENCE POINT LOCATION: orange painted x CL of rd @ driveway ELEVATION OF PROPOSED SYSTEM SITE 5.00 [ 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: 100 FT NORMALLY WET: [ ]YES [X]NO WELLS: PUBLIC: FT LIMITED USE: FT PRIVATE: FT NON-POTABLE: FT BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: 51 FT POTABLE WATER LINES: 60 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 ffUSDUArSOIL SERIES:Winder loamy sand USDA SOIL SERIES:Winder loamy sand sell#/Color Texture Depth Munsell#/Color Texture Depth 10YR 712 Sand 0 To 6 1 OYR 7/2 Sand 0 To 6 10YR 411 Sand 6 To 19 10YR 4/1 Sand 6 To 20 -10YR 5/1 Sand 10 To 22 10YR 5/1 Sand 11 To 20 10YR 4/2 Sandy Clay Loam 22 To 35 10YR 4/3 Sandy Clay Loam 20 To 36 10YR 6/2 Sandy Clay Loam 35 To 41 1 OYR 5/2 Sandy Clay Loam 36 To 44 10YN 6/2 Loamy Sand 41 To 55 10YR 6/2 Loamy Sand 44 To 52 10YR 7/1; Sand 55 To 61 10YR 7/1 Sand 52 To 60 HOLE CAVING Refusal 61 To 72 HOLE CAVING Refusal 60 To 72 OBSERVED WATER TABLE: 8.00 INCHES [. ABOVE / BELOW ] EXISTING GRADE TYPE: [ PERCHED / APPARENT ] ESTIMATED WET SEASON WATER TABLE ELEVATION: 10 INCHES [ ABOVE / HELOW ] EXISTING GRADE HIGH WATER TABLE VEGETATION: [ ]YES [X]NO MOTTLING: [X]YES [ ]NO DEPTH: 10.00 INCHES SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: Sand/0.60 DEPTH OF EXCAVATION: 41 INCHES DRAINFIELD CONFIGURATION: [ ] TRENCH [X] BED [ ] OTHER (SPECIFY) REMARKS/ADDITIONAL CRITERIA WSWT determined using USDA WSS and soil borings.. 10yr5/1 stripping In 10yr4/1 matrix>10%with diffuse boundaries starting at 10"In SB1. SB1 5"below BM.SB2 6"below BM. SITE EVALUATED BY: DATE: 10/23/2017 Ingram,Brian(Title nvironmental Specialist II)(ENVIRONMENTAL HEALTH) DH 4015, 08/09 (Obsoletes Previous editions which may not be used) Incorporated: 64E-6.001, FAC Page 3 of 4 AP1310086 EID1794341 v 1.0.2 Iroperty Card = Page 1 of l77ys y J Michelle Franklin, CFA--Saint Lucie County Property Appraiser--All rights reserved. Property Identification Site Address:TBD Parcel ID:2334-700-0003- Account#: 162250 Sec/Town/Range: 000-2 34/35S/39E Map ID:23/34S Zoning: Use Type:6000 Jurisdiction:Saint Lucie County Ownership Legal Description Daniel Hernandez ROGERS RANCHETTES(PB 46-24)LOT 2(2.50 AC)(OR Heather Hernandez 3978-206) 5356 NW Mims CT I Port St Lucie,FL 34986-2780 ' 1 Current Values Historical Values 3-year Just/Market: $78,375 Assessed: $688 Year Just/Market Assessed Exemptions Taxable Exemptions: $0 Taxable: $688 2017 $78,375 $688 $0 $688 2016 $75,000 $688 $0 $688 2015 $75,000 $688 $0 $688 Sale History Date Book/Page Sale Code Deed Grantor Price Primary Building Information Finished Area of this building:0 SF Gross Area of this building:0 SF Exterior Data View: Roof Cover: Roof Structure: Building Type: Year Built:N/A Frame: Grade: Effective Year:2014 Primary Wall: Story Height: No.Units:0 Secondary Wall: Interior Data Bedrooms:0 A/C%:0% Electric: Primary Int Wall: Full Baths:0 Heated%:N/A% Heat Type: Avg Hgt/Floor:0 Half Baths:0 Sprinkled%:0% Heat Fuel: Primary Floors: Total Areas Finished/Under Air 0 (SF): Gross Area(SF): 0 coo ID rr 67 O O rfO:J. id G O O tOo G_ OC O 664 6 f0 OOOOO OO Cl) VCAn Q) f C Cr + LO Ir G UiX f{i Ifi (A o W X J = 9 03 M 2A cc O O 5 w > 2 0 O C � O O O C O � F- O � ui'� � 6 0 �n � Ln c ui it a c• O m p L a If isy Ln Ca v+ to ~ 0, .. io W J m 'CO, crs Q _a N F !6 C L' y . N ?,.r r r r r r r r W •7— c > ��N CD W CDCc o �co a c a. O 3 0 (n � n •� O = s Cl) �CO 0 f-.0 00 �_ c C 05 F C4 ;O } O Q O 2 O O CL a ry a. Y u� a c m 5 ,_ O W v U - 9 W E O _i V L r •V C a C N U A H L_ _ p r C Q O d D' N Q V J N W _ O •C ? 0 Z Z Z Z V > co . M to ti V 4 N f r 10 CD ttp://www.pasic.org/RECard/ 10/9/2017 I ' STATE OF FLORIDA Yvvww PERMIT NO. DEPARTMENT OF HEALTH DATE PAID: ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID: 3V SYSTEM RECEIPT #: �`"°"8'`�• APPLICATION FOR CONSTRUCTION PERMIT APPLICATION FOR: I New System [ ] Existing System [ ] Holding Tank [ ] Innovative N [ ] Repair I ] Abandonment I ] Temporary [ ] " APPLICANT: C QtV16 AGENT: ,�kCcti �� ��l$�r n t TELEPHONE: RZ'��d' tl �dIC7 j MAILING ADDRESS: v x �q�-� cJ 31 t 0 Acp 2s ocmamac:csaca=�m�amoacaosaaacmarsaaccamccmcmeaaaoccoaasa a�saaaccmmcaan�� � acccrossccamaccc TO BE COMPLETED BY APPLICANT OR APPLICANTS 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. a acaaCa"J�Caamaaaaas Oa O�QaOaaacaaaaaoaaCaaaa=aaaaaa'i aC aCamaaammCam�mC�a��C��.aj:mm���m�aCC�-7� PROPERTY INFORMATION LOT: 'Z, BLOCK: SUBDIVISIONs�6 G� �'S ��.�rla� c� ��j PLATTED: 7i8c�S PROPERTY ID #: Z-33q 5d- 000 000. -Z. ZONING: �� L;�� I/M OR EQUIVALENT: I Y / N ] PROPERTY SIZE: Z•G ACRES WATER SUPPLY: [XI PRIVATE PUBLIC I ]<=2000GPD I 1>2000GPD IS SEWER AVAILABLE AS PER 381.0065, FS? I Y / N ] DISTANCE TO SEWER: FT PROPERTY ADDRESS: DIRECTIONS TO PROPERTY: V1/fQ U BUILDING INFORMATION 0�3 RESIDENTIAL [ ] COMMERCIAL Unit Type of No. of • Building Commercial/Institutional System Design No Establishment Bedrooms Area Sqft Table 1, Chapter 64E-6, PAC 1 / f ),r 63;�0-3 3 4 I ] Floor/E(juipment Drains •[ ] Other (Specify) SIGNATURE: - DATE: DH 4015, 08/0' sol ,etie evious editions which may not be used) Incorporated 64E-6.001, 'FAC Page 1 of 4 i STATE OF FLORIDA PERMIT #. DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS wa APPLICANT av-) 1�2��c'!✓t clt7.-. AGENT: /V" ✓vTjc L�„���(`I?S �✓��� j C/ LOT: C BLOCK: SUBDIVISION: ���C� '�,y� y PROPERTY ID #: j�jt� •� -(�aO3 y��` 7i [Section/Township/Parcel No. or Tax ID Number] .TO BE COMPLETED BY ENGINEER, HEALTH DEPARTMENT EMPLOYEE,OR OTHER QUALIFIED PERSON. ENGINEERS MUSX 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: -Z•5- ACRES TOTAL ESTIMATED SEWAGE FLOW: GALLONS PER DAY [RESIDENCES-TABLE 1/OTHER-TABLE23 AUTHORIZED SEWAGE FLOW: GALLONS PER DAY [1500 GPD/ACRE OR 2500 GPD/ACRE] UNOBSTRUCTED AREA AVAILABLE: SQ,iFT UNOBSTRUCTED AREA REQUIRED: SQFT BENCHMARK/REFERENCE POINT LOCATION: PPpd d- L64— ELEVATION OF PROPOSED SYSTEM SITE IS [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 [X] NO WELLS: PUBLIC: Zob FT LIMITED USE: ! 6C> FT PRIVATE: Z--FT NON-POTABLE:�L FT BUILDING FOUNDATIONS: _7>j5_FT PROPERTY LINES: 14 FT POTABLE WATER LINES: FT SITE SUBJECT TO FREQUENT FLOODING: [ ] YES DO NO 10 YEAR FLOODING? K] YES [ ] NO 10 YEAR FLOOD ELEVATION FOR SITE: 18-0 FT MSL/116'M SITE ELEVATION: T MSL/!tg=- SOIL PROFILE INFORMATION SITE 1 SOIL PROFILE INFORMATION SITE 2 MUNSELL #/COLOR TEXTURE DEPTH MUNSELL #/COLOR TEXTURE DEPTH TO TO TO TO TO TO TO TO TO TO TO TO TO TO TO TO TO TO USDA SOIL SERIES: USDA SOIL SERIES: OBSERVED WATER TABLE: INCHES [ABOVE / BELOW] EXISTING GRADE. TYPE: [PERCHED / APPARENT] ESTIMATED WET SEASON WATER TABLE ELEVATION: INCHES [ABOVE / BELOW] EXISTING GRADE HIGH WATER TABLE VEGETATION: ( ] YES [ ] NO MOTTLING: [ ] YES [ ] NO DEPTH: INCHES SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: DEPTH OF EXCAVATION: INCHES DRAINFIELD CONFIGURATION: [ ] TRENCH [ ] BED [ ] OTHER (SPECIFY) REMARKS/ADDITIONAL CRITERIA: SITE EVALUATED BY: DATE: DH 4015, 06109 (Obsolete: previous editions which may not be used) Incorporated: 64E-6.001,FAC Page 3 of 4 TI 0ogle Maps Muller Rd �. Sam VanHul{'s Ice Cra Q m pcIrcle H Qtrus. - � VA G (� seminole TdOa a(Flodde p ti Garay Ru,9.Y Area Fj!' Ad* Q sm OCH.SPIMbing T a Semtary kind Creatm Batt PlaceO 'ap OD !' t( Troatcarta t�roduasO s , Rent Haven � Whote;ale Nursery 1$ Fd •{:RCa.`aap Rd nz -- 'eltAtdr�y Rd Tu .-.._-y/llid:rry Rd Qm tY U_'Cn..?7td mm"Ptodwe-0 Wi.{ a.1v Rj - ; •vsrd:v�vrt4 a F FPLS&SWaon®Google TtlWnasRoducc6 >` ItildtvayFaym 1 ;�- Map data©2017 Google United States 1000 ft, 6� sstl 'v hips://www.google.com/maps/place/Muller+Rd,+Fort+Pierce,+FL+34945/cD27.3855921,-80.4333217,15z/data=!4m5!3m4!1 sOx88deed6a72804353:Oxd398f7533178ffc1!8m2!3d27.3889516!4d-80.4318... 112