HomeMy WebLinkAboutApplication For Construction Permit—E
STATE OF F LORIDA
DEPART ENT or HEALTH
ONSIs SEMAGE TREAT T AND DISPOSsl2,
SYSTFUM
APPLICATION FOR CONSTRUCTION PERMIT
APPLI 1 .r
L g) A1kLSx-tA [ ] Existing System [ ] Holding Tank
[ ) Repair [ ] Abandonment [ ] Temporary
APPLICANT Focus Homes
d ®
PERMIT r70. Si:4(09
DATE PAID:
FEE PPSD: �a
RECEIPT #:
[ ) Innovative
AGENT: Brian Davis Septi.c & Backhoe Services
TELEPHONE: 772 , 571. 8200
MAILING ADDRESS: P • 0 BOX 99, Fellsmere, FL 32948
TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. SYST'ms 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 SFAS CREATED OR
PLATTED (MK/DD/YY) IF REQUESTING CONSIDERATION OF STATUTORY GRANDFATHER PROVISIONS.
PROPERTY _INFORMATION
LOT: 26 BLOCK: 56 SUBDIVISION: LAKEWOOD PARK -UNIT 51
PLATTED :
PROPERTY ID 4: 1301-605-0404-000-6 ZONING: R I/M OR EQUIVALENT:
[ Y /yam''
PROPERTY SIZE: 0.38 ACRES WATER SUPPLY: [ ] 1VATE PUBLIC [ ]<=2000GPD [ 1>2000GPD
IS SEWER AVAILABLE AS PER 381.0065, FS? [ Y /9 DISTANCE TO .SEWER: 7,0600iFT
PROPERTY ADDRESS: 8407 DELAND AVE Fort Pierce FL
DIRECTIONS TO PROPERTY: Turn R On US Highway 1
BUILDING INFORMATION [ �] RESIDENTIAL [ ] CO10JERCIAL
Unit Type of No. of Building Commercial/Institutional System Design
No Establishment Bedrooms Area Sq.Et Table 1, Chapter 64E-6, FAC
1 House 4-
2� ,
3
4
[ ] Floor/Equipment Drains [ ] Other (Sbacity) I
SIGNATURE: J---- DATE
DH 4015, 08/09 (Obsoletes previous editions which may not be used)
Incorporated 64E-6.001, FAC Page 1 of 4
STATE OF FLORIDA PERMIT #.
DEPARTMENT OF EMALTH
'a ONSITE SEWAGE TREATMENT AND DISPOSAL SYS^sEN
.f s' SITE EVALUATION AND SYSTEM SPECIFICATIONS
Focus Homes
APPLICANT: AGENT:
2101z
Brian Davis Septic & Backhoe
LOT: 26 BLOCK 56 SUBDIVISION : LAKEWOOD PARK -UNIT 5
PROPERTY ID #: 1301-603-0404-000-6 [Section/Township/Parcel No. or Tax ID Number]
TO BE COMPLETED BY ENGINEER, HEALTH DEPARTEMENT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINNEERS
MUST PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE A�LT, ITEMS.
PROPERTY SIZE CONFORMS TO SITE PLAN: (A YES [ ] NO NET USAB' d• 1�I ACRES
TOTAL ESTIMATED SEWAGE FLOW: GALLONS PER DAY [ I�REQUIRED:25
OTHER-TABLE23
AUTHORIZED SEWAGE FLOW: Z GALLONS PER DAY 150000 GPD/ACRE]
UNOBSTRUCTED AREA AVAILABLE: _T _SQFT �^�UN�O-QBSTRUC 1 Tj0 SQFT
BENCHMARK/REFERENCE POINT LOCATION: �� 1 5� ��
ELEVATION OF PROPOSED SYSTEM SITE IS [ ] BENCMAWREFERENCE POINT
THE MINIMUM SETBA WHICH CAN BE MAINTASNED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES
SURFACE WATER: N f� FT DITCFIES/ 9: N1� FT NORMALLY WET? [ ] YES NO
WELLS: PUBLIC: FT LnlSTED USE
PRIVATE: FT NON -POTABLE: FT
BUILDING FOUNDATIONS: �` FT PROPER LINES:12 FT POTABLE WATER LINES: ja FT
SITE SUBJECT TO FREQUENT FLOODING: I YES '(13 NO 10 YEAR FLOODING? [ ] YES th NO
10 YEAR FLOOD ELEVATION FOR.SITE: FT MSL/NGVD SITE ELEVATION:FT MSL/NGVD
FAN
SOIL PROFILE INFORMi3TION SITE 1 v
SELL #/ OLOR TEXTURE DEPTH
TO
S
$ TO'
O IL TO:
S 4,4 TO '
4114 L-5 TO
TO
TO
USDA SOIL SERIES: C%. t
SOIL PROFILE INFORMATION SITE 2
0"
MUNSELL #/COLOR
TEXTURE
DEPTH
$
TO
S
3 To
wl-35-1
TO
TOLS
T .
J
L- 116
TO
TO
TO
USDA SOIL SERIES: e U R dt N_
l
OBSERVED WATER TABLE:.�S INCHES [ABOVE / ELOW ErYISTIL3G GRADE. TYP ] RCHED /QAI2EN ]
ESTIMATED WET SEASON WATER TABLE ELEVATION: ( INCHES [ABOVE LO EXIST E
HIGH WATER TABLE VEGETATION: [ ] YES EXI NO MOTTLING: [Ad YES [ ] DEPTH:- /.3 INCHES
SOIL TEXTURE/LOADING PATE FOR SYSTEM SIZING: ��� DEPTH OF EXCAVATION INCHES
DRAINFIELD CONFIGURATION: [x TRENCH [ ] BED [ ] OTHER (SPECIFY)
REMARKS/ADDITIONAL CRITERIA: � 4 ( its Ol 0,41 W,
Sip
SITE EVALUATED BY: / ✓ � j `lam 0 111k7
D9 4015, 08/09 (obsoletes previous editions which may not be used) Incorporated: 64E-6-00,
i. 8 `-}-° 1 `PEL-AN r> AVM vp
i(� G O?Pa Zf 4
Mill
O: \
STATE OF FLORIDA PERM3T
-- REPAIR, MODIFY, ®R ABAND ,
PLfCATl06� To CONSTRUCT,
N A tltfELL
❑.SOu1hWeSf PLEASE
0 Northwest (°Deno
0 St. Johns River
.•.. ,. �'�- lho
ILLOUTALZAPPUCAFJLEF1EiQS
as Required Fields Where Appiicabre)
0 South Florida wale
. wrrbacYOrl� rrl sponsible rot complating
this roan I
0 Suwannee. River OPAM08
lnd roltsaexg ft permit epplicaNcrr (a the
a d6legated autlrat where apgcaWa.
2UelegatedAuthority (If Appiicabls)
�
VYvner, Legal Name If Corporation
2.Vya-7 Jt K9,11- mad
"Well Location -Address, Road Name or
Parcel ID No. (PIN) or Alternate Key a.
Section or Lan d Grant "Township 'F
5. SarAtuC P0JR1I Arr,0,ao
6.
7. "Type ofWorts: �lConstrvcfio�n __Repair Modif'
umbv Lr
8 'Ns ^ lion _Abandonment ~
I No. 59-32520
a Unique ID_
Stipulations RegWmd (See AftaciI
Quad No• Detineatton No.
UP Application No.
°state -zip
Block Unit
Check if 62-524. z Yes II
E-snail Address _ �q
State ---.- zip
r Of Proposed Wells Wesson fcr nopalr. P.fcd fkoticn orN>,tldwrrt�]at
9 'S afy t 4 d
pe n on ed usets) of vvellis):
�estic Landscape irrigation I
!��
r s
—Agricultural
—Bottled Water Supply _ RecraatlonArea Irrigaticn
rogation
Site Investigation
—Livestock
_Public Water Supply (Limited USWDOFI) —Nursery
Irrigation
Monitoring
Test
_Public Water Supply (Cammunity orNon-Community/DEP)—�fRe�cl/lndus'fiat
_Class I Injection _ __Golf
COUISO Ini atior.
_ __Earth -Coupled Geothermal
�HVAC supply
OCT 2 1 2021
Class V Injection: _Recharge —GommerciaVlndustrial Disposal____PIVAC Return
11qulfer Storage and Recovery
Remediation: Recovery Air Sparge _.___Other (o=ib,,)
_Drainage
F'�OH
in St Lucie COL
____Other (oa�cabe)
10.•Dtstance from Septic S tern •f s 00
-f-r� ;,R3�bNG/
(rtoro Not auYAM U(:rubEf are pemdtrca b/ a tlitcn prim hirtp eut IE11)
Ys t 2 fL --� -. 11. Faallty Description _ l a'' r,�1,r?.,_ 12. Estimated Start Date
13.•Estimated Well Depth �t2. 'Estimated Casing Depth I '-To "` fL
rt. "Primary Casing Diamotor in. Open Hope: From
14. Estimated Screen Interval: From VTO�(
{L I 15.'Primary Casing Material: Black Steel Galvanized .-'PVC
Stainless Steal
Not Cased Other,
16. Secondary Casing: Telescope Casing _ _Liner, Surface Casing Dlameter in.
17. Secondary Casing Material: Black Steel Galvanized PVC
18.'MOthod of Construction, Repair, orAbandonmont: Stainless Steel
u Other
9br Cable Tool Jstied . V.or• Rot, SOnlc Combination (Two or More tVTethods) Hand driven (Well Point, Sand Point) Hydraulic Point (Direct Push)
Horizontal Drilling Plugged by Approved Method Other (oearrli:aP
18, PropoFromsed outing I�ntes Of for the Primary, Secondary. and Adc�tional Casing:
From FO Seal Material (Sontonite a gte6t Cement Outer t
From To Seal Material O Seal Material �8entonite Neat Cement Other
From To Seal Material }
(,_Bentonfte ideal Cement Ottter }
20. Indicate total number of existing wells on site
List number of existing unused welts on site 47/
21.•Is this well orany existing well or water withdrawal On the.4er's contiguous propertycovered under a Consumptive/Water Use Permit (CUp1WUP)
or CUPIWUP Application? Yes � No If yes, complete the following: CUP/WUP No.
22. Latitude - Longitude �_ District Well ID No,
23. Data Obtained From: GPS ° Map 1Survey Datum: NAD 27 NAD 83
srcnarunrvarM�tnaappUcdamSaorTCaGa,FlutaardmWCcCo,aduwu.mu WGS84
e 1� W i re iwrrw d. h� Uxn mu'9no ww'*d Prior to �t rr at8 «•1i r tl+.t,.m Lm mrerd?u,c,q�,,ry U�sr uw trtmr• .^n lvovtd� b eo-srcb..:d eel l ern ace"
rmwyOclC9HattuWlrro�taQHacabcaariMandNHraSIoECfn ^lYavMCljDtt]T].aS uroa,tonreuairaPrUoarYr�dma�wba,l
Y t+cm oMvt�dr+^.1 .�.m>o�l �crtu�ons.11cyy.tnp'a 7-9M. mCmdC.�ou 9 Ira S+K fc Uw cYr.:{t.�.r Ufa 4Jemukn pvr�GrJbnr�rt�o. rrdaLtlhaw 0�rmm.^dtlo cc w'Y Cn
CW° wAKn]a OaA MarConq.'c9�tltin=natlmWUgy,�ryt;'.-, nUdkC�x•,. cr ^i° :tbi'�.•�G:�t.••:-y-•z Qmu cavern 4a:°wf^D P-vw-w N6tia VOW 01
�^ by 7u" P=oTSaUnpCrm]Ciprs'acicCwvnr oacurn anr. to a. ds7:.Tn„sn �ti tier rtan4h.ray�'r. n¢YGr cbandtr _.r
Approvat Granted ey
Fee Received $ f Receipt No.
THIS PERMIT IS tdOT VALID UNTIL PROPERLY SIGNED BY AN AUT
PERMIT SHALL BE AVAILABLEAT THE WELL SITE DURING_ ALL CO
Issue Dale
Expiration DetAL-/66�, Hydrologist Approval
/—�
_ Chock no.. wim
OFFICER OR RFPRESEN-fATIV2 OP THE W ID OR DELEGATEOAUT-HORITY. THE
ION, REPAIR, MODII ICA'IZUt•1. OR A8AIVDONs9I_NTArTMT1F:c
D
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
1 CONSTRUCTION PERMIT FOR: OSTDS New
APPLICANT: (Focus Homes LLC of Florida)
PROPERTY ADDRESS: 8407 Deland Ave Fort Pierce. FL 34951
LOT: 26 BLOCK: 56 SUBDIVISION: Lakewood Park
PROPERTY ID #: 1301-605-0404-000-6
PERMIT #:56-SF-2372969
APPLICATION #: AP1732449
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT # : PR1675184
[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, REQUIRE THE APPLICANT TO MODIFY THE
PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE HULL 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 [ 500 ] GALLONS / GPD AA500. AA800. or AS500L ATU CAPACITY
A [ ] GALLONS / GPD N/A CAPACITY
N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ 300 ] GALLONS DOSING TANK CAPACITY [67.00 ]GALLONS @[ 6 ]DOSES PER 24 HRS #Pumps [ 1 ]
D [ 500 ] SQUARE FEET Net2fim(08WRAM.9-12500 SYSTEM
R [ ] SQUARE FEET . N/A SYSTEM
A TYPE SYSTEM: [ ] STANDARD [ ] FILLED [X] MOUND [ ]
I CONFIGURATION: [X] TRENCH [ ] BED [ ]
N
F LOCATION OF BENCHMARK: CL Of Road @ East PL,
I ELEVATION OF PROPOSED SYSTEM SITE [ 0.00 ][INCHES FT ][ ABOVE F13MLOW1 BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 11.00][ INCHES FT ][ABOVE BELOW]BENCHMARK/REFERENCE POINT
L
WK.
O
T
H
E
R
Myu.ixe:U: t Gy.UUI INCHES EXCAVATION REQUIRED: [ ] INCHES
system is sized for 4 bedrooms with a maximum occupancy of 8 persons (2 per bedroom), for a total estimated flow of
gpd•
Performing Lift Dosing.
Install all components consistent with engineer design.
2 year ME contract, ATU operating permit, and written notice of ATU required for final approval.
SPECIFICATIONS BY. Brian Dav' TITLE: Master Septic Tank Contractor
APPROVED BY: Z TITLE: Environmental Specialist III St. Lucie CHD
Brian J I am
DATE ISSUED: 10/21/2021 EXPIRATION DATE: 04/21/2023
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
j Incorporated: 64E-6.003, FAC Page 1 of 3
v 1.1.4 AP1732449 SE1597734
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 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.