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HomeMy WebLinkAboutOSTDS NewSTATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT FOR: OSTDS New APPLICANT: Dionne Morris PROPERTY ADDRESS: LOT 3005 Cortez Blvd Fort Pierce, FL 34981 BLOCK: PROPERTY ID #: 2420-421-0003-000-0 SUBDIVISION: PERMIT #:56-SF-2356071 APPLICATION # : AP 1758114 DATE PAID• FEE PAID: RECEIPT #: DOCUMENT #: PR1675073 [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 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 Seotic 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 [ 500 ] SQUARE FEET Drainfield new SYSTEM R [ ] SQUARE FEET N/A SYSTEM A TYPE SYSTEM: [ ] STANDARD [ ] FILLED pc] MOUND I CONFIGURATION: [XI TRENCH ( ] BED [ ] N F LOCATION OF BENCHMARK: Orange painted nail in tree E of system I ELEVATION OF PROPOSED SYSTEM SITE [ 40.00][ INCHES FT ][ ABOVE BELOW BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 38.001 INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT L D FILL REQUIRED: [20.001 INCHES EXCAVATION REQUIRED: [ 44.001 INCHES The system is sized for 4 bedrooms with a maximum occupancy of 8 persons (2 per bedroom), for a total estimated flow of 400 gpd. T Elu Z .DVA H R I Vil "I SPECIFICATIONS BY: Dianna TITLE: CEHPBY- I APPROVED BY: TITLE: Environmental Specialist III St. Lucie CHD Brian J I am DATE ISSUED: 11/01/2021 EXPIRATION DATE: 05/01/2023 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 AP1758114 S1:16,1512 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. a` " 06" PP for STATEOFFLORiGAPERMITA4 16"TIONTO;CONSTRUCT, REPAIR,MODIFY,ORABANDONAW6L,L 59-32619 e , Partnit No: • r SDUIhWeSt PLEASE FILLQUTALLAPPu6ABLE FiELDs Florida Uniqu( � q a� Morthwest Menotea RequiredAelds fte*a pplkabls) PertnilSlipulations Required (Bee Aliaetced) -' 5L Johns River t o South Florltla . The,iotarw°uroRwctarisr«awurw�lorcomp►eNno ydrlcmm,d�orwnrdG,yEhepermnopal{rnfknmthe e2r624 Quad No. DalfEieancn No.�_� . ©Suwannee_Rlyer ' opprapifakdefr0oledouthodlywhercoppkoble. AppiptiomNo pDEP CUP/li" • Delegated Atithodty.,(If.Applicabie) .� �! �: ` G 3' '0wP9r��gatNams 1f Corporallo dress ICU"State "ZIP Telephone Number 'We1LLo on -Address, Road Name or . umber, City /f%j 'Patce1,10 No. ©(PIN),or • ©A{temate'Key Lot black. Unit . �Ot`'i L Eu jc: /'I��eS `u fVictS ' Check if 62 52k Yes O No -Section or Land Grant.' 'Township "Range `County y Subdiv_islon `Water,Well Gontrador •License N one Number 1 r�ss r �� f .�� JTr=�� .i f.E.,� a ' �c� umber ?efe s, '7 ,� ` Address — on • � T � � ZIP City State ° 7. T pa of Wodc ntEacloi'snstrucUon ©Repair ©GModiticaifb Abandonment .y . 8.. 'Numborof Proposed -wells _ , , ° � 'Raasonrorl3epsk MIo011tcatton,orASandomwt.. _ _ • 9, "Specify (intended Uses) of W60(s): Domestic . mandscape lalgation DAgriculturel irrigation 13 Sitelnvestigatlons . �Bottied WaferSupply `` 17Ftecneaticn Area (mgation Llvestodt C1 Monitoring QPubiic WaterSupply (Lhited UseIDOHj ON' urse`ry Mitigation Cl Tesl °!Public Water9uppiy (Corrrmun(ty or Non Community(DEP) " EIC,ammarclat/Industdai 13 Earth -Coupled Geothermal Na ❑Class I• Injection.. � ` � D Golf Course Irrigation• ❑ HVAC supply ° r V� 1 ° `2d21 Class V=Injection:. Recharge' . ©Commetciaihr dusttfa{ Disposal ©Aquifer storage and Recovery ©Dtalnage R;emedlation: ©Recovery ©Air S'parge�.�Julv IN Pull ©Other (OesFN,e) frfeiaC se on P .. © Other (oesame) 10 •Distance irgm Septic Syste i 5'200 ft 11 Facility Descriptto . AT 12 Estimate V .� Pnmary' Casing Diameter_. -. in: Opan'Hole Fro To 13'Fatimated Well do, ! Estimated Castng`Oeptlr _ , 4 Estimated Screen Interval: From 10d To % Pt{mary Casin •Material ©'Bla dt. p plh 4!#e . VC ©5tafnlass 5tee( J g S ' 16,SecondaryCasing: •©Telescope Casing Liner ';Surface.Gasina 'Dlamelar in. �s 17 Secondary Casing Material ©Black Steel ®Galut�nized QPVC QStatnless Steel • �Olher - 18 Method ofCattstruction Repair.orAbondonmenh ©Auger ®Cable ToolJetted•ORotary ®sonic armizontai Drflifa or ©Plugged byA proved Method00ther [oesaw) Point)and D HydraufiaPoint (DrfeEd Push)e g ) � iW ry 1 at Dement �©Othet 1g. Proposed Grouting Int al forttiePrima ,.Secondary, and J#d idonal�Casing From - �f To ',''Seal Matenai,(OBerltonilE3 ` NErat Cement• ©Other, - t Seal; Material (©Bentornte ©Ne � . .,• ", From - _ To Seat Material (Qba Atonito . MNeat Cement ©Other - 1 Frorr To .Seal Matedai (©Bentonite ',Neat Cement`, Other, - - t L#st°number of existin covered wells an'site_ 20 Indicatetotal number of.existing wells on site 2 9• 21.'{s this well,or an existing well or water witted i the owner's contiguousproperty co a under a ConsumptivelWater Use PeEmd (CUPNVUP) or CUPMUP Application? •'Yes'.. , If yes, complete the following: CUPIWUP No. . •Distract Well ID;No. . " Longitude... 22 Latitude a ©curve . ,. Datum..., NAD"27 NAD 83 WGS•84 , 23 Data:ObtalntrdFrom.' ©GPS elfYr P y' . 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OMOS c"', 1 1, - � , ­, _ Ilu v Monitoring R', 000— 011"T"'Supp Y Iy',,(LJrO,ite'drUs )H)Nursery';I 'gNon 11- 2021 rc illindostd6f,', nit oncdirnmunvloep'), co me.. W, ,y,br N tip"*, - )HJn,!St'WcR0Cqkin In I ljm 'kPio✓ *io le EA1. FROWN TH, I M., I 4� V A1(:, lit 60plip Y, T -J t7i, 4�9, EW*iawd'Cd§ g Depth w, e Fro& 4 Gfilonliedl-, p4mor essSteel r Cl s "Oth le, C, asin g,� dpir Other IV' "x,-+ f" Ale 'S" nIc' V , -Rd Ter-', 'b#Mdtftdd,jd(Cd ' j k DO Op Qnm1A sr Ajjj' CA1d37Tc6W6tte& - , i�y Wolf on, pp. - 11,11- 1 41; to . .. . . 'in' d' Fin, 'Poc, 7n'P,7777, Proposed19 BPustsj lal Primary;Secondary.,,,AQL� Ong V, r4 -tlbii�,dlq At ea m n 0 T -, , 11101AII �`� �,� �%', _� - " op tent, oaj�Miti4dC(j3,p lie 13""" me) t,,', 0 Or! 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C,),R M TH OVitV ,7 R :.SEWP*W, E C Wdko 7 'NOTVALID:UNTIVIRROPERLYS OFFICEROR RIT I Abbj'Fi6AT:j6t4;,OR WIN 7- A;. q,� St. Lucie County Health Department �)0 5150 NW Milner Dr Port Saint Lucie, FL 34983 HIMTH PAYING ON: a: 56-SF-2356071 BILL ooc tt:56-BID-5658592 CONSTRUCTION APPLICATION M AP1758114 RECEIVED FROM: Reliable Septic & Service AMOUNT PAID: $ 430.00 PAYMENT FORM: CREDIT CARD 977348 PAYMENT DATE: 10/19/2021 MAIL TO: Dionne Morris FACILITY NAME: PROPERTY LOCATION: 3005 Cortez Blvd Fort Pierce, FL 34981 Lot: Block: Property ID: 2420-421-0003-000-0 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 $ 100.00 126 - 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 RECEIVED BY: WhighamJL AUDIT CONTROL NO. 56-PID-5322505 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM APPLICATION FOR CONSTRUCTION PERMIT APPLICATION FOR: PERMIT NO. DATE PAID: O / Z FEE PAID: cy3o. RECEIPT #: I [✓] New System [ ] Existing System [ ] Holding Tank [ ] Innovative [ ] Repair [ ] Abandonment [ ] Temporary [ ] APPLICANT: Dionne Morris AGENT: Reliable Septic Treasure Coast Indian River Septic TELEPHONE : 772-562-4242 MAILING ADDRESS: P.O. Box 1116. Vero Beach, FL 32961 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. PROPERTY INFORMATION LOT: BLOCK: SUBDIVISION: Metes and Bounds PROPERTY ID #: 2420421-0003-000-0 PLATTED: Pre-72 ZONING: RS-4 I/M OR EQUIVALENT: [ No 0 ] PROPERTY SIZE: 4.08 ACRES WATER SUPPLY: [ ✓] PRIVATE PUBLIC [ ]<=2000GPD [ ]>2000GPD IS SEWER AVAILABLE AS PER 381.0065, FS? [ No 0 ] DISTANCE TO SEWER: N/A FT PROPERTY ADDRESS : 3005 Cortez BLVD Fort Pierce, FL 34981 DIRECTIONS TO PROPERTY: BUILDING INFORMATION [✓] RESIDENTIAL [ ] COMMERCIAL Unit Type of No. of Building Commercial/Institutional System Design No Establishment Bedrooms Area Sqft Table 1, Chapter 64E-6, FAC 1 Single Family Residence 4 2110 2 3 4 [ ] Floor/Equ ent Drai [ ] Other (Specify) SIGNATURE: DATE:. 10/ 15/2 l 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 HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM Bra W awl' SITE EVALUATION AND SYSTEM SPECIFICATIONS APPLICANT: Dionne Morris AGENT: LOT: BLOCK: SUBDIVISION: PROPERTY ID # : 2420-421-0003-000-0 [Tax ID Number M] 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: [✓] YES [ ] NO NET USABLE AREA AVAILABLE: 4.08 ACRES TOTAL ESTIMATED SEWAGE FLOW: 400 GALLONS PER DAY [RESIDENCES-TABLEI 0] AUTHORIZED SEWAGE FLOW: 6120 GALLONS PER DAY [1500 GPD/ACRE 1E] UNOBSTRUCTED AREA AVAILABLE: 800 SQFT UNOBSTRUCTED AREA REQUIRED: 750 SQFT BENCHMARK/REFERENCE POINT LOCATION: Orange painted nail in tree E of system ELEVATION OF PROPOSED SYSTEM SITE IS40 [INCHES M] [BELOW] BENCHMARK THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING MUMMS SURFACE WATER:na FT DITCHES/SWALES:na FT NORMALLY WET? [ ( YES (✓] NO WELLS: PUBLIC:na FT LIMITED USE:na FT PRIVATE: (D- FT NON—POTABLE:na FT BUILDING FOUNDATIONS:. Q FT PROPERTY LINES : 7 5 FT POTABLE WATER LINES :., FT SITE SUBJECT TO FREQUENT FLOODING: [ ] YES [✓I NO 10 YEAR FLOODING? ( ] YES (✓] NO 10 YEAR FLOOD ELEVATION FOR SITE: FT MSL/NGVD SITE ELEVATION: FT MSL/NGVD �viL rxvr'J." IN&UiiMNXIO11 ST.TL 1 MUNSELL #/COLOR TEXTURE DEPTH 10YR 3/1 Sand 0 TO 6 10YR 411 Sand 6 To 27 10YR 511 Sand 22 TO 27 I OYR 3/2 Sand 27 TO 35 1OYR 4/2 Loamy Sand 35 TO 44 10YR 6/2 Sand 44 TO 58 1OYR 6/2 Sandv Clav Loam 58 To 64 REFUSAL REFUSAL 64 TO 72 TO USDA SOIL SERIES: Ankona and Farmton Sands rtcvr-t 1 kN 1N&UkMATlviv blTz c LL #/COLOR TEXTURE IOYR 5/1 1 OYR 4/2 1 OYR 6/2 1 OYR 6/2 REFUSAL Sand DEPTH n mn Q Sand 8 To 16 Sand 16 TO 26 Sand 26 TO 30 Sand 30 TO 57 Sandv Clav Loam 57 To 60 REFUSAL 60 To 72 mn USDA SOIL SERIES: Ankona and Fannton Sands OBSERVED WATER TABLE:35 INCHES [BELOW Br] EXISTING GRADE. TYPE -.[APPARENT El] ESTIMATED WET SEASON WATER TABLE ELEVATION.22 INCHES [.BELOW a] EXISTING GRADE HIGH WATER TABLE VEGETATION: [ ] YES [✓] NO MOTTLING: IVI YES [ I NO DEPTH:22 INCHES SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING:Sand/.8 DEPTH OF EXCAVATION:44 INCHES DRAINFIELD CONFIGURATION: [✓] TRENCH [ i BED ( ] OTHER (SPECIFY) REMARKS/ADDITIONAL CRITERIA: WSWT determined using USDA WSS and soil borings. 10YR 5/1 stripping in a 10YR 4/1 matrix >10% with diffuse boundaries starting at 22" in SB 1. SB 1= 40" below BM. SB2= 42" below BM. Refusal due to saturation in both profiles. SITE EVALUATED BY: Dianna May C.E.H.P. 21-2170 �_�--- /"ij� DATE: 10/13/2021 DR 4015, 08109 (Obsoletes previous editions which may not be used) Incorporated: 64E-6.001. FAC Page 3 of 4