HomeMy WebLinkAboutOSTDS NewSTATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION PERMIT FOR: OSTDS New
APPLICANT: Ghazanfar Saeed
PROPERTY ADDRESS: 5502 Winter Garden Pkwy Fort Pierce, FL 34951
LOT: 20 BLOCK: 159 SUBDIVISION: Lakewood Park
PROPERTY ID #: 1301-614-0080-000-6
PERMIT #:56-SF-1828918
APPLICATION #: AP1735058
DATE PAID:
FEE PAID•
RECEIPT #:
DOCUMENT #: PR1673144
[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 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
R [ ] SQUARE FEET
A TYPE SYSTEM: [X]
I CONFIGURATION: [X]
N
F LOCATION OF BENCHMARK:
SYSTEM
N/A SYSTEM
STANDARD [ ] FILLED [ ]
TRENCH [ ] BED [ ]
:) of iron rod at elevation: 23.57
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE
L
D E
0
T
H
E
R
MOUND [ ]
[ 38.00 ] [ INCHES FT ] [ ABOVE BELOW ] BENCHMARK/REFERENCE POINT
[ 8.00 ][ INCHES FT ][ ABOVE BELOW] BENCHMARK/REFERENCE POINT
ILL REQUIRED: [ 0.001 INCHES EXCAVATION REQUIRED: t J mums
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.
SPECIFICATIONS B Ian P Moore TITLE: CEHP 19-2072
APPROVED BY: Environmental Specialist II
Nicole Mon ez
St. Lucie CHD
DATE ISSUED: 10/11/20 1 EXPIRATION DATE: 04/11/2023
DH 4016, 08/09 (Obsoletes all previous edi s which may not be used)
Incorporated: 64E-6.003, FAC Page 1 of 3
v 1.1.4 AP1735058 SE1609549
I G-
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 287106, 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.
eBridge Web Viewer Page 1 of 1
Oct 19 21. 12:54p p.1
STATE OF FLORIDA WELL COMPLETION REPORT E
C EeW E
a J� irit� Southwest .. - PL AE-.-E'tcL. S
E,arhvsest PD_rotes Re:;uirsa=iet''s 5:rnere App iran e:
St Jnhns River
DEC 12
South Florida
Suwannee River
aoYESwLS`- DEP
= DelegaledAutholiy ;Ir Applicaate; FEI
H.I AL- unty
1.'Pe,m I Number2:iM�&- -CLIPxvUF %.mber _...____„ 'CID Nurntter 62.524 Deli ieai:on No.
2.' Nurrber of permitted 'sel's constnxAed, repaired, or abando:,e;JF S %Lriber of oern•.ted we9;s not =st =ed. repa'red, or ataaidoned
3 'O%r:ters Name GUA-uA At�6'� f-4- 4 'Ctmptet on Date r'
/ S. Florida Uq@ a ID
(��%�'
`) -s�
6 i -' )1t+1Ti 2-t-,li "i •Ri t' D� �t T� �Pj 4` f�L
'Melt Location-Add%ms, Road Na .e or Number. City ZIP
7 'County �� !, iarI, 'Sezticnand Gran! ' awn ;hip Range
6. Lahtuce Lorg tude
Q. Data Obtained From: GPS Map Savey Dalurr: NAD 27 NAD 83 WGS 84
' UType of Wane Cons1.'uction _Reoak _ttic: ifrcation �hban:cronxn;
1_ Spec;fy tnteride Uses} o! Vk*;!(s)'
gaircn
aril Irr gaGon Site Investigation
Domestic Landscape Ir?'gatior L vesto
vestock hlonitGri°ig
�L
_601led Water Supply Recreation Area 1'rigaticr. NLrserr Irrigaticr sTest
_P,.blic Water S..pply (U.nited UsefDOHj ConimerciaYindus,.rial Ear'.'s-Cosp!ec GecJie..mal
_Public Water Supply (Community or Nor-Comrhuni:y+DEP i vGolf Course Irrigaycr• _HVAC Supply
_Glass I Injection _,- HVAC Re urn
Class V Injection: _Recharge Corrmerc,aUtndustnal Disposal _Aquifer Storage and Recovery _____Drainage
ReTwd'aWn: _Recovery __Ai• Sparge--Otler,Casrnut
Other roes:• be.
12.'Drill Method: _Auger _ Cable Tool Rotary _Ccmbinapcn {Two or More Metaads; Jetted �,So 1@c
_
I•lorzortal Drilling I lyoraulic Point ;Dire 'Push) 01nor
13 •f.Aeas,rred Static V'later Level _ ft. 1.4easu-ed ?J-nping Water Le% -el ft. A9er Hours a; GPW.
14•-MeasuringPoint Descrrbe) W.1-chis•_,Y f:. Ahave�Selow LaraSJrface 'Hawing:_Yes No
15' Casing Material: Black Steel Ga ,ranized X ?VC �S:a pleas Sleel —Not Casec Other
tti.'To:at %Vetl Depth qj�_R. Cased Depth `'� n h 'Open He e: From -- Tc — t: 'Screen' Frcrri'Q To_7 t:. Slot Size-.4C%
17.'Abandonmenl: Other (Explainj
Fro-n (:. To ft. No. o' Bags Seat Mater at (Check One, Neat Camert Sentorite Otter
Fro"t a To ft. Na, ct Bags Seal Matena (Check One; Neat Car .ert Berclorile Other
Frorr P_ To ft. No. cf Bags_ ._ Seal Patent (Check One;: Neat Car•,ant Bentarnte Other
From fL ,c tL No. of Bags Sea) Materta: ;Chet -( One;: Neat Cement Rentonrte Other
Froryt ft 7c fL No. of 13ags Seat Materia: (Crete Ore;: Neat C_rttent Benton a Other
18 'Surface Casing DiaT.ete• and Depth
Dia n. Frcr^ ft. TO It. No. <)f t3ags Sea 'rrlxenal (Check One). Neat Cement Berttorke Ctrer
Cia r in. F•orr f:. To ft. No of Bags Sea to a ial ;C teoic (are► hleat Cement___ i3ert:erila�Cther
19 -Prima sing D'aame:e• and Depth:
Dia 11 in, Fron•-) ft. To ': t ft. No cf Bags Seat fu!ate'rzl tClteck One) ^hea: Cement � Bentnllte Other
_jEft.
Dik n. Fron, f:. To No ofsags Seal Idate•,al fCheck One) ®Neat Current �Bentc'tite�Ot-ler
Dra in. From P T� f:. No of nags_ _ Seal %isle, al (Check Orte)-_.,-.Neat Cerrent_-__t3ertenite_Other
Dia in. From Y C 2 No of Gap Seal Alater.al (Clrock One)-�._Neai Cement Bertc^.ite_Ot ter
Dra in. From ft To tt. No of bags Seal klater al ((.heck One):_Neat Cement�Bertcn.ite_Omer
20.-Liner Casino Diameter and Depth:
Die in, -•From ft. To Nc. of Bags_ Seal Material (Chet% Czar) _,Neal Car,en: Oertoni:e t7ihe�
_R
Dia ��^ Frcrrft. To_ ft No. of Sags Sea Mla'arial (CytecK One): —Neat Ce" teat~BentonitesOther
Dia / r7- From ft. To _•-. _ft. r,o. of Bags- Sea Mta:erial (C-,ec< Ore):,__,, Neat Cer►ehl`Sentoni:w_Other
21.-Telescope Cas iaxeter and Depth
a Frart R To K No. of Bugs Seal flatedal (Check One;. Beat Cement_ Bentanite_ Sher
Dia n. From ft. To i. No. cf Bags Seal uaterial (Check ,7 _Neat C» test Be., te� Omar
ma_n. rrc -t (:. To 1. No. o' Eats Sea %1wedal (check One'. _Neat Ce nert-3ei:on le_ -Diner
22, Pur-o Type (If known): 2a Chern cat Analysis tNNhe't ReQLired):
Centrifuge _Jet _Sub lershle T,nbirre Iron c'dm S:rlfatE_ apm Crlarh a: n
Florsepct'rer Pimp. Canscity (GPtAj
PL,rrp Depth ft. Intake Depth ft Laaoralary lest t-relo lest Kr
24 Water Well CAnt1`2tla1'
. -- r--7
'Contractor Nacre r r w� �e J t�rG cenye Numte@ �' 7,� E-rice IAdst,esS
'Contractor's Signature <.1z °o L.-Drlfer's .Varre ,Prirt or Type) JC'CYrr .J Tylt°kt-,
:rc `i°h•,t,h&�^rCrs:Jltn trL'r.�3C v::h, icon ,<aJar1?�',a,Ldl
FORM LEG-R.05-: 2 ;6+101
Flu a4rD341- t-)(a) FAC.
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