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HomeMy WebLinkAboutOSTDSSCANNED PERMIT #: 56-SF-I 767496 . STATE OF FLORIDA By, !!dd APPLICATION #:AP1293398 DEPARTMENT OF HEAT THst Lucie COal& DATE PAID: ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID: SYSTEM FRE-CEIVEDI CEIPT #: UMENT #: PR1066179 Y 0 7 2018 i CONSTRUCTION PERMIT FOR: OSTDS New I .uceGount , F��►r�ilEtiM� APPLICANT: Anne lanniccheri PROPERTY ADDRESS: Refuge Ln Fort Pierce, FL 34982 LOT: 2 BLOCK: PROPERTY ID #: 4504-702-0003-000-5 SUBDIVIS Edens Refuge [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] [OR TAX ID NUMBER] i 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 IRESULT 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 [ 500 ] SQUARE FEET Drainfield new SYSTEM R [ ] SQUARE FEET N/A SYSTEM A TYPE SYSTEM: [X] STANDARD [ ] FILLED [] MOUND [ ] I CONFIGURATION:• [X] TRENCH [ ] BED [ ] N F LOCATION OF BENCHMARK: site BM painted X CL of Rd center of property I ELEVATION OF PROPOSED SYSTEM SITE [ 55.001 INCHES FT ][ABOVE BELOW]BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 25.001'( INCHES FT ][ABOVE BELOW] BENCHMARK/REFERENCE POINT L D E O T H E R LL REQUIRED: [ U.UU] INCHES EXCAVATION REQUIRED: [ J INUME5 he system is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total estimated flow of )0 gpd. he licensed contractor installing the system is responsible for installing the minimum category of tank in accordance with 64E-6.013(3)(0, FAC. O WSWT. BOTTOM DF NOT TO BE > 30" BELOW GRADE. SPECIFICATIONS BY: Brian J Ingr;�* TITLE: Environmental Specialist II APPROVED BY: "Ti'1LE: Environmental Specialist II St. Lucie CHD Brian Ingram DATE ISSUED: 06/13/2017 EXPIRATION DATE: 12/13/2018 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 AP1293398 SE1037336 FILE COPY 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, anng, 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 requiredlby law, with the Court of Appeal in the appropriate District Court. The notice must be filed w'thin 30 days of rendition of the final order. d'iEEf'1�yEtt��STC i•�yd Jyl"v �i k��'�i l�r�;�i h9 �`f ail. Ft PZLiy �w,'�.�f4�.�}{V.t�+' _ SF �7 NIODIFY� OR AaAMDON AMU r-1 NtzQhtvvs = • r 1� (c. .y t ri•� �. 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M`4`7 r Off HEALTH PAYING ON: PERM RECEIVED FROM: Atlar PAYMENT FORM: MOI` MAIL TO: Anne lanniccheri FACILITY NAME: ,,,, Land I I I - ` St. Lucie Cou i ty Health Department 5150 NW Milner Dr Port Saint Lucie, FL 34983 I I -1767495 BILL Doc #:56-BID-3442578 CONSTRUCTION APPLICATION #: AP1293398 PROPERTY LOCATION: Refuge Ln Fort Pierce, FL 34982 2 Lot: Property ID: 4504-702-0003-000-5 EXPLANATION or DESCRIPTION: -1 - OSTDS Construction'Application and Plan Review,i 123 - OSTDS Construction Site Evaluation 126 - OSTDS Construction Permit (New or Mod, Amem 127 - OSTDS Construction System Inspection 128 - OSTDS Construction System Inspection Researc 133 - OSTDS Construction Reinspection I -1 - Surcharge (All) -1 - OSTDS New Permit Surcharge RECEIVED BY: VanceMH I Block: ment) Fee AMOUNT PAID: $ 515.00 PAYMENT DATE: 06/02/2017 3, QUANTITY FEE 1 $ 100.00 1 $ 115.00 1 $ 55.00 1 $ 75.00 1 $ 5.00 1 $ 50.00 1 $ 15.00 1 $ 100.00 AUDIT CONTROL NO. 56-PID-3267889 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATME SYSTEM APPLICATION FOR CONST APPLICATION FOR: ] New System [ ] Existing Sys ] Repair [ ']" Abandonment APPLICANT: p `{y`�I GG�,� ►�'i AGENT: MAILING ADDRESS: AND DISPOSAL ION PERMIT -Anne-i 77 2--3Co ('5-0( r 5 -Z6 � PERMIT 140.1F `DATE PAID: FEE PAID: RECEIPT #':�yy_p�y�_ I l Holding Tank [ ] Innovative I ] Temporary [ ] AL:p��g3CD&A-4. e1 TELEPHONE: /• < ( 5I d =1;j(9 Cl 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 CONSIDEEATION OF STATUTORY GRANDFATHER PROVISIONS. PROPERTY INFORMATION �" LOT: G — BLOCK: — SUBDIVISION: L ctl, (��� PLATTED: PROPERTY ID # : ZONING :C I /M OR EQUIVALENT : [ Y / N ] PROPERTY SIZE: C?A-, I ACRES WATER SUPPLY: [� PRIVATE PUBLIC [ ,]<=2000GPD [ 1>2000GPD IS SEWER AVAILABLE AS PER 381.0065, FS? [ Y / DISTANCE TO SEWER: FT PROPERTY ADDRESS: 1G2Lz .G Z��A ,P _ I DIRECTIONS TO PROPERTY: . I I — I BUILDING INFORMATION i A4 RESIDENTIAL [ ] COMMERCIAL Unit Type of No. of Building Commercial/Institutional System Design No Establishment Bedrooms Area Sift Table 1, Chapter 64E-6, PAC 2 1 3 . 4 [ ] Floor/Equipment Drains SIGNATURE: DH 4P15, 08/09 (Obbel.e)bes p Incorporated 64E-6;.001, FAC I [ ] Other (Specify) DATE )us editions which may not be used) r Page 1 of 4 rr STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND, DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM 'SPECIFICATION I APPLICANT: Anne lanniccheri CONTRACTOR / AGENT: Atlantic Land Design LOT: 2 BLOCK: SUBDIVISION: Edens Refuge ID#: APPLICATION # AP1293398 PERMIT # 56-SF-1767495 DOCUMENT # SE1037336 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]YE TOTAL ESTIMATED SEWAGE FLOW: 400 GALL( AUTHORIZED SEWAGE FLOW: 915.01 GALL( UNOBSTRUCTED AREA AVAILABLE: 929.00 SQFT BENCHMARK/REFERENCE POINT LOCATION: Site BM ELEVATION OF PROPOSED SYSTEM SITE 55.00 [ ]NO NET USABLE AREA AVAILABLE: 0.61 ACRES PER DAY [ RESIDENCES -TABLET / OTHER -TABLE 2 ] PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE ] UNOBSTRUCTED,AREA REQUIRED: 750.00 SQFT X CL of Rd center of property ,HE S / 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: FT LIMITED USE: FT PRIVATE: FT NON -POTABLE: FT BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: 5 FT POTABLE WATER LINES: 50 FT SITE SUBJECT TO FREQUENT FLOODING? [ ]YES [X]NO 10 YEAR FLOODING? [ ]YES [X]NO] 10 YEAR FLOOD ELEVATION FOR SITE: FTI[ MSL / NGVD ] SITE ELEVATION: FT [ MSL / NGVD SOTT. PROFTT.F. TNFORMATTON STTF. 1 SOTT. PROFTT.F. TNFORMATTON STTE 2 USDA SOIL SERIES:St. Munsell #/Color Lucie sand Texture Depth 10YR 4/1 Sand 0 To 19 10YR 5/1 Sand 19 To 27 10YR 6/1 Sand 27 To 40 10YR 7/1 Sand 40 To 53 10YR 8/1 Sand 53 To 72 i USDA SOIL SERIES:St. Munsell #/Color Lucie sand Texture Depth 10YR 4/1 Sand 0 To 15 10YR 5/1 Sand 15 To 24 10YR 6/1 Sand 24 To 44 10YR 7/1 Sand 44 To 54 10YR 8/1 Sand 54 To 72 OBSERVED WATER TABLE: 72.00 INCHES [ ABOVE / BELOW ] EXISTING GRADE TYPE: [ PERCHED / APPARENT ] ESTIMATED WET SEASON WATER TABLE ELEVATION: 72 INCHES [ ABOVE / BELOW ] EXISTING GRADE HIGH WATER TABLE VEGETATION: [ ]YES [X]NO MOTTLING: [ ]YES [XINO DEPTH: INCHES SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: Sand/0.80 DEPTH OF EXCAVATION: INCHES DRAINFIELD CONFIGURATION: [X ] TRENCH [ ] BED [ ] OTHER (SPECIFY) REMARKS/ADDITIONAL CRITERIA WSWT determined using USDA WSS, soil borings, and area topography. No WSWT indicators is either SBs. SB1 55" above BM. SB2 25" above BM. 3rd SB done down hill to verify no WSWT Indicators at lower elevation SITE EVALUATED BY: Ingram, Brian (�e: Environmental Specialist II) (ENVIRONMENTAL HEALTH) DH 4015, 08/09 (Obsoletes previous editions which may not be'used) Incorporated: 64E-6.001, FAC DATE: 06/08/2017 Page 3 of 4 AP1293398 EID1767496 v 1.0.2 '& STATE OF FLORIDA PERMIT DEPARTMENT OF HEALTH I ONSITE SEWAGE TREATMENTIAND DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS APPLICANT: 1`7 0 1 _4Z-1 perC ] AGENT: 44 LOT: �- BLOCK: SUBDIVISION: PROPERTY ID # : lk; �0 4> 70 L.. `(%� i% -. j [Section/Township/Parcel No. or Tax ID Number] 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: AUTHORIZED SEWAGE FLOW: UNOBSTRUCTED AREA AVAILABLE: 'e] 'S [ ] NO NET USABLE AREA, AVAILABLE: 0-& i ACRES GALLONS PER DAY [RESIDENCES -TABLE 1/OTHER-TABLE21 GALLONS PER DAY 11500 GPD/ACRE OR 2500 GPD/ACRE] SQFT UNOBSTRUCTED AREA REQUIRED: SQFT BENCHMARK/REFERENCE POINT LOCATION: 4- Lp t d goo, o, 14 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: 10-- FT DITCHES/SWALES:_ 1!5' FT NqjMLLY WET? [ ] YES ki NO WELLS: PUBLIC: '7-O'O FT LIMITED USE:_.160 FT PRIVATE: -75 FT NON -POTABLE: (22 FT BUILDING FOUNDATIONS:_ FT PROPERTY LINES: 4_FT POTABLE WATER LINES: FT FT SITE SUBJECT TO FREQUENT FLOODING: 10 YEAR.FLOOD ELEVATION FOR SITE: —��� •. .. - ..._. .�.. as --Ursa .�va� A11G 1 MUNSELL #/COLOR TEXTURE TO TO TO TO TO TO TO USDA SOIL SERIES: NO 10 YEAR FLOODING? [ ] YES _]. NO FT MSL/NGVD SITE ELEVATION: FT MSL/NGVD SOIL PROFILE INFORMATION SITE 2 MUNSELL #/COLOR TEXTURE DEPTH TO TO TO TO TO TO TO TO TO USDA SOIL SERIES: i OBSERVED WATER TABLE: i 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, 08/09 (Obsoletes previous editions which mayl not be used) Incorporated: 64E-6.001, FAC Page 3 of 4 FDOH in St. Lucie County a m - s te e, £ _$ x s E. o gg�m£E�o e E. � � � y yy � Environmental Health 9 �: " �' =. �.� 5 ,$ �. 5 9 .1 �_ �- asy -g'2 5 �� a 'i- Site Plan Approved for,Construction d = �, o q d as � ON � :4 ��' �Q �s Supersedes All Previous Site Plans for � � `� �e F o r. ~ y S 0 g`g 3 6. Od� rr,��$ _t •"-S m OSTDS # 56-Sr- -17 ro7*Well #0 ,,T. Date: / 3 / Reviewer: s > yN Ogb�p Y+ 8 CUSTOM RESIDENCE FOR: Steve LiCausi Design Group, Inc. s, LABERGE RESIDENCE RESIDENTIAL DESIGNERS YY REFUGE N ,LAE 10710 SW WCSt1a%1n Blvd., Port SL Luei4 FL, 3.1987 STi. LUCIE COUNTY, FLORIDA OIFice& 1.:(772) 785fi565 POF.maleA Mh oNFodorv6vl,erslon vsi. M�atevvrmr "r _o 2i 8I� F CUSTOM RESIDENCE"R: s., LABERGE RESIDENCE SteveLiCa Design Group, Inc. N RESIDENTIAL DESIGNERS PP REFUGE LANE 10710 SW Wesdaun Blvd., Port St. Lucie, FL, 34987 ST. LUCIE COUNTY, FLORIDA Office &F c(772)785-6465