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HomeMy WebLinkAboutAPPLICATION FOR CONSTRUCTION PERMITtLoU STATE OF FLORIDMLUSft. r { DEPARTMENT OF HEALTH v ONSITE SEWAGE TREATMENT SYSTEM APPLICATION FOR CONSTRUC APPLICATION FOR: [v/] New System [ ] Existing System [ ] Repair [ ] /Abandonment APPLICANT: �Qt3 O A AGENT: o m ) e-S (46, ,AJS j MAILING, ADDRESS: MQ)-7 POO C J i 10 fflo 3 ND DIS12L, ION PERMIT [ ] Holding Tank [ ] Temporary PERMIT •NO, YO'SYe� DATE PAID: FEE PAID: RECEIPT #: [ ] Innovative TELEPHONE: L' j� �/�^"3 i 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 QQ �p LOT: CJ� BLOCK: SUBDIVISION: �f�F�I` %� �oi�s���, %��� PLATTED: PROPERTY ID #: '� J�� rC1�"tW.u�' ZONING: Q I/M OR EQUIVALENT: [ Y /N ] PROPERTY SIZE: ACRES WATER SUPPLY: A PRIVATE PUBLIC [ ]<=2000GPD [ ]>2000GPD IS SEWER AVAILABLE AS PER 381.0065, FS? [ Y] DISTANCE TO SEWER: FT PROPERTY ADDRESS: 5 KQ, c1) G DRiOe RA - t u c-) e.. FL, DIRECTIOONS TO PROPERTY: 0 of)41,gde-�Jcj-WRd 0(0 -7� ► 1.f}N Lot r !� oA& S K q K aO ei 1Dk rve- A.J'-r4 eA. 61 %� -4- 01 k JA R K , Lu Coam, tot SKLtK,ro yj<4 i-ernf, l`"l� BVILDING 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 aA,�q� 1-b� 2. �b;9 2 3 4 [ ] Floor/Equipment Drains [ ] Other (Specify) SIGNATURE: DR 4015, 08/ Incorporated i (Obsoletes previou ditions which may not be used) 3-6.001, PAC DATE: ;?- I (P 20/0 Page 1 of 4 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND SITE EVALUATION AND SYSTEM S APPLICANT: John Moran CONTRACTOR / AGENT: LOT: 85 Jamie Sabins SUBDIVISION: Treasure Coast Air Park ID# ISPOSAL SYSTEM APPLICATION # AP1331303 PERMIT # 56-SF-1826971 DOCUMENT # SE1066890 TO BE COMPLETED BY ENGINEER, HEALTH DEPARTMENT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEERS MUST PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMI�TAL. COMPLETE ALL ITEMS. PROPERTY SIZE CONFORMS TO SITE PLAN: [X]YES TOTAL ESTIMATED SEWAGE FLOW: 300 GALLONS AUTHORIZED SEWAGE FLOW: 3434.99 GALLONS UNOBSTRUCTED AREA AVAILABLE: 750.00 SQFT BENCHMARK/REFERENCE POINT LOCATION: orange painte ELEVATION OF PROPOSED SYSTEM SITE 24.00 1F [ ]NO NET USABLE AREA AVAILABLE: 2.29 ACRES PER DAY [ RESIDENCES-TABLEI / OTHER -TABLE 2 ] PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE ] UNOBSTRUCTED AREA REQUIRED: 750.00 SOFT J X CL of Rd Center of Lear PI / FT ] [ ABOVE /I BELOW I] 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: 100 FT NON -POTABLE: FT BUILDING FOUNDATIONS: 5 FT PROPERTi LINES: 50 FT POTABLE WATER LINES: 50 FT SITE SUBJECT TO FREQUENT FLOODING? [ ]YES 10 YEAR FLOOD ELEVATION FOR SITE: FT[ enTT. 0DnRTT.7 TM7nRMATTAN CTTF. 1 USDA SOIL SERIES:Wabasso sand Munsell #/Color Texture Depth 1 OYR 4/1 Sand 0 To 9 10YR 611 Sand 9 To 28 10YR 6/1 Sand 18 To 35 10YR 4/2 Sand 35 To 39 10YR 4/4 Sandy Clay Loam 39 To 54 1 OYR 4/2 Sandy Clay Loam 54 To 66 10GY 6/1 Loamy Sand 66 To 72 [ X ] NO 10 YEAR FLOODING? [ - ] YES [ X ] NO) IMSL / NGVD ] SITE ELEVATION: FT [ MSL / NGVD CnTT. DRnVTT.V.. TNFnRMATTAN RTTE 2 USDA SOIL SERIES:Wabasso sand Munsell #/Color Texture Depth 10YR 4/1 Sand 0 To 13 10YR 5/1 Sand 13 To 30 1 OYR 6/1 Sand 19 To 35 16YR 412 Sand 35 To 41 10YR 414 Sandy Clay Loam 41 To 55 10GY 6/1 Sandy Clay Loam 55 To 65 1 OGY 6/1 Loamy Sand 65 To 72 i OBSERVED WATER TABLE: 56.00 INCHES [ ABOVE / BELOW ] EXISTING GRADE TYPE: [ PERCHED / APPARENT ] ESTIMATED WET SEASON WATER TABLE ELEVATION: 19 INCHES [ ABOVE / BELOW ] EXISTING GRADE HIGH WATER TABLE VEGETATION: [ ]YES [X]NO MOTTLING: [X]YES [ ]NO DEPTH: 19.00 INCHES SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: Sand/0.60 DEPTH OF EXCAVATION: INCHES DRAINFIELD CONFIGURATION: [ ] TRENCH [X] BEDI [ ] OTHER (SPECIFY) REMARKS/ADDITIONAL CRITERIA WSWT determined using USDA WSS and soil borings. 10YR6/1 stripping in 10YR5/1 matrix >10% with diffuse boundaries starting at 19" in SB1. SB1 24" below BM. SB2 21" below BM. SITE EVALUATED BY: Ingram, Brian (Tit . Environmental Specialist II) (ENVIRONMENTAL HEALTH) DH 4015, 08/09 (Obsoletes previous editions whi may not be used) Incorporated: 64E-6.001, FAC AP1331303 EID1826971 DATE, 03/01/2018 Page 3 of 4 v '1.0.2 -,sr-_ IS-Moilf 51- n,7-q 2/1912018 2:2.6 PM Receipt #17654 Tales Store: 1 St Lucie County Health Department 5150 NW Milner Drive Port St Lucie, FL 34983 Environmental Health Division 772-873-4931 Item # 4ty Price Ext Price 68 1 $115.00 $-115.00 T Well Constructiai 6 1 $75 00 $75.00 T *Initial Inspection 3 1 $100.00 $100.00 T *New Application 30 1 $50 00 $50.00 T *New Other Inspecti< 5 1 $55.00 $55.00 T *New Permit 7 1 $5.00 $5.00 T *New Research Surc 4 1 115.00 $115 DOT *New Site Evaluation i 2 1 $100.00 $100.00 T *New System Count; 1 1 $15.00 $15.00 T *OSTDS County Sur Subtotal: $630.00 Local Sales Tax 0 °/u Tax + $0.00 RECEIPT TOTAL: $630.00 Check: $630.00 208 Skyking Dr Sabins/Moran I Thank You 8, Have a Good Dayl I I I��I�I IIIII II�II IIIII �IIII III IIII 17654', 'roperty Card Fage 1 oI I Michelle Franklin, CFA -- Saint Lucie Cc Property Site Address: SKYKING Parcel ID: 4224-501-0085- DR 000-7 Map ID: 42/23X Zoning: AG-5 Ownership John R Moran 13307 Polo Club RD Apt C107 Wellington, FL 33414 Current Values Just/Market: $51,500 Assessed: Exemptions: $0 Taxable: Date Book/Page 10-29-2015 3805/1197 02-27-2001 1378/0357 08-08-1988 0601/0841 View: Year Built: N/A Primary Wall: Bedrooms: 0 Full Baths: 0 Half Baths: 0 $51,500 Year $51,500 2017 2016 2015 66-5r, V�7-07( 6 g - ��rz my Property Appraiser -- All rights reserved. ientification Account 9: 125846 Sec/Town/Range: 24/37S/38E Use Type: 0000 Jurisdiction: Saint Lucie County Description JRE COAST AIRPARK LOT 85 (2.29 AC) (OR 3805- Historical Values 3-year Just/Market Assessed Exemptions Taxable $51,500 $51,500 $0 $51,500 $51,500 $51,500 $0 $51,500 $48,100 $48,100 $0 $48,100 Sale History Sale Code Deed Grantor 0001 WD Brinker Joe E XX00 WD Owens,Emerson J XX00 WD Primary Building Information Finished Area of this building: 0 SF Gross Area of this building: 0 SF Ex terior Data Roof Cover: Roof Structure: Frame: Grade: Story Height: No. Units: 0 Interior Data A/C %: 0% Electric: Heated %: N/A% Heat Type: Sprinkled %: 0% Heat Fuel: Total Areas Price $59,900 $22,000 $14,000 Building Type: Effective Year: 2014 Secondary Wall: Primary Int Wall: Avg Hgt/Floor: 0 Primary Floors: Finished/Under Air 0 (SF): Gross Area (SF): 0 Land Size (acres): 2.29. Land Size (SF): 99,752.4 Total Building Count: 1 Special Features and Yard Items Type Qty Units Year Bit I This information is believed to be correct at thiis time but it is subject to change and is not warranted. © Copyright 2018 Saint Lucie County Property Appraiser. All rights reserved. iff—Ilaininir naoln nrrr/T?R('arrl/ 17R/701 FILE COPY Mission: 1!7 Rick Scott To protect, promote 8 im��� Govemar of all people in Florida thrstate, county&communis•O� �:� �. � Celeste Philip, MD, MPH L018 HE r a State Surgeon General and Secretary y, Perr�jWQ: o be the Healthiest State in the Nation Florida Department of Health in St. Lucie County Conditions for Issuance of Water Well Permits 2017 • Contact the Florida Department of Health,in Saint Lucie County (FDOH — St. Lucie) prior to constructing or abandoning any well. a. Call the FDOH — St. Lucie Well b. Provide the following information i. Permit number ii. Driller name iii. Address iv. Date and time to begin co at 772-873-4936 or email donment • A minimum of 24 hours' notice is requirId before constructing any._public water supply wells. Please call our main office at 772-873-4931 and speak with Environmental Health Staff or provide notification by email to SLCDOH-WELLSCcDFLHEALTH.GOV • Submit revisions to permit and/or site map and associated fee within 48 hours of well construction or abandonment. Florida Department of Health St Lucie County • Division of Disease Control and Health Protection Bureau of Environmental Health 5150 NW Milner Drive Port SL Lucie, FL 34983 PHONE: 772/873-4931 • FAX: 772/595-1306 FloridaHealth.gov Accredited Health Department Public Health Accreditation Board ' P STATE OF FLORIDA PERMIT APPLICATION REPAIR, MODIFY, OR ABANDON A WELL ❑Southwest PLEASE FILL OUT ALLAPP ❑ Northwest (*Denotes Required Fie []St. Johns River ❑ South Florida the forwatm an ibrwall ding is i this Ibrrrt and forwardfng the / ❑ Suwannee River appropriate delegated outhon ❑DEP ❑ Delegated Authority (If Applicable) *O_Wrier, Legal Name if Corporation _ *Addrest 2. /71 K Y'�AK N *Well Location -Address, Road Name or Number, City 3.�2�i *Parcel ID N . (PIN) orAltemate Key (Circle O ) 4. -2a9,, SfLvG► tlonoraLandGras��pwrship *Range QQun r 5. /y *Water Well Obntractor License �t"Aap" STNu) Sr- IgD,to9 -7- CONSTRUCT, Permit No. .-.) f -IELDS Florida Unique ID e Applicable) Permit Stipulations Required (See Attached) for completing cation to the 62524 Quad No. Delineation No. opllcehle. CUPIWUPApplication No. Ciro-zl�l.a r=1- 3y z ( *State *ZIP 'Telephone Number Atria "-Jv V� _ Lot Block Unit IYP4aaLP. OWN* heck if 6-2: Subdivision 254—Yes — No , '097d/ dn1110 - `�seaol•co� hone Nur it - E-mailAddres� 42n/3w06. 7. *Type of Work: _X Construction —Repair —Modification Abandonment •Reason for Repair, Modtliration, orAbandanment 8. *Number of Proposed Wells �� 9. *Specify Intended Uses) of Well(&): /AjLlpm w%% iC Domestic Landscape Irrigation Agricultural Irrigation Site Investigation � (11]`vJ t'J _Bottled Water Supply _Recreation Area Irrigation —vestock _Monitoring —Public Water Supply (Limited Use/DOH) _Nursery Inigatlon —Test F+ublic Water Supply (Community or Non-Community/DEP) 1, CommerciaUlndustrial —Earth-Coupled Geothermal — —Golf Course Irrigation _HVAC Supply MAR 2 2018 _Class I Injection —HVAC Return Class V Injection: —Recharge—CommerciaVlndustdal Disposal Aquifer Storage and Recovery —Drainage Remediation: Recovery _Air Sparge —Other (Describe) FMIHIIIi Other (Describe) hr OAGI (Note: Not all types otweiis are permitted by a given permitting aul�l) . 10'Distance from Septic S tern !f s200 ft. �" � 11. Facility$asrdption 12. Estimated Start Date ' 'y 13.*Estimated Well Depth �ft. 'Estimat Casing Depth O 0 8. 'Primary Casing Diameter in. Open Hole: From To ft. 14. Estimated Screen Interval: From-P, • / 15'Pdmary Casing Material: Black Steel r Galvanized PVC Stainless Steel NotCased Other. 16. Secondary Casing: Telescope Casing Liner SurfaceI asing Diameter in. 17. Secondary Casing Material: Black Steel Galvanized PVC Stainless Steel Other 18'Method of Construction, Repair, or Abandonment Auger Cable Tool Jetted RotarySonic Combination (Two or More Methods) Hand Driven (Well Point, Sand Point) Hydraulic Point (Direct Push) Horizontai Ddliing Plugged by Approved Method Other (Describe) 19. Proosed routing al for the Primary, So' and Additional Casing: From__ TOSeal'Materia! V Bentonite Neat Cement Other ) From To Seal Material L_Bentonite Neat Cement Other 1 From -TO -Seal Material L_Bentonite Neat Cement Other m ) FroTo Sea) Material L_Bentonite Neat Cement Other ) `� 20. Indicate total number of existing wells on site - List nulmber of existing unused wells on site 21 'Is this well or any existing well orwaterwithcjyawai on the owner's contiguous property covered under a Consumptiva/Water Use Permit (CUP/WUP) or CUP/WUP Application? Yes �/ No If yes, complete the following: CUP/WUP No. District Well ID No. 22. Latitude gitude 23. Data Obtained From: GPS Map Survey Datum: NAD 27 NAD 83 WGS 84 I hereby oamythst I wlticomplywIth the sppllm bnft of=a40. FleddaAdminMalM Cade, and trod. water Iea*lhstlainttieowrlerafthe property, Malthehdomw0on pmviddd Isssem K andthattamawareofmy ins penrdaraN0WltsdtarpepetmRNrmeded,hobesnorwd9beeblabadpdortommmenramenlafweil reepdnameswwarCWpter373,FlarldaS4tules.tortaMtdnaprepalprabandmdbwa%or, Inmythdlam donewabn IfuMamrtlfyNala111Mmma0onpprsNG0bl0daapp0oailonbamuaMendtnatlwlPabWn Ifasaanttar0uawnar,that the WomftprovidedIsseanalaandllallhavaWamadNaownaraftllatr naasoeryapproval flan oeurfadelek stars, orknl9 Pp11abM. lapin fo prevWes-0 rule mlbaUsaKCWad aEavaL Dwf4raer WtstoaaslvinaparaonnaloftNaWMDorDslaaatadAamodlye=ss oompkDml mDu ObtrlolwlWn 30 days a0er e0on o}ua atlurStod, npal6 mOdiiasdIL or to Na watl sRa duMptha coestnldmn, repal modlllMtloe, orsbandommantsu0rerired try WY parea abandon dbyNb mdt,otlllapsrmacl ,wNdl raeotue�nt ' nature of Contra 'Ucense No. g �t'=fOwneroEAgent 'D to BELOW THIS LINE - FOR OFFICIAL USE ONLY Approval Granted By Issue Da to 7 2 �]s Expira0on Date 7 2 Hydrologist Approval Mehl Fee Recebed $ Receipt No. Check No. THIS PERMIT IS NOT VAUD UNTiL PROPERLY SIGNED BYAN AUTHORIZED OFFICER OR REPRESENTATWE OF THE WMD OR DELEGATEDAUTHORITY. THE PERMIT SHALL SEAVAILABLEAT THE WELL SITE DURING ALL CONSTRUCTION, REPAIR, MODIFICATION, ORABANDONMENTACTIVITIES. DEP Fotm: 62532.900(7) Incorporated In 62-932.400(1), F.A.C. Effective Date: Octo(ier 7, 2010 Page t of 2 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREff SYSTEM CONSTRUCTION PERMIT FOR: APPLICANT: John Moran PROPERTY ADDRESS: TBD APR 12 2018 ST. Lucie So Permit OSTDS New :ing Dr Port Saint Lucie, F 1 34987 LOT: $$ BLOCK: PROPERTY ID #: 4224-501-0085-0 PERMIT #:56-SF-1826971 APPLICATION # : AP 1331303 DATE PAID: FEE PAID: RECEIPT #: DOCUMENT #: PR1096230 Treasure Coast Air Park [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 [ 900 ] GALLONS / GPD SeDtic new CAPACITY A [ ] GALLONS / GPD N/A CAPACITY N [ ] GALLONS GREASE INTERCEPTOR CAPACITY ([MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K j ] 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 [x] MOUND [ ] I CONFIGURATION: [ ] TRENCH [x] BED [ ] N F LOCATION OF BENCHMARK: orange painted X CL of Rd Center of Lear PI I ELEVATION OF PROPOSED SYSTEM SITE [ 24.00][ INCHES FT ][ ABOVE BELOW BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 19.001[ INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT L D FILL REQUIRED: [23.001 INCHES EXCAVATION REQUIRED: [ ] INCHES The system is sized for 2 bedrooms with a maximum occupancy of 4 persons. (2 per bedroom), for a total estimated flow of 0 300 gpd. I T The licensed contractor installing the system is responsible fogy installing the minimum category of tank in accordance with H s. 64E-6.013(3)(0, FAC. E R SPECIFICATIONS BY: Brian J APPROVED BY: A"""�°_1 TITLE: DATE ISSUED: 03/02/2018 DR 4016, 08/09 (Obsoletes all previous editions Incorporated: 64E-6.003, FAC v 1.1.4 — TITLE: Environmental Specialist II ronmental Specialist II St. Lucie CHD EXPIRATION DATE: 09/02/2019 may not be used) 331303 SE1066890 Page 1 of 3 F 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 iae received by the Agency Clerk for the Department, within twenty-one (21) days from the r ceipt 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, Florid governed by the Florida Rules of Appellate Procedi by filing one copy of a Notice of Appeal with the Ag second copy, accompanied by the filing fees requir appropriate District Court. The notice must be filed Statutes. Review proceedings are Such proceedings may be commenced icy Clerk of the Department of Health and a I by law, with the Court of Appeal in the rithin 30 days of rendition of the final order. HEALTH PAYING ON: RECEIVED FROM: PAYMENT FORM: MAIL TO: John Moran FACILITY NAME: PROPERTY LOCATION: TBD Skyking Dr Port Saint Lucie, FL 34987 85 Lot: St. Lucie County Health Department 5150 NW Milner Dr Port Saint Lucie, FL 34983 Block: Property ID: 4224-501-0085-000-7 I EXPLANATION or DESCRIPTION: i I 128 - OSTDS Construction System Inspection Research Fee -1 - Surcharge (All) -1 - OSTDS New Permit Surcharge -1 - OSTDS Construction Application and Plan Review, 123 - OSTDS Construction Site Evaluation 126 - OSTDS Construction Permit (New or Mod, 127 - OSTDS Construction System Inspection 133 - OSTDS Construction Reinspection RECEIVED BY: CONSTRUCTION APPLICATION #: AP1331303 AMOUNT PAID: $ 515.00 PAYMENT DATE: 02/2812018 QUANTITY FEE 1 $ 5.00 1 $ 15.00 1 $ 100.00 1 $ 100.00 1 $ 115.00 1 $ 55.00 1 $ 75.00 1 $ 50.00 AUDIT CONTROL NO. 56-PID-3489889