HomeMy WebLinkAboutOSTDS NEWi
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATM
SYSTEM
CONSTRUCTION PERMIT FOR:
APPLICANT: Luke Baxley
PROPERTY ADDRESS: 19601
LOT:
BLOCK:
AND DISPOSAL
SCANNED
BY
St Lucie County
OSTDS New
r Rd Fort Pierce„ FL 34945
PROPERTY ID #: 2222-211-0001-000-3
ION:
PERMIT # : 56-SF-1837823
APPLICATION #:AP1354471
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT # : PR1126627
[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 SPEC.1-
PERIOD OF TIME. ANY
CHANGE IN MATERIAL FACTS,
WHICH SERVED AS A BASIS FOR ISSUANCE I�O�F
THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE
PERMIT APPLICATION. SUCH MODIFICATIONS f44y
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 I
CAPACITY
N [
] GALLONS GREASE INTERCEPTOR CAPACITY
[MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [
] GALLONS DOSING TANK CAPACITY �[
]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ]
D [ 667 ] SQUARE FEET Drainfield new I SYSTEM
R [ ] SQUARE FEET N/A I SYSTEM
A TYPE SYSTEM: [ ] STANDARD [ ] FILLE DC1 MOUND [ ]
I CONFIGURATION: [ ] TRENCH [XI BED �[ ]
N
F LOCATION OF BENCHMARK: nail in fence post 8'S&42'E f NW lot corner
I ELNVATION OF PROPOSED SYSTEM SITE [ 28.00]I[ INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 13.00][ INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: [ 33.001 INCHES EXCAVAT:
The system is sized for 4 bedrooms with a maximum occupa is
O 400 gpd.
T The licensed contractor installing the system is responsible for
H s. 64E-6.013(3)(0, FAC.
I
E
R
SPECIFICATIONS BY: K�
./i
APPROVED BY: TITLE:
Brian J Ingr
DATE ISSUED: 07/23/2018
DH 4016, 08/09 (Obsoletes all previous editions i
Incorporated: 64E-6.003, FAC
v 1.1.4
N REQUIRED: [ ] INCHES
of 8 persons (2 per bedroom), for a total estimated flow of
installing the minimum category of tank in accordance with
TITLE: (fO�Ss/GVIc�� 9!44ie-er PE
ental Specialist II St. Lucie CHD
EXPIRATION DATE: 01/23/2020
may not be used)
AP1354471
,I
I
SE1086692
Page 1 of 3
NOTICE OF RIGHTS
A party whose substantial interest is affected by this order may petition for an
administrative hearing pursuant to section 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 an d 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. I
Mediation is not available as an altelrnative remedy.
Your failure to submit a petition for Dearing 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 ord r, 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 F
by filing one copy of a Notice of Appeal with
second copy, accompanied by the filing fees
appropriate District Court. The notice must t
Such proceedings may be commenced
Agency Clerk of the Department of Health and a
squired by law, with the Court of Appeal in the
filed within 30 days of rendition of the final order.
STATE OF FLORIDA PERMITAPPL'ICATION TO:CONSTRUCT;
PAI V RER• MODIFY,,ORABANDON"A'.WELL
MouthWest' pi gEFACOurALOWP,LtCABLEFIELDS'
ONorltrvvest,-('Denate5'Raquired;FietdsWhere'Applipiile
13 St.. Johns River- rtie waDirx d'obaiecbr& nrpansGs►: raewi;alwrp.
OSouth Florida p,Isllim+ka,m/wwamikythe pmmttapacmtb to ,
L7Suwannee River. „Fyrop,ter.l,Mp,ad.utrorsiyw+o,.:paset4.
r. GDEP' f'
O Detegated Authority -(If Applicable)
' •Owns ," Legal Namljf Ccirporation "A , ress;: •City,7190
9 1Weq Location Address: Roed.Namkor Ntimber.
•Parcel 1 N `(P,IN) orAltemate;K . Circte'One .
14':' 1 c°�s.�
F; •Se on or l and %rent' Towns p, rigs 5tibd Wn,.
r 5; ` Ifs
for W..n Contra
•ctor• •LI rise umber ' elephone Nmur
'Water.Well:Coritractora+At)dreas"_ _ .. _ _ .
7-•Typeof'Worki Consiructton,_Repair'=Moditicatldti° Abandonment
m"caTn'
:ID+
ens Required (Sea Attached).
o. - Detinssuon No.
IicaVoh No.
FL _ -54c0& 'Kl-1 6Ayt&sU
`State, 'ZIP r , •Tet_ephona:Number
Lob: Block= Unit`
Check if 62 524':_ Yes o
_ 0.dL4&1 41C r Cor.
8 'Number of Proposed,Wellc ' , to a ps r r cmcax�; or .Oh4w RIP' '!rw, � —
' • 8 'Specify hrtended-Uses) of WNI(s): ,_ i . , . e I"% ,�;/j�
DomesNoi Lendsca 1 ro9 d9 ,,_� pe= algallon" ! Agriculturetd " alron _51te Inves allow
PG Y rrigation I='estock, _Monitoring, {_
Botlled Water Su f = ' _Recraatfon Aroa 1
FubltcWaterSupply(UnitedUsarDQH)` j °_Nurserylrtigauon r_Teat D
Public Water Supply,(Ct#nMun `or No_w.Commuef /DEP Gem ensa0l ustrial oupte l_GeothermalPt V 2 O ZO1B
m nd Earth-C -A
?— o7Gourselrrigauon, HVAGSupply;
_ =pleas l injoctlon — _ WAG Retum,
C18se:V In)ecflon: _Recharge==CamrttarcieVlndustrial DlBpasal rApuiferStorage.and Re eovery,_Qreinage, FD
r H in St Ltirdstbun
Remedletlon. Reomry; Air Sparge Other (O.> oe1,
_Other( +4e)3 I (Mori Notii ; �d u.vem�Abeeyapiwnm-3y+asuvalkyj
10 •Dlstanoa honi Septic System if s200 n tf. Fac81 Description • , �.. 12_ Estimated Start vale
13'Eatlmated.W6I Depth=_it, ° mated Casing, •P imary'Ciasing Dlametei in. Open Hole: From Tb . ff.
14: Esurrlated:Screen interval. From TJ- it; ,
15 Piititary,Casinp tUlatedal; . B1eck:Stee1: t;aivaafaad PVC ' StaNless Steel,
._ ` NotCased� Of�lnr '.
18: Seoondary, Casing: ` Teleacope.Casinp Liner i SWace Casing `Diameter in:
17:Seoonda!YQaaing,MabdbI: BledcSteet GaManized PVC, Stableac.Steel , Other
18.'Metlrod.otCbnatructior% Repair, orAWndonmenL- AuDer., _ CftI9,T6d:' Jetted- Rotary. SOnic
Combinmtion (Two'or M_ era Meli►ode)3 Hand'44n.(We11. Point, Sand Point) = - Hydraullo P`oinl.(Oirecf Push)
Nori2ontei.O4ll1np, Plugged.byAporovedbiethod': Otherton�;twt
19. Proposed OroutIn rvai for It+a Primary, Secondary, a d ivonat.Cesirlg:
u From $Oat Material ( _Bentonhe at Cement_Other 1
' - From, . To . Seal Materialf - BQntonite . Neat Cemant Other
From To sablUateriatf Ben(ontte• NearCement Other )
From To seal Material( 1il ntonite _ Neat•Cemont _ Other )'
n 20:IndfE�tetotelnumtierofezisUngwellson'site List number ofextsung'unused wellbonsite,
21Mathis wenoRenyexfatingwellorwater hd aiontheowner's:corAiguoueproperrycovered'underaConsumptive/Water: Use' Perm[t(CUPANUP)
or CUPMtUPAppUbatlon? ' ` Yes' o I(yes, complete ftfollowing; CUPNVUP'No Dfstrtct Well tD No.
322. Latltude, ongitude'
3
f 23: Date.Oblelned'From: GPS' , Map. Survey= Datum: NAD 27 NAD83, WGS:84
"I rw�DyoM*rstl�.r-Im"ww[..}�iO.eb er.rtrd.mrr r:�aerrw.coe.:v,e au.wsr° ronyow��: w..wrw.a p.;g w.rr.Ms. u.r+■uw Msaw�l...rar�rew.na
! ,W NrwlasalaW wdWW!!tiLlr.Y4 ArlM.rWIM.t/a3Wrb.t. mrMaw+ot wbw07e�suWrCYIYeA�,kWMlshi,M6berlrialwa rtf„ -� ;
'.R�MYYcrt».IfMMrrnfl+Ml.1YirwtpwM'dh1W q�7rbn4wPr.4MfhI1.R1a11ib. N4t6tbarr,leYtiM4iennNMMMYr��..y1ptl11rM Flt�n10�,�""�tiir��,. ,
. R•�YMMP+!idn lea. UEwY,«W:erMfi?�eww.I.�lb`ir. 1.lM hannrr.wf. +M/rM►>M.r �rM�l e00YL 0Y.�[aD1aM411 tiwM/r�falii Meer
`" ,t°^l�!�l.�o•N. oYhl:l1wl11naeN,yl.IWosiyYDonaYror<fuiJi4 Apl,�ror:FdOe�,N 4MO+:in.k artweer��..lnirnrit:�r,Mo�y/rt�wiuM;
'tladwrrti N>�Mrrte.YleaMi•Rr�trien,MMMaau� .. 9
8 . 'Uoa►Ie No. - .^ S ti to otOwlnr , $M
' f
Apt?rovrl;t3rene d 8y` •— tasue t)ale'- Eicp"Iran Doe Iiydrotopist Approyaf
- - - v�r'Ti
lFsrRaa.Md: S, _ Race Nor Cheek No:
;THIS PERMIT IS NOT VALID UNTIC PROPERLY SIGNED BY'ANAUTHORIEW,OFFICEt3 OR REPREGMTATWE OF THE WMD,ORDELZOATEDAOTigORITY. THE,
mekmrr "LL be AVAILAME ATiHE,YVELL SITE VURiNG,AL-L CONSMCTiON;,REPAIR, MODIFICA770N, ORA9ANDONMENTACTIVITIE6.
DEP»7)C, po*or 7, 2810..0Page-1 of
St. Lucie County Health Department
l - -
f^a 5150 NW Milner Dr Port Saint Lucie, FL 34983
HEALTH
PAYING ON: PERMIT #: 56-SF-1837823 BILL DOC #:56-BID-3824451 CONSTRUCTION APPLICATION #: AP1354471
RECEIVED FROM: Justin Young I AMOUNT PAID: $ 105.00
PAYMENT FORM: CREDIT CARD PAYMENT DATE: 07/11/2018
MAIL TO: Luke Baxley
FACILITY NAME:
PROPERTY LOCATION:
19601 Kelly Rd
Fort Pierce, FL 34945
Lot: I Block:
Property ID: 2222-211-0001-000-3
EXPLANATION or DESCRI TION: QUANTITY FEE
126 - OSTDS Construction Permit (New or Mod, Amendment) 1 $ 55.00
139 - OSTDS Application Approval Existing, No Ins 1 $ 35.00
-1 - Surcharge (All) 1 $ 15.00
RECEIVED BY: VanceMH
AUDIT CONTROL NO. 56-PID-3617008
PAYING ON:
RECEIVED FROM:
PAYMENT FORM:
MAIL TO: Luke Baxley
FACILITY NAME:
PROPERTY LOCATION:
TBD Sneed Rd
Fort Pierce, FL 34945
Lot:
St. Luc County Health Department
5150 NW Milner Dr Port Saint Lucie, FL 34983
-183782 BILL DOC #:56-BID-3711707 CONSTRUCTION APPLICATION #: AP1338298
Property ID: 2222-211-0001-000-3
Block:
AMOUNT PAID: $ 515.00
PAYMENT DATE: 04/1.0/2018
EXPLANATION -or DESCRIPTION: QUANTITY - FEE
128 - OSTDS Construction System Inspection Re§l
-1 - Surcharge (All)
-1 - OSTDS New Permit Surcharge
-1 - OSTDS Construction Application and Plan Rev
123 - OSTDS Construction Site Evaluation
126 - OSTDS Construction Permit (New or Mod, Ar
127 - OSTDS Construction System Inspection
133 - OSTDS Construction Reinspection
RECEIVED BY:
r
Fee
,New
1
1
1
1
1
1
1
1
W v.vv
$ 15.00
$ 100.00
$ 100.00
$ 115.00
$ 55.00
$ 75.00
$ 50.00
i
AUDIT CONTROL NO. 56-PID-3511049
L. 18'
9 STATE OF FLORIDA
DEPA-RTMENT OF HE?
ONSYTE SEWAGE TRf
'.,��t SYSTEM
APPLICATION FOR C
APPLICATION FOR:
New System [ ] Existir
[ ] Repair [ .] Abandon
APPLICANT:
AGENT:
MAILING ADDRESS:
\ y,
PERMIT NO. Sr •� 837U Z3
,TH , DATE .PAI-D:
,TMENT AND DISPOSAL FEE PAID:
RECEIPT #: C7
INSTRUCTION PERMIT G�-
System [ ] Holding Tank [ ] Innovative
ent [ ] Temporary [ ]
TELEPHONE: s(nt-L(3fo �(2
I�l. Swie (U(o Hari Si-(uc:h, RL 54V(,
____________________________.-_
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 4.8:9.552, 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:
PROPERTY ID #: Z2-Z2-- W- 0001 - 6b0.3
PROPERTY SIZE: 36•0,9j ACRES WATER
IS SEWER AVAILABLE AS PER 3.81.0065,
PROPERTY ADDRESS: --t%O I _- Vietw f
DIRECTIONS TO PROPERTY:
BUILDING INFORMATION
Unit Type of
No Establishment
1
2
3
4
[ ] Floor/Equipment Drains
SIGNATURE:
�. PLATTED:
ZONINGAG-5 I/M OR EQUIVALENT: '[ Y/N ]
Y: [ ] PRIVATE PUBLIC [ ]<=2000G-PD [ ]>2000GPD
[ Y /a ] DISTANCE TO SEWER: i FT
1-cxyx
[ ] RESIDENTIAL [ ] COMMERCIAL i
No... of Building Commercial,/Institutiorial System Design
Bedrooms Area Sgf't, Table 1,, Chapt:er-64E-'6> FAC
[ ] Other (Specify)
DR 4015, 08/.0.9 (Obsole:tes'previous editions which may not be used)
Incorporated 64E-6.00:1, FAC
.DATE: -q -(( I R
Page 1 0f 4
9n STATE OF FLORIDA
DEPARTMENT OF HEAL
�= ONSITE SEWAGE TREA
SYSTEM
APPLICATION FOR CC
APPLICATION FOR:
[ New System [ ] Existing
[ '] Repair [ ] Abandonm,
APPLICANT: L ke
AGENT: J � 14AA'(1 (40 U C4
MAILING ADDRESS:f�Pflr,�I-
PERMIT NO.5'0'SF_/�37WY
DATE PAID:
AND DISPOSAL, FEE PAID:
RECEIPT #:
TRUCTION PERMIT
ystem [ ] Holding Tank
t [ ] Temporary
[ ] Innovative
TELEPHONE : �I'U3
TO BE COMPLETED BY APPLICANT OR APPLICCANT'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 CONS DERATION OF STATUTORY GRANDFATHER PROVISIONS.
PROPERTY INFORMATION
LOT: BLOCK: SUBDIVISION:
PLATTED:
PROPERTY ID #: ZZZZ- I ZONING: AG-S I/M OR EQUIVALENT: [ YEN ]
PROPERTY SIZE: 38.05 ACRES WATER SUP LY: [ ✓J` PRIVATE PUBLIC [ ]<=2000GPD [ 1>2000GPD
IS SEWER AVAILABLE AS PER 381.0065, FS? [ Ye ] DISTANCE TO SEWER: FT
PROPERTY ADDRESS: -'tS a Sn-j�e rJ( Q
i
DIRECTIONS TO PROPERTY:
BUILDING INFORMATION
Unit Type of
No Establishment
1 Stvwle Fa ,'I�n &,C&E
QCT
2
3
4
[ _] Floor/Equipment Drains
w
[ x] RESIDENTIAL [ ] COMMERCIAL
No. of Building Commercial/Institutional System Design
Bedrooms Area Sqft Table 1, Chapter 64E-6, FAC
q L-I(-) r,-
=1 F�
'I -
[ ] Other ( Specify)
II
SIGNATURE:--
DH 4015, 08/09 (Obsoletes previous edi
Incorporated 64E-6.001, FAC
which may not be used)
DATE:
Page 1 of 4
txe
STATE OF FLORIDA,
DEPARTMENT OF HEALTH
" ONS I TE SEWAGE TREATN
SITE EVALUATION AND
• hoc ve t�
APPLICANT: SYNERGY HOMES
LOT: N/A BLOCK: N/A
PROPERTY ID # : 2222-211-OOC
AND DISPOSAL SYSTEM
TEM SPECIFICATIONS
SION:
PERMIT
AGENT: SYNERGY HOMES
[ 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: 400
AUTHORIZED SEWAGE. FLOW: 57840
UNOBSTRUCTED AREA AVAILABLE: 1001
BENCHMARK/REFERENCE POINT LOCATION:]
ELEVATION OF PROPOSED SYSTEM SITE IS
THE MINIMUM SETBACK WHICH CAN BE MAINTP.
SURFACE WATER: 256 FT DITCH
WELLS: PUBLIC: N/A FT LIMITED USE:
BUILDING FOUNDATIONS:? FT 7
SITE SUBJECT TO FREQUENT FLOODING: [ ]
10 YEAR FLOOD ELEVATION FOR SITE:
SOIL PROFILE INFORMATION SITE 1
YES [ 1 NO NET USABLE AREA AVAILABLE: 38.56
_GALLONS PER DAY [ RESIDENCES -TABLE 1
_GALLONS PER DAY [ 1500 GPD/ACRE
SQFT UNOBSTRUCTED AREA REQUIRED: 1001
IN FENCE POST 8'S&42'E OF THE NW LOT CORNER (23.9 NAVD88)
[ FT 1 [ BELOW .]
ACRES
]
SQFT
ENCE POINT
:D FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES
SWALES: N/A FT NORMALLY WET? [ I YES (%/] NO
FT PRIVATE:120 FT NON—POTABLE:567 FT
?ERTY LINES:341 FT POTABLE WATER LINES:67 FT
S [ ] NO 10 YEAR FLOODING? I ] YES I ] NO
FT MSL/NGVD SITE ELEVATION: 21.9 FT M&LINGVD
MUNSELL #/COLOR
TEXTURE
DEPTH
10YR 5/3
FS
00" TO 04"
IOYR 7/2
FS
04" To 29"
10YR 5/3
FS/MARL
29" To ' O"
40YR 7/3
FS
50" TO 72"
TO
TO
TO
TO
TO
USDA SOIL SERIES:
RIVIERA FINE
SAND
SOIL PROFILE INFORMATION SITE 2
MUNSELL #/COLOR TEXTURE DEPTH
IOYR 5/3 FS 00" TO 03"
IOYR 7/2 FS 03" To 30"
10YR 5/3 FS/MARL 30" TO 51"
10YR 7/3 FS 51" To 72"
TO
TO
TO
TO
TOE
USDA SOIL SERIES: RIVIERA FINE SAND
OBSERVED WATER TABLE:28 INCHES [BELOW ] EXISTING GRADE. TYPE:[APPARENf ]
ESTIMATED WET SEASON -WATER TABLE ELEVATION:9 INCHES [.BELOW ] EXISTING GRADE
HIGH WATER TABLE VEGETATION: [ ] YES [,1] I O MOTTLING: [V/] YES [ ] NO DEPTH: 9 INCHES
SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING:0.6/FINE SAND DEPTH OF EXCAVATION: N/A INCHES
DRAINFIELD CONFIGURATION: [ ]�;W,9,H [�] BED ( ] OTHER (SPECIFY)
REMARKS/ADDITIONAL CRITER�4X��W�%6-W��*-lM ''NRIPPING OF IOYR 7/1 IN A 10YR7/2 MATRIX, >10% FOUND FROM
9"-12" BELOW SITE. ALL ELE S.NA D I
=`ate •�G Sc:• �'�
JOB #20578
SITE EVALUATED.BY: T.�'. fNC./RICHARD BOYETTE FL P.E. #42485 DATE: 07- -2018
DR 4015, 08/09 (Obsoletes &Midus �TA_ l .4i.h' not be used) Incorporated: 64E-6.001, FAC Page 3 of 4
Xs
"""'8/0NAL ��•��''�
'�«rrrnin�urt��
C_
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATM
SYSTEM
CONSTRUCTION PERMIT FOR: OSTDS�NO,',,
APPLICANT: Luke Baxley
PROPERTY ADDRESS: TBD Sneed Rd Fort
LOT:
BLOCK:
PROPERTY ID #: 2222-211-0001-000-3
' AND:DI OSAL
ixr
FL 34945
SUBDIVISION:
PERMIT #: 56-SF-1 837823
APPLICATION # : AP 1338298
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR1103495
'!
[SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
[OR TAX xA NUMBER]
g
SYSTEM MUST BE CONSTRUCTED IN ACCOICII+NS AND STANDARDS OF SECTION
381.0065 F.S., AND CHAPTER 69E-6 F.pI C. D& ARTE¢E T p PROiJALOF SYSTEM DOES NOT GUARANTEE
i ce. jy ��� 4v
SATISFACTORY PERFORMANCE FOR ANY SPECIFIC P�ERIQ CHANGE IN MATERIAL FACTS,
h�,;? A t ti wtNl zx,"� THE APPLICANT TO MODIFY THE
WHICH SERVED AS A BASIS FOR ISSUANCE OF T I$':� PE, I QUA
PERMIT APPLICATION. SUCH MODIFICATIONS MAY $T HI`S" PERMIT BEING MADE NULL AND VOID.
ISSUANCE OF THIS PERMIT DOES NOT EXEMPT HE, PPLI T FROM COMPLIANCE WITH OTHER FEDERAL,
STATE, OR LOCAL PERMITTING REQUIRED FOR DI OF OF THIS PROPERTY.
SYSTEM DESIGN AND SPECIFICATIONS 1
T [ 1,050 ] GALLONS / GPD Septic i
A [ ] GALLONS / GPD
N [ ] GALLONS GREASE INTERCEPTOR CAP C:
K [ ] GALLONS DOSING TANK CAPACITY
D [ 667 ] SQUARE FEET Drainfield new
R [ ] SQUARE FEET N/A
A TYPE SYSTEM: [ ] STANDARD [ ] FIIL-
I CONFIGURATION: [ ] TRENCH [XI BED e
N
F LOCATION OF BENCHMARK: Nail In fence post 8'SIj
& Iz
I ELEVATION OF PROPOSED SYSTEM SITE [ 281
E BOTTOM OF DRAINFIELD TO BE
L
D FILL REQUIRED: [ 37.00] INCHES EXC
The system is sized for 4 bedrooms with a maximum ocei
O 400 gpd.
T The licensed contractor installing the system is responsib
H s. 64E-6.013(3)(0, FAC.
E
R
I
i
w CAPACITY.
CAPACITY
Y [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
[ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ]
_ SYSTEM
_ SYSTEM
[x MOUND I ]
] ' m
}� 4+.i1 tl.. 11
f thy' N11V 1 t 4�fne,i3
BE BELOW BENCHMARK/REFERENCE POINT
i�] I I11�'H:ES ];• VE BELOW BENCHMARK/REFERENCE POINT
'ATION REQUIRED: [ ] INCHES
fancy of 8 persons (2 per bedroom), for a total estimated flow of
for installing the minimum category of tank in accordance with
SPECIFICATIONS BY:
TIE
t�
APPROVED BY: : EnVq;•ro nt�a'1 S e
Brian J Ingram .K, p>,.,..:.,.a.
DATE ISSUED: 04/20/2018
a
DH 4016, 08/09 (Obsoletes all previous editions hi h may not be used)
Incorporated: 64E-6.003, FAC
v 1.1.4 AP1338298
ist II St. Lucie CHD
EXPIRATION DATE
SE1073835
10/20/ 9
Page 1 3
A party whose substantial interest
administrative hearing pursuant to section
proceedings are governed by Rule 28-10,
administrative hearing must be in writing
Department, within twenty-one (21) days f
Agency Clerk is 4052 Bald Cypress Way,
Clerk's facsimile number is 850-413-8743.
Mediation is not available as an alt
Your failure to submit a petition for
constitute a waiver of your right to an adm
order'.
Should this order become a`fina[..oi
to judicial review pursuant to Section 1,2O�E
governed by the Florida Rules of Appe ,'M
by filing one copy of a Notice of Appeal 11
second copy, accompanied by the filing fei
appropriate District Court. The notice mus
NOTICE OF RIGHTS
s affected by this order may petition for an
120.569 and 120.57, Florida Statutes. Such
Florida Administrative Code. A petition for
nd must be received by the Agency Clerk for the
-om the receipt of this order. The address of the
31N A-02, Tallahassee, Florida 32399. The Agency
ative
from receipt of this order will
this order shall become a'final
l r; aNparty h"ova s adversely affected by it is entitled
3, FFloM �t tutes. Review proceedings are
ProGe..Kre. Such proceedings may be commenced
the Agency Clerk of the Department of Health and a
required by law, with the Court of Appeal in the
be filed within 30 days of rendition of the final order.
N OIL
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o� STATE OF FLORIDA
_ DEPARTMENT OF HEALT
ONSITE SEWAGE TREAT
.ti SITE EVALUATION AND
APPLICANT: SYNERGY HOMES
LOT: N/A BLOCK: N/A
PROPERTY ID #: 2222-211-0001-000-3
AND DISPOSAL SYSTEM
TEM SPECIFICATIONS
:SIQN: N/A
PERMIT #-
: SYNERGY HOMES
[ Tax ID Number
TO BE COMPLETED BY ENGINEER,--%HEATAy;= E TO 'l6 LOYEE,OR OTHER QUALIFIED PERSON. ENGINEERS
MUST PROVIDE REGISTRATION'-NUMBERWAND,? IGNT,AfO EAL EACH PAGE OF SUBMITTAL. -COMPLETE ALL ITEMS.
' ..lN
PROPERTY SIZE CONFORMS TO S TE
TOTAL ESTIMATED SEWAGE FLOW:
AUTHORIZED SEWAGE FLOW: 5
UNOBSTRUCTED AREA AVAILABLE: 1
BENCMIARK/REFERENCE POINT LOCATION: NAI
ELEVATION OF PROPOSED SYSTEM SITE IS2.3
YES [ ] NO NET USABLE AREA AVAILABLE: •38.56
_GALLONS PER DAY [ RESIDENCES -TABLE I
_GALLONS PER DAY [ 1500 GPD/ACRE
SQFT UNOBSTRUCTED AREA REQUIRED: 1001
IN FENCE POST 8'S&42'E OF THE NW LOT CORNER (23.9 NAVD88)
[ Fr ] [ BELOW •] BENCHMARK/REFERENCE POINT
ACRES
SQFT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE., PROPOSED SYSTEM TO THE FOLLOWING FEATURES
SURFACE WATER:256 FT DITC S/SWALES: N/A FT NORMALLY WET? [ I YES ]t/] NO
WELLS: PUBLIC: N/A FT LIMITED USE : I N/A FT ,tiPRE, TE : 120 FT NON -POTABLE : 595 FT
BUILDING FOUNDATIONS:7 FT ONERTY LLINES';41'� FT POTABLE WATER LINES:67 FT
dy
SITE SUBJECT TO FREQUENT FLOODING: YES`'...[ ],y,NS�. �� 10 YEAR FLOODING? [ ] YES ] ] NO
10 YEAR FLOOD ELEVATION FOR SITE: :fit ',,FT M L7,1 yr SITE ELEVATION:21.6 FT DfsbfN6V3D
SOIL PROFILE INFORMATION SITE 1 SOIL PROFILE INFORMATION SITE 2
MUNSELL #/COLOR TEXTURE DEPTH v MUNSELL #/COLOR TEXTURE DEPTH
10YR 5/3 FS 00" To 03" 10YR 5/3 FS 00" TO 03"
10YR 7/2 FS 03" TO 27" 10YR 7/2 FS 03" TO 28"
10YR 5/3 FS/MARL 27" To 49" IOYR 5/3 FS/MARL 28" To 48"
10YR 7/3 FS 49" To; 72" 10YR 7/3 FS 48" To 72"
TO, TO
TO1 TO
TO� TO
TOI TO
TO I TO
• USDA SOIL SERIES: RIVIERA FINE SAND USDA SOIL SERIF : RIVIERA FINE SAND
OBSERVED WATER TABLE: 44 INCHES [BELOW '] EXI- TING Gk%AD 'l yy, PE: [APPARENT ]
ESTIMATED WET SEASON WATER TABLE ELEVATION: 5 :A NCHStP:,,sB� A(i� ] EXISTING GRADE
HIGH WATER TABLE VEGETATION: [ ] YES [t/] NO MQI'T ITGS, S ( ] NO DEPTH: 5 INCHES
unrttUuq
SOIL TEXTURE/LOADING Rf\wtpFgAMSry �SIZ ING: 0.6/FINE SANDw DEPTH OF EXCAVATION: N/A INCHES
DRAINFIELD CONFIGURA'�� [ ,.}..TijEI�1?tT�,,� �t/] BED [ ]'OTHER (SPECIFY)
REMARKS/ADDITIONAL=E�'AWONSNAND98
R7 E1� SE WP' TNG OF 10YR 7/1 IN A 10YR7/2 MATRIX, >10% FOUND FROM
5"-8" BELOW SITE. ALIi's
- 42485.
JOB #20578 =
SITE EVALUATED BY • S INC./RICHARD BOYETTE, FL P.E. #42485 ~ DATE: 03-21-2018
DH 4015, 0e/09 (Obsoletes vr� 'otiS.�dSbsdn (i, may not be used) Incorporated: 64E-6.001, FAC Page 3 of 4
rr�,1111
4
stom Soil Resource Report
St. Lucie County, Florida
38—Riviera fine
Map Unit Setting
i National map unit
Elevation: 0 to 80
Mean annual prec
Mean annual air tE
Frost -free period.
Farmland classific
Map Unit Composition
Riviera and similar
Minor components:
Estimates are base
Description of Riviera
0 to 2 percent slopes
2tzw2
ion: 44 to 59 inches
nature: 68 to 77 degrees F
to 365 days
: Farmland of unique importance
)ils: 80 percent
?0 percent
on observations, descriptions, and transects of the mapunif.
Setting
Landform: Drainageways on marine terraces, flatwoods on marine terraces
Landform positionj(three-dimensional): Tread, dip, talf
Down -slope shap : Linear
Across -slope sha e: Linear, concave
Parent material: andy and loamy marine deposits
Typical profile
A - 0 to 6 inches: ine sand
E - 6 to 28 inches: I fine sand
BVE - 28 to 36 incl1es: fine sandy loam
Btg - 36 to 42 inches: sandy clay loam
C - 42 to 80 inched fine sand
Properties and qualities
Slope: 0 to 2 perc8nt
Depth to restrictive feature: More than 80 inches
Natural drainage class: Poorly drained
Runoff class: Very �igh
Capacity of the most limiting layer to transmit water (Ksat): Moderately high to
high (0.60 to 6.00 in/hr)
Depth to water table: About 0 to 12 inches
Frequency of flooding: None
Frequency of pondir g: None
Salinity, maximum irk profile: Nonsaline to very slightly saline (0.0 to 2.0
mmhos/cm) -
Sodium adsorption ratio, maximum in profile: 4.0
Available water storage in profile: Low (about 5.8 inches)
Interpretive groups
Land capability classification (irrigated): None specified
Land capability classification (nonirrigated): 3w
Hydrologic Soil Groin: A/D ,
Ecological site: Slough (R155XY011 FL)
Forage suitability group: Sandy over loamy soils on flats of hydric or mesic
lowlands (G155 B241 FL)
10
LETTER FROM PROPERTI OWNER GRANTING AUTHORIZATION
TO ACT
. A COPY OF THIS LETTER MUST BE SUBMITTED FOR EACH PROPERTY OWNER INVOLVED
I� LUKE BAXLEY , being duly sworn declare that I am the owner of the
(PROPERTY OWNER)
property involved in the application. I hereby. grant
of Syneray Homes LLQ to ad on my behalf. I further declare that all statements, answers,
and information herein submitted is in.all respects true and correct to the best of my knowledge
and belief.
�aue
Signature
2222-211-0001-000-3
Address
2/5/2018 11:32 AM EST
Date
r