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HomeMy WebLinkAboutOSTDS NEWAWN BY STATE OF FLORIDA Mudec0*1 DEPARTMENT.OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM RECEIV CONSTRUCTION PERMIT FOR: OSTDS New I MAY 21 2018 ST. APPLICANT: (St. Lucie Habitat for Humanity Inc) PROPERTY ADDRESS: 7901 Deer Park Ave Fort Pierce, FL 34951 LOT: 21 BLOCK: 44 PROPERTY ID #: 1301-605-0118-000-4 PERMIT #: 56-S F-1 840698 APPLICATION .#:AP1340175 DATE PAID: FEE PAID: RECEIPT #: # : PR1115255 SUBDIVISION: Lakewood Park [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] [OR TAX ID NUMBER] SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION 381.0065c, 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 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 [X] FILLED [] MOUND [ ] I CONFIGURATION: [ ] TRENCH [x] BED [ ] N F LOCATION OF BENCHMARK: BM#1 NID, N edge of Deer Park Ave near NW property corner I ELEVATION OF PROPOSED SYSTEM SITE [ 2.00 ][INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT E BOTTOM OF,DRAINFIELD TO BE L D i 0 T H E R [ 3.00 ][INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT ,L REQUIRED: t"11Uul INCHES EXCAVATIVN REQUIRED: L J 1Ncnra 1e system is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total estimated flow of 10 gpd• ie licensed contractor installing the system is responsible for installing the minimum category of tank in accordance with 64E-6.013(3)(f), FAC. FILE COPY SPECIFICATIONS BY: Brian J Ingram TITLE: Environmental Specialist II APPROVED BY: sw-- TITLE: Environmental Specialist II DATE ISSUED Brian J I ram 05/03/2018 EXPIRATION DATE: DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E-6.003, FAC St. Lucie CHD 11 /03/2019 Page 1 of 3 v 1.1.9 AP1340175 SE1075582 NOTICE OF RIGHTS J 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 i 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. 0 i St. Lucie County Health Department 5150 NW Milner Dr Port Saint Lucie, FL 34983 PAYING ON: PERMIT #: 56-SF-1840698 BILL DOG #:56-BID-3717473 CONSTRUCTION APPLICATION #: AP1340175 RECEIVED FROM: St Lucie Habitat for Humanitv AMOUNT PAID: $ 515.00 PAYMENT FORM: CHECK 11937 PAYMENT DATE: 04/19/2018 MAIL TO: (St. Lucie Habitat for Humanity Inc) FACILITY NAME: PROPERTY LOCATION: 7901 Deer Park Ave Fort Pierce,'FL 34951 21 Lot: Property ID: 1301-605-0118-000-4 EXPLANATION or DESCRIPTION: 44 Block: 128 - OSTDS Construction System Inspection Research Fee -1 - Surcharge (All) -1 - OSTDS New Permit Surcharge -1 - OSTDS Construction Application and Plan Review,New 123 - OSTDS Construction Site Evaluation 126 - OSTDS Construction Permit (New or Mod, Amendment) 127 - OSTDS Construction System Inspection 133 - OSTDS Construction Reinspection QUANTITY FEE , 1 $ 5.00 1 $ 15.00 1 $ 100.00 1 $ 100.00 1 $ 115m0 1 $ 55.00 1 $ 75.00 1 $ 50.00 RECEIVED BY: VanceMH AUDIT CONTROL NO. 56-PID-3517714 eo� STATE OF FLORIDA 1 DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM APPLICATION FOR CONSTRUCTION PERMIT APPLICATION FOR: wtk,(,6-5-_24-3 6/.,,//' PERMIT NO.� 12h6060<16' DATE PAID: FEE' PAID : RECEIPT #: [V/] New System [ ] Existing System [ ] Holding Tank [ ] Innovative [ ] Repair [ ] Abandonment [ ] Temporary [ ] APPLICANT: St. Lucie Habitat for Humanity, Inc. AGENT: St. Lucie Habitat for Humanity, Inc. TELEPHONE: 772-464-1117 MAILING ADDRESS: 702 South 6th Street, Ft. Pierce, FL 34950 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: 21 BLOCK: 44 SUBDIVISION: Lakewood Park Unit 5 PLATTED: 1958 PROPERTY ID #: 1301-605-0118-000-4 ZONING: RS-4 I/M OR EQUIVALENT: [ No PROPERTY SIZE: .235 ACRES WATER SUPPLY: [,/] PRIVATE PUBLIC [ ]<=2000GPD [ ]>2000GPD IS SEWER AVAILABLE AS PER 381.0065, FS? [ No ] DISTANCE TO SEWER: FT PROPERTY ADDRESS: 7901 Deer Park Fort Pierce, FL DIRECTIONS TO PROPERTY: From the intersection of Kings Highway and Indrio Road, travel west on Indrio Road to Fort Pierce Boulevard, travel north on Fort Pierce Blvd. 1.33 miles to Deer Park Avenue, travel west on Deer Park Ave .14 miles to lot on south side of road. BUILDING -INFORMATION [,/] RESIDENTIAL [ ] COMMERCIAL Unit Type of No Establishment 1 Residential 2 3 4 [ ] Floor/Equipment Drains No. of Building Commercial/Institutional System Design Bedrooms Area Sqft Table 1, Chapter 64E-6, FAC 3 1948 300 [ ] Other (Specify) SIGNATURE: 1 DATE: Lt 1 DH 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated 64E-6.001, FAC , Page 1 of 4 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATION APPLICANT: St. Lucie Habitat for Humanity Inc CONTRACTOR / AGENT: St Lucie Habitat for Humanity LOT: 21 BLOCK: 44 SUBDIVISION: Lakewood Park ID#: 1301-605-0118-000-4 APPLICATION,# AP1340'175 PERMIT # 56-SF-1840698 DOCUMENT # SE1075582 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]YES [ ]NO NET USABLE AREA AVAILABLE: 0.24 ACRES TOTAL ESTIMATED SEWAGE FLOW: 300 GALLONS PER DAY [ RESIDENCES -TABLET / OTHER -TABLE 2 ] AUTHORIZED SEWAGE FLOW: 359.99 GALLONS PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE ] UNOBSTRUCTED AREA AVAILABLE: 1244.00 SQFT UNOBSTRUCTED AREA REQUIRED: 750.00 SQFT BENCHMARK/REFERENCE POINT LOCATION: BM#1 NiD, N edge of Deer Park Ave near NW property corner ELEVATION OF PROPOSED SYSTEM SITE 2.00 [ INCHES / 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: 15 FT NORMALLY -WET: [ ]YES [X]NO WELLS: PUBLIC: FT LIMITED USE: FT PRIVATE: 75 FT NON -POTABLE: FT BUILDING FOUNDATIONS: 5 FT PROPERTY'LINES: 5 r FT POTABLE WATER LINES: 60 FT SITE SUBJECT TO FREQUENT FLOODING? [ ]YES [X]NO 10 YEAR FLOODING? [ ]YES [X]NO] 10 YEAR FLOOD,ELEVATION FOR SITE: FT[ MSL / NGVD ] SITE ELEVATION: FT [ MSL / NGVD QnTT. DVMWTT.r TW7nMMaMTAN CTTF. 1 SOTL PROFILE INFORMATION SITE 2 USDA SOIL SERIES:Pepper sand Munsell #/Color Texture Depth 10YR 3/1 Sand 0 To 4 10YR 4/1 Sand 4 To 12 10YR 5/2 Sand 12 To 31 1 OYR 6/2 Sand 25 To 57 1 OYR 5/2 Sandy Clay Loam 57 To 72 USDA SOIL SERIES:Pepper sand Munsell #/Color Texture Depth 10YR 3/2 Sand • 0 To 5 10YR 4/1 Sand 5 TO 15 10YR 5/2 .,Sand 15 To 27 10YR 6/1 Sand 26 To 55 10YR 6/2 v Sand 55 To 67 HOLE CAVING Refusal 67 To 72 OBSERVED WATER TABLE: 48.00 INCHES [ ABOVE / BELOW ] EXISTING GRADE TYPE: [ PERCHED / APPARENT ] ESTIMATED WET'SEASON WATER TABLE ELEVATION: 25 INCHES [ ABOVE / BELOW ] EXISTING GRADE HIGH WATER TABLE VEGETATION: [ ]YES [X]NO MOTTLING:' [X]YES [ ]NO DEPTH: 25.00 INCHES SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING DRAINFIELD CONFIGURATION: [ ] TRENCH r REMARKS/ADDITIONAL CRITERIA Sand/0.60 DEPTH OF EXCAVATION: INCHES [XI BED [ ] OTHER (SPECIFY) WSWT determined using USDA WSS and soil borings. 10YR6/2 stripping in 10YR5/2 matrix >10% with diffuse boundaries starting at 25" in SB1. SB1 2" below BM. SB2 1" above BM SITE EVALUATED BY: Ingram, Brian (Tit[¢! Environmental Specialist,//) (ENVIRONMENTAL HEALTH) DR 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated: 64E-6.001, FAC AP11340175 EID1840698 DATE: 04/25/2018 Page 3 of 4 v 1.0.2 S o� STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS PERMIT #. APPLICANT: St. Lucie Habitat for Humanity, Inc AGENT: Same i LOT: 21 BLOCK: 44 SUBDIVISION: Lakewood Park Unit 5 PROPERTY ID # : 1301-605-0118-000-4 [ Tax ID Number ] TO BE COMPLETED BY ENGINEER, HEALTH DEPARTMENT EMPLOYE9,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 TOTAL ESTIMATED SEWAGE FLOW: 300 GALLONS PER DAY [RESIDENCES-TABLEI AUTHORIZED SEWAGE FLOW: 1500 GALLONS PER DAY [1500 GPD/ACRE UNOBSTRUCTED AREA AVAILABLE: 1539+/- SQFT UNOBSTRUCTED AREA REQUIRED:_ 23 ACRES ] ] SQFT BENCHMARK/REFERENCE POINT LOCATION: North edge of pavement west property line extended ELEVATION OF PROPOSED SYSTEM SITE IS0.2 [FT ] [BELOW •] BENCHMARK/REFERENCE POINT THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES SURFACE WATER: n/a FT DITCHES/SWALES:20 FT NORMALLY WET? [ J YES [✓] NO WELLS: PUBLIC: n/a FT LIMITED USE: n/a FT PRIVATE: +75 FT NON —POTABLE: n/a FT BUILDING FOUNDATIONS:5 FT PROPERTY LINES:5 FT POTABLE WATER LINES: n/a FT SITE SUBJECT TO FREQUENT FLOODING: [ ] YES [✓] NO 10 YEAR FLOODING? [ ] YES [✓] NO 10 YEAR FLOOD ELEVATION FOR SITE : Zone X FT MSL/NGVD SITE ELEVATION: Zone X 20.7FT MSL/NGVD SOIL PROFILE INFORMATION SITE 1 MUNSELL #/COLOR TEXTURE DEPTH TO TO TO TO TO TO TO TO TO USDA SOIL SERIES: SOIL PROFILE INFORMATION SITE 2 MUNSELL #/COLOR USDA SOIL SERIES: TEXTURE DEPTH TV TO TO TO TO TO TO TO mn OBSERVED WATER TABLE: INCHES [ABOVE/BELOW f] 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: DRAINFIELD CONFIGURATION: [ 1 TRENCH [ ] BED REMARKS/ADDITIONAL CRITERIA: SITE EVALUATED BY: DEPTH OF EXCAVATION: [ ] OTHER J(SPECIFY) DATE: INCHES DH 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated: 64E-6.001, FAC Page 3 of 4 Property Card Page 1 of 1 Michelle Franklin, CFA -- Saint Lucie County Property Appraiser -- All rights reserved. Property Identification Site Address: 7901 DEER Parcel ID: 1301-605-0118- Account #: 1162 Sec/Town/Range: PARK AVE 000-4 11/34S/39E Map ID: 13/11N Zoning: RS-4 Use Type: 0000 Jurisdiction: Saint Lucie County Ownership Legal Description St Lucie Habitat for Humanity LAKEWOOD PARK -UNIT 5- BLK 44 LOT21 (MAP 13/11N) 702 S 6th ST (OR 3961-548) Fort Pierce, FL 34950 Current Values Historical Values 3-year Just/Market: $6,800 Assessed: $6,734 Year Just/Market Assessed Exemptions Taxable Exemptions: $0 Taxable: $6,734 2017 $6,800 $6,734 $0 $6,734. 2016 $6,300 $6,122 $0 $6,122 2015 $5,900 $5,566 $0 $5,566 Sale History Date Book/Page Sale Code Deed Grantor Price 01-27-2017 3961 / 0548 0117 WD Woodin (TR) Richard K $10,500 07-30-2010 3255 / 1528 0130 QC Woodin (TR),Richard K $100 02-02-2010 3168 / 1481 0111 TD Van Haezebrouck,George T $3,700 Primary Building Information Finished Area of this building: 0 SF Gross Area of this building: 0 SF Exterior Data View: Roof Cover: Roof Structure: Building Type: Year Built: N/A Frame: Grade: Effective Year: 2014 Primary Wall: Story Height: No. Units: 0 Secondary Wall: Interior Data Bedrooms: 0 A/C %: 0% Electric: Primary Int Wall: Full Baths: 0 Heated %: N/A% Heat Type: Avg Hgt/Floor: 0 Half Baths: 0 Sprinkled %: 0% Heat Fuel: Primary Floors: , Ls Total Areas Finished/Under Air 0 (SF): Gross Area (SF): 0 Land Size (acres): 0.27 �•��� �'����' ���.Y Land Size (SF): 11,790 '^ Total Building Count: I Special Features and Yard Items Type Qty Units Year Bit This information is believed to be correct at this time but it is subject to change and is not warranted. © Copyright 2018 Saint Lucie County Property -Appraiser. All rights reserved. ttp://www.paslc.org/RECard/ 4/19/2018 IV Custom Soil Resource Report Minor Components Canaveral Percent of map unit: 5 percent Landform: Dunes on marine terraces, ridges on marine terraces Landform position (three-dimensional): Interfluve Down-slope�shape: Convex Across -slope shape: Linear Hydric soil rating: No Sanitary landfill Percent of map unit: 5 percent Hydric soil rating: Unranked 31—Pepper and EauGallie sands Map Unit Setting National map unit symbol. ljpvs Mean annual precipitation: 49 to 58 inches Mean annual air temperature: 70 to 77 degrees F Frost -free period. 350 to 365 days Farmland classification: Farmland of unique importance Map Unit Composition Pepper and similar soils: 45 percent Eaugallie and similar soils: 45 percent Minor components: 10 percent Estimates are based on observations, descriptions, and transects of the mapunit. Description of Pepper Setting Landform: Flatwoods on marine terraces Landform position (three-dimensional): Talf Down -slope shape: Convex Across -slope shape: Linear Parent material: Sandy and loamy marine deposits Typical profile A - 0 to 6 inches: sand E - 6 to 23 inches: sand Bh1 - 23 to 33 inches: sand Bh2 - 33 to 57 inches: sand Btg - 57 to 80 inches: sandy loam Properties and qualities Slope: 0 to 2 percent Depth to restrictive feature: 16 to 31 inches to ortstein Natural drainage class: Poorly drained Runoff class: High 11 Custom Soil Resource Report Capacity of the most limiting layer to transmit water (Ksat): Moderately low to moderately high (0.06 to 0.20 in/hr) Depth to water table: About 6 to 18 inches Frequency of flooding: None Frequency of ponding: None Salinity, maximum in 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: Very low (about 1.1 inches) Interpretive groups Land capability classification (irrigated): None specified Land capability classification (nonirrigated): 4w Hydrologic Soil Group: D Forage suitability group: Sandy soils on flats of mesic or hydric lowlands (G156BC141FL) Hydric soil rating: No Description of Eaugallie Setting Landform: Flatwoods on marine terraces Landform position (three-dimensional): Talf Down -slope shape: Convex Across -slope shape: Linear Parent material: Sandy and loamy marine deposits Typical profile A - 0 to 5 inches: sand E - 5 to 26 inches: sand Bh - 26 to 47 inches: sand Btg - 47 to 62 inches: sandy loam Cg - 62 to 80 inches: sand Properties and qualities Slope: 0 to 2 percent Depth to restrictive feature:, More than 80 inches Natural drainage class: Poorly drained Runoff class: High ' Capacity of the most limiting layer to transmit water (Ksat): Moderately low to high (0.06 to 1.98 in/hr) Depth to water table: About 6 to 18 inches Frequency of flooding: None Frequency of ponding: None Salinity, maximum in 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: Moderate (about 7.2 inches) Interpretive groups Land capability classification (irrigated): None specified Land capability classification (nonirrigated): 4w Hydrologic Soil Group: A/D Forage suitability group: Sandy soils on flats of mesic or hydric lowlands (G156BC141FL) Hydric soil rating: No 12 G Mission: f protect promote8 of Improve the health RECEIVED Rick Scott all people m plodda through integrated Governor state, county 8 community efforts. '" ��'_"' AY 2 �p�g Celeste Philip, MD, MPH State Surgeon General and Secretary Vision: To be fhe 'h+�a� } �o �rrnl�In�� Florida Department of 'He alth In St. Lucre County Conditions for Issuance of Water Well Permits Effective Jule 24, 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 Line at 772-873-4936 or email SLCDOH_WELLS FLHEALTH.GOV b. Provide the following information: i. Permit number ii. Driller name iii. Address iv. Date and tirne to begin construction/abandonment A minimum of 24 hours' notice is required '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 CD - L OH WELLSO-FLHEALTH.GOV • Submit revisions to permit and/or site map and associated fee within 48 0 construction or abandonment. hors of well Florida Department of Health SL Lucie County • Division of Disease Control and Health Protection Bureau of Environmental Health 5150 NW Mllner Drive Port SL Lude, FL 34983 PHONE: 772/873-4931 • F Accredited Health Department FloridaHealth.gov FAX: 772/595-1306 ' Public Health Accreditation Board r r • rV• • • • • 1 /111 1 r1 �,1111V1� 1 V v,V1�J 11•Yvl, REPAIR, MODIFY, OR ABANDON A WELL ❑ Southwest ❑ Northwest PLEASE FILL OUT ALL APPLICABLE FIELDS ('Denotes Required Fields Where Applicable) ❑ St. Johns River ❑South Florida The water wellcontractorisresponsible forcompleting El Suwannee River this form and forwarding tliepennit application to the appropriate delegated authority where applicable. ❑ DEP ❑ Delegated Authority (If Applicable) Permit No. ✓ Ira 6 Florida Unique ID Permit Sf ulation equired ,(See Attached) -- — 62-524 Quad No. Delineation No. Application No. 'owner, Leg Nam`e�t L;orporatloy� ess /� "41 � '95/ State '21P Telephone Number 2. 'Well Location -Address, oad-K&me o 14m ef, t /,mod/ �IMS - ///P D- "Parcel ID No. (PIN) or Alter to K (Circle One) - 4.' 'Sec�tiotn�or/�ad/' je 'County 5yb/ Q `Water Well Contractor License Number 6. yI 9/t/ .3 7 s - 'Water Well Contracto s Address Lot Block Unit Check if 62-524:❑ Yes ❑ No 72vZ �7/S` Srl?n.�,elsr�ei+s • .�� cC­P-j 'Tel e hoe Number E-mail Address City State ZIP 7. 'Type of Work: YConstruction ❑ Repair ❑ Modification❑ Abandonment 8. "Number of Proposed Wells 'Reason for Repair. Modifies 9. Xpecify Intended Use(s) of Well(s): I Domestic ❑ Landscape Irrigation ❑ Agricultural Irrigation ❑ Site Investigations ] Bottled Water Supply ❑ Recreation Area Irrigation ❑ Livestock ❑ Monitoring ] Public Water Supply (Limited Use/DOH) ❑ Nursey Irrigation ❑ Test ] Public Water Supply (Community or Non-Community/DEP)❑ Commercial/Industrial Earth -Coupled Geothermal ] Class I Injection ❑ Golf Course Irrigation HVAC Supply :lass V Injection: ❑ Recharge ❑ CommerciaUlndustrial HVAC Return Disposal ❑ Aquifer Storage and Recovery ❑ Drainage Remediation: ❑ Recovery ❑ Air Sparge ❑ Other (Describe) ❑ Other (Describe) 10.'Distance from Septic System if <_ 200 ft. 11. Facility Description 13."Estimated Well Depth _T 5 ft. 'Estimated Casing Depth 7 ft. Primary Casing Diameter A 14. Estimated Screen Interval: From ? To ft. 15.^Primary Casing Material: Black Steel Galvanized PVC Stainless Steel Not Cased Other: 16. Secondary Casing: Telescope Casing Liner Surface Casing Diameter'----- m MAY 3 2018 FDOH In St Lude 12. Estimated Start Date f7_)ft4J Open Hole: Frofn 17. Secondary Casing Material: -Black Ste'et"Galvanized PVC Stainless Steel Other 18."Method of Construction, Repair, or Abandonment: Auger t✓Cable Tool Jetted Rotary Sonic Combination (Two or More Methods) Hand Driven (Well Point, Sand Point) Hydraulic Point (Direct Push) Horizontal Drilling Plugged by Approved Method Other (Describe) 19. Proposed Grouting Interval for the Primary, Se In and Additional Casing: From t% To Seal Material tonite Neat Cement Bee� Other ) From TO Seal MatMated(tonite Neat Cement Other ) From To Seal MatedI ( f-Bentonite Neat Cement Other ) From To _j 5 Seal Mated ( /tentonite Neat Cement Other ) 20. Indicate total number of existing wells on site List number of existing unused wells on site 21." Is this well or any existing well or water withdr al on the owner's contiguous property covered under a Consumptive/Water Use Permit (CUP/WUP) or CUP/WUP Application. Yes f No If yes, complete the following: CUP/WUP No. District Well ID No. 22. Latitude Longitude 23. Data Obtained From: GPS Map Survey I hereby certify that I will amply wdh the applicable rules of Tide 40, Florida Administrative Code, and that a water use permit or artificial facharge pennil. if needed. has been or vAg be obtained prior to commencement of well construction. I fmthor certify that at Information provided In this application Is accurate and that I will obtain nocassory approval from other federal, state, arbial governments, it applicable. 1 agree to provide a,vell completion report to the District within 30 days after completion of the construction, repair, modification. or abandonment suthou@ed by this pemill, of mite permit expitallon,,Vilrichevor occurs first. n .. , - Approval Granted By Fee Received S f/O..y 'I it incc+ Nn Issue Date Receipt No. Datum: NAD 27 NAD 83 WGS 84 I certify that 1 am Ina ovmer of the property, that the information provided is accurate, and that I am avaro of my responsibilities under Chapter 373. Florida Statutes, to maintain or property abandon this wog; or, I c ffify Pan I am file agent for the ovmer. that lite intamtatlon provided is accurate, and that I have Informed the owner of their responsibilities as slated above. Comer consents lu agosdng personnel 01 1111S N1MD Of Delegated Authority access to the well silo during the construction, rolian, Modification. or abnodonmonl authorized by this permit. Expiration Date IV !?l I y _ Hydrologist Approval Check No. THIS PERMIT IS NOT VALID UNTIL PROPERLY SIGNED BY AN AUTHORIZED OFFICER.OR REPRESENTATIVE OF THE WMD OR DELEGATED AUTHORITY. THE PERMIT SHALL BE AVAILABLE AT THE WELL SITE DURING ALL CONSTRUCTION. REPAIR, MODIFICATION, OR ABANDONMENT ACTIVITIES. Fnrm• R9-537 9nni11 Inr•.mmnrateld•in R9.537 dnnf1l F A r; FHartivP natp, rlrtnhp.r 7 MCI Pane 1 of 7 518.91 15"CMP FND 5/8" IRC (NO ID) N00"1.3'02" 0.34' FEET OF :D SPACE _ SYSTEM' kINFIELD= iL Li _OT 22 ' RESIDENTIAL = 21.99' CEL ID: )501190001 FND 5/8" IRC I (NO ID)(HELD) N:1165858.23 E: 849041.56 D.E. �. OHW OHW OHW IE P_U. & D_E. — — CANT 30160501020009 )T 5 r S892 T CENTERLINE SWALI 695.00'(P) _ oL 15" CMP — o INV. = 19.22' E (F) 0.06 (F) FND 1/2" IP 7dll 0.0 p) (NO ID) (LASH PINE N26�T0`t6,�0.14' 13.51 31.83' 0 18.00' 13.33' o 2 COVER ENTRY o zo j PROPOSED ONE STORYop I `' � RESIDENTIAL F-1¢ M FFE = 21.83' I PARCEL ID: Ew 130160501190001 I - _ f 31.97' 44.67• OPEN PATIO V-3-511 L — LOT 23 B L O C 4 4 I — OHW_ oyw oaw c — — 10.00 WIDE PoCI_w& D.E. — — ® OCCUPIED PARCEL ID: 130160501030006 LOT 6 VEL. = 20.46' IVVV VG (]I .85 26.60' 113.40' I SEPTIC IS 75' FROM PROPERTY WELL 40.00' P) PLAT DAT a �I LOT 20 Y (C CALCUTAT GR 30 FROM FIELD MEASUREMEI v ONE STORY RESIDENTIALFOUND CJ (M) FIELD MTEVER REME oorFC = 21.67' m P.C.C. POINT OMP01 O o' • ^ PARCEL ID: z P.R.C. P.LS. POINT OE PROFESL U ~'130160501170007 � Le. UCENSES►NEIRC r IRON ROCAP IR IRON ROD w A DELTA ( TRAL R RADIUS L ARC LEN CB CHORD BE ARING N.A.V.D. NORTH Al IERICM P U PUBLIC Ulm rry PROPOSED D.E. DRAINAGE -CONC. A/C PRM PERMANE I INv °OHW �� FND 1/2" IP INVERT NOTES (NO ID) S26048'19"E 0.1' 1) NOT VAUD WITHOUT THE: SURVEYOR AND MAPPER. 2) ADDITIONS. OF DELETIONS — — — — THAN THE SIGNING SURVEY01 — — SIGNING SURVEYOR. °'�� 10.00' WIDE. P.U. & D.E. DESCRIPTION ) OVERALL PARCEL CONTAIAII 5) THE LAST DATE OF FIELD -- OHW— 10.00' WIDE P.U. & D.E., 6) THE E ASTING FOUND FIEL S89.46'58"E. ALL 07HE R BEI `-PROPOSED WELL DISTANCES SHOWN ARE PER OTHERWISE:. CC>�PIEq 7) ALL LINES SHOWN INTERS'. u �+ AS NON -RADIAL (NR). Pt! LID• i3 7 pQ 8) LANDS SHOWN HEREON W RESL' ivirohm ,cial Health OBTAINED AND AGREEMENTS, B S ' nPrldl�@Ti for Construction 8) UNDERGROUND UTIUTIES, IMPROVEMENTS WERE NOT LC Su eats Ail PrEvious Site Plans for 9)DESCRIBED PROPERTY IS L THE FEDERAL EMERGENCY M/ Xf N0.12111Co070A ST. IL ICIE C 10) SOME INFORMATION WAS 3053 AND LB 4980 ON FEBF 11) TREES SHOWN HEREON A e1'A _ - 12) EACH S SHOWN HE f A AT If1 /tC 1BQIffR ANGLE) VERTICAL DATUM EASEMENT REFERENCE MONUMENT WIRE AND THE ORIGIN, 3 SURVEY MAPS OR REPO IS PROHIBITED, WITHOUT C N PROVIDED BY CUENT AI '10,250 SQUARE FEET, M( IORK WAS MARCH 6, 2016 CONTROL FOR THE CFSITE INGS SHOWN ARE RELATIV :CORD PLAT (P) AND FIEL TING A CURVE ARE RADIA RE NOT ABSTRACTED BY T AND/OR EASEMENTS OF RI OTHERS THROUGH APPR01 TUTY SERVICES, FOUNDAM :ATEQ AS A PART OF THIS CATFD WITHIN AN AREA Hi VAGEMENT AGENCY (FEMA), )LINTY, FLORIDA. W17- H AN I 38TAINED FROM••A,SWRVEY IARY 14, 2Q17.• THE'FILE'N IE TO BE .SAyED. a i EON ARE�USING.'%aCAL.- RECEIVED Rick Scott Mission: Governor To protect, promote & improve the health ' of all people in Florida through integrated state, county & community efforts. r' � Il v ! •: ' I�Ly `^ AY 21 2 01 g Celeste Philip,MD MPH ' State Surgeon General and Secretary p� �1 �r vision: To be the ST.. L ! . PArf11l IYt� Florida Department of Health in St. Lucie County Conditions for Issuance of Water Well Permits Effective July 24, 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 Line at 772-873-4936 or email SLCDOH-WELLS(c)FLHEALTH.GOV b. Provide the following information: i. Permit number ii. Driller name iii. Address iv. Date and time to begin construction/abandonment • A minimum of 24 hours' notice is required 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-WELLSO-FLHEALTH.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 or Disease Control and Health Protection Bureau of Environmental Health 5150 NW Milner Drive Accredited Health Department PortSL Lude, FL34983 Public Health Accreditation Board PHONE: 772/873-4931 • FAX: 7721595-1306 FloridaHealth.gov INTERIOR DOOR SCHEDULE 0 - SQE DESCRIPTION REMARKS de4FpD GENERAL DOOR B IMNDOW NOTES. 2 AU WONWNueRSSWu0E 9PeWE �WMi� =NNTEHNBM WIN LON'e uui[oucxtausS aF�iExER4 4aTe PER IHE PROOuciaveROVw WNNEMATpN MQU4x0 TxE NixeER LOUNOx, EUE, SIN ttPEs of l vEgFIw1 REO4RE044 FORW4a0maUNT91OeE WSTRIE EFORE BInAxo0PEx6L(: e ��tzxntJ �% jv I I Site Reviewer nhaY J EXTERIOR DOOR & WINDOW SCHEDULE t M.O. (1M*H X NT.) (F 4N NEB). M1- 1 ,.-.�-•- ee�� n ow � ES1rN7E� ES r l 1 1' � PRODUCTAPPROVAL NUMBER EXPIRATION SYN. REM LOCATION O DESIGN PRESSURES ODUCT RATED DESIGN PRESSURES Px + pTOEx Q Qi aN-afow,roO.v 9 Q iaYLJ0000RWwLFRWE:1,+•`^^. PEEP ,MxO2JOx J-1tMx6-+P JEIDl.II1 SEE ELLV9 Mao R,1,xLRE - Q e-Pnx'cL uErEa LG dNwJROw - EE E- RN,xaa - b GK �T � eEmooxa I I " I„r N I xT sed G�N,ExExT. �. MCOFFEf4=0 b vlXIJY i�7 )OH in St. Lucii6bu�p Environmental Health in Approv , or Construction des All Pre s k P ans for -5F-1&40Wf. . & wen # 51-Z?3 0 'Q Cm N 6K d 4 I f. I e Px,J-2 m FRaNTE,RRa• I ex F n-r n SQUARE FOOTAGE uw+4 ,xl ss. OxROGE: ISS AF. TO — uE uxoERNx OT-Px+6-S' tS-x x,J-Svt qb b t S - Q 2 INTERIOR DIMENSIONS PLAN A-1.0 rc.L K*a Habitat PLANS PREPARED FOR: for Humanity" 1� PLANS PREPARED BY: >11111111 V­ k WHOLE11111S1ENG,MG 151SL WaNlad. gW1,2tt F Pierre, I, FI,v..3l9Vr nrcrc.�'m. DRAWWNO NOTICE LounoN oRRwacnmPo' MSMV a�s­ xG4 P,Ew5EO4RTxGTOER M WMwtt WE91N4 REGWOIGGNEx9W1 ENGINEERING LICENSE: aom-� PEP,�EJ ORAWINO NOTICE: • • xvx ¢0.watm[�x lnnsexi oe wrteoTw Txoul A Pp xwA m. . , rPROJEOTNUMBER: �1 ["'EN'Rm E: DEERPARK [7mA7-' HDEERPARK SIZE ADORESS: DEERPARK FORT PIERCE, FL 34951 SHEET DEWM"ON: FLOOR PLAN SHEETNUMBER: A - 1.0 INTERIOR DOOR SCHEDULE N SQE DESCRIPTION REMARKS P ELSTE�EEOM GENERALDOORSNINDOWNOTES: MsxWTNEw+ TEOaEM suss INSiNL6nUMM Mg EPRSOOICTMw HwNW— EM%nON UNGl WMBEALOCn1pN.sIZE.%xoT UOF O u.4FOR WK6000RUNISTOeEtxsi%LLFO EMxcs RECEIVED EXTER104 DOOR 8 MM&YV S U 6 M.0.flMDTH , ) (FT -INCHES) rmitting MANUFACTURER DESIGN PRESSURES PRODUCT APPpOVAI NUMBER EXPIRATION SYM. 1 REy, T ! 11C1e CD TIONT �Ws r OPENING DESIGN PRESSURES PRODUCT RATED DESIGN PRESSURES pps WNpvx - T-Yvfi' M. ]�6 WxOW 6W RWI a%T,woous •m6 sEE ELEV9 © RIxSUI bWtm 000e$P%NELSTEELR WwLFRN,E.MSMD:PEEP IM,vO ROOY S-1U.%s-tm �ELonEx sEE EIEV9 M66 ftt,tssg6 - O WisWNGWwiWMVA FNwE ilaxL0. - 6EE ELEYS - PLANS PREPARED FOR: Habitat for Humanity" >= Wk WHOLE: HOUSE. EJ`lO1NFAXINO � _ � 4Li151. Lurte III,J. Suiln ]Ol Fort Pum, FT, i19N DRAWING NOTICE ewe 0 b ' Y g N �L Ne sEoxocMn o, , 4 2 GK - >< a ,uunoN FKruR s u-r,rrxtz-v if• -a is il` MEOFrcwTlaxs - i N eEwocMa uSEOFORu%Y�VMYs mu�unw.. s¢E �e rxiz m WTSONEGwWNG4 Plews6caxrncr OEElcx b C b 1 --"'---1 b x % WTHFNV OUE81pxe REGMgw GMFNSIONs ER al p6-0,T T. 6 t6a Uo , _ Pa• RMSNNEMSWTNYW,ER ) � F6DIAiES. CARNETS. MPN N 6.�YN ERS. r...'_ �.....,_....ti • .- �0�. E� a ENGINEERING LICENSE: Fs d WR ETE • 1NINO Roots 9 � e � 9• f. u _.,_;' I F `i .C�... e 9•'R e - � `�$ DRAWING N0710EMeo s III • _ Is-P%,e-YI Y NxuEwN%rzYin %snows __ I sa • mxRM � s• Ia—� I is }—saO �• a (PROJECT NUMBER:�mMo �euiEO fi-1T6. -I,rr N I i ❑ W I �� __ s I I A�6------- — .Ts I 0 0 o on �< 6.,G• N�TE:Y%.STwW„� p ,T..• TaYT c%R%cE utxmPPER[O - ,.a t?jq 5Wu1s 5Aimn,si %seian U SITE NAME ar-mx,s-Y cEWNO •_........_-.. _ b i 1?xt 6 ]T-Pxis'-6 to-. %,Y-e cY o-,xRooNEt r,.ENGONSwuY.E. w.,ERSaPTENER / `, i �. I N 7 5 / \ / SITE NUMBER: ........ _.,. u....... HAB-DEERPARK DOH in St. Lucie Coulln SITE ADDRESS: _,DEERPARK Environmental Health SQUARE FOOTAGE FORT PIERCE, FL U951 „6 .F. SHEET DESCRIPTION: Site Plan Approve.dftr Coaskuption s esP. 2 INTERIOR DIMENSIONS PLAN FLOOR PLAN Supersedes All Prevkoibs Sibi Plans for rSHEET NUMBER: me *5 -Sf- lifYo69 if R wpll * 61-243./ I A - 1.0 e: 51�YIL