HomeMy WebLinkAboutSEWAGE CONSTRUCTION INSPECTION & FINAL APPROVALSCANNED RECEIVED
s' V (BY
atLu�0s Cunt MAR 2 9
2Q19
APPLICATION #: RP1350863
e
STATE OF FLORIDA Permitting Department
PERMIT #:56-SF-1856631
St. Lucie County
k '�
DEPARTMENT OF HEALTH
#: F11276008
"ts ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
DOCUMENT
DATE PAID:06/19/2018
-��
CONSTRUCTION INSPECTION AND FINAL APPROVAL
i
FEE PAID:515.00
RECEIPT #:56-PID-3597965
APPL IcANT:
Grande Construction of Florida, INC
AGEN ' : Greg Oldakowski (Grande Construction)
PROPERTY ADDRESS: 12366 Lear PI Port Saint Lucie, FL 34987
LOT:'53
BLOCK:
SU13E SION:
Treasure Coast Air Park ID#: 4224.501-0053-000-4
III'II
CHECKED [XI ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED.
TANK INSTALLATION
SETBACKS
[ ] [01]
TANK SIZE [11 1050.00 [21 300.00 [
] [271
SURFACE WATER FT
[ ] [021
TANK MATERIAL Concrete [
] [281
DITCHES FT
[ ] [031
OUTLET DEVICE [
] [291
PRIVATE WELLS 80 FT
[ 11 (041
MULTI -CHAMBERED [ Y N ] [
] [301
PUBLIC WELLS FT
[ ]1 [05]
OUTLET FILTER Polylok PL-122 [
] [311
IRRIGATION WELLS 80 FT
[ ][061
LEGEND 1. 01-011-09DC3 2. 01-011-96SC4 [
] [321
POTABLE WATER 60 FT
[ ] [071
WATERTIGHT [
] [331
BUILDING FOUNDATIONS 6 FT
[ ]i [081
LEVEL [
] [341
PROPERTY LINES 80 FT
[ ]j [091
DEPTH TO LID [
] [351
OTHER FT
DRAINFIELD INSTALLATION
FILLED / MOUND SYSTEM
[ 1 [101
AREA [1] 540 [21 SQFT [
] [361
DRAINFIELD COVER
[ ]� [111
DISTRIBUTION BOX HEADER x [
] [371
SHOULDERS
[121
NUMBER OF DRAINLINES 1. 5.00 2. [
] [381
SLOPES
[ ], [131
DRAINLINE SEPARATION [
] [391
STABILIZATION 03/29/2019
[ j! [14]
DRAINLINE SLOPE
[ 11 [151
DEPTH OF COVER
ADDITIONAL INFORMATION
[ [161
ELEVATION . [ ABOVE / BELOW ]BM 2.00 [
7 [401
UNOBSTRUCTED AREA
[ [171
SYSTEM LOCATION [
] [411
STORMWATER RUNOFF
[ [181
DOSING PUMPS 1.00 [
] [421
ALARMS
[ [191 -AGGREGATE
SIZE [
] , [431
MAINTENANCE AGREEMENT
[ } [201
AGGREGATE EXCESSIVE FINES [
] [441
BUILDING AREA
[ }' [211
AGGREGATE DEPTH [
] [451
LOCATION CONFORMS WITH SITE PLAN
[
] [46]
FINAL SITE GRADING
FILL / EXCAVATION MATERIAL
[
] [47]
CONTRACTOR David Whiteside (Accurate Se
[ [221
FILL AMOUNT
[
] [481
OTHER INFILTRATOR Quick4 EQ36 (single c
[ 1231
FILL TEXTURE
[ [241
EXCAVATION DEPTH
ABANDONMENT
[ [251
AREA REPLACED [
] [491
TANK PUMPED
[ [261
REPLACEMENT MATERIAL [
] [50]
TANK CRUSHED & FILLED
Comments: Comments are on page 2.
/
St. Lucie CHD DATE: 01/04/2019
CO 3TRUCTION
[ APPROVED
DISAPPROVED Envi nfal Specialist II Br'
J Ingram (ENVIRONMENTAL HEALTH)
FINAL
SYSTEM
[ APPROVED / DISAPPROVED ]:
Lucie CHID DATE: 03/29/2019
I
Environmental Specialist II B
n J Ingram (ENVIRONMENTAL HEALTH) _
(ExI1Yanation
of
Violations on following page)
g11I
DH
016, 08/09
(Obsoletes all previous editions which may not be used)
2 3
lid
Incorporated:
69E-6.003, FAG
Page of
11
EH Database v 1.0.1 AP1350863
EID1856631
The
ST,
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION INSPECTION AND FINAL APPROVAL
Comment
APPLICATION #:AP1350863
PERMIT #:56-SF-1856631
DOCUMENT #: F11276008
DATE PAID:06/19/2018
FEE PAID:515.00
RECEIPT #:56-PID-3597965
is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total estimated flow of 300
filter, DT, bames1/3 hp pump, and 5x9 long DF installed. No violations, system ok to cover. Contractor notified
final inspection for mound system and final site grading.
)proved. Contractor and building department emailed final approval.
DH 40161 Q'8/09 (Obsoletes all previous editions which may not be used)
Incorporal;d: 64E-6.003, FAC Page 2 of 3
EH Database v 1.0.1 AP1350863 EID1856631
y
SCANNED PERMIT #:56-SF-1856631
BY APPLICATION #: AP1350863
t STATE OF FLORIDA _ ode OW*
DEPARTMENT OF HEALTH DATE PAID:
,^ ONSITE SEWAGE TREATMENT AND DIS O�C �1�®
FEE PAID:
SYSTEM
CEIPT #:
JUG. I 1 t 018 D cUMENT #: PR1124552
`[': !� ! t Lnc. }yermittin
CONSTRI�I CTION PERMIT FOR: OSTDS New
APPLICANT: (Grande Construction of Florida, INC)
PROPERTY ADDRESS: TBD Sky King/Lear PI Port Saint Lucie, FL 34987
LOT: I BLOCK: SUBDIVISION: Treasure Coast Air Park
PROPERTY ID #: 4224-501-0053-000-4 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
[OR TAX ID NUMBER]
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION
381.00 '5, 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'S APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID.
ISSUANC�E OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL,
STATE, 'IIOR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY.
SYSTEM LSIGN AND SPECIFICATIONS
11
T 1900 ] 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 [ I ] SQUARE FEET N/A SYSTEM
A TYPE VIi STEM: [ ] STANDARD [x] FILLED [] MOUND [ ]
I CONFIGURATION: [ ] TRENCH [x] BED [ ]
N 11
F LOCATION OF BENCHMARK: Site BM #2 PK NiD PCP 2391, center of intersection if sky king and fear
I ELEVATION OF PROPOSED SYSTEM SITE [ 11.00 ] [INCHES FT ] [ABOVE BELOW ]BENcm-n=/REFERENCE POINT
E BOTTO OF DRAINFIELD TO BE [ 2.00 ][INCHES FT ][ABOVE BELOW] BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: [ 9.00 INCHES EXCAVATION REQUIRED: [ 33.001 INCHES
The system is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total estimated flow of
° 300 gpd.
T The lic8nsed contractor installing the system is responsible for installing the minimum category of tank in accordance with
H s. 64E-6.013(3)(1), FAC.
E
R
SPECIFICATIONS BY: Brian J Ingram TITLE: Environmental Specialist II
APPROVED Y: TLE: Environmental Specialist II St. Lucie CHD
II Brian J In
DATE ISSUED: 07/09/2018 EXPIRATION DATE: 01/09/2020
DH 4016, 0,8/09 (Obsoletes all previous editions which .may not be used)
Incorporated: 64E-6.003, FAC Page 1 of 3
11 v 1.1.4 AP1350863 SE1084639
BILE COPY
NOTICE OF RIGHTS
A party whose substantial interest is affected by this order may petition for an
iistrative hearing pursuant to sections 120.569 and 120.57, Florida Statutes. Such
edings are governed by Rule 28-106, Florida Administrative Code. A petition for
iistrative hearing must be in writing and must be received by the Agency Clerk for the
rtment, within twenty-one (21) days from the receipt of this order. The address of the
,y Clerk is 4052 Bald Cypress Way, BIN A-02, Tallahassee, Florida 32399. The Agency
s facsimile number is 850-413-6743.
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
itute a waiver of your right to an administrative hearing, and this order shall become a 'final
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
g i�emed by the Florida Rules of Appellate Procedure. Such proceedings may be commenced
b,! 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.
St. Lucie County Health Department
5150 NW Milner Dr Port Saint Lucie, FL 34983
PAYING ON: PERMIT#:56-SF-1856631 13ILL DOC #:56-BID-3801481 CONSTRUCTION APPLICATION #: API 350863
RECEiI ,
ED FROM: Grande Construction AMOUNT PAID: $ 515.00
PAYMENT FORM: CHECK 4088 PAYMENT DATE: 06/19/2018
MAIL
FACI
(Grande Construction of Florida, INC)
Y NAME:
I
�TY LOCATION:
BD Sky King/Lear Pl
Qrt Saint Lucie, FL 34987
Lbt: 53
Block:
4224-501-0053-000-4
Property ID:
EXPLANATION or DESCRIPTION:
QUANTITY
FEE
128 - O' TDS Construction System Inspection Research Fee
1
$
5.00
-1 - Sur harge (All)
1
$
15.00
-1 - OS7DS New Permit Surcharge
i
1
$
100.00
-1 - OS I DS Construction Application and Plan Review,New
1
$
100.00
123 - O II TDS Construction Site Evaluation
1
$
115.00
126 - O$T DS Construction Permit (New or Mod, Amendment)
1
$
55.00
127 - OS�1DS Construction System Inspection
1
$
75.00
133 - O TDS Construction Reinspection
1
$
50.00
BY: VanceMH AUDIT CONTROL NO. 56-PID-3597965
STATE OF FLORIDA PERMIT N0. �� �-�
'i DEPARTMENT OF HEALTH DATE PAID:
ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID:
-• A k • SYSTEM RECEIPT # : G•
APPLICATION FOR CONSTRUCTION PERMIT
APPL CATION FOR:
New System [ ] Existing System [ ] Holding Tank [ ] Innovative
[ ],' Repair [ ] Abandonment [ ] Temporary [ ]
APPL I,CANT : GRANDE CONSTRUCTION OF FLORIDA, INC
�L
AGEN • GREG OLDAK W 5Z8',
O SKI, PRESIDENT TELEPHONE: 772 336 7240
MAIL G ADDRESS: P.O. BOX 881765 PORT ST LUCIE, FL 34988
TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. SYSTEMS MUST BE CONSTRUCTED
BY A ERSON LICENSED PURSUANT TO 489.105(3)(m) OR 489.552, FLORIDA STATUTES. IT IS THE
APPLIii 'S RESPONSIBILITY TO PROVIDE DOCUMENTATION OF THE DATE THE LOT WAS CREATED OR
PLATTED (MM/DD/YY) IF REQUESTING CONSIDERATION OF STATUTORY GRANDFATHER PROVISIONS.
PROPE�TY INFORMATION
LOT: IP3 BLOCK; SUBDIVISION: TREASURE COAST AIRPARK
CK
ID # : -4424501-0053-000/4
PLATTED: BOOK 26
ZONING: AG-5 I/M OR EQUIVALENT: [ Yes ]
PROPERTY SIZE: 2.57 ACRES WATER SUPPLY: [,(] PRIVATE PUBLIC [ ]<=2000GPD [ 1>2000GPD
IS SEWER AVAILABLE AS PER 381.0065, FS? [ Yes ] DISTANCE TO SEWER: N/A FT
I
PROPS TY ADDRESS: T.B.D. SKYKING DR. / LEAR PL. CORNER LOT
DIRECTIONS TO PROPERTY: GLADES CUT-OFF TO SKYKING DR
BUILD G INFORMATION RESIDENTIAL [ ] COMMERCIAL
Unit a of No. of Building Commercial/Institutional System Design
No Establishment Bedrooms Area Sqft Table 1, Chapter 64E-6, FAC
1 SINGLE-FAMILY RES 3 2370 total
2
i
3
4
j ] &floor/Equipment Drains [ ] Other (Specify)
0 W1VbyL/X (,9,1lT DATE: 6-18-18
DH 4015I, 08/09 (Obsoletes previous editions which may not be used)
Incorporated 64E-6.001, PAC Page 1 of 4
STATE OF FLORIDA APPLICATION # AP1350863
DEPARTMENT OF HEALTH PERMIT # 56-SF-1856631
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATION DOCUMENT # SE1084639
APPLICA*T: Grande Construction of Florida, INC
CONTRAC�fOR / AGENT: Grande Construction
LOT: 53 � BLOCK:
SUBDI, SION: Treasure Coast Air Park ID#: 4224-501-0053-000-4
TO BE OMPLETED 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.
PROPERTIII SIZE CONFORMS TO SITE PLAN: [X]YES [ ]NO NET USABLE AREA AVAILABLE: 2,57 ACRES
i
TOTAL E TIMATED SEWAGE FLOW: 300 GALLONS PER DAY [ RESIDENCES -TABLE( / OTHER -TABLE 2 ]
AUTHORS( D SEWAGE FLOW: 3864.99 GALLONS PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE ]
UNOBSTRI CTED AREA AVAILABLE: 1000.00 SQFT UNOBSTRUCTED AREA REQUIRED: 750.00 SQFT
BENC /REFERENCE POINT LOCATION: Site BM #2 PK NiD PCP 2391, center of intersection if sky king and lear
ELEVATI ITT OF PROPOSED SYSTEM SITE 11.00 [ INCHES / FT ] ( ABOVE / BELOW ] BENCHMARK/REFERENCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES
SURFACE
TER: FT
DITCHES/SWALES: 10() FT
NORMALLY WET: [ ]YES
[X]NO
WELLS:
PUBLIC: FT LIMITED USE: FT PRIVATE:
75 FT NON -POTABLE:
75 FT
BUILDIN,IFOUNDATIONS:
5 FT
PROPERTY LINES: 100 FT
POTABLE WATER LINES:
50 FT
SITE SU337CT TO FREQUENT FLOODING?
[ ]YES [X]NO
10 YEAR FLOODING? [ ]YES
[X]NO]
10 YEAR
ELEVATION FOR SITE:
FT[ MSL / NGVD ] SITE ELEVATION: FT [ MSL
/ NGVD
SOIL PR i:LOOD
ILE INFORMATION SITE 1
CP1TT. DRMFTT.L
TWWe"MM Mm ^%l crmv n
USDA SO L SERIES:Pineda sand
Munsel #/Color Texture
Depth
10YR 4/1
Fill - Sandy Clay Loam
0 To 24
10YR 412 �',�
Loamy Sand
24 To 42
10YR 5/8
jil
CMN/PRM RF
33 To 42
1 OYR 5/2
Fine Sand
42 To 55
10YR 6/6
Sand
55 To 61
10YR 4/3 jIj
Sandy Clay Loam
61 To 72
I
USDA SOIL SERIES:Pineda sand
. Munsell #/Color Texture
Depth
10YR 4/1
Sandy Clay Loam
0 To 33
10YR 4/2
Loamy Sand
33 To 50
10YR 5/8
Loamy Sand
35 To 50
10YR 5/2
Fine Sand
50 To 63
10YR 6/4
Sand
63 To 72
OBSERVED (WATER TABLE: 42,00 INCHES [ ABOVE / BELOW ] EXISTING GRADE TYPE: [ PERCHED / APPARENT ]
ESTIMATED1I7- SEASON WATER TABLE r,=VATION: 33 INCHES r ABOVE / sEL0573 EXSSTSNG GRADE
HIGH WATER
TABLE VEGETATION: [ ]YES Ex ]NO MOTTLING: [X]YES [ ]NO DEPTH: 33.00 INCHES
SOIL TEX7! /LOADING RATE FOR SYSTEM SIZING: Loamy Sand/0.60 DEPTH OF EXCAVATION: II 33 INCHES
DRAINFIELD CONFIGURATION: [ ] TRENCH [XI BED [ ] OTHER (SPECIFY)
REMARKS/ADDITIONAL CRITERIA
10YR5/8
SB1 11"
SITE
fined using USDA WSS and soil borings.
PROM RF mottling In 10YR4/2 matrix > 2% starting at 33" In SB1.
: SM. S82 22" above BM.
'EDDY:
Ingram, Brlan (TINE
DH 4015, 06),Q9 (Obsoletes Previous editions which
`anmental Specialist III (ENVIRONMENTAL HEALTH)
not be used) Incorporated: 64E-6.001, PAC
DATE: 06/2612018
Page 3 of 4
AP1350863 E1131856631 v 1.0.2
M
•rvperry L;' Page 1 of
51
Michelle Franklin, CFA -- Saint Lucie County Property Appraiser -- All rights reserved.
i
Property Identification
Sit Address: Lear PL Parcel ID: 4224-501-0053- Account #: 125815 Sec/Town/Range:
000-4 24/37S/38E
Mab ID: 42/23X Zoning: AG Use Type: 0000 Jurisdiction: Saint Lucie
County
Oi nership Legal Description
Da id S Lewis TREASURE COAST AIRPARK LOT 53 (2.57 AC) (OR 4114-
Lal' ra Lewis 1348)
2215 Pleasant View RD
Ple sant View, TN 37146
j current Values Historical Values 3-year
i
Jus;' Market: $57,800 Assessed: $57,800 Year Just/Market Assessed Exemptions Taxable
Ex I� ptions: $0 Taxable: $57,800 2017 $57,800 $57,800 $0 $57,800
2016 $57,800 $57,800 $0 $57,800
2015 $55,900 $55,900. $0 $55,900
I
Sale History
Dati Book/Page Sale Code Deed Grantor Price
03 2-2018 4114 / 1348 0001 WD Rodriguez Michael $100,000
03 8-2017 3971 / 2826 0001 WD Bayerdorffer (TR) Herman C $95,000
04-;16-2015 3737 / 2423 0130 WD Bayerdorffer Herman C $100
Primary Building Information
Finished Area of this building: 0 SF
Gross Area of this building: 0 SF
i
Exterior Data
View: Roof Cover: Roof Structure: Building Type:
Year B' ilt: N/A Frame: Grade: Effective Year: 2014
Prima Wall: Story Height: No. Units: 0 Secondary Wall:
Interior Data
Bed roo s: 0 A/C %: 0% Electric: Primary Int Wall:
Full Ba s: 0 Heated %: N/A% Heat Type: Avg Hgt/Floor: 0
Half B' hs: 0 Sprinkled %: 0% Heat Fuel: Primary Floors:
Total Areas
Finished/Under Air 0
(SF):
Gross Area (SF): 0
Land Size (acres): 2.57
Land Size (SF): 111,949.2
Total Building Count: 1
I
I
Special Features and Yard Items
j Type Qty Units YearBlt
This information is believed to be correct at this time but it is subject to charge and is not warranted.
® Copyright 2018 Saint Lucie County Property Appraiser. All rights reserved.
tps://Www. ')�aslc.org/RECard1 6/19/2018
1) ff -faw Iffoe Werdw M, Mb ocdo.
Custom Soil Resource Report 5-6'`TP - / g-566.3/
t. Lucie County, Florida
32—Pineda sand, 0 to 2 percent slopes
Map Unit Setting
National map unit symbol. • 2x1 nb
Elevation: 0 to 100 feet
Mean annual precipitation: 47 to 58 inches
Mean annual air temperature: 70 to 77 degrees F
Frost -free period. 355 to 365 days
Farmland classification: Farmland of unique importance
Map Unit Composition
Pineda and similar soils. 85 percent
Minor components: 15 percent
Estimates are based on observations, descriptions, and transects of the mapunit.
Description of Pineda
Setting
Landform: Drainageways on marine terraces, flats on marine terraces
Landform position (three-dimensional): Tread, dip, talf
Down -slope shape: Linear
Across -slope shape: Linear, concave
Parent material: Sandy and loamy marine deposits
Typical profile
A - 0 to 5 inches. sand
E - 5 to 19 inches: sand
Bw - 19 to 35 inches: sand
Btg/E - 35 to 381nches: sandy loam
Btg - 38 to 60 inches: sandy loam-
Cg - 60 to 801nches. loamy sand
Properties and qualities
Slope: 0 to 2 percent
Depth to restrictive feature: More than 80 inches
Natural drainage class: Poorly drained
Runoff class: Very high
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 0 to 12 inches
Frequency of flooding: None
Frequency of ponding. None
Calcium carbonate, maximum in profile: 4 percent
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: Low (about 4.6 inches)
Interpretive groups
Land capability classification (irrigated): None specified
Land capability classification (nonirrigated): 3w
Hydrologic Soil Group: C/D
13
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LEGEND & ABBREVIATIONS
GAS.- Off RVCDADS Root
UE.- URUn EASEYDR
DE: DAAdIw MOW
CORDDMC
DIED
YIASAOD
CGR
C CAL0.NIED
LML LMER= ED NMrAL %vC
lE-LNFAfiFD UIRN[55
US.. CI[ 910CR R StYGO
C � _ f[]{oEvl�MallWl
ani = OVEW1E umtn ura
Rl- "Doc PCrrR Pon
®- rArm YOm
- t1TEROM 002
m- ELtLTRePa mx
Co- WA?M Vg%%
RT'- NONFORCSD C011= Pi
CU. flID r100A DLYNOW
WAW: WORTH ST. ME DMR WATER
oPdr Aar
ovDa
J aSITE tl
A.
—
WELL
- sANRARr sEwa
- UCM ME
1.1�
- WIfC SICILIL so
+- SIWI
20 rw9 6CATE m
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DESCRIPTION
lR Ox TRW9RR COAST —AM ACEDPWNC TO THE NAP OR PUT MAIM AS MORDED W Put COWL 28.
--
PAR()) 14 OF THE PUDUC KW= Or U. LUOE CDUNtr. FL*RtOA
,� S
SURVEYOR'S NOTES
I
i I
1. ms SVFVR w m THE mvNS TNRROF MI War — Wmaot TM SGAATM AND IM GRG— RA6E0 Sm or A
nom UCCNSOD 6VRrtYDR MO lOPcfN.
r
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2. AWL YRSURFI m ME BASED DH THE UNWED 5W6 SUIMY FORT Pm . rEET MD men" IWRAII) VxlLS)
a � o
oTHERNSE sPECmm.
S TM OENTDOLVC Of IEAR %ACC S ASSURED To DrAW ROM OW32'21' WEST AND ALL DINER DCARQ G SWOWI N4tGW1
LOT 52
Am RELME ttm+R6
('m 0
C. MY11 i RAVE BEEROUIEDM!D10W 1 WIIW:W NNE DIEH A= LOCAMP M OTHER AJ R Mo rRER
yy
I TI[ HOMMAL loc TpW or Rdl-oHfANSlpryp PEA7OAS MC aonED M SCALr. tRt= NORD ODWW5L
DE
S Nt ASSISSNWI OF DMROWENEAL CVWCMM f DISTENT. WAS Wd PRFORAWD AS A PART d 110 SUMR.
W
7. ORRAU PARCM EDNTANS 2.57 AWES DOAE oR LEM.
_
6. IMMIGLS S1OIN W"IAV 1MS 0WAW1. An ROT s-c oc p .
O. ARDIIOW D DWECRo to THE rACT FIRM TITS DRWHO NAY HAVE BEEN ALTERED IW Sn BY REPRODUCI WA Dos AW
IU
m tAKADWED WHEll O�TM WAD OWN
to ME LAST RATE d REED WORN BASS mCEYE2R IB 2Dn.
7 O
It. MO o0NS OR �DRnMB To SVIDEY YAPS oR REPONrS Dr OTHER 1NAI iM SPALWO PMTT W PMms ARC PR"Ho no
W:DWR WRiTim COVSM d THE 90NWC PAAR OR PARK.
U V A
lE WANDS HEREON WERE NOI ADSTRALTED BY eTYWRY mSIWI OPOIIP, DIE„ FOR IDCH16-OP-Fax L SEIIDPts.
= 6
OR
iR90D am, oa aTHR DaTNuuDTTs ar RIFaRD
Go
11 UVATOWS SHIN HDWAN ME SMATNC TOM WORTH AYIWCYI NERIIUI. MIWI d -M(RAW D6) MID REEDOtCE
_
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SURVEYOR'S CERTIFICATE
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I HEREDT cFAlrl' RUT TM OR RDARV ANO IOPORIAPHO s.", AS s " NFIED 6 A
PRE OAEORWI
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AND CORIER WEPWLSWTAHoN d A mb SURIET MARC "DER YF
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OUROE Alq SIO 611RLEY IS IWC AMO ARWGI[ W IM DER d Irt NMOx1EOCE AND
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DIIIn. I NRMR CEATIY RUT DM SUNYTY Cn0QCA MM IM Afzcrel STA10AIm5
O PPACRCE IW SU1MY3 SR rWRN d iM no1EDA 00tP0 d PRQCS_9M1L SLW1CIptS
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Rick Scott
Mission:
o protect, promote & improve the health GoYernor
I all people in Florida through Integrated , a Celeste Philip, ' MA MPH
ate, county& community efforts.
1g;�g 1D.41Y TP Slate Surgeon General and Secretary
Vision; To be the Healthiest State in IhOation
Florida Department of Health in St. Lucie County
Conditions for Issuance of Wafter Well Permits
Effective J ul'y 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 772-873-4936or email
SLC DOH-WELLSCcDFLHEALTH. GOV
b. Provide the following information:
i. Permit -number
ii. Driller name
iii. Address
iv. Date and time to begin construction/abandonment
a 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-WELLS(@_FLHEALTH.GOV
Submit revisions to permit and/or site map and associated fee within 48 hours of well
construction or abandonment.
Flo Ida Department of Health
St CI ucle County • Division of Disease Control and Health Protection
Buie, au of Environmental Health
615 1 NW Milner Drive
Pod S' t. Lucie, FL 34983
PHONE: 7721873-4931 • FAX: 772/595-1306
Accredited Health Department
Public Health Accreditation Board
STATE OF FLORIDA PERMIT APPLICATION TO CONSTRU� REPAIR, MODIFY, OR'ABANDON A WELL
OSouthwest Permit No. _ '5:
E3 Northwest PLEASE FILL OUT ALLAPPLICABLE FIELDS Florida Unique ID
❑ St. Johns River (`Denotes Required Fields Where' Applicable). Permit stipulations'Required (See Attached)
OSouth Florida The waterwou conlraciorls responsible for comp%ting
O Suwannee River (his form and forwarding (he Permit appacaffon to the 62-524
O DEP `nPmPrrafo deragafad authority where applicable, Quad NO. -Delineation No.
D Delegated Authority (if Applicable) ICUPIWUP Application No. --
1 6 40 f�s4lcU-e c S'j lac lb % gal Marne if Corporation J%(76 � Z _ '8 rs 2. 2 'Address •City _
G e` state 'ZIP ' Telephone Number
IT ell Location -Address, Road Name or Number, City
4. Iarcel !0 No. (PIN} orAitemate Key (Circle One)
I .� 3 7 S Lot Block Unll
etn or Land Grant •Township -Ra � �� Er -S-" CO
�� 417 /i r:/Uvl. r`
5 J .ti & J �� Or 9f �r County Subdivision Check if 62-524: Yes _ No .
ater Well Contractor Z y - ` � �l - 1,4/
a License Number Telephone Number P-matlAddress
titer Well Contractors Address U z-'e <-Ae�! `]
7. pe cityState.
Of Work: rConstruction _Repair ,Modification Abandonment Zl` P _ 8. umber of Proposed Wells J
S• ' pacify Intended Use(s) of Well(.): 'Reason for Repair; Mootnwlion, orAbar rn
p D
�X Domestic Landscape Irrigation !] D
I —Agricultural !ntalien Bottled Water Supply _Recreation Area Irrigation _Livestock g —Site Investigation
—!Public Water supply Limited Use/DOH) _Monitoring
11 PP Y ( ,Nursery Irrigation ____Test JUL 9 g(�
Public Water Supply (Community or Non-Community/DEP)—Commercialllndustrial �JU 2018
_Earth -Coupled Geothermal
C1.4Class I Injection Golf Course Course Irrigation HVAG Supply
1 V Injection: Recharge _HVAC Return
_Commercialllnduslrial Disposal _Aquifer storage and Recovery Re dialion; —Recovery _Drainage F OH In St Lpda COU
I ry __Air Sparge —Other roescr;be)_ EN IRONMENTAL HEA H
D`lher loesvibe) Official Use Only
10 jstance from Septic System if s20D ft. �J (Note: Nolatl ypes ofwelis e a pumitled by a given permlitlng authorttyl
13. Ilstimated Well Depth %_v� 11 •Facility Description f • r` J� (f 12. Estimated Start Dale
P tt. `Estimated Casing Depth `/Si `ft, Primary Casing "Diameter 2-. in. Open Hole: From
14• I' timated Screen Interval: From SJd Te i6o ft.TO--ft.
15.•F� imary Casing Material; Black Steel
Galvanized _PVC Stainless Steel
Not Cased Other:
16, S' condary Casing; _Telescope Casing _Liner
17.S IcOndary Casio Material; --- Surface Casing Diameter in.
g Black Steel Galvanized PVC
18.' ethod Of Construction, Repair, orAbandonment: _Auger Cable Tool Stainless Steel Other
Combination (Two or More Methods --� Jetted Rotary Sonic
Horizontal Drilling) Hand Driven (Well Point, Sand Point
Plugged by Approved Method ) Hydra tic Point (Direct Push)
19. l�romosed Grouting Interval for the Primary, Seconds Olhertocscdna)
F('I m TO Seal Material ni and Additional Casing;
To L_Benlonite Neat Cement Other i
FI m Seal Material L_Bentonite Neal Cement_Olher_
7o Seal Material Benlonite ) Fr m To Seal Material �- Neal'Cemenl"Other 1
L_Bentonite Neat Cement —Other
20. Indicate total number of existing veils on site
List number or 21."Is his well or any existing well or waterwithdrayval an the owner's contiguous s propertexisting unused wells on site
or CUPIWUP A g property rty covered under Cons umptivefWater Use Permit (CUPR'YUP)
Application? Yes No If yes, complete the following: CUPIWUP No.
22. L dude District Well ID No.
Longitude
23, D a Obtained From: GPS
In mar I a Inntlwn Map Survey Datum: NAD27 NAD83 WGS64
u[ °y -comply wlln the"i'llpDie mles or nil. 40 Flnrd a AGmWLI WoLdu, and l naiawa(Pr
pormlio pl'ArJ I cnaraapomnlLMnpodotl. Aaa boon civil bo pClaylod (rl ma ca oryncY mall pm lhp or of lno
Ss oltPr I turn caddy Ihol all Idormellon prvrapoa In Ihl$ o pry to P mbnt of well C D rty fool Mip Intel..lbn pmvWpd Is neeprui9 ] d Inel i am ewary of my
° fpP:ovol lr 11 feel
l 1) Wslab; )cal PP 1 nli accuralp orb th..l l will ob!+In ' p wullwa?'Chaplor 373. Fr W Slolulus,.l m inlnlnar.ppp tly.bsndon lhts well; or,lro'M y.1 rry m
mmpl U aowunmon0, )I apC)I bb I aM1 po to provide a wmr Ina Chi tar IM owner. lhul Iha ldor. I:a prwldbd l c role "o thml l F o l brmad eU: owner afLiob
�daoGod to 11u DbI Ih wtldn 3o a s ear mmplea°n of trip. can I II NAP Clbnllraa as ablad o0ovp. N o
pbpndon. dnl sulhp,liad by lhl.pormll, a! ns. prm)Ia°plotter, watchovar preprs rrel. a°nls to al I
ropolr. modMrol!on, or. V In Iln aunna IAa ppnpin,rl,a N a poaonn I I Iola whlD ar Dalaaplad Au. 0 aam°S n. A+I,mod!M1ullpn, er pbanaonmpnl eu)npdrad by lnQ Permil. H
'Signal I,rpol Contractor `'�"-'�
a- Ucens- eNo, S �a�ofOwner orAgenl
II 'Date
A44tov dlGs2gtel5 9y � � / _ r r-7 , , . t �j
Issue Dale / / Expiratlon Date (. `.' Z tl
Fee R$'teived $ Hydrologist Approval
,
Receipt No. _ Check No. Innlarr
THIS PERMIT IS NOT VALID UNTIL PROPERLY SIGNED BYAN AUTHORIZED OFFICER OR REPRESENTATIVE OF THE WMD OR OELEGATEDAUTHORITY, THE
PERM T SHALL BE AVAILABLE AT THE WELL SITE DURING ALL CONSTRUCTION, REPAIR,. MODIFICATION, OR ABANDONMENT ACTIVITIES,
OEP f,�Trn: 6Z-532.9000) Incorporated in 62.532.400(1), F.A.C. Effective Date: October.7, 2010
Page 1 of 2
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