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Home My WebLink AboutOSTDS NEWt SCANNED STATE OF FLORIDA BY DEPARTMENT OF HEALTRge JLU ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM RECEIVED CONSTRUCTION PERMIT FOR: OSTDS New ST. Lucie County, Permitting I ' APPLICANT: Jose Macias PROPERTY ADDRESS : TBD Brocksmith Rd Fort Pierce, FL 34945 LOT: 2 111 BLOCK: SUBDIVISION: PERMIT #:01 APPLICATION #: A DATE PAID:_ FEE PAID: — RECEIPT #:— DOCUMENT # : P [SECTION, TOWNSHIP, RANGE, PARCEL PROPERTY ID # : 2329-502-0002-000-1 [OR TAX ID NUMBER] 1 SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS F SECTION 381.0065 F.S., AND CHAPTER 64E-6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NO • GUARANTEE SATISFACORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATE TAT. FACTS, WHICH STVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE 6 PERMIT PLICATION. 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, O„ LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY. SYSTEM DESIGN AM SPECIFICATIONS T ( 10,�50 ] GALLONS / GPD Septic new CAPACITY A [ ] GALLONS / GPD N/A CAPACITY N [ I GALLONS GREASE INTERCEPTOR CAPACITY. Ebax MUM CAPACITY SINGLE TANK:1250 GALLONS] K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS U ]DOSES PER 24 HRS #Plumps [ ] D [ R [ A TYPE I CONF N F LOCA I ELEV E BOTT L D FILL O T H APPROVED DATE ISS DH 4016, 17 ] SQUARE FEET Drainfield new SYSTEM ] SQUARE FEET N/A SYSTEM STEM: [ ] STANDARD [ ] FILLED [XI MOUND [ ] RATION: [ ] TRENCH EXI BED [ ] N OF BENCHMARK: 16d nail in S side of oak tree N of system ON OF PROPOSED SYSTEM SITE [ 08.00It INCHES FT ][ABOVE BELOW BENCHMARK/REFERS CE POINT OF DRAINFIELD.TO BE [ 32.00][.INCHES FT ][ABOVE BELOW BENCHMARK/REFERS CE POINT tED: [ 24.001 INCHES EXCAVATION REQUIRED: [ 17.00 ] INCHES, Is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total estimated flow d contractor installing the system is responsible for installing the minimum category of tank in accordance 3(3)(f), FAC. FILE COP DNS BY: Brian J In am TITLE: Environmental Specialist II TITLE: Environmental Specialist II Brian J In am 07/18/2018 EXPIRATION DATE: - (09 (Obsoletes all previous editions which may not be used) is 64E-6.003, FAC v 1.1.4 AP1349573 SE1086091 St. I.ucie CHD 1/18/2020 Page 1 of 3 i STATE OF FLORIDA PERMIT APPLICATION TO CONSTRUCT, REPAIR, MODIFY, OR ABANDON:A. WELL O Southwest PLEASE FILL OUT ALL APPLICABLE FIELDS ❑ Northwest (*Denotes Required Fields Where Applicable) O St. Johns River OSouth Florida Thewaterwellmntmdortslerponsible(orcompleting ❑Suwannee River this form and forwarding the permitapplication to the appropriate delegated authority where applicable ❑ DEP 0 Delegated Authority (If Applicable) Permit No: SS ^ aSs 5(.P Florida Unique ID Permit Stipulations Required (Sae Attached) 62-524 Quad No. Delineation No. CUPNWP Application No. ABOVEs• OFFICIAL 1. Jos ,Mitzi Macias 3120 .Rogers Rd Fort Pierce, FL 34981 er, Legal Name ifCorporation *Address *City *State *ZIP Telephone t lumber- 2. TBDBrocksmith Rd *Wei iLocation - Address, Road Name or Number, City 3.232-502-0002-000-1 *Pan" I ID No. (PIN)or Altemate Key (Circle One) Lot Block Unit 4, St Lucie Check if 62-524:❑ Ye ❑✓ No *SecIon or Land Grant "Township *Range *County Subdivision 5, Tmo:hy W Williams 11343 772-464-2967 timwilliams4cw bellsouth:net *Wat,rWell Contractor *License Number *Telephone Number E-mail Address 6.7805NImmokolee Rd Fort Pierce FL 3495 *Wat "r Well Contractor's Address City State IP 7. *Typ of Work; Q Construction ❑ Repair ❑ Modification[] Abandonment 8. *Num er of Proposed Wells 1 'Reason for Repay. Modlffcatlon, orAbandonment 9. *Speci� Intended Use(s) of Well(s): ^ate to p MD Do estic Landscape Irrigation Agricultural Irrigation Site Investigations ❑ Bohr', d Water Supply H Recreation -Area Irrigation ElLivestock H Monitoring ❑ Pobl c'WaterSupply (Limited Use/DOH) ❑ Nursery Irrigation ❑ Test ❑Pub c Water Supply (Community or Non-Community/DEP)❑ Commercial/Industrial Earth -Coupled Geothermal JUL 1 E 2018 Clas ;1 Injection ❑ Golf Course Irrigation HVAC Supply HVAC Return Class V If ection: ❑ Recharge ❑ commercial/Industrial Disposal ❑ Aquifer Storage and Recovery ❑ Drainage Remedial un: ❑ Recovery ❑ Air Sparge ❑ Other vesaibe) COu ❑ Othe i (Describe) , . 10.*Dista ce from Septic System If 5 200 R. + 11. Facility Description residence 12.: Estimated Start Date 13.*Esfim IiIted Well Depth 120 ft. *Estimated Casing Depth. 100 ft. Primary Casing Diameter Z in. Open Hole: From To 14. Estim �ted Screen Interval. From 100 TO 120 g; 15.*Prima �. Casing Material: Black Steel Galvanized ,/ PVC Stainless:Steel Not Cased Other. 16.:Seconc ary Casing: Telescope Casing Liner Surface Casing Diameter in. 1.7. Secon nary Casing Material: Black'Steel Galvanized PVC Stainless Steel Other 18.*Metho of Construction. Repair, or Abandonment: Auger Cable Tool Jetted ✓ Rotary Sonic Combination (Two or More Methods) Hand Driven (Well Point, Sand Point) Hydraulic Point (Direct Push) Florizontal Drilling Plugged by Approved Method Other (oescdbe) 19. Propos e d Grouting Interval for the Primary, Secondary, and Additional Casing: From 1 To Seal Material,( Bentonite. Neat Cement Other ) From 1 To Seal Material ( Bentonite Neat Cement Other ) From !1 To Seal Material( Bentonite Neat Cement Other 1 From I To Seal Material ( Bentonite Neat Cement Other ) 20. Indicat total number of existing Wells on.site 0 List number of existing unused -wells on site . 0 21.*I9 this ell or any -'existing well or water withdrawal on the owner's contiguous property covered under a Consumptive/Water Use Permit (CU /WUP) orCLIP Application? Yes t/ No If yes, complete the. following: CUPNVUP No. District Well ID No. 22. Latitud Longitude 23. Data 0 I tained From: GPS Map Survey Datum: NAD 27 NAD 83 WGS 84 I horobyeotgfy I vg comply with the epp6eable m1as efTi0o 40. FMddaAdmMshoVve Code; and Vint a later lwdiry that l am the amorof ft wpody, Not the lnfamtaVon pravldea la aeeumte, end that l am awai army tree permRcrerD feduirge pernil, Ifneeded, has been of w10 be obtained pdar to eomnencement WtveB respoasld'itles under chapter 373, Florida Stalules, to m%nlain orprbpody abandnetldswau, car, I C uwu that l am w.dm.dom I f -W dint as lnie neean praO n ads oppfmdon Isoaumlo and hul l.xia eMaln the egentfor rho owner; amt the rnfo"an p Idadis nowale. and that l have in(omcd the awneratln°Ir nooassory opp[ov aU et Ieda_tal s to, arWcal vemngnls lappGrabb I agree to ptovldo a weD respmmGG6es osslaled etic re, Owner col�senls to eD persatmd of Vis El' orUelegaled AVlhar ty crams wmplaDan 10 a tNsWctwithln days att mpleVon of the wnstrudlon. wpal , modiewaon, or to thew li silo du trig the construction, repair. modiffwl aabwdonmenl etMalted by lhb perml abandon ._ ' tryl spa e 7 esWan, Wchavbroteuia.6rsL ' 11343 6/11h8 gnatu of onirae or 'License No. Sik6bire of Owner orAgonni •Date Approval Gra Ited By Issue Date 7 f� $/( fi_ _ _ _ Expiration Date I Y�Hydiologist:Approval _ Fee Receive $ Receipt No. Check No. in THIS PERMI IS -NOT VALID UNTIL.PROPERLY SIGNED BY AN AUTHORIZED OFFICER OR REPRESENTATIVE OF THE WMD OR DELEGATED AUTHORITY. PERMIT SHA -L BE AVAILABLE AT THE WELL SITE DURING ALL CONSTRUCTION, REPAIR, MODIFICATION, OR ABANDONMENT ACTIVITIES. DEP Fonn: 62r532.900(1) Incorporated In62-532.400(1), F:A.C. Effective Dale: October7, 2010 �P;