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HomeMy WebLinkAboutOSTDS NEWs SCANNED PERMIT #:56-SF-1875323 BY STATE OF FLORIDA ����@ ®�� APPLICATION #: gP1362994 '.DEPARTMENT OF HEALTH 'tty . DATE PAID: b�. ONSITE SEWAGE TREATMENT AND DISPOSAL` FEE PAID: a' SYSTEM RECEIPT .#: Qet 5t,�9 OGO�� DOCUMENT #: PR1166409 ;. L( CONSTRUCT ON PERMIT FOR: OSTDS New APPLICANT Tabitha Hestor %4SOFOPY': PROPERTY DRESS: 3136, Brocksmith Rd Fort Pierce, FL 34945 LOT: 6 BLOCK: SUBDIVISION: Drawdy/Brocksmith Rd [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] PROPERTY ID #: 2329-502-0006-000-9 [OR TAR ID NUMBER] SYSTEM BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION 381.0065,.S., rT AND CHAPTER 64E-6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACT11 PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS, WHICH SEP,VED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE PERMIT LICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID. ISSUANCE F OTHIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL, STATE, OR OCAL PERMITTING REQUIRED FOR DEVELOPMENT OF, THIS PROPERTY. SYSTEM DEsj�GN AND SPECIFICATIONS T [ 1,05 ] 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 .[ R [ A TYPE I CONFI ] SQUARE FEET Drainfield new SYSTEM ] SQUARE FEET N/A SYSTEM :M: [ ] STANDARD [ ] FILLED [X] MOUND [ ] PION: [X] TRENCH [ ] BED [ ] LOCATIONI OF BENCHMARK: Site BM nail in E side of Brocksmith Rd. ELEiVATIO1 OF PROPOSED SYSTEM SITE [ 25.0011 INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT BOTTOM Oi DRAINFIELD TO BE [ 20.001 INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT FILL REQUIRED: [23.001.INCHES EXCAVATION REQUIRED: [ 62.00] INCHES The syste is sized for 4 bedrooms with a maximum occupancy of 8 persons (2 per bedroom), for a total estimated flow of 400 gpd. The licens d contractor installing the system is responsible for installing the minimum category of tank in accordance with s. 64E-6. 3(3)(0, FAC. CIFICATI NS BY: Brian J In r TITLE: � g Environmental Specialist. II 'ROVED B < <' '-' '�I'j'LE: Environmental Specialist II St. Lucie CHD Brian a Ingr E ISSUED 10/08/2018 EXPIRATION DATE: 04/08/2020 4016, 08 09 (Obsoletes all previous editions which may not be used) orporate : 64E-6.003, FAC Page 1 of 3 v 1.1.4 AP1362994 SE1116335 NOTICE OF RIGHTS 7. A party whose substantial interest is affected by this order may petition for an ,trative hearing pursuant to sections 120.569 and 120.57, Florida Statutes. Such proce' dings are governed by Rule 28-106, Florida Administrative Code. A petition for admi' strative hearing must be in writing and must be received by the Agency Clerk for the Depa' ment, within twenty-one (21) days from the receipt of this order. The address of the Agen y Clerk is 4052 Bald Cypress Way, BIN A-02, Tallahassee, Florida 32399. The Agency Clerk' 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 ite 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 judi� ial review pursuant to Section 120.68, Florida Statutes. Review proceedings are gover ed by the Florida Rules of Appellate Procedure. Such proceedings may be commenced by ill one copy of a Notice of Appeal with the Agency Clerk of the Department of Health and a secon copy, accompanied by the fling fees required by law, with the Court of Appeal in the appro date 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'i N: PERMIT #: 56-SF-1875323 BILL DOC #:56-BID-3958481 CONSTRUCTION APPLICATION #: AP1362994 RECEIV D FROM: Groza Builders, Inc. AMOUNT PAID: $ 515.00 PAYME FORM: CHECK 2076 PAYMENT DATE: 09/06/2018 MAIL TOII Tabitha Hestor FACILITY NAME : PROPER Y LOCATION: 31 6 Brocksmith Rd Fo i Pierce, FL 34945 128 - OS -1 - Surc 4- OST -1 - OST 123 - OS 126-OS 127-OS' 133 - OSI 6 Block: ,perty ID: 2329-502-0006-000-9 EXPLANATION or DESCRIPTION: QUANTITY FEE FDS Construction System Inspection Research Fee 1 $ 5.00 arge (All) 1 $ 15.00 IS New Permit Surcharge 1 $ 100.00 IS Construction Application and Plan Review,New 1 $ 100.00 'DS Construction Site Evaluation 1 $ 115.00 'DS Construction Permit (New or Mod, Amendment) 1 $ 55.00 'DS Construction System Inspection 1 $ 75.00 DS Construction Reinspection 1 $ 50.00 RECEIVED BY: WhighamJL AUDIT CONTROL NO. 56-PID-3701664 'SF-; o STATE OF FLORIDA Pma k No. j�a DEPARTMENT OF HEALTH DATE PAID: ONSITE SEWAGE TREATMWT AND DISPOSAL FEE PAID: SYSTEM RECEIPT APPLICATION FOR CONSTRtrCTION PERMIT ICATION FOR: New System [ ] Existing System j ] Holding Tank [ ] Innovative Repair [ ] Abandonment j ] Temporary [ ] ICANT: �ft (b t-v-OA P : G2o2,� u.l. CE ILs TL'LEm6m : 7G43 XG ADDRESS: TO g COMPLETED BY APPLICANT OR APPLICANT'S AUTH01tIZED AGENT. SYSTEMS MUST BE CONSTRUCTED BY A PERSON LICENSED PURSUANT TO 489.105(3)(m) OA 489.652; FLORIDA STATUTES. IT IS THE APPI FCANT'S RESPONSIBILITY TO PROVIDE DOCM49NTATION OF THE DATE 1-A LOT WAS CREATED OR PLFi ED (biK/Db/YY) IF REQUESTING CONSIDERATION OF STATUTORY GRANDFATHER PROVISIONS. PROP RTY INFORMATION LOT; BL0CI4: -- SUBDIVISION: �RO ot.�[(PLAT'Tb : D IS u ID #: 23Zcj - SbwL- nbb(0-00q0-%-NING: I/M OR EQUIVALEN?': [ it / N l SIZE: 495 ACRES .WATER SUPPLY: [Jji PRIVATE PU9LIC [ ]<=2000GPD [ ]>2000GPn AVAILABLE AS PER 381.0065, FS? j Y (&,�] _ DISTANCE TO SEWER: FT TY ADDRESS: �J 10 CONS TO PROPERTY: D� d�or� S• INFORMATION Unit a of No iitabli 1 l 2 3 4 [ ] " oor/Equipment SIGNAT:: _. e _=7 156 RESIDENTIAL [ j COtIIdiRCIAL No. of . Building Commercial/,Iiistitutional System Design Bedrooms Area S t Table 1, Chdpter 64E-6; FAC [ ] Other (Specify) v DO 4015' 08/09 (Obsoletes previous editions which may not be used) Incorpo,ated 64E-6.001, FAC DATE: Page 1 of 4 STATE OF FLORIDA APPLICATION # AP1362994 DEPARTMENT OF HEALTH PERMIT # 56-SF-1875323 ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATION DOCUMENT # SE1116335 nPLICANT: Tabitha Hestor CONTRACTOR t AGENT: Groza Builders, Inc. LOT: 6 BLOCK: SUBDIVISI N: Drawdy/Brocksmith Rd ID#: 2329-502-0006-000-9 TO BE COMPETED BY ENGINEER, HEALTH DEPARTMENT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEERS MUST PROVIDE REGISTRATIO NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS. ROPERTY SI E CONFORMS TO SITE PLAN: [X]YES [ ]NO NET USABLE AREA AVAILABLE: 5.00 ACRES TOTAL ESTI 11 TED SEWAGE FLOW: 400 GALLONS PER DAY [ RESIDENCES -TABLET / OTHER -TABLE 2 ] AUTHORIZED EWAGE FLOW: 7500.00 GALLONS PER DAY [ 1500 GPD/ACRE I OR 2500, GPD/ACRE ] ULIOBSTRIICTE AREA AVAILABLE: 2000.00 SQFT UNOBSTRUCTED AREA REQUIRED: 750.00 SQFT EC BINHMARK/ FERENCE POINT LOCATION: Site BM nail in E side of Brocksmith Rd. ELEVATION O PROPOSED SYSTEM SITE 25.00 [ INCHES / FT ] [ ABOVE / BELOW ] BENCHMARK/REFERENCE POINT THE MINIMUM[ SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES SIURFACE WAT R: 75 FT DITCHES/SWALES: 75 FT NORMALLY WET: [ ]YES [X]NO WELLS: P LIC: FT LIMITED USE: FT PRIVATE: 100 FT NON -POTABLE: FT BIIILDING FO ATIONS: 5 FT PROPERTY LINES: 5 FT POTABLE WATER LINES: 50 FT SITE SUBJEC TO FREQUENT FLOODING? [ ]YES Ex ]NO 10 YEAR FLOODING? [ ]YES [X]NO] 10 YEAR FLO ELEVATION FOR SITE: FT [ MSL / NGVD ] SITE ELEVATION: FT [ MSL / NGVD I SOTT. PROFTT.F1 TNFORMATTnN STTF. 9 RATT. PROFTT.F. TNFORMATTnN SITE 2 USDA SOIL SERIES:Riviera C Munsell #/or fine sand f Texture Depth 1 OYR 2/1 11 Loamy Sand 0 To 4 1 OYR 4/1 Sand 4 To 14 JOYR 5/2 Sand 14 To 25 10YR 6/2 Sand 19 To 25 110YR 414 Loamy Sand 25 To 28 1JOYR 3/4 ... Sandy Clay Loam 28 To 35 1;0YR 5/11 Sandy Clay Loam 35 To 48 1;OGY 6/1 Sandy Clay Loam 48 To 62 1;0GY 6/1 Loamy Sand 62 To 72 USDA SOIL SERIES:Riviera fine sand Munsell #/Color Texture Depth 1 OYR 2/1 Loamy Sand 0 To 4 10YR 4/1 Sand 4 To 14 10YR 5/2 Sand 14 To 25 1 OYR 6/1 Sand 21 To 30 1 OYR 4/3 Sandy Clay Loam 30 To 42 1 OYR 5/1 Sandy Clay Loam 42 To 50 10GY 6/1 Sandy Clay Loam 50 To 61 1 OGY 6/1 Loamy Sand 61 To 71 VED WATER TABLE: 51.00 INCHES [ ABOVE / HELOW ] EXISTING GRADE TYPE: [ PERCHED / APPARENT ] ATED WE SEASON WATER TABLE ELEVATION: 19 INCHES [ ABOVE / BELOW ] EXISTING GRADE WATER TNBLE VEGETATION: [ ]YES [X]NO MOTTLING: [X]YES [ ]NO DEPTH: 19.00 INCHES TEXT LOADING RATE FOR SYSTEM SIZING: Sand/0.80 DEPTH OF'EXCAVATION: 62 INCHES FIELD COI IFIGURATION: [X ] TRENCH [ ] BED [ ] OTHER (SPECIFY) 3MARKS/ADDITIONAL CRITERIA WSWT determin 'd using USDA WSS and soil borings. 19YR6/2 stripphi in 10YR5/2 matrix >10%" with diffuse boundaries starting at 19" in SB1. S81 25" below B . SB2 28" below BM. SI E EVALUATED BY: DATE: 09/18/2018 Ingram, Brian (Title: Env' mental Specialist II) (ENVIRONMENTAL HEALTH) DR 4015, 08/09 iDbsoletes previous editions which may not be used) Incorporated: 64E-6.001, FAC Page 3 of 4 APVU2994 FI111R74193 �, i n 2 STATE OF FLORIDA PERMIT DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS APPLI T: AG VrI4 A 11%if i'�IZ_ AGENT: �I�Z Q 1 U► ErLs rl.�C.. LOT: BLOCK: cam, SUBDIVISION: PROPER Y ID #: Z J2 +' SdZ'��o� ���-9 [Section/Township/Parcel No. or Tax ID Number] TO BE IMPLETED BY -ENGINEER, HEALTH DEPARTEMENT EMPLOYEE,OR OTHER QUALIFIED PERSON. ENGINNEERS MUST PgOVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS. PROPER SIZE CONFORMS TO SITE PLAN: j�j YES [ J NO NET USABLE AREA AVAILABLE: ACRES TOTAL TIMATED SEWAGE FLOW: GALLONS PER DAY [RESIDENCES -TABLE 1•/OTHER-TABLE2] AUTHORI ?,ED SEWAGE FLOW: GALLONS PER DAY [1500 GPD/ACRE OR 2500 GPD/ACRE] UNOBST t7_TED AREA AVAILABLE: SQFT UNOBSTRUCTED AREA REQUIRED: SQFT /Ql. BENC REFERENCE POINT LOCATION: 5C.. CouN C. e,e r-AZ1 . ZZ4` '11 • "ftt� ELEVAT3 OF PROPOSED SYSTEM SITE IS [INCHES/FT] [ABOVE/BELOW] BE HMARK/REFERENCE POINT THE MINIMUM SETBACK Q ICH CAN BE MAINTAINED FROM THE P�POSED SYSTEM TO THE FOLLOWING FEATURES SURFAC WATER. ( FT DITCHES/SWALES14. FT NORMALLY WET? YES [ ] [ ] NO WELLS :, UBLIC: ZOO FT LIMITED USE: 'I Cl, %=o � S. FT PRIVATE: FT NON -POTABLE: SD FT BUILDI FOUNDATIONS: r( FT PROPERTY LINES: S FT POTABLE WATER LINES: tm FT SITE SU JECT TO FREQUENT FLOODING: [ ] YES [ ] NO 10 YEAR FLOODING? [ ] YES [ ] NO 10 YEA FLOOD ELEVATION FOR SITE: FT MSL/NGVD SITE ELEVATION: FT MSL/NGVD SOIL PROFILE INFORMATION SITE.1 MUNSE t #/COLOR TEXTURE DEPTH TO TO TO TO TO TO TO TO TO USDA ' OIL SERIES: SOIL PROFILE INFORMATIVN bl"rX L MUNSELL #/COLOR TEXTURE DEPTH TO TO TO TO TO TO TO TO TO USDA .SOIL SERIES: OBSERVE WATER TABLE: INCHES [,ABOVE / BELOW] EXISTING GRADE. TYPE:[PERCHED / APPARENT] ESTIMAT D WET SEASON WATER TABLE ELEVATION: INCHES [ABOVE / BELOW] EXISTING GRADE HIGH WA ER TABLE VEGETATION: [ ] YES [ ] NO MOTTLING: [ ] YES [ ] NO DEPTH: INCHES SOIL TENURE/LOADING RATE FOR SYSTEM SIZING: DEPTH OF EXCAVATION: INCHES DRAINFI LD CONFIGURATION: [ ] TRENCH [ ] BED [ ] OTHER (SPECIFY) REMARKS/ ADDITIONAL CRITERIA: SITE EVLATED BY: DATE: D8 4015, 40/09 (obsol revious editions which may not be used) Incorporated: 64E-6.001, FAC Page 3 of 4 Page 1 of 1 k7 13 20 Michelle Franklin, CFA — Saint Lucie County Property Appraiser -- All rights reserved. Property Identification Site 2 ddress: Parcel ID: 2329-502-0006- Account #: 182596 Sec/Town/Range: BRO KSMITH RD 000-9 29/35S/39E Map : 23/29N Zoning: Use Type: 6000 Jurisdiction: Saint Lucie County Ow iership Legal Description Tabit a Smith Hester DRAWDY/BROCKSMITH ROAD SUBDIVISION (PB 75-23) 3208 1 iver DR LOT 6 (5.01 AC-218,236 SF) Fort lerce, FL 34981 Current Values Historical Values 3-year Just/ A 1 arket: $105,210 Assessed: $1,378 Year Just/Market Assessed Exemptions Taxable Exem' tions: $0 Taxable: $1,378 2018 $105,210 $1,378 $0 $1,378 Sale History Date Book/Page Sale Code Deed Grantor Price 06-28 2018 4151 / 2086 0001 WD Drawdy Properties LLC $130,000 Total Areas Finished/Under Air 0 (SF); Gross Area (SF): 0 Land Size (acres): 5.01 Land Size (SF): 218,236 Total Building Count: Special Features and Yard Items; Type Qty Units Year Blt 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. pd.�3aqv Custom Soil Resource Report J-S t,5r7532.3 Lucie County, Florida 38—Riviera fine sand, 0 to 2 percent slopes Map Unit Setting National map unit symbol. 2tzw2 Elevation: 0 to 80 feet Mean annual precipitation: 44 to 59 inches Mean annual air temperature: 68 to 77 degrees F Frost -free period. 350 to 365 days Farmland classification: Farmland of unique importance Map Unit Composition Riviera and similar soils: 80 percent Minor components: 20 percent Estimates are based on observations, descriptions, and'transects of the mapunit. Description of Riviera Setting Landform: Drainageways on marine terraces, flatwoods 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 6 inches: fine sand E - 6 to 28 inches: fine sand BME - 28 to 36 inches. fine sandy loam Btg - 36 to 42 inches. sandy clay loam C - 42 to 80 inches: fine 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 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 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: Low (about 5.8 inches) Interpretive groups Land capability classification (irrigated): None specified Land capability classification (nonirrigated): 3w Hydrologic Soil Group: AID Ecologicalsite: Slough (R155XY011FL) Forage suitability group: Sandy over loamy.soils on flats of hydric or mesic lowlands (G 1 55XB241 FL) 10 Custom Soil Resource Report Other vegetative classification: Slough (R155XY011 FL) Hydric soil rating: Yes Minor Components Wabasso Percent of map unit.- 8 percent Landform: Flatwoods on marine terraces Landform position (three-dimensional): Tread, talf Down -slope shape: Linear, convex Across -slope shape: Linear Other vegetative classification: South Florida Flatwoods (R155XY003FL) Hydric soil rating: No Pinellas Percent of map unit: 4 percent Landform: Flatwoods on marine terraces Landform position (three-dimensional): Tread, talf Down -slope shape: Linear, convex Across -slope shape: Linear Ecological site: Cabbage Palm Flatwoods (R155XY005FL) Other vegetative classification: Cabbage Palm Flatwoods (R155XY005FL) Hydric soil rating: No Hallandale Percent of map unit. 4 percent Landform: Flatwoods on marine terraces Landform position (three-dimensional): Tread, talf Down -slope shape: Linear Across -slope shape: Linear Other vegetative classification: South Florida Flatwoods (R155XY003FL) Hydric soil rating: Yes Oldsmar Percent of map unit. 2 percent Landform: Flatwoods on marine terraces Landform position (three-dimensional): Talf Down -slope shape: Linear, convex Across -slope shape: Linear Other vegetative classification: South Florida Flatwoods (R155XY003FL) Hydric soil rating: No Floridana Percent of map unit: 2 percent Landform: Depressions on marine terraces Landform position (three-dimensional): Tread, dip . Down -slope shape: Concave, linear Across -slope shape: Concave, linear Other vegetative classification: Freshwater Marshes and Ponds (R155XY010FL) Hydric soil rating: Yes 11 -r; Missfi n: To prot� t, promote & improve the health of all p pie in Florida through integrated state, Z mly & community efforts. •I x N`:. HEALTH Vision: To be the Healthiest State in the Nation Rick Scott Governor Celeste Philip, MD, MPH State Surgeon General and Secretary 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 ccD-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-WELLS(cD-FLHEALTH.GOV Submit revisions to permit and/or site map and associated fee within 48 hours of well construction or abandonment. Florida i epartment of Health St Lucie ounty • Division of Disease Control and Health Protection Bureau If Environmental Health 5150 NA Wilner Drive Port St. L 11 cie, FL 34983 • FAX: 772/595-1306 Accredited Health Department Public Health Accreditation Board STATE OF FLORIDA PERMIT APPLICATION TO CONSTRUCT, REPAIR, MODIFY, OR ABANDON A WELL ,.. Q Southwest D Northwest PLEAS1: FILL OUT ALL APPLICABLE FICLDS ('Denotes Required Fields Where Applicable) DSt. Johns River 0South Florida Me walervreq,:otrfraerorksrespartslbleforcornplet+ng ❑Suwannee River this form andronvarding the permtr appuestrlon ro the ❑ DEP appropnrted-Itmeardaothorlrywhenapplicable. D Delegated Authority (If Applicable) V 53o-13 Unique t I • 3 Stipulations Required (See Attached) e2-524 quad No, Delineation No, CUPNW P Application No, Number cel ru NO. (f' IN) Of Altem ey (Cif a Qne) �s a l� I t� Lot Block l�NJ �'"—_+✓ Check If 62-524:❑ Yes 0 No aeon or LaAirnd Gr 1 "T sh' Te en. r o nt rr Sub i ' ' n y 4t7 7 n ttgr WellAactor ,.,� r 'Li ease Number elephont J tuber E ddress er Well Contractor's Address city State ZIP ie of Work. Y-� Construction ❑ Repair ❑ lvtodification❑ Abandonment. nber of Proposed Wells —. I •Reason for P.opair. Modification, or Abandonment icify Intended USe(S) of Well(s): mestic Landscape Irrigation A D D :tied Water Supply ® Recreation Area Irrigation ❑ Agricultural Irrigation ❑ Site Investigations Livestock Monitoring illc Water Supply (Limited Use/DOH) ❑ Nursery Irrigation ❑ Test Xic Water Supply (Community or Non-Community/DEP)P Commerciallindustrial E] Earth -Coupled Geothermal OCT s 20�� ss I Injection Golf Course Irrigation ❑ HVAC Supply L J HVAC Return injection: ❑ Recharge ❑ Commercialllndustrial Disposal ❑ Aquifer Storage and Recovery ❑ Drainage mviii ration: ❑ Recovery [] Alr Sparge ❑ Other (d.acrioe) ther (Desadbe) 10.' !stance from Septic System if 5 200 ft. 11. Facility Description 113-IMifitnalsid'Well Dopth a-Esam2rted OW51'ss vepth: - n, primary Cusing Diameter_ 17, 14. ttmated Screen Interval: From 1%Q To ,,20 ft. 15.113 mart' casing Material: Black Steel Galvanized CPV C Stainless Steel Not Cased Other: S. 19. 20. 21. 22. 21 Fee I THIS 12. Estimated Start Date LL, Open Hole: From To —Tit, ndary Casing: Telescope Casing Liner Surface Casing Diameter in. ndary Casing Material: Black Steel Galvanized PVC Stainless Steel Other od of Construction. Repair, or Abandonment: Auger Cable Tool Jetted 1 Rotary Sonic CDmbinallon (Two or More Methods) Hand Driven (Well Point, Sand Point) Hydrau 1 (Direct Push) Horizontal Drilling Plugged by Approved Method Other foescnboi tiled Gr ling In for the Primary, Secondary, and Addili i_ To Seal Material ( Bentonite sat Cement Other I To Sea[ Material ( Bentonite ea Other i To Seal Material ( Bentonite Neat Cement Other ) To Seat Material ( Bentonite Neat Cement Other ate total number of existing wells on site List number of existing unused wells on site s well or any existinrell or water withdr on the owner's contiguous propert�yy covered under a Constimptive[Water Use Permlt (CUPIVUUP 1P/WUP Application. Yes No If yes, complete the following: C51WUP No. District Well ID No, ide I brink,, Obtained From: GP!ap, Survey Nat l Will tvmmyWlel the aptWatablC soft of 1l4o4e, mW .nlggalluu Codo. and that. Wowrtigdef teiharge purmq d navuvW, itaa boar artl,g be p . .triad prwr to aantnt4,camant of wog how Corey Out tip InraftnuOon providud lit this application 1; acanate and dials vrat dbtan pwl from older federal. Nara. Or lacgl govemmenlg, W opprirable. I aging to pmv7da a "a sit to his 7etdor within 30 daye ahel omgalalion of via oonatykilan, repair, morakation, of rudto by lhKer parmit, at the hai Th aaP1radan1WAkhoyer acsun tint of Contractor'Ll�ense No. Granted-ByAal, -� e2 a. - - Issue Date Datum: NAD 27 NAD 83 WGS 84 1 corti7 Vial Inn, tho owpa, ortna proporty, that uia arrotmatton provided I&acculale, 00Itel l am aware or toy rutpootllW bas.tmOm Cltuplur 377, Flofldu.Sfub;ua, lg ntrdtdabl of propolly Oballtlon hire well; W.1 eordy dtut I am the agent fortheowrar.thatthe inrartnaGonprovdidIearavfato,aneiIlia, 1hovain, me;dtheovmerolthPit rotpongibigti Jay Aated agave, Comer eoneente.la albstmif panonitolorlhF,vNID er Ddggated Atithodty Agee.. to �,g we'd a e�eduiing rho a�it1rfie�nn, tacalr. matgAogBan. a agandonment autltorixad by gd, pHdd1. Expirm4on bale "'� Hydrologist Approval lived S ` Recelpt•No. Check No. nlaal. RMIT IS NOT VALID -UNTIL PROPERLY SIGNED BY AN AUTHORIZED OFFICER OR REPRESENTATIVE OF THE WMD OR DELEGATED AUTHORITY, THE SHALL BE AVAILABLE AT THE WELL SITE DURING ALL CONSTRUCTION, REPAIR, MODIFICATION, OR ABANDONMENT ACTIVITIES, iD Page Qi Y - vvvaLu�sx,�oaatLUJps .mRt :qS I I I IL_i I \• �' I , r1 ,� I I li � II I I l i l I II i I I I I i I I t ' I I I l I I It i I I ^ I I I I iII I I 1 I I , I I I 1 i t I I I I I 1 I I I I f I I I I I I eya z ,usre aro`taarr W-99w 911=JrX9 A1D3. bJV 0/10/2018 821 AM Sales Receipt #19758 Store: I St Lucie County Health Department 5150 tIW Milner Drive port St Lucie, FL 34983 EmAronmenlal Health Division 772-873-4931 Item # Qty Price Ext Price 68 1 $1-15.00 $-115.00 T Well COn SIrLICti4n Subtotal: $I.15.00 Local Sales Taw 0 °ro Tax' + $0.00 RECEIPT TOTAL: $115.00 Credit Card: $115.00 Visa 59-28793 3136 Brocksmith rd Thank You 8 Have a Good Day! I anal ll�l✓r IYI,II lidfll Illil Imll I��I PRWPAREDFDR TABITHA Sti16P WEVER 3 9 5DU7Ji HR0(KSAi17! y ROAD FORrPrERCE ftawm � 9 GROZ4 BUILDERS, AURORA TSH TABn'HA SMRH-NESTER BROCKSMITH RD. FT. PIERCE, FL . PIERCE BUILDING DEPARTNENTPRODUCEAPPROVAL SUBMITTAL AFFIDAVIT BUILDING PERMIT OWNERS NAME CONTRACTOR- GROMBUIIDERS CONiM=R'SADDRFSS 511 SWPORTSTLUCE BLVD IO.OP9W[ PbMT Mm[Lg1361 YA�4IINI\4 MtTXW 4•AifMMMpr _ m.f pwn �� mncsdru oxsxnmons w.vt�iwuwrm P \IrenO�iro,ma.4yb 4� .h A3. mmvou•n 4euunu4mn ww lsm ra4r41w wv°6NT,ewmvww rii:ei\.'q anq�\ lmwwx• .n wrs Rm®.uwN.T ad4•:a TxmMTw t;rc�nuw�nLlcf.w•Duma uon�o c\ur400alew ou•o:ooa•w wwu wwv x•� vsl�ssc wwaox raaM1•wa x•wwnwn wessse wa.�u M1MAf MRN•M 1N0.1 AT4rIV UA1IE NIoln NfoNvm NhID1]IeC n.Usat �1ro ftN NIRn4mwa•Nm .af•Fa4 .m/4r.f wyO «Rn �ufoa�°'e NOTE: ALL MANUFACURM HOLES MISTBE FILLED WITH APPROPWATE FASTFNERS Lwwwv¢nmmemncremu,ln �� xa�suvevxPraa Ifb[R�nS1�R�v[� •ywWR Nara Nom AtDWK6 ortf. FDOH in St. Lucie County .Environmental Health Site Plan Approved for Construction Supersedes All Previous Site Plans for OSTDS'#fib-18W3Z3 & Well. '#5 - Date 10ArlI ff- . Reviewted -1um\ DRAWING INDEX OI COVER PAGE AI FOUNDATION RAN A7 FLOOR PLAN All ELECTRICAL PLAN A4 EXTERIOR ELEVATIONS AS WAD PLAN A6 ROOF PLAN BI ENGINEERb DUAL PAGE BR ENGINEER'S DETAD. PAGE BUILIDING CRITERIA =-- ure�o� Nrewui �ee� c ean�o Mo.n rarorar awamoN4 ' naN u u*icaa a.Lo uriLs4 � v"'"rn".•�ae� rw emren fR44 Obb. N4Y1 @ N COeH1RL 04H YtS 62G !\TYA e4B Yb 4b nE •PG bif �MMmuuaa W ATER•A IR•LAND TR.OwwdafF�Ad 7DA953 chrleheera®b/urAl fe•413%B,9( CIIRSEOMER D. BEER$ P.E. FLORIDA LICENSE NO.645P4 DATE Port Chaeoft R (.1)m I C1 8 N FOUNDATION NOTES ALL CONCRETE SMALL NAVE A MN. COMPFE66WE 6TRMdTA OF 5OOP PIN 4 26 DAY6 FOR Rd% I SLAW RELNFDRON STEEL 1RQ SU Ll. GE ASTM. GRAcc b DEFORMED BILLET 6TL CLEAR COV9R SHALL BE 3• FOR FOofNGb A CIO• IN BEAMS. LAPPED STEEL. MIN W. Id' 6TD. 11O "IO SO DEGREE SENDS. PIGS SHALL BEAR ON UNPMURBED SOIL NO PROPERLY COMPACTEIP FILL DODO P6F MNJ. FILL MATERIAL SHALL Be COMPACTED TO 65% OENWY OF A STANDARD PROCTOR. To BE VERIRED BY GEMS" CONTRACTORIOONER. ELECTRIC bOrACE ORDENO TO BE BONDED TO FTG 6M CONTRACTOR TO VERffY ALL NOSE BIBS I =. 1 TYPE CONTRACTOR TO ROUGN N AIN CHASE A/O DRAIN LNE6. 4 02NCIM6 AS NEEDED CONTRACTOR TO V13LffY A/O PX&AOS FOR SLAB RECEOWA"a CURB RMIT6 • ALL LVORD CONTRACTOR TO CETERI9NE ANY SLOPE OF SLAB REOMTS LAP ALL NORM Rd REBAR 7D' MIN Au 6TL MIN. GRADE SO BOR OP FIG 191E Ir BELOI FIN IM GRADE ALL CON6IRUCTION 69ALL BE N ACCORDANCE UM TN@ FLM dBDLNG CODE 20I4 LD AND LOCAL CODF9 AS TNT. MAT &FPLr f¢t411Mtr aeP6IS &iw�W.fee fe• ) • � 3 rsW.NRc Pl i ilw wwL - MONO EDGE FOOTER �1°"4f TrP m mRlr � a°veu f1 ):,f_ FI CTIRB ��� TTP FOOTING rtra�ll�}I rTrP WICURS k O`s'"' I,r ATEP• FOOTER •O• aRe T.6ALATeAN. eLAe ecvNwv vaL Fe arpue.nvla F3 traRtaPeta BELL FOOTE eu6fOXOn1 ' tvae °Sr PI � BEARING POD ECORNERDETAIL FOO li i.. ................ ....... �„• , I.3� v ._._ _____.______ M) I _______ f _______P ....... 3'-0' Kf IS-0. S•3}" tS' ' 6'-0' Si. • ._____ .__ .• Ian ------ - t- IO I 2r•4- R.e:w• { 1 I •I • I 2D'49'i• 10'i' S'-IL' 5,101 0' ! 9 � 9• r �� ,�, I ..,'ate, !0 1, � N�, � � 6 , _ _- _ n -- O I 1^ �--------------- ---------------� ur°r•mmANaAFf O I IJ - • ! •.0 m'PfD I • b Tp i0 n ------- ------� M ''------- --------------- --- pptlL------ y 20'-0' E.-I tl m ' ni ---- —_____ © O ________••________�_ ! Im 1 . I I n ! _ TREATMENT PROVIDER AND NEED FOR RE -INSPECTION AND TREATMENT CONTRACT RENEWAL SHALL BE PROVIDm. 2. CONDENSATE AND ROOF DOWNSPOUTS SMALL DISQIMGEAl LEAST V-0• AWAY FROM BUILDING SIDE WALLS, 3. INITIAL TREATMENT SHALL BE DONE AFTER ALL E)=VATION AND BACIMLL IS COMPLETE 4. MINIMUM 6 MILVAPOR BAWLER MUSTSE INSTALLED TO PROTECT AGAINSTRAINPALL DILUTION. S. SOILTREATMENT MUSTI E APPLIED UNDER ALL EXTERIOR CONOT MORGRADEWMUNIIG'OFT'HESTRUCR3LE SIDEWALLS. 6, AN E)(TERROR VERTICAL CHEMICAL BARRIER MUST BE INSTALLED AFTER CONSTRUCTION. 7. A CERTIFICATE OF COMPLIANCE MUST BE ISSUED TO THE BUILDING DEPARTMENT BY A LICE Sm PEST CONTROL COMPANY BEFORE FINAL. INSPECTION, 3000 PSI CONCRETE SLAB V THICK W/ FIBERMESH (OR 6' X6" 10 /10 W.W.F.) OVER 6 MILL VLSQUEEN AND CLEAN, COMPACTED, TERMITE v ram•,! BATH .� rvpa r w„e j {''RCITCNL:N I en1 � 17 1 °u r.vn cw ••,1 UTIL 1 t • MASTER ° BAT14 •� M61mAYeN CTO¢TGVF9GY 1'f RAYDOv I' oniRemeertc FLUM51IT6 RISER N,T,8, P ME ImAll W ATER•AIR•LAND 1040 HIbwr Drt" Dr. dojben®byU`t 84167E-0636 RM Omde, Fblldz 33903 lev 413687-9013 Q4216TOFIffR D. ffEERA P.E RDRA)A UCEN3 E ND. 846(N DATE IIIP0(919 n� 31R I Z ,.P i Ilull�®®II�®11�11 II�'� II� III ®IIIII� ®II� 1 Ile�:. � III ®IIII� II� III 1 0 NI 0 9 ` I In 16h111I i �� } r_ ❑n In i. — `ca/iiiioco - - - i iel P.:. N,• 'I CI !II U ❑ �y./ice }• _. 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