HomeMy WebLinkAboutD O H SEWAGE TREATMENT SYSTEMPERMIT #:56-SF-1866666
APPLICATION #: AP1356815
STATE OF FLORIDA
DEPARTMENT OF HEALTH
DATE PAID:
ONSITE SEWAGE TREATMENT AND
DISPOSAL FEE PAID:
SYSTEM
RECEIPT #:
DOCUMENT #: P R1139444
RMIT FOR: OSTDS New
CANT Kenneth Williams
G�LiFaa��b�
PROP RTY ADDRESS: 17701 Wagonwheel Ln Fort Pierce, FL 34947 BY T
LOT 7 BLOCK: SUBDIVISION:
' I
PROPERTY ID #: 3211-701-0009-000-2
[SECTION, TOWNSHIP; RANGE, PARCEL NUMBER]
[OR TAX ID NUMBER]
SYST.p1E1IIM
MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION '
3811065, F.S., AND CHAPTER 64E-6, F.A.C.
DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE
SATISIIIIFACTORY PERFORMANCE FOR ANY SPECIFIC
PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS,
WHICF[ 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'J OR LOCAL PERMITTING REQUIRED FOR
DEVELOPMENT
I
OF THIS PROPERTY.
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[ DH 401
Incorp
[ DESIGN AND SPECIFICATIONS
1,200 ] GALLONS / GPD Septic new CAPACITY
] GALLONS / GPD N/A CAPACITY
] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ J
767 ] SQUARE FEET Drainfield new SYSTEM
] SQUARE FEET N/A SYSTEM
SYSTEM: [ ] STANDARD [ ] FILLED [X] MOUND [ ]
IGURATION: [ ] TRENCH [X] BED [ ] .
IN OF BENCHMARK: Site BM ND center of
ON OF PROPOSED SYSTEM SITE
OF DRAINFIELD TO BE
[ 4.00 ][ INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT
[ 3.00 ][ INCHES FT ][ ABOVE BELOW]BENCHMARK/REFERENCE POINT
K4D: [ 15.001 INCHES EXCAVATION REQUIRED: [ 14.00 ] INCHES
is sized for 4 bedrooms with a maximum occupancy of 8 persons (2 per bedroom), for a total estimated flow of
1sed contractor installing the system is responsible for installing the minimum category of tank in accordance with
.013(3)(f), FAC.
,TIONS BY: Brian J I -ram TITLE:
Environmental Specialist II
BY: a ITLE: Environmental Specialist II St. Lucie CHD
Brian a I ram
ED: 08/13/2018V EXPIRATION DATE: 02/13/2020
08/09 (Obsoletes all previous editions which may not be used)
ted: 64E-6.003, FAC He Co' 1page 1 of 3
v 1.1.4 AP1356815 SE1089472 - - .—
I
1
'STATE OF FLORIDA PERMIT APPLICATION TO CO S RUCT, 1
REPAIR, MODIFY, OR ABANDON AWELL PermitNo,r,
❑ S,OuthWest PLEASE FILL OUTALLAPPLICABLE FIELDS rroli unrqurru-
D Northwest VDanotes Required Fields Where Applicable) PermitSllpulations Required (See Attached)
13 St. Johns River
Theweterwelfco{/U¢e(orfstuspon�bfeforcompfeflnp
Y ,,, a.'southFlorida this:roimpgdJbnYarltingthe;permRappAcaf<onrothe 62.624QGedNo. DelfnedcnNo..
y Q Suwannee River appMpdefedefegerdd0vjhwIWheioappff6bie.
yr°n;wu Q DEP CUPNVUPApplicallon No.
tJ Delegated Authority (If Applicable) ,
Winer,, Legal'Name if Corporation 'Address -city •State *ZIP `Telephone Number
2. 11 L��_')/LIQ.q`D',11.[tl �,r Lkj 4*-- t,e rr.Y a=r _ ^I. (iS-
3.
arCel ID No..(PIN) orAltemate Key.(Circle O.he) Lot Block Uhlt
4. �� P�•�rrcc GxL.,I�m e� ECM t'r s
' e onor and Grant °Township anoe zCbunty Subdivision Chsck,ff 62-524:—Yes —No
5. —fit al 1-�On.wiO+I.� tvCII Q%,�II� se uXA Z 991 ? S�ld_3
# ater well Contractor %cenmber *Telephone Number E-mail Address
7. " ype of Work: �COnsFruction _Repair ,ModitiCation __Abandonment
8. • uMberof PropoAed Walls •RaosonrorRepair ModNicatroA,orAbandonment.
9.` paclfy Intended Use(s) of Vfb(t(s): d D D. MOVIE
I
Domestic Landscape irrigation ;�griculturai irrigation Site Investigatio 'Battied VvaterSupply �AecreationArea.trrigatfon Lwe$toi k ,_MonRoringPublic Water'Supply (Limited •USeIDOH) .._.Nursery irrigation _Test,
IiPublic Water:Suppiy`(Community, orNoh-CommunityfDEP) ^—CorrimeraaVlndustrtal _Earth -Coupled Geothermal' UG 13 2018
_ Golf Course Irrgatioh HVAC, Supply
lass I injection _HVAG Return
Cie " V Injection:___-_RecHarge—CommerciaUlndustrial DisposalAqufferStorage arid —'Recovery —Drainage
Re Idlation: Recovery Air Sparge `Other (Describe) G1$t (,tldeftunly
Other (Dedarmel Vh ON9®11 h
I 'Note: Not d typos ofwailsoro pormitled by a given per;WWmp ty�el
10' �tstan� from Septic System ifs 200 ft, 11. Facility Description 5--7,A Z fK/'� ,' I Y 12. Estimated Start Date
tlmated Well Depth eft.. "Estimated Casing Depth / ft. •Primary Casing Dlanteter Q. in. .Open Hole: From To ft.
14. tlmated Screen Interval: From Z I 70, it, ` v
15+ imary Casing Material: slack Steel 1/ Galvanized PVC Stainless Steel
Not•Cased Other:
16. Qmondary Casing; Telescope Ca6ing ,Liner ,_ Surface Casing Diameter In,
17. III condary Casing Material: Black Steel Galvanized ✓ PVO, Stainless Steel Other
IV PthodofConstruCUorlRepair, orAbandonment: -__Auger _ arable Tool Jetted Rotary Sonlo
Combinatiow(Two,or'More Methods) Hand.Ddven (Wali'Point, Sand:Point) Hydraulic Point (Direct II Horizon{aLDrlNtng Plugged byApproved Method Other 1p—Abi
19. Pi*600sed GrouBnt7 interval"fee ffia PAmnnr Cer nn.le.a. �..a eaara...a nL-�..
20. Inkate total numberof existing wells.on site List numberof existing unused wells on site
21`Is�l Is well or any existing well orwaterwithdrawalon the owhoes contiguous property covered under a Consumpti"ater Uso Permit (CUPA4l
o ICUPNVUP Application? Yes No If yes, complete'Fie following: CUPiWUP No, District Vvelt ID No,
22. L Rude Longitude
23.DII Obtained From: PPS Map Sunrey Datum; NAD27 NAD83 WGS84
I hemtry eNy WdIXlQcompiywAfrlhe oppligbfe rureeorTHlede, FlerldaAdMNchatbn Cede. eid ltlalevrater ,•:' 1 .
uaepe eFadffklnl�aMn'"ppormn,Ifneaiad.hesboenorvAEgoot+bN�edpdortoeommwfwneolbrwee p°�rthMlamlh.GrOt rof,Ihoptopllty,OmlthahromgfbnorOfaQle,accurste,a,idNalommruaofmq
rospermlbytleo (ewer OtiaDlar373 FIORdq 6tot dc7, to nwWeN or p It 11 M>enden IFI ft "r eeNbUfal t om
eonstrd INnhAi,wtliry Wetllnrormaeap edlnlhleSPPY�ngomu�loeeldlllatlaipotito4r.theq�cMferlhoawiuLthdtluNfaimaden ieuklalbocarrto.antltaliieattlluvahfarmddlheexnerafhla
necoma pppreval6eneamfadare4Wate,otbMlgwarnmenlgltapp4otila'laeraetoprovldodvrctl,ro�pomStiudypmdatedeDovaO+marmruenbtodlaYnppeteonnddlMhWA0er0ol�MelilLAkiltysom o:
eompletl' raFoilktlieDbtrl*wNhN30doyogkq:eamyeUbriaflheeoniuuctkn,reayGmodUluiWn,a libxeAdledJdliptheearobudlnnhDycmadlApaan,ara6andonmmtaW oft dbyftPur o1,
ehetido eulhalcedbllhfaMnnM,arlhepeenflerptr@tlanwhktleveroceurcame
Appro Granted`By-
issue Date E7ryiratfon Date 2' i3 ?.0 HydrologistApproval,,
Fee Rellg1etved S Receipt No, Check No.
THIS PERMPER- MIT IS NOT VALID UNTIL PROPERLY -SIGNED BY ANAUTHORIZED OFFIGER'OR REP.,RESENTAiNE OF THE WMD OR DELEGATEDAUTHORRY. THE
1]SHA1L-01 iAVAILABLEA'rTHE WELLSITE DURINGALLR, M
CONMUCTION,.REPAIODIFICATION; ORABANDONMENTACTIV,ITiES.
FERI
FORM L G•R.040;01(Blfo) This permit invalid for.90 days fromthei dete'°f.issue. Rule 4010-1101(1); FA C.
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