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• 4 PERMIT #: 56-SF-1875990
APPLICATION # : AP 1363444
" .STATE OF FLORIDA
DEPARTMENT OF HEALTH DATE PAID:
ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID:
SYSTEM
u FI EIPT #:
�°"PDIIMENT # : PR1167657
� ®20i8
CONSTRUCTION PERMIT FOR: OSTDS New ��
APPLICANT: Guiseppe Gambina .c�_
PROPERTY ADDRESS: 8359 Calumet Ct Port Saint Lucie, FL 34986 ��!/ •�y ` ?
LOT: 159 BLOCK: SUBDIVISION: Sabal Creek Phase IV
[SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
PROPERTY IDi #: 3328-701-0012-000-5 [OR TAX ID NUMBER]
I
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION
381.0065, iF.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 [
2,050
] GALLONS / GPD
Septic new CAPACITY
A [
] GALLONS / GPD
N/A CAPACITY
N [
] GALLONS GREASE
INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K.
750
11 GALLONS DOSING
TANK CAPACITY [166.67]GALLONS @[ 6 ]DOSES PER 24 HRS #Pumps [ 1 ]
D [
625
) SQUARE FEET
Drainfeld new SYSTEM
R [
625
I] SQUARE FEET
Drainfield new SYSTEM
A TYPE SYSTEM: [ ] STANDARD [ ] FILLED DO MOUND [ ]
I CONFIGURATION: [x] TRENCH [ ] BED [ ]
N
F LOCATION OF BENCHMARK: NID in cutout, center of cul-de-sac
I ELEVATION OF PROPOSED SYSTEM SITE [ 5.00 ][ INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 4.00 ][INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: [19.001 INCHES EXCAVATION REQUIRED: [ 41.001 INCHES
The syste is sized for 6 bedrooms with a maximum occupancy of 12 persons (2 per bedroom), for a total estimated flow of
0 1000
T Dose ENTIRE drainfield each cycle.
H Pumps must be certified as suitable for distributing sewage effluent.
The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance with
E s. 64E-6.013(3)M. FAC.
R I I
SPECIFICATIONS BY: Brian J Ingr" TITLE: Environmental Specialist II
APPROVED BY:I I+E: Environmental Specialist II St. Lucie CHD
Brian J. In
DATE ISSUED:] 10/17/2018 EXPIRATION DATE: 04/17/2020
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporatedi: 64E-6.003, FAC
v 1.1.4 AP1363444 SE1117445
Page 1 of 3
I
NOTICE OF RIGHTS
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
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.
e , v
St. Lucie County Health Department
5150 NW Milner Dr Port Saint Lucie, FL 34983
PAYING ON: PERMIT #: 56-SF-1875990 BILL ooc #:56-BID-3960977 CONSTRUCTION APPLICATION #: AP1363444
RECEIVED FROM: Telese Builders LLC AMOUNT PAID: $ 515.00
PAYMENT FORM: CHECK 1060 PAYMENT DATE: 09/10/2018
MAIL TO: Guiseppe Gambina
i
FACILITY NAME:
PROPER I IY LOCATION:
8359 .Calumet Ct
Port Saint Lucie, FL 34986
159
Lot: Block:
Property ID: 3328-701-00.12-000-5
EXPLANATION or DESCRIPTION:
i
QUANTITY
FEE
128 - OSTDS Construction System Inspection Research Fee
1
$
5.00
-1 - Surcharge (All)
1
$
15.00
-1 - OSTD'S New Permit Surcharge
1
$
100.00
-1 - OSTDS Construction Application and Plan Review,New
1
$
100.00
123 - OSiDS Construction Site Evaluation
1
$
115.00
• I
126 - OSTDS Construction Permit (New or Mod, Amendment)
1
$
55.00
127 - OSTDS Construction System Inspection
1
$
75.00
133 - OSTDS Construction Reinspection
1
$
50.00
RECEIVED BY: VanceMH AUDIT CONTROL NO. 56-PID-3706882
i
STATE OF FLORIDA
DEPARTMENT OF HEALTH
° ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
APPLICATION FOR CONSTRUCTION PERMIT
N FOR:
km.M 5-�.6-18?g(P
PERMIT NO.
DATE PAID:
FEE PAID: G Q )C
RECEIPT #: IDG6
System [ ] Existing System [ ] Holding Tank [ ] Innovative
it [ ] Abandonment [ ] Temporary [ l
AGENT: Joseph Telese �ocoo SP�n��l�lri-Ff� n .� �f�i.P/., TELEPHONE: 772-260-4889
MAILING ADDRESS: -703 SW Goldshine Ct. Palm City, Fl. 34990-1528
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: 159' BLOCK: SUBDIVISION: Sable Creek Phase IV
PROPERTY IID #: 3328-701-0012-000-5
PLATTED:
ZONING: I/M OR EQUIVALENT: [ No ]
PROPERTYISIZE: 2.76 ACRES WATER SUPPLY: [,(] PRIVATE PUBLIC [ ]<=2000GPD [ 1>2000GPD
I
IS SEWER �VAILABLE AS PER 381.0065, FS? [ No ] DISTANCE TO SEWER: FT
PROPERTY7ss: 8359 Calumet Ct. PORT ST• L UCIE . Ft. 34q8In
DIRECTIONS TO PROPERTY: PGA Village St. Lucie West East Gate Entrance, 1st stop make Left, continue to Calumet Ct.
BUILDING INFORMATION
Unit Type of
No Establishment
1 Single Family
2
3
[ ✓ ] RESIDENTIAL [ ] COMMERCIAL
No. of Building Commercial/Institutional System Design
Bedrooms Area Sqft Table 1, Chapter 64E-6, FAC
6Z�9
4 I
[ ] Flodr/Equ pment Drains [ ] Other (Specify) NA
SIGNATURE
DH 4015, 08/09 (Obsoletes previous editions which may not be used)
Incorporated 64E-6.001, PAC
DATE: 1 % - -/ 42
Page 1 of 4
STATE OF FLORIDA
' DEPARTMENT OF - HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
r SITE EVALUATION AND SYSTEM SPECIFICATION
APPLICANT: Guiseppe Gambina
CONTRACTOR / AGENT: Telese Builders LLC
LOT: 159 BLOCK:
APPLICATION # AP1363444
PERMIT # 56-SF-1875990
DOCUMENT # SE1117445
,SUBDIVISION: Sabal Creek Phase IV ID#: 3328-701-0012-000-5
TO BE COMPLETED BY ENGINEER, HEALTH DEPARTMENT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEERS MUST PROVIDE
REGISTRATION �UMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS.
PROPERTY SIZE CONFORMS TO SITE PLAN: EX ]YES [ ]NO NET USABLE AREA AVAILABLE: 2.76 ACRES
TOTAL ESTIMATTED SEWAGE FLOW: 1000 GALLONS PER DAY [ RESIDENCES -TABLET / OTHER -TABLE 2 ]
AUTHORIZED SEWAGE FLOW: 4140.01 GALLONS PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE ]
UNOBSTRUCTED AREA AVAILABLE: 6650.00 SQFT UNOBSTRUCTED AREA REQUIRED: 1875.00 SQFT
BENCHMARK/REFERENCE POINT LOCATION: NiD in cutout, center of cul-de-sac
ELEVATION OF PROPOSED SYSTEM SITE 5.00 [ 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: FT NORMALLY WET: [ ]YES [X]NO
WELLS: PUBLIC: FT LIMITED USE: FT PRIVATE: 125 FT NON -POTABLE: FT
BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: 5 FT POTABLE WATER LINES:. 100 FT
SITE SUBJECT TO FREQUENT FLOODING? [ ]YES [X]NO 10 YEAR FLOODING? [ ]YES [X]NO]
10 YEAR FLOO)1 ELEVATION FOR SITE: FT[ MSL / NGVD ] SITE ELEVATION: FT [ MSL / NGVD
RATT. PROF'TT.F. TNFARMATTON RTTE 1 SOIL PROFILE INFORMATION SITE 2
USDA SOIL SERIES:
Munsell #/Color
I
Texture
Depth
10YR 5/1
Sand
0 To 16
10YR 5/2
Sand
16 To 25
1 OYR 7/1
Loamy Sand
25 To 41
10YR 5/3
Loamy Sand
36 To 41
10YR 6/1
Fine Sand
41 To 51
10YR 6/1
Sandy Loam
51 To 65
10YR 6/2
Sandy Clay Loam
65 To 72
USDA SOIL SERIES:
Munsell #/Color
Texture
Depth
1 OYR 4/1
Sand
0 To 15
10YR 5/2
Loamy Sand
15 To 23
10YR 7/1
Loamy Sand
23 To 34
10YR 518
CMN/PRM RF
23 To 34
10YR 5/3
Loamy Sand
34 To 40
10YR 6/1
Fine Sand
40 To 48
1 OYR 6/1
Loamy Sand
48 To 60
10YR 6/2
Sandy Clay Loam
60 To 72
OBSERVED WATEI TABLE: 72.00 INCHES [ ABOVE / BELOW ] EXISTING GRADE TYPE: [ PERCHED / APPARENT ]
ESTIMATED WET SEASON WATER TABLE ELEVATION: 23 INCHES [ ABOVE / BELOW ] EXISTING GRADE
HIGH WATER TABLE VEGETATION: [ ]YES [X]NO MOTTLING: [X]YES [ ]NO DEPTH: 23.00 INCHES
SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: Sand/0.80 DEPTH OF EXCAVATION: 41 INCHES .
DRAINFIELD CONFIGURATION: [X] TRENCH [ ] BED [ ] OTHER (SPECIFY)
REMARKS/ADDITIONAL CRITERIA
WSWT determined using USDA WSS and soil borings.
10YR5/8 CMN PROM RF mottling in 10YR711 matrix >2% starting at 23" in SB2.
SB1 3" below BM ISB2 5" below BM.
SITE EVALUATED BY: r.r_ DATE: 09/17/2018
Ingram, Brian (Title: Envirental Specialist 11) (ENVIRONMENTAL HEALTH)
DR 4015, 08/09 (,bsoletes previous editions which may not be used) Incorporated: 64E-6.001, FAC Page 3 of 4
AP1363444 EID1875990 v 1.0.2
STATE OF FLORIDA PERMIT APPLICATION TO CONSTRUCT,
REPAIR, MODIFY, OR ABANDON A WELL
0. Southwest
01 Northwest
PLEASE FILL OUT ALL APPLICABLE FIELDS
('Denotes Required Fields Where Applicable)
:..'St. Johns River
ISouth Florida
The tyRiNr WL•hLUldfOilUr la rtspon5ibfL2for:Rrnplemb!
Suwannee
h i ram and IonvofCing lhe.;v(1,7lr opplrral= to 'he
.1 River
anproitnowJ[derantlaWbout wlw. eoppixrVe.
!-I DEP
J Delegated Authority (If Applicable)
5F-;k7gi9-o
No. -5 ry
Unique ID L �i ?9�
Stipulations Required (See Attached)
62-524 Ouad No. Delineation No.
CUP!WUP Application No.
s 40
owner. Legal Name IT Corp rauolll I 'Aaoress City -Slate 'ZIP Telephone Number
3q,9
'VVeli Location - Address, Road Name or Number, City
3. 32)'zS--7OI 00 L-0,-1.2—a5—_
4. 2•Parcel ID No. PIINN)%or Alternate Key (Circle One) n r , , ; C Lot Block Unit
.3L_(pJ r r Ia x r `�C��C� {- _ Check if 62-524:❑ Yes ❑' No
'Section or Land Grant TgntnshJp tR,ange , ^ k; or my 5ubdiylRIan r p y
5.�' i15 '%i +L )� i 1 ph ✓b h { b5r r '.t %��r F� u. 3 rJ14��/ it ll4F e a;'�ai�
Watpr Well Contractor a q License Number t Tele hone Number I E-mail Address
.,�pu i,,a� t. _ � �qt' ..��, ��4 k ' ' ' c,_,—._._.i .,• r � I ^ .
`Water Well Contractor's Address City State *ZIP
7. 'Tiype of Work: 2 Construction ❑ Repair ❑ Modification❑ Abandonment
8. 'Number of Proposed Wells I
•Reason;cr Pepair. Modihcai
__
9. -Specify intended Use(s) of Well(s):
%A1 rC
❑ Domestic Landscape Irrigation
❑ Bottled Water Supply
Agricultural Irrigation ❑
Site Investigations ��J
Recreation Area Irrigation
❑❑
Livestock ❑
Monitoring
❑ Public Water Supply (Limited Use/DOH)
❑
Nursery Irrigation ❑
Test
❑ Public Water Supply (Community or Non-Community/DEP)❑
Commercial/Industrial ❑
Earth -Coupled Geothermal
❑ Class I Injection
❑
Golf Course Irrigation ❑
HVAC Supply
Class V Injection: ❑ Recharge ❑ Commercial/Industrial
Disposal
HVAC Return
❑ Aquifer Storage and Recovery ❑ Draina?i
P.emediation: ❑ Recovery.[] Air Sparge ❑ Other
(DO-Ilboy
❑ Other (Describe)
or
CT 1 7 2018
In St Lucie County
10'Distance from Septic System if <_ 200 ft. _ /11. Facility Description e J 12. Estimated Start Date
13.'Estimated Well Depth R. "Estimated Ca��slIninng Depth 1fl. Primary Casing Diameter In. Open Hole: From To ft.
14. Estimated Screen Interval: From �To i �? fl.
15.'Primary Casing Material: Black Steel Galvanized av
Stainless Steel SC4
Not Cased Other: _ St e's,� ;
16. Secondary Casing: Telescope Casing Liner SLlrtace Casing Diameter in. �1.
17. Secondary Casing Material: Black Steel Galvanized PVC Stainless Steel Other C
18.'Method of Construction, Repair. or Abandonment: Auger Cable fool Jetted Rotary Sonic �V
Combination (Two or More Methods) Hand Driven (Well Point. Sand Point) Hydrauli�irect Push)
Horizontal Drilling Plugged by Approved Method Other tcumnuci
19. Proposed WLiting Into al for the Primary, Secondary, and Additional Casin :
Fr,om_' To Seal fulateria! ( Bentonite ement Other )
From To Seal Material ( Bentonite-Cement Other }
From To Seal Material ( Bentonite Neat Cement Other )
From To Seal Material ( Bentonite 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 withd1a vt ai-,Qn the owners contiguous property covered under a ConsumptiveANater Use Permit (CUPN'+IUP)
on CUPMIUP Appitcation? Yes No f yes, complete the following: CU�/WUP No. Distnct•Well ID No.
22. Latitude Longitude
23. Data Obtained From: GPS Map Survey Datum: NAD 27 NAD 83 WGS 84
1 hwuby caddy that 1-1 comply with me apphmible tile: of Lha 4 (d,l uwlsnabvc Cad- and lnAl a calla, I Lamy ml u ainWho
f the avmel pfopedli.OWhBea intourmann prov,410 I;: a xuraw, and thin I i0f aware army
ego Iteatri't atutld aialla^,Large• peanut. +I rnodeU, has Leon or :vJl ba aalamcd loom to onmmcnalnornl aY.vul: rasponsintbita fault, Chapter 373, Randu Slmutal, In malf.1— or prepcdy abandon thn, wrlf, or. i a .iffy mat I mu
a0ala"'bon. I rainfic( cMbty mat all infounatlan piov,dodin this appllaaflon is ➢c"fale and Nit I %tiAl amain :be a0mt fe, thea.ner, that tho rawnabon pmoided Is accufate. and 111011 have mtarmoa the oxner at lhoi:
nnrnasary apprnwl from other fadarit. ctal.++, or Inxat gavarnn a fti. d applicable, I ng,., 10 pie—,,, o _11 respanslbib4ac as cNted above. O mar consent, to allomn;l pa^.ennal of th eWID or D1ltgried Aulhonly aecra
compleoap rop Wo thn M.trict viamt 30 days attar eomphibon of the cansirii rlpnla, 4nwd5:acan, o: in thn woll Bile during the eonaaueenn inpala. m,mratim. w abandnnmont oamori{ed by aaa pnrnnt.
nhandnnNnnt autwnrod by mR permit, nI me p o.,t napirndn ah:ahovar cnnfs :rsl. ///y
� n + , ! dq � • 1 � V
r Uc nature of Contractor License No.'Signature of nor or Agent'Date
Approval Granted•Bv Issue Date 1V/ It/ f i Expiration Date _YL(I71Z47MydrologislApproval
_—
Fee Received 5_ Receipt No. Check No. I— Waal,
THIS P1ERMIT 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 CO 15TRUCTION. REPAIR, MODIFICATION. OR ABANDONMENT ACTIVITIES.
)EP Fdrrr.. 62-532.900(1) Incorporated in 62-532 400(t), F.A.C. Effective Dale: October 7, 20'10 Page 1 of 2
F.
.098
�--
L`r c ai 5.67' 5.6T n I .
_
e... N r;J •; �5� a..: � ...
bo
_
v.
13.67' 13.33' N
o E o .A
". pl ' r......._.., w m � 6.6730.67' n> o0 3.33'
' CA)q 3.67' u- _
PROPOSED SINGLE
cm
21.0 . _n FAMILY RESIDENCE
FFE= 28.50 NGVD
I
m o cs FFE= 27.00 NAVD I
r- o. f
67'
p
14.33' 7.0' N I
co V o 30.33'
6.
"I �3 n
�V C:OVP 9.3s'
ro 13.0'
I V O —
26.33' w
28.0' 2�
COUP
IENT �F
29.33'
OPEN DECK
I I .
co
POOLN�
I . �.. - ' '• � .. SPA " -``,;t:;• I
111.33'
I:.il `< r, • . `ram.=4 '., i J .
60.0'
5.67's Nv
CE
8.6•o p
1T
I .o I 28
-
I W PR�P�SFn I
Rick Scott
Mission: Vwr Governor
To protect, promote &improve the health
of all people in Florida through integrated
state, county &community efforts. } .ESL Celeste Philip, MD, MPH
HEALTH
.. E A LTH State Surgeon General and Secretary
t'IGf�il.� f7
Vision: To be the Healthiest State in the Nation
• I
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(�FLHEALTH.GOV
b. Provide the following information:
i. Permit number
ii. Driller name
iii. Address
iv. Date and time to begin construction/abandonment
• JA 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
lHealth Staff or provide notification by email to SLCDOH-WELLS(aFLHEALTH.GOV
• ISubmit 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 of Disease Control and Health Protection
Bureau of Environmental Health
5150 NW Milner Drive
! Accredited Health Department
Port St. Lucie, FL34983 � :Public Health Accrtaditafion Board
PHONE: 71,2/873-4931 • FAX: 772/595-1308
FloridaHeal th.9ov