HomeMy WebLinkAboutD O H PAPERWORK - 2STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATION
APPLICANT: Larry SE
CONTRACTOR / AGENT:
LOT: 12
SUBDIVISION:
Steven Marshall
BLOCK: 2
Sunland Gardens ID#: 3414-501-1412-200-8
APPLICATION # AP1202623
PERMIT # 56-SF-1627568
DOCUMENT # SE970494
County
TO BE COMPLETED 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.
PROPERTY ISIZE CONFORMS TO SITE PLAN: EX ]YES [ ]NO NET USABLE AREA AVAILABLE: 1.31 ACRES
TOTAL ESTIMATED SEWAGE FLOW: 200 GALLONS PER DAY [ RESIDENCES-TABLEI / OTHER -TABLE 2 ]
AUTHORIZED SEWAGE FLOW: 1965.01 GALLONS PER DAY [ 1500 GPD/ACRE I OR 2500 GPD/ACRE ]
UNOBSTRUCTTED AREA AVAILABLE: 4500.00 SQFT UNOBSTRUCTED AREA REQUIRED: 375.00 SQFT
BENCHMARK%REFERENCE POINT LOCATION: Nall With ribbon In utility pole at sW Corner Of properly
--ELEVATION10F PROPOSED SYSTEM SITE 10.00 [ 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: 80 FT NORMALLY WET: [ ]YES [X]NO
WELLS: iPUBLIC: FT LIMITED USE: FT PRIVATE: FT NON -POTABLE: FT
BUILDING FOUNDATIONS: 10 FT PROPERTY LINES: 30 FT POTABLE WATER LINES: FT
• SITE SUBJECT TO FREQUENT FLOODING? [ ]YES [X]NO 10 YEAR FLOODING? [ ]YES [X]NO]
10 YEAR FLOOD ELEVATION FOR SITE: FT[ MSL / NGVD ] SITE ELEVATION: FT [ MSL / NGVD
SOIL PROFILE INFORMATION SITE 1 10" SOIL PROFILE INFORMATION SITE 2 in"
USDA SOILISERIES:
Munsell #/Color
Texture
Depth
10YR 5/1
Sand
0 To 18
10YR 6/1
Sand
18 To 24
10YR 2/1
Loamy Sand
24 To 30
1OYR 3/2
Loamy Sand
30 To 34
10YR 3/4
Sand
34 To 42
10YR 3/2
Sand
42 To 68
10YR 7/2
Sand
68 To 72
USDA SOIL SERIES:
Munsell #/Color
Texture
Depth
10YR 511
Sand
0 To 18
10YR 6/1
Sand
18 To 24
10YR 2/1
Loamy Sand
24 To 30
10YR 3/2
Loamy Sand
30 To 34
10YR 3/4
Sand
34 To 42
10YR 3/2
Sand
42 To 68
10YR 7/2
Sand
68 To 72
OBSERVED WATER TABLE: 50.00 .INCHES [ ABOVE / BELOW ] EXISTING GRADE TYPE: [ .PERCHED / APPARENT ]
ESTIMATED WET SEASON WATER TABLE ELEVATION: 24 INCHES [ ABOVE / BELOW ] EXISTING GRADE
HIGH WATER TABLE VEGETATION: [ ]YES [X]NO MOTTLING: [ ]YES [X]NO DEPTH: INCHES
I
SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: Sand/0.60 DEPTH OF EXCAVATION: INCHES
DRAINFIELD CONFIGURATION., [ ] TRENCH [X ] BED [ ] OTHER (SPECIFY)
REMARKS/ADDITIONAL CRITERIA
SHWT based on USDA web soil survey, historical flll events, and soil borings. Stripping at 24" in 10YR 6/1 matrix.
SITE EVALUATED BY: DATE: 09/03/2015
Kirchner, Jacob (Title: Environmental Specialist 1) ff
DR 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated: 64E-6.001, PAC LLP� ���
AP1202623 EID1627668 ���UJJJ____ v 1.0.2 IUI
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CONSTRICTION PERMIT FOR: OSTDS New
APPLICANT: Larry Seegott
PROPERTY ADDRESS: Dyer Rd Port Saint Lucie, FL 34952
LOT: 12 BLOCK: 2 SUBDIVISION: Sunland Gardens
PERMIT #:56-SF-1627568
APPLICATION #:AP1202623
DATE PAID:
FEE PAID:
RECEIPT #•
DOCUMENT #: PR986572
ID #: 3414-501-1412-200-8 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
PROPER
[OR TAX ID NUMBER]
it
SYSTEMS MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION
I
381.00615, 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 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 [ 1900 ] GALLONS / GPD Septic 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 [ 1334 ] SQUARE FEET SYSTEM
R [ i ] SQUARE FEET N/A SYSTEM
A TYPE SYSTEM: [ ] STANDARD [ ] FILLED 1XI MOUND [ ]
I CONFIGURATION: [ ] TRENCH [xl. BED []
N
F LOCATION OF BENCHMARK: Nail with ribbon in
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE
L
D FILL REQU]
The system
O of 200 gpd.
T The license
s. 64E-6.01
H
E
i
R
at sw corner of
[ 10.0011 INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT
[ 10.00][ INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT
RED: [18.001 INCHES. EXCAVATION REQUIRED: [ ] INCHES
is sized for 2 bedrooms with a maximum occupancy of 4 persons (2 per bedroom), for a total estimated flow
contractor installing the system is responsible for installing the minimum category of tank in accordance with
3)(f), FAC.
i
APPROVED BY:
DATE ISSUED:
DH 4016,I 08/09
Incorporated:
BY: Jacob K Kirchner TITLE: Environmental Specialist I
TITLE: Environmental Specialist I
Jacob K Kirchner
09/03/2015
(Obsoletes all previous editions which may not be used)
64E-6.003, FAC
v 1.1.4 AP1202623
St. Lucie CHD
EXPIRATION DATE: 03/03/2017
SE970494
Page 1 of 3
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 # A02, Tallahassee, Florida 32399-1703. The
Agency Clerk's facsimile number is 850-410-1448.
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.
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cility'Descriptioritart .Date
13'EsdmatedtWell Depth ft 'Estimatetl Casing Depth ft. 'Primary Casing. Diameter « in., Oper Hole From �T6 ft
14 Estirrtated Screed lnterval Frcm7 �' Toft: .
1.
15'PriinaryCasmg.Matenal. Black.Steel Galvanized . PVC Stainless Steel.
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16 Seconds CaT sl a esco a Casin ; Liner .Surface Casing Diameter! in.
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18'Method of Constriction Repair, or.Abandonment. Auger_ " `Cable Tool JetteB "__L iy.. Sonic.
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Hotzonlal'Drilling Plugged by Appro Method her (Descdue)
19 Proposed Groutingtinterval for the Primary,.Se nary, an "Additional Casing:
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From To 1 ►Seal Materlalt' Q�ntonite. Neat Cer]rient Other ? _
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?0. Indicate totatnumber of existing wells o . 51 List numberof existing' unused wells on site
Z1 'Is this welIb any existing well orwaterwithdra al on the owner's contiguous property covered under a ConsurnptivdMater Use Permit (CUP/WUP)` • : ;
or;CUP/WUPApplfcation?.:. '....Yes .. : No If yes, complete. the following: CUPMUP. No. District Well ID No.
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�2. Latitude Longitude
13 Data ObtainedFrorti: GPS Map Survey Datum: NAD 27 NAD 83 UIfGS 84
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Signature of Contractor• j_i,_ 'License;No. Si at re ot.OwnerorAgen--BELOW THIS LINE -
FOR _
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