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Home My WebLink AboutD O H - PAPERWORKPERMIT #: 56-SF-1 887072 APPLICATION # : AP 1370265 n STATE OF FLORIDA DEPARTMENT OF HEALTH DATE PAID: r ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID: SYSTEM RECEIPT # "~ wi DOCUMENT # : PR1181415 SCANNED CONSTRUCTIION PERMIT FOR: OSTDS New 13Y APPLICANT : Tristen and Alexis Trefelner St Lucie County PROPERTY ADDRESS: TBD Slash Pine Trl Fort Pierce, FL 34951 LOT: BLOCK: SUBDIVISION: [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] PROPERTY ID #: 1407-313-0015-000-1 [OR TAX ID NUMBER] I SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION 381.0065, 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 AIPPLICATION. 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. i SYSTEM DESIGN AND SPECIFICATIONS T [ 1,050 ] 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 [ 500 ] SQUARE FEET Drainfield new SYSTEM R [ ] SQUARE FEET N/A SYSTEM A TYPE SYSTEM: [ ] STANDARD [ ] FILLED [XI MOUND [ ] I CONFIGURATION: [x] TRENCH [ ] BED [ ] N F LOCATION OF BENCHMARK: 16d nail in PP near NW property corner I ELEVATION OF PROPOSED SYSTEM SITE [ 22.001 INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 21.001 INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT L D FILL REQUIRED: [19.001 INCHES EXCAVATION REQUIRED: [ 41.001 INCHES The system is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total estimated flow of ° 400 gpd. T The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance with H s. 64E-6 i013(3)(0, FAC. E R SPECIFICATIONS BY: Brian J Ingram TITLE: Environmental Specialist II APPROVED Bi: TITLE: Environmental Specialist II St. Lucie CHD Brian J Ingr DATE ISSUED: 11/19/2018 EXPIRATION DATE: 05/19/2020 DH 4016, 08/09 (Obsoletes all previous edit'of be sed) Incorporated: 64E-6.003, FAC T. 1 f 3 v 1.1.4 AP13702 5,/ .1q 7 3 15 UP �;� Eel1Nil�r permitting nrf% A . -- ie 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 gove6d 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 seco i d 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. St. Lucie County Health Department rfo 5150 NW Milner Dr Port Saint Lucie, FL 34983 - MALT! PAYING ON: PERMIT #: 56-SF-1887072 BILL DOC #:56-BID-4004297 CONSTRUCTION APPLICATION #: AP1370265 _ RECEIVED FROM: James Trefelner AMOUNT.PAID: $ 515.00 PAYME T FORM: CHECK 1664 PAYMENT DATE: 10/24/2018 MAIL TO: Tristen and Alexis Trefelner I FACILITY NAME: PROPERTY LOCATION: TBD Slash Pine Trl Fol rt Pierce, FL 34951 Lot: Block: Property ID: 1407-313-0015-000-1 EXPLANATION or DESCRIPTION: 128 - OSTDS Construction System Inspection Research Fee -1 - Surcharge (All) -1 - OSTDS New Permit Surcharge -1 - OSTDS Construction Application and Plan Review,New 123 - OSTDS Construction Site Evaluation I 126 - OSTDS Construction Permit (New or Mod, Amendment) 127 - OSTDS Construction System Inspection i 133 - OSTDS Construction Reinspection RECEIVED BY: MontanezNM QUANTITY FEE 1 $ 5.00 1 $ 15.00 1 $ 100.00 1 $ 100.00 1 $ 115.00 r 1 $ 55.00 1 $ 75.00 1 $ 50.00 AUDIT CONTROL NO. 56-PID-3778543 mac, STATE OF FLORIDA PERMIT NO. - 10019 lV p2 DEPARTMENT OF HEALTH DATE PAID: ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID: (/ 11 ( SYSTEM RECEIPT #: . Y`Op°'E``� APPLICATION FOR CONSTRUCTION PERMIT APPLICATION FOR: New System [ ] Existing System [ ] Holding Tank [ ] Innovative [ ] Repair [ ] Abandonment [ ] Temporary [ ] APPLICANT : Tristen and Alexis Trefelner AGENT: James Trefelner TELEPHONE: 772-201-9833 MAILING ADDRESS: 1760 Copenhaver Road Fort Pierce, Florida 34945 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: BLOCK: SUBDIVISION: PLATTED: PROPERTY ID #: 1407-313-0015-000-1 ZONING: AR-1 I/M OR EQUIVALENT: [ No ] i PROPERTY SIZE: 1.04 ACRES WATER SUPPLY: [,/] PRIVATE PUBLIC [ ]<=2000GPD [ ]>2000GPD IS SEWER AVAILABLE AS, PER 381.0065, FS? [ No ] DISTANCE TO SEWER: FT PROPERTY ADDRESS: Slash Pine Trail DIRECTIONS TO PROPERTY: See Map BUILDING INFORMATION [ VJ RESIDENTIAL [ ] CONNERCIAL Unit Type of No. of Building Commercial/Institutional System Design No Establishment Bedrooms Area Sqft Table 1, Chapter 64E-6, FAC 1 Residence 3 2459 i 2 3 4 [ ] Floor/Equipment Drains Other (Specify) Garbage grinders/ Disposals SIGNATURE: DATE: 10/23/2018 DH 4015�, 08/ (Obsoletes previous editions which may not be used) Incorporated 64E-6.001, FAC Page 1 of 4 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATION APPLICANT Tristen and Alexis Trefelner CONTRACTOR / AGENT: James Trefelner LOT: I BLOCK: SUBDIVISION: ID# : 1407-313-0015-000-1 APPLICATION # AP1370265 PERMIT # 56-SF-1887072 DOCUMENT # SE1131315 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 SIZE CONFORMS TO SITE PLAN: EX ]YES ( ]NO NET USABLE AREA AVAILABLE: 1.04 ACRES TOTAL ESTIMATED SEWAGE FLOW: 400 GALLONS PER DAY [ RESIDENCES -TABLET / OTHER -TABLE 2 ] AUTHORIZE SEWAGE FLOW: 1559.99 GALLONS PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE ] UNOBSTRUCTED AREA AVAILABLE: 1000.00 SQFT UNOBSTRUCTED AREA REQUIRED: 750.00 SQFT BENCHMARK/REFERENCE POINT LOCATION: 16d nail in PP near NW property corner ELEVATION IOF PROPOSED SYSTEM SITE 22.00 [ 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: 20 FT NORMALLY WET: [ ]YES [X]NO WELLS: PUBLIC: FT LIMITED USE: FT PRIVATE: 80 FT NON -POTABLE: FT BUILDING FiUNDATIONS: 5 FT PROPERTY•LINES: 25 FT POTABLE WATER LINES: 70 FT SITE SUBJECT TO FREQUENT FLOODING? [ ]YES [X]NO 10 YEAR FLOODING? [ ]YES [X]NO] 10 YEAR FLOOD ELEVATION FOR SITE: r FT[ MSL / NGVD ] SITE ELEVATION: FT [ MSL / NGVD SOIL PROFILE INFORMATION STTF. 1 SnTT. PRAFTT.F. TNFnRMATTON ATTF. 2 USDA SOIL SERIES:Lawnwood sand Munsell #/Color Texture Depth 1 OYR 5/1 Sand 0 To 26 10YR 6/1 Sand 23 To 30 1 OYR 5/2 Sand 30 To 34 10YR 2/2 Spodic Material 34 To 41 10YR 3/4 Fine Sand 41 To 47 10YR 4/6 Sand 47 To 54 10YR 6/4 Sand 54 To 72 USDA SOIL SERIES:Lawnwood sand Munsell #/Color Texture Depth 10YR 4/1. Sand 0 To 8 10YR 5/2 Sand 8 To 29 1 OYR 6/2 Sand 26 To 33 10YR 6/1 Sand 33 To 37 7.5YR 3/1 Spodic Material 37 To 41 10YR 3/4 Fine Sand 41 To 49 10YR 4/6 Fine Sand 49 To 56 10YR 6/3 Fine Sand 56 To 72 OBSERVED WAITER TABLE: 51.00 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. 10YR6/1 stripping in 10YR5/1 matrix>10% with diffuse boundaries starting at 23" in SB1. SB1 22" below RM. SB219" below BM. 42 SITE EVALUATED BY: c _ _ DATE: 11/07/2018 Ingram, Brian (Title: E onmental Specialist 11) (ENVIRONMENTAL HEALTH) DH 4015, 08/09 (Obsoletes previous editions which not be used) Incorporated: 64E-6.001, FAC Page 3 of 4 AP1370266 EID1887072 V 1.0.2 APPLICANT'S NAME: �atVVIe- 5 III EGAL DESCRIPTION: Q:a4z:41 M 1447 r �I ®�15 -4>01 1 r T PROPOSERSEPTI SYST'Et1�Sl�' INFQR AT N F 3 ;.: ,� I certify that there are no potable private wells within 75 feet of the available area for the proposed septic system, that there are no non -potable wells within 50 feet of the available area for the proposed septic system, that there are no wells within 25 feet of a pesticide -treated building foundation, that there are no public wells that serve less than 25 people or less than 15 homes or businesses within 100 feet of the proposed septic system, that there are no public wells that serve more than 25 people or more than 15 homes or businesses within 200 feet of the proposed septic system, that the water line from the water meter or well to the structure is at least 10 feet from the available area for the proposed septic system unless the plans show the line to be double sleeved, that there is not a gravity sewer line, low pressure sewer line or vacuum sewage line in a public easement or right-of-way that abuts the property, that there are no lakes, streams, wetlands, or surface water within 75 feet of the available area for the proposed septic system unless the property was created prior to 1972, that the septic system is Po posed on the side of the lot farthest from surface water, that al.l private wells, septic systems and surface water on adjacent or contiguous land within 75 feet of the applicant's lot are shown on the site plan, that all public wells within 200 feet of the applicant's lot are shown on the site plan, and that the location of'building or residences, swimming pools, recorded easements, paved areas or driveways, sidewalks, the general slope of the property, filled areas, drainage features, and surface waters such as lakes, ponds, streams, canals, or � 'etiands are shown on the applicants lot. The natural grade elevation in the area of the proposed septic system and the benchmark must be shown on the site plan. Please locate the benchmark within 200 feet of the proposed septic System. I NOTE: MUST BE CERTIFIED BY A FLORIDA REGISTERED SURVEYOR OR ENGINEER i lacef •rats scptic,•ScpficApppPage3U7 CERTIFIED BY: FLORIDA PROFESSIONAL -NO.: G� � DATE: lO""�7—' _ 10B \0. �.r Mission: To protect, promote & improve the health of all people in Florida through integrated sta , county & community efforts. i e v6 o 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 i 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(aD-FLHEALTH GOV b. Provide the following information: i. Permit number ii. Driller name iii. Address iv. Date and time to begin construction/abandonment IP 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(aD-FLHEALTH GOV Submit 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 (` d 918 Port St. t,cle, FL3a983 Accredited Health 19pa rTj PHONE 772t873-4931 • FAX: 772t595-1306 ' = Public Health Accreditation Board FloridaHealth.gov Sr-- d do(610-1o% STATE OF FLORIDA PERMIT APPLICATION TO CONSTRUCT, S�' O�"!r!" REPAIR, MODIFY, OR ABANDON A WELL Permit No. ❑ Southwest PLEASE FILL OUTALLAPPLICABLE FIELDS Florida Unique ID ❑ Northwest ('Denotes Required Fields Where Applicable) Permit Stipulations Required (See Attached) ❑ St. Johns River ❑ South Florida The water well contractor is responsible for completing this form and forwarcring the permit application to the 62-524 Quad No. Delineation No. []Suwannee River appropriate delegated authority whom applicable. ❑DEP ❑ Delegated Authority (if Applicable) Application i�6 6, P d 'Owner, Legal Name if Corporation 'Address ity eStat 'ZIP 'Telephone Number z. �1 Zk Slr) �(iy-� l JG t , �1aa11 - ? i ail �� i -��i -iQJ, `` e�cation -Address, Road Names r Number, City 'Pa'rcel ID No. (PIN) orAltemate Key (Circle One) Lot Block Unit I; 4. :ti .1 it N_, *Section or Land Grant 'Township "Range County Subdivision Check if 62-524: _ Yes ZrNo 5.`�;t>:�..�. 'Wafgr Well Cont ctor 'License Number `Telepho a Number E-mail Address I V _ -- I t r? - — - _ 2 . irtc 6. Q State 7. *Type of Work: Construction _Repair _Modification Abandonment 8. 'Number of Proposed Wells 'Reason for Repair, Modification, arAbandonment 9.'Sp&cify Intended Use(s) of Well(s): 11 p�% n°f"i'(�%]I ` Domestic _Landscape Irrigation Agricultural Irrigation Site Investigation Mow l`J _Boned Water Supply _Recreation Area Irrigation Livestock _Monitoring I _Nursery Irrigation Test Public Water Supply (Limited Use/DOH) Commercial/lndustrial _Earth -Coupled Geothermal 3 Public Water Supply (Community or Non-Community/DEP) _Golf Course Irrigation _HVAC Supply N OV } 9 2018 Class I Injection _HVAC Return Class V Injection: _Recharge CommerciaUlndustrial Disposal Aquifer Storage and Recovery _Drainage Remediation: _Recovery Air Sparge Other (Desbe) F OH in $t _M(Luaa Cou _Other (Describe) (Note: Not all types oIt ells are permitted by a given permitting aulhonty) 10 °Distance from Septic System if S200 fL J - 11. Facility Description' (� S%� 12. Estimated Start Date 13.°Estimated Well Depth I l t� ft. *Estimated Casing Depth 10 0% 'Primary Casing Diameter 2 n. Open Hole: From To fL 14. Estimated Screen Interval: From�(�(Tof % C�fl. 15.*Pr ary Casing Material: Black Steel Galvanized . VPVC Stainless Steel Not Cased Other. 16. Secondary Casing: Telescope Casing truer Surface Casing Diameter in. 17. Secondary Casing Material: Black Steel Galvanized PVC Stainless Steel Other 18'Metliod of Construction, Repair, orAbandonment: Auger Cable Tool Jetted Rotary Sonic Combination (Two or More Methods) Hand Driven (Well Point, Sand Point) Hydraulic Point (Direct Push) Horizontal Drilling Plugged by Approved Method Other (Describe) 19. Proposed Grouting Interval for the Primary, Secondary, and Additional Casing: From To Seal Material (^Bentonite Neat Cement Other ) From To Seal Material (_Benton)te Neat Cement Other ) From To Seal Material L_Bentonite Neat Cement Other ) From To Seal Material L_Bentonite Neat Cement Other ) 20. Indicate total number of existing wells on site List number of existing unused wells on site 21.1s this well or any existing well or water withdrawal on the owner's contiguous property covered under a Consumptive/Water Use Permit (CUP/WUP) or:CUP/WUP Application? Yes —3c--No If yes, complete the following: CUPIWOP No. District Well ID No. 22. Latitude Longitude 23. Data Obtained From: GPS Map Survey Datum: NAD 27 NAD 83 WGS 84 I herohy rarfify Thad wglmrtraly wlm the aap5rahto rotes otTillede.Fla&,aAdanntserarrvo code, and out awater 1cortiythatlnatth c ncrofthoprapedythattheinranna prwidedisarnrmtoandthattamowomor Approval Granted By Fee Received $ n ortviff be obtained of to tmmmencemenl of well In uas tfration is ac—to and that IwM obtain mr nsrbatles under Chapter373.Inf unarm Statutes, i ma'vtlain orpropedy abandar&n-aWet; ar. Ice,* ort that 1 am aPP agent rm ma mrncr, rout me Mromuuon pravidcd Lz aaMedG and mall hero informN mo ownv of melr mrments, it appricabte. I agree to provide a wan Maponsr bes as stated above. Owner Bents Io amovvirtg personnel of NO wMD'"WegatedAuOiarity acres Iefion of the wnstmalon, mpafr, madificatton, or to the 7unn g Ute calsbtrNOn. ',modification, or abandonmerd auerorized by ft permit. Won, 01cheverocarts first. 'License No. 'S ature of Owner s A nt 'Dot Issue Date 9 / i' Expiration Receipt No. Check No. tnttiatt J IS NOT VALID UNTIL PROPERLY SIGNED BYAN AUTHORIZED OFFICER OR REPRESENTATIVE OF THE WMD OR DELEGATED AUTHORITY. THE L BE AVAILABLE AT THE WELL SITE DURING ALL CONSTRUCTION, REPAIR, MODIFICATION, OR ABANDONMENTACTIVITIES. DEP F.onn:; 62-532.900(1) Incorporated in 62-532.400(1), FAG. Effective Date: October7, 2010 Page 1 of 2 - 17,15 � 0 � 8 FND 51IRC 19,55 I - I S'11.1 E " 20' SETBACK UNREADABLE F oq ----- BENCHMARK ---- - ----, 25.0 0; ' PROPOSED ,--� GREEN AREA 10 PROPOSED a �' ------------- " 18,37 DRAINFIELD--"'- rn +-350SQ FT / 38.00' ,30 x - dAF 51 .92' 8.33 N � � 6.00' 6.00 LC <18.50 160.92' `— . PRO SED G CD 0 v 1 S RY CBS (A CD . > o SIDENCE o MINIMUMV COVERED \ 3 5 0 0- FFE = 24.5' M 7.25' PORCH 52.00' 1o.R.. PARCEL 18,52 ID: c� .50, 11.83' 1407-313-0015-000-1 y 21, o °� PROPOSED WATERLINE �//-ini C�T 16.67 10.00' PROPOSED WELL - 75.0' 5 PROPOSED .... ; �0'X22'y 00 00 16' SHELL DRIVE .CD5NCRETE: Lo 00 -------— - --- � .;�-.-•. . --- — 20' SETBACK -- PROPOSED x 20,21 • DRAINAGE PIPE '