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Home My WebLink AboutD O H PAPERWORKt Mission: To protect, promote & Improve the health of all people in Florida through integrated state, county & community efforts. alffill, Rick Scott ECODGovernor dlCel to Philip, MD, MPH HEALTH p TH State Surgeon Genial and Secretary Vision: To be the Healthiest State In the Nat on Florida Department of Health in St. Lucie County Conditions for Issuance of Water Well Permits SCANNED PY Effective July 24, 2017 St Luce County 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 SLC DOH-WELLS(cD FLH EALTH. 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-WELLSaa.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 NN Milner Drive Port St. Lucie, FL 34983 PHONE: 7721873-4931 • FAX: 772/595-1306 FloridaHealth.gov Accredited Health Department Public Health Accreditation Board 4 • a i't0p STATE OF FLORIDA PERMIT APPLICATION TO CONSTRUCT, REPAIR, MODIFY, OR ABANDON A WELL Peru N,. 59-29223 1$oi LEASE F:LL QLTAAAFPLICABLE FIELDS �'.,nda Uriicilei0_ E ❑Nor Northwest ('Denies Required Fields Where-.Apptfczblej ?a.-1:54>,Iascns Required (sea — OSL Johns River i JSouth Florida' %Iv aa�rvne.aa-ec;ma 3;F-.a;ot-cc-p;ai+� Y,'S corn end/xa.-ding heperrrf, acofx,>:inn:; t!s e2-52G Qoad No.�_CeliceaGJn tJ= ,y DEPannaa.Rfvar aAo.. ,z:2 C31.-� �fi'/`ers ec;trrac•s Lm Delegated Authority (If Applicable_) CUPflJUP Aapnat!on Nam_ Re-c- me Legal Name Co.porabon,. Ci 79 ((o�� .if k D� L �L ? t ��P 'Telephone Number 111 Location -Address, goad Name or Number. City 33 Z1 — Sb''"i — L) 0 o r— coo ti 8 mall No (PIN) o Alt rna[ Key (Circle On.) Let i3lack Uni; ctiogor Land GrantT •To:vnship Range— 'County_ Subdnrslon Check? S2-524._Yes _N3 iL^rWell Conhactor ll{795 `f MPUWZ11ilr`11`nc'L"Rrn-'I Ccrh 'License NurnFrr •Telephone Number E-mall Address—'--- ,D, Do,[ er7�ft{ For•i- pte.vc.� ter Well Cenlractor s Address CI Ie of FL Work: Consbuclion _Repair —Moth ication —Abandonment State Zip mber of Proposed Welle I ecify Intended Usc(s) of Welifs): //q�� cluestig Lane scape Irricatior.. —Agricultural Irrigahon _Site Investigation L� p owed Water Supply ®� _Recreation Area!rricaticn _Livestock —Monitoring /biic Water Supply (Limited UseIDOH) _Nursery Irrigation —Test ablic Water Supply (Community or Ncn-Community/D'cp)—Commeroiat/lndusbia! _Earth -Coupled Geothermal 'ass I Injection —Golf Course Irrigation _HVAC Supply MAR 1 2019 —HVAC Return / Injection: _P.ecI arce—Commerciapindustrial Cisposal —Aquifer Storage and Recovery —Drairage 'iztion: —Recovery —Air Sparge _Other _ her fo:xTw% H T.'�(' L'lldoco c.ae.a'oAar:r•.4:•,.e,�: aoa••naeemaewG-.e ante from Septic System Ifs 200 o°ENVIRONMENTALH t.]j-� 11. Facility Description 5 (t mated Well Depth / O U tl 12 Estimated Start Date P! ft. -Estimated Casing Depth S D ({, -primary Casing Diameter m. Open Hole: From_To_h. :haled Screen Interval: From _Tg_;r / Z G- lary Casino Material_Slack Steel _-_Galvanized )`-- PVC g _, rainless Seel _NotCased _Other ndary Casing: _Telescope Casing _ Liner _ Surface Casing Diameter_ in. ndary Casing Material- _Black Steal _Galvanized _pvc _Stainless Steel _Other hod of Construction, Repair, grAbandenmen-: _Auger Cable Tool _Combination (Two or More Methods —_Jetted _-[Rotary __gonic _Horizontal Drilling _99 YAPPlu _--Plugged b _proved Hand thriven (VJ=1I PoiMethod _Oth=_ra•�_r�• Point, Sand Point) _Hydraulic Point (Direct Push) used Grouting Interval for the Primary. Secondary, and Additional Casing: n__TO__Seat Material �_Bentonite__Neai Cement Other ) m_Tg_Seat Material (__Bentonite Neal Cement_Other n_To_Seal Material L_Bentonit= Neat Cement_Othor 1 n_To_Seal Material I_Bentonite_Neat Czment_Olher ) ate total number of existing wells on site Lis{ numbar ofexistin is well or S' unused an site any onthetamer'scontiguous gropery covered under a Consump6veNdaterUse Permit(CUr.'JJUP) UPNJUP Applicacgn7 _dos �No No IF yes, compHte the following: CUP/WUP No. ude Distriu VJell ID No. Longitude Obtained From:_GPS ?Aap _Survey Datum: NAO 27 r,v aa�•.r a%aure a:a�.v::n>•nr. c. �,e •-.. aGm _ _ _NAD 53 __WGSS= 14.cCa-.�/-n'ttl,a/_e:Mf.v+>-N:ae--�Y"a,e �-CT: c—er�anaYUy".a` �/CID.i-L-r >eivelry v�i.^clNif.�a'or y[v-Y.v- ..a-]NY.Te LL=Y clai. af,tr]LNa'a+:v:enn a:::�l'•.>a=-1,q e': L-a•'wl>:C. L'µ�s ifa:r3.l. Fl>-:aS:CC-a. V'•;r b)>#•�C y :rttS }.+ L1Ylaan L:.. v-Cel ecrv��v+SDI i::?` nnl v! - .. VLII•ae.CiwvoeaY, vJ.ea�-a ?.vyi �': :>r. >.cicS�ti. ]ivi, 3'a'CiivL�illv.. a N:]•�:>:1� - I:GiGn »:•i:L-aG:., Cn--�ru .. i-l:•+�•Ai: p.'P]aSY.'�-`��'a-"�•va��.'u)•YIIY:e,.-lGrM:.-1ou-a:T-.'N�v.O'•, :'-, .:.n e � •.1 -•]:•vim-:-•�•-•fca"Y_f.-J:ae ._va..a-a .>.beb::..,t.e-. • a a of^ ce�nva'Rr 'License No. gr. 11e1f0 a Agant -e+-> •.� : ><swrs,• Granted By /(� .ad S— Y'ALID UIfIL PROPERLY SIGNED Issue Dat^.5////cf Ezci:avc., Receipt No. ' ; ChecR EY _Y'AU7h ORIZEC OFFICER OR REPRESENTATIVE E OF t52c32.903(:t Inc•?-ara:^C I�uLi52.<o0{11, FAD E.Ye:N�e Dx:e: Oc!os-].?file THE Faae t of2 X q Ri STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT FOR: OSTDS New APPLICANT: Susan Beckman . PROPERTY ADDRESS: 7816 Saddlebrook Dr Port Saint Lucie. FL 34986 LOT: 5 BLOCK: PROPERTY ID #: 3321-501-0005-000-8 SUBDIVISION: Saba[ Creek I PERMIT #:56-SF-1923683 APPLICATION #: AP1397590 DATE PAID:. FEE PAID: RECEIPT # DOCUMENT #: PR1205255 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] [OR TAX ID NUMBER] 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 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 [ 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 RRS #Pumps [ ] D [ 500 ] SQUARE FEET Drainfie[d new SYSTEM R [ ] SQUARE FEET N/A SYSTEM A TYPE BYSTEM: [ ] STANDARD [ ] FILLED [X] MOUND I CONFIGURATION: [x] TRENCH [ ] BED [ ] N F LOCATION OF BENCHMARK: FND N&D E side of Rd, NE I ELEVATION OF PROPOSED SYSTEM SITE [ 5.00 ] E BOTTOM OF DRAINFIELD TO BE [ 2.00 ] L D 0 T H E R corner. elev 24.04' FT ][ ABOVE BELOW BENCHMARK/REFERENCE POINT FT ][ ABOVE BELOW]]3ENCHMARK/REFERENCE POINT muulH u: LGD.UUJ INCHES EXCAVATION REQUIRED: L 4"I.UUJ INCHES system is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total estimated Flow of gpd. SPECIFICATIONS BY: Brian J Inqy4im TITLE: Environmental Specialist II APPROVED BY: ^- z �- TITLE: Environmental Specialist II St. Lucie CUD Brian J Ingr,¢m DATE ISSUED: 03/01/2019 (/ I EXPIRATION DATE: 09/01/2020 DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E-6.003, FAC Page 1 of 3 v 1. 1.4 AP1397590 SE1154931 Try 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. a<a St. Lucie County Health Department 5150 NW Milner Dr Port Saint Lucie, FL 34983 HEALTH PAYING ON: PERMIT#:56-SF-1923683 BILL Doc#:56-BID-4080294 CONSTRUCTION APPLICATION#: AP1397590 RECEIVED FROM: ASHTON SEPTIC TANKS, INC. AMOUNT PAID: $ 515.00 PAYMENT FORM: CREDIT CARD PAYMENT DATE: 01/25/2019 MAIL TO: Susan Beckman FACILITY NAME: PROPERTY LOCATION: 7816 Saddlebrook Dr Port Saint Lucie, FL 34986 5 Lot: Block: Property ID: 3321-501-0005-000-8 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 126 - OSTDS Construction Permit (New or Mod, Amendment) 127 - OSTDS Construction System Inspection 133 - OSTDS Construction Reinspection 1 1 1 1 1 QUANTITY FEE $ 5.00 $ 15.00 $ 100.00 $ 100.00 $ 115.00 $ 55.00 $ 75.00 $ 50.00 RECEIVED BY: MontanezNM AUDIT CONTROL NO. 56-PID-3857865 Note: Held do to incomplete. Needed well application. � txe stye at STATE OF FLORIDA S ` DEPARTMENT OF HEALTH n ONSITE SEWAGE TREATMENT AND DISPOSAL ,N SYSTEM APPLICATION FOR CONSTRUCTION PERMIT APPLICATION FOR: Well no. Em-l" toga? PERMIT NO. Ste- SF - 110-303 DATE PAID: FEE PAID: C RECEIPT #: [J] New System [ ] Existing System [ ] Holding Tank [ ] Innovative [ ] Repair [ ] Abandonment [ ] Temporary [ ] APPLICANT: Susan Beckman AGENT: Ashton Septic Tanks TELEPHONE:772-216-9927 MAILING ADDRESS: 376 Cyclone Dr Ft. Pierce, FL 34950 ------------------------------------------------------------- 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: 5 BLOCK: Phase SUBDIVISION: Saba[Creek PLATTED: 1980 PROPERTY ID #: 3321-501-0005-000-8 ZONING: AR-1 I/M OR EQUIVALENT: [ No ] PROPERTY SIZE: 4.04 ACRES WATER SUPPLY: [ ] PRIVATE PUBLIC [J ]<=2000GPD [ ]>2000GPD IS SEWER AVAILABLE AS PER 381.0065, FS? [ No ] DISTANCE TO SEWER: N/A FT PROPERTY ADDRESS: 7816 Saddlebrook Dr DIRECTIONS TO PROPERTY: 7816 Saddlebrook Dr BUILDING INFORMATION [✓] RESIDENTIAL [ ] COMMERCIAL Unit Type of No. of Building Commercial/Institutional System Design No Establishment Bedrooms Area Sqft Table 1, Chapter 64E-6, FAC 1 Single Family 3 17T/ ( 300 GPD 2 3 4 [ ] Floor/Equipment Drains [ ] Other (Specify) a V / U SIGNATURE: � DATE: DH 4015, 08 09 (Obsole es previous editions which may not be used) Incorporat d 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: Susan Beckman CONTRACTOR / AGENT: ASHTON SEPTIC TANKS, INC. LOT: 5 BLOCK: SU13DMSION: SabalCreek I ID#: 3321-501-0005-000-8 APPLICATION # AP1397590 PERMIT # 56-SF-1923683 DOCUMENT # R1=1154Q31 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: IX]YES [ ]NO NET USABLE AREA AVAILABLE: 4.04 ACRES TOTAL ESTIMATED SEWAGE FLOW: 400 GALLONS PER DAY [ I RESIDENCES -TABLET / OTHER -TABLE 2 ] AUTHORIZED SEWAGE FLOW: 10099.98 GALLONS PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE ] UNOBSTRUCTED AREA AVAILABLE: 1536.00 SQFT UNOBSTRUCTED AREA REQUIRED: 1000.00 SQFT BENCHMARK/REFERENCE POINT LOCATION: FND N&D E side of Rd, NE property Come ELEVATION, OF PROPOSED SYSTEM SITE 5.00 [ INCHE9 / FT I [ ABOVE / BENCHMARK/REFERENCE POINT THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES SURFACE WATER: FT DITCHES/SWALES: 75 FT NORMALLY WET: [ ]YES [X]NO WELLS: PUBLIC: FT LIMITED USE: FT PRIVATE: 100 FT NON -POTABLE: FT BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: 35 FT POTABLE WATER LINES: 85 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 SOIL PROFILE INFORMATION SITE 2 USDA SOIL SERIES:Wabasso sand Munsell #/Color Texture Depth 10YR 5/3 Sand 0 To 26 10YR 5/2 Sand 17 To 26 10YR 611 Sand 26 To 30 10YR 2/1 Spodic Material - 30 To 41 1 OYR 3/3 Fine Sand 41 To 49 10YR 5/4 Sand 49 To 55 1 OYR 5/2 Sandy Clay Loam 55 To 67 1 OYR 612 Sand 67 To 72 USDA SOIL SERIES:Wabasso sand Munsell #/Color Texture Depth 10YR 4/2 Loamy Sand 0 To 5 10YR 6/3 Sand 5 To 27 10YR 6/2 Sand 18 To 31 7.5YR 312 Spodic Material 31 To 40 1 OYR 3/4 Fine Sand 40 To 48 10YR 4/4 Sand 48 To 54 1 OYR 5/2 Sandy Clay Loam 54 To 63 1 OYR 6/2 Loamy Sand 63 To 72 OBSERVED WATER TABLE: 60.00 INCHES [ ABOVE / BELOW 3 EXISTING GRADE TYPE: [ PERCHED / APPARENT ] ESTIMATED WET SEASON WATER TABLE ELEVATION: 17 INCHES I ABOVE / BELOW ] EXISTING GRADE HIGH WATER TABLE VEGETATION: [ ]YES [X]NO MOTTLING: [X]YES [ ]NO DEPTH: INCHES SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: Sand/0.80 DEPTH OF EXCAVATION: 41 INCHES DRAINFIELD CONFIGURATION: [X ] TRENCH I ] BED [ ] OTHER (SPECIFY) REMARKS/ADDITIONAL CRITERIA WSWT determined using USDA WSS and soil borings. 10YR512 stripping In 110YR513 matrix >10% with diffuse boundaries starting at 17" in SB1. SBI 5" below BM. SB2 4" below BM. IV SITE EVALUATED BY: DATE: 02/19/2019 Ingram, Brian He: Environmental Specialist il) (ENVIRONMENTAL HEALTH) DN 4015, 08/09 (Obsoletea previous editions which may not be used) Incorporated; 64E-6.001, PAC Page 3 of 4 AP1397690 EID1923683 v 1.0.2