HomeMy WebLinkAboutD O H PAPERWORKSTATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATM
SYSTEM
PERMIT #:56-SF-I952604
APPLICATION #: AP1416204
DATE PAID:
AND DISPOSAL
FEE PAID:
DECEIVED
RECEIPT #:
#: PR1240190
JUN 2 b 1019
sr. LuOle County, Permitting
DOCUMENT
��
FILE C
FOR:
CONSTROCTION PERMIT
OSTDS New
APPLICANT:
Port St. Lucie Properties, Inc)
CANNE®
PROPERTY ADDRESS:
5714 Sunset Blvd Fort Pierce, FL 34982
by
LOT: 10
BLOCK: 65 SUBDIVISION: Indian River Estates
St I nr[e ('.nun{ /
[SECTION, TOWNSHIP,
RANGE, PARCEL NUMBER]
PROPERTY ID #:
3402-609-0488-000.6
[OR TAX ID NUMBER]
� SYSTEM MUST
BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS
AND STANDARDS OF SECTION
381.0065, £.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,
jWHICH 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 [ 900 ] GALLONS / GPD Septic new CAPACITY
A [ ] GALLONS / GPD N/A CAPACITY
N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
I K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 NRS #Pumps [
D [ 375 ] SQUARE FEET Drainfield new SYSTEM
R [ ] SQUARE FEET N/A SYSTEM
A TYPE SYSTEM: [ ] STANDARD [x] FILLED [] MOUND
I CONFIGURATION: [x] TRENCH [ ] BED [ ]
N
F LOCATION OF BENCHMARK: Site BM
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE
L
D F
0
T
H
E
R
.on,
I
"X", CL of rd, center of property
2.00 ][ INCHES FT IASOVE BELOW] BENCHMARK/REFERENCE POINT
1.00 ][INCHES FT ][ ABOVE BELOW] BENCHMARK/REFERENCE POINT
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 Ingr,4 TITLE: Environmental Specialist II
APPROVED BY: TLE: Environmental Specialist II St. Lucie CHU
Brian J Ingr�
DATE ISSUED: 06/12/2019 EXPIRATION DATE: 12/12/2020
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 M1416204 SE1189531
It .
NOTICE OF RIGHTS
I
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 850413-8743.
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.
yNir�t" St. Lucie County Health Department
`�
5150 NW Milner Dr Port Saint Lucie, FL 34983
,HEALTH
PAYING ON: u:56-SF-1952604 BILL DOCII:56-BID-4201926 CONSTRUCTION APPLICATION 9: AP1416204
(RECEIVED FROM: Alexander J. Piazza PSM, Inc John Erick AMOUNT PAID: $ 515.00
PAYMENT FORM: CHECK 2008 PAYMENT DATE: 05/28/2019
IMAIL TO: (Port St. Lucie Properties, Inc)
I
I
,I
I
I
'I
FACILITY NAME:
PROPERTY LOCATION:
i 5714 Sunset Blvd
Fort Pierce, FL 34982
10
Lot:
Block:
65
Property ID: 3402-609-0488-000-6
EXPLANATION or DESCRIPTION: QUANTITY FEE
I 128 - OSTDS Construction System Inspection Research Fee
1
$
5.00
-1 - Surcharge (All)
1
$
15.00
-1 - OSTDS New Permit Surcharge
I
1
$
100.00
-1 - OSTDS Construction Application and Plan Review,New
1
$
100.00
123 - OSTDS Construction Site Evaluation
1
$
115.00
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: MontanezNM AUDIT CONTROL NO. 56-PID-3954283
i
4 STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
APPLICATION FOR CONSTRUCTION PERMIT
APPLICATION FOR:
PERMIT . 'J O`t
DATE PAID.
5 �q
FEE PAID:
RECEIPT #:
New System [ ] Existing System [ ] Holding Tank [ ] Innovative.
[� ] Repair [ ] Abandonment [ ] Temporary [ ]
APPLICANT: Port St. Lucie Properties, Inc.
AGENT: Alexander J. Piazza PSM, Inc. TELEPHONE:
i
11�.ILING ADDRESS: 619 SW Biltmore Street, Port St. Lucie, Florida 34983
772-340-7770
TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. SYSTEMS MUST BE CONSTRUC
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.
rk! •ar. _•
10 BLOCK: 65 SUBDIVISION:
Indian River Estates Unit 8 PLATTED: 1958
PROPERTY ID #: 3402-609-0488-000-6 ZONING: R I/M OR EQUIVALENT: [ No ]
PROPERTY SIZE: 0.23 ACRES WATER SUPPLY: [,/] PRIVATE PUBLIC [ ]<=2000GPD [ 1>2000GPD
IS SEWER AVAILABLE AS PER 381.0065, FS? I No ] DISTANCE TO SEWER: FT
PROPERTY ADDRESS: 51.1_l Sunset Boulevard, Fort Pierce, FL 34982
DIRECTIONS TO PROPERTY: SEE MAP
INFORMATION [ ✓ ]
t Type of
Establishment
I RESIDENCE
2
3
4
[ ] COMMERCIAL
No. of Building , Commercial/Institutional System Design
Bedrooms Area Sqft Table 1, Chapter 64E-6, FAC
3 1,376
] Floor/Equipment Drains [,/] Other (Specify) GARBAGE GRINDERS/DISPOSALS
Alexander J Piazza
DATE: 5-20-19
4015, 08/09 (Obsoletes previous editions which may not be used)
orporated 64E-6.001, FAC Page 1 of 4
STATE OF FLORIDA APPLICATION # AP1416204
DEPARTMENT OF HEALTH PERMIT # 56-SF-1952604
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM DOCUMENT #SE1189531
SITE EVALUATION AND SYSTEM SPECIFICATION
APPLICANT: Port St. Lucie Properties, Inc
CONTRACTOR / AGENT: Alexander J. Piazza PSM,Inc John Erickson 772-260-5049
�OT: 10 BLOCK: 65
SUBDIVISION: Indian River Estates ID#:3402-609-0488-000-6
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: [X]YES [ ]NO NET USABLE AREA AVAILABLE: 0.23 ACRES
TOTAL ESTIMATED SEWAGE FLOW: 300 GALLONS PER DAY [ RESIDENCES -TABLET / OTHER -TABLE 2 ]
• AUTHORIZED SEWAGE FLOW: 345.01 GALLONS PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE ]
I
UNOBSTRUCTED AREA AVAILABLE: 750.00 SQFT UNOBSTRUCTED AREA REQUIRED: 750.00 SQFT
BENCHMARK/REFERENCE POINT LOCATION: Site BM Orange paint "X" CL of rd center of property
ELEVATION OF PROPOSED SYSTEM SITE 2.00 [ INCHES / FT ] [[MOVE / BELOW ] BENCHMARK/REFERENCE POINT
I
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES
SURFACE WATER: FT DITCHES/SWALES: 15 FT NORMALLY WET: [ ]YES IX]NO
I
WELLS: PUBLIC: FT LIMITED USE: FT PRIVATE: 150 FT NON -POTABLE: FT
BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: 5 FT POTABLE WATER LINES:_ 35 FT
(SITE SUBJECT TO FREQUENT FLOODING? [ ]YES [X]NO 10 YEAR FLOODING? [ ]YES [X]NO]
10 YEAR FLOOD ELEVATION FOR SITE: FT[ MSL / NGVD I SITE ELEVATION: FT C MSL / NGVD
ROTT. PROFTT.E TMFORMATTON RTTC 1 SOTT. PROFILE TNFORMATION SITE 2
USDA SOIL SERIES:Waveland fine sand
Munsell #/Color Texture
Depth
1 OYR 5/1
Fine Sand
0 To 35
1 OYR 611
Fine Sand
25 To 35
1 OYR 211
Spodic Material
35 To 41
7.5YR 3/3
Spodic Material
41 To 46
10YR 4/2
Fine Sand
46 To 55
1 OYR 513
Fine Sand
55 To 72
USDA SOIL SERIES:Waveland fine sand
Munsell#fColor Texture
Depth
10YR 5/1
Fine Sand
0 To 37
10YR 611
Fine Sand
28 To 40
10YR 2/2
Spodic Material
40 To 45
7.5YR 3/2
Spodic Material
45 To 48
1 OYR 4/2
Fine Sand
48 To 55
1 OYR 512
Fine Sand
55 To 72
OBSERVED WATER TABLE: 61.00 INCHES ( ABOVE / BELOW I EXISTING GRADE TYPE: [ PERCHED / APPARENT 1
ESTIMATED WET SEASON WATER TABLE ELEVATION: 25 INCHES [ ABOVE / HELOW I EXISTING GRADE
HIGH WATER TABLE VEGETATION: [ ]YES [X]NO MOTTLING: [X]YES I ]NO DEPTH: 25.00 INCHES
SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: Fine Sand/0.80 DEPTH OF EXCAVATION: 48
DRAINFIELD CONFIGURATION: [X ] TRENCH [ ] BED [ ] OTHER (SPECIFY)
r REMARKS/ADDITIONAL CRITERIA
NWT determined using USDA WSS and soli borings.
Stripped Matrix-10YR611 stripping In IOYR611 matrix >10%with diffuse boundaries starting at 25" in S131.
1 2" above SM. SB2 3" above BM„
SITE EVALUATED BY: DATE:
Ingram, Brian (I e: Envir ental Specialist ll) (ENVIRONMENTAL HEALTH)
DH 4015, 08/09 (Obeoletes previous editions vhlch may of be Mead) Incorporated: 64E-6.001, FAC
AP1416204 EID1952604
INCHES
06/03/2019
Page 3 of 4
v 1.0.2
��TMe
A STATE OF FLORIDA PERMIT #.56_5r_4e15 po
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
APPLICANT:
Port St. Lucie Properties, Inc.
AGENT:
Alexander I. Piazza PSM, Inc.
LOT: 10
BLOCK: 65 SUBDIVISION:
Indian River. Estates Unit 8
PRO I ERTY ID
# : 3402-609-0488-000-6
[ Tax ID Number
l
I
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: I✓] YES [ ] NO NET USABLE AREA AVAILABLE: 0.23 ACRES
TOTAL ESTIMATED SEWAGE FLOW: 500 GALLONS PER DAY [RESIDENCES -TABLE I/OTHER-TABLE2 ]
AUTHORIZED SEWAGE FLOW: GALLONS PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE ]
UNOBSTRUCTED AREA AVAILABLE: 750 SQFT UNOBSTRUCTED AREA REQUIRED: 750 SQFT
BEN CHMARK/REFERENCE'POINT LOCATION:
ELEVATION OF PROPOSED SYSTEM SITE IS34 [INCHES/FT ] [ABOVE/BELOW'] BENCHMARK/REFERENCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES
SURFACE WATER:100 FT . DITCHES/SWALES:15 FT NORMALLY WET? [ I YES [,(I NO
WELLS: PUBLIC: 200 FT LIMITED USE: 100 FT PRIVATE: 75 FT NON —POTABLE: 100 FT
BUILDING FOUNDATIONS:5 FT PROPERTY LINES:10 FT POTABLE WATER LINES: FT
SIT IE SUBJECT TO FREQUENT FLOODING: [ ] YES [✓] NO 10 YEAR FLOODING? [ ] YES I✓] NO
10 NEAR FLOOD ELEVATION FOR SITE: FT MSL/NGVD SITE ELEVATION: FT MSL/NGVD
TEXTURE
TO
TO
TO
TO
TO
TO
TO
(VED WATER TABLE: 40+ INCHES [BELOW
B,TED WET SEASON WATER TABLE ELEVATION:
WATER TABLE VEGETATION: [ I YES [ I NO
SOIL PROFILE INFORMATION SITE 2
MUNSELL #/COLOR TEXTURE DEPTH
TO
TO
TO
TO
TO
TO
TO
TO
TO
USDA SOIL SERIES:
r] EXISTING GRADE. TYPE:[ PERCHED/ APPARENT ]
_ INCHES [.ABOVE/BELOW ] EXISTING GRADE
MOTTLING: [ [ YES I ] NO DEPTH: INCHES
TEXTURE/LOADING RATE FOR SYSTEM SIZING: DEPTH OF EXCAVATION:
FIELD CONFIGURATION: [,/] TRENCH [ ] BED [ ] OTHER (SPECIFY)
KS/ADDITIONAL CRITERIA:
Alexander J Piazza ;�Uwn".-'°
EVALUATED BY: mie=IASIoumao-wW
INCHES
5-20-19
JH k015, 12/11 (obsoletes previous editions which may not be used) 10Corporated: 64E-6.001, FAC Page 3 of 4
AI'PLICANT'S NAIYIE: Port St. Lucie Properties, Inc. 56,5E c]rJZ(a5
LEGAL DESCRIPTION: Lot 10, Block 65, Indian Riyer Estates Unit 8 (PB 10, PG 73)
jI 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 fine 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
ate 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
proposed on the side of the lot farthest from surface water, that all 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
wetlands are shown on the applicants lot.
The natural grade elevation in the area of theproposed septic system and the benchmark must
be shown on the site plan. Please locate the benchmark within 200 feet of the proposed septic
system.
NOTE: MUST BE CERTIFIED BY A FLORIDA
REGISTERED SURVEYOR OR ENGINEER.
agimyagme H�m�eirma
Alexander J Piazza -
CERTIFIED BY: a. oin° °ixo°°am
FLORIDA PROFESSIONAL NO.: 6330
DATE: 05/20/19 JOB NO.: 18-3906
dots/ rbmshep[ics/Sep ticApppPage207