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Home My WebLink AboutD O H PAPERWORKSTATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM r— PERbaT #:56-SF-1884680 APPLICATION #:AP1368472 DATE PAID: FEE PAID: RE IPT #: oc #: PR1169402 j DEC 0 8 2018 CONSTRUCTION PERMIT FOR: OSTDS New I ST. Lucle County, Pennitting SCANNED BY APPLICANT (Grande Construction of Florida, INC) _ _ St 1 nri® Cou Mry— PROPERTY ADDRESS: 18101 Wagonwheel Ln Port Saint Lucie, FL 34987 LOT: 11 ' BLOCK: SUBDIVISION: Carlton Country Estates PROPERTY ID #: 3211-701-0013-000-3 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] [OR TAR ID NUMBER] SYSTEM MOST 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 [ 1,200 ] 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 I ]GALLONS e[ ]DOSES PER 24 Has #Pumps [ D [ 575 ] SQUARE FEET Drainfield new SYSTEM R [ I SQUARE FEET N/A SYSTEM A TYPE SYSTEM: [ I STANDARD [ ] FILLED D4] MOUND [ ] I CONFIGURATION: [X] TRENCH [ ] BED I N F LOCATION OF BENCHMARK: 13M#1 NiD, N side of Rd, W I ELEVATION OF PROPOSED SYSTEM SITE [ 10.001 E BOTTOM OF DRAINFIELD TO BE [ 1.00 ] L D FILL REQUIRED: 129.001 INCHES EXCAVA line extended N FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT FT ]I ABOVE BELOW I BENCHMARK/REFERENCE POINT The system Is sized for 5 bedrooms with a maximum occupancy of 10 persons (2 per bedroom), for a total estimated flow of 0 460 gpd. T The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance with H s. 64E-6.013(3)(0, FAC. E FILE COPY R I SPECIFICATIONS BY: Brian J In am TITLE: A _ Environmental Specialist II APPROVED BY: A TITLE: Environmental Specialist II St. Lucie CED Brian J In DATE ISSUED: 10/31/2018 EXPIRATION DATE: 04/30/2020 DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E-6.003, PAC Page 1 of 3 v 1.1.4 A111368472 SE1132397 NOTICE OF RIGHTS A party whose substantial interest is affected by this order may petition for an r.. 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, Florida32399. 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 filir g 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. ^" St. Lucie County Health Department E1 Y�` IMa 5150 NW Milner Dr Port Saint Lucie, FL 34983 HEALTH PAYING ON: PERMITtr.56-SF-1884080 BILL DOC#56-BID-4030917 CONSTRUCTION APPLICATION#:AP1368472 RECEIVED FROM: Grande Construction AMOUNT PAID: $ 195.00 PAYMENT FORM: CHECK 4428 4429 PAYMENT DATE: 11/26/2018 MAIL TO: (Grande Construction of Florida, INC) FACILITY NAME : PROPERTY LOCATION: 18101 Wagonwheel Ln Port Saint Lucie, FL 34987 Lot: 11 Property ID: 3211-701-0013-000-3 ' EXPLANATION or DESCRIPTION: 124 - OSTDS Construction Repair or Mod Site Evaluation Block: 126 - OSTDS Construction Permit (New or Mod, Amendment) -1 - OSTDS Revision QUANTITY FEE 1 $ 115.00 1 $ 55.00 1 $ 25.00 RECEIVED BY: VanceMH AUDIT CONTROL NO. 56-PID-3806293 Note: $35 paid on 11/20 St. Lucie County Health Department HEALTH 5150 NW Milner Dr Port Saint Lucie, FL 34983 -PAYING ON: PERMIT a: 56-SF-1884080 BILL Doc x:56-BID-4030917 CONSTRUCTION APPLICATION M. AP1368472 RECEIVED FROM: Grande Construction AMOUNT PAID: $ 35.00 PAYMENT FORM: CHECK 4428 PAYMENT DATE: 11/2012018 MAIL TO (Grande Construction of Florida, INC) I FACILITY NAME: PROPERTY LOCATION: 18101 Wagonwheel Ln Port Saint Lucie, FL 34987 11 Lot: Property ID: 3211-701-0013-000-3 EXPLANATION or DESCRIPTION: 139 - OSTDS Application Approval Existing, No Insp Block: 1 QUANTITY FEE $ 35.00 RECEIVED BY: MontanezNM AUDIT CONTROL NO. 56-PID-3806293 HEALTH' 'PAYING ON: RECEIVED FROM: PAYMENT FORM: St. Lucie County Health Department 5150 NW Milner Dr Port Saint Lucie, FL 34983 PERMIT#:56-SF-1884080 BILLooca:56-BID-3997597 CONSTRUCTION APPLICATION #: AP1368472 Grande Construction AMOUNT PAID: $ 515.00 CHECK 4328 PAYMENT DATE: 10/1112018 MAIL TO, (Grande Construction of Florida, INC) 1 FACILITY NAME: PROPERTY LOCATION: 18101 Wagonwheel Ln Port Saint Lucie, FL 34987 11 Lot: Block: Property ID: 3211-701-0013-000-3 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 QUANTITY FEE 1 $ 5.00 1 $ 15.00 1 $ 100.00 1 $ 100.00 1 $ 115.00 1 $ 55.00 1 $ 75.00 1 $ 50.00 RECEIVED BY: MontanezNM AUDIT CONTROL NO. 56-PID-3768627 E �< STATE OF FLORIDA PERMIT NO. Uf ` I V4090 DEPARTMENT OF HEALTH DATE PAID: l0 p ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID: CK.#,q32FS SYSTEM RECEIPT #: APPLICATION FOR CONSTRUCTION PERMIT APPLICATION FOR: IV New system [ ] Existing System [ ] Holding Tank [ ] Innovative [ ] Repair [ ] Abandonment [ ] Temporary [ ] APPLICANT: GRANDE CONSTRUCTION OF FLORIDA, INC AGENT: GREGOLDAKOWSKI,PRESIDENT-OWNER AGENT TELEPHONE:772-336-7240 MAILING ADDRESS: PO BOX 881765 PORT ST LUCIE, FL 34988 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: 11 BLOCK: SUBDIVISION: CARLTON COUNTRY ESTATES PLATTED: BOOK46 PROPERTY ID #: 3211-701-0013-000/3 ZONING: PUD-CO I/M OR EQUIVALENT: [ No ] PROPERTY SIZE: 5.2 � ACRES WATER SUPPLY: [,(] PRIVATE PUBLIC [ ]<=2000GPD [ 1>2000GPD IS SEWER AVAILABLE AS PER 381.0065, FS? [ No ] DISTANCE TO SEWER: FT PROPERTY ADDRESS: 18101 WAGONWHEEL LN.. FT PIERCE DIRECTIONS TO PROPERTY: OKEECHOBEE RD., WEST TO IDEAL HOLDINGS RD., SOUTH TO WAGONWHEEL IN BUILDING INFORMATION Unit Type of No Establishment I SINGLE FAMILY RES 2 3 4 [ ] RESIDENTIAL [ ] COMMERCIAL No. of Building Commercial/Institutional System Design Bedrooms Area Sq£t Table 1, Chapter 64E-6, FAC 5 2610 A/C [ ] Floor/Equipment Drains [ ] Other (Specify) SIGNATURE: DATE: 10/10/2018 DH 4015, 08/09 (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: Grande Construction of Florida, INC CONTRACTOR. / AGENT: Grande Construction LOT: ,111 1 BLOCK: SUBDIVISION: Carlton Country Estates ID#: 3211-701-0013-000-3 APPLICATION # AP1368472 PERMIT # 56SF-1884080 DOCUMENT # RF1IA9AQ7 TO BE COMPLETED BY ENGINEER, HEALTH DEPARTMENT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEERS MUST PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PACE OF SUBMITTAL. COMPLETE ALL ITEMS. PROPERTY SIZE CONFORMS TO SITE PLAN: [X]YES I ]NO NET USABLE AREA AVAILABLE: 5.20 ACRES TOTAL ESTIMATED SEWAGE FLOW: 460 GALLONS PER DAY [ RESIDENCES-TABLEI / OTHER -TABLE 2 ] AUTHORIZED SEWAGE FLOW: 7800.00 GALLONS PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE ] UNOBSTRUCTED AREA AVAILABLE: 2000.00 SQFT UNOBSTRUCTED AREA REQUIRED: 863.00 SQFT BENCHMARK/REFERENCE POINT LOCATION: BM#1 NiD, N side of Rd, W property line e ELEVATION OF PROPOSED SYSTEM SITE 10.00 I INCHES / FT 1 [ ABOVE / W THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES POINT SURFACE WATER: FT DITCHES/SWALES: FT NORMALLY WET: [ ]YES [X]NO WELLS: PUBLIC: FT LIMITED USE: FT PRIVATE: 100 FT NON -POTABLE: 100 FT BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: 120 FT POTABLE WATER LINES: 75 PT SITE SUBJECT TO FREQUENT FLOODING? [ ]YES IX]NO 10 YEAR FLOODING? I ]YES [X]NO] 10 YEAR FLOOD ELEVATION FOR SITE: FT [ MSL / NGVD ] SITE ELEVATION: FT [ MSL / NGVD SOIL PROFILE INFORMATION SITE 1 ROTT. PROPTT.F. TNRORMAM`rnM RTTP. 9 USDA SOIL SERIES: Munsell #/Color Texture Depth 1 OYR 4/2 Sand 0 To 3 1OYR 6/2 Sand 3To24 I OYR 5/8 CMN/PRM RF 13 To 24 1 OYR 6/6 Sand 24 To 31 1 OYR 42 Sand 31 To 39 5Y 52 Sandy Clay Loam 39 To 43 5Y 5/2 Loamy Sand 43 To 48 1 OYR 52 Sand 48 To 61 IOYR 6/1 Sandy Clay Loam 61 To 72 USDA SOIL SERIES: Munsell #/Color Texture Depth I OYR 4/2 Sand 0 To 5 1 OYR 6/2 Sand 5 To 25 1OYR 518 CMN/PRM RF 16 To 25 1 OYR 6/4 Sand 25 To 31 1 OYR 42 Sand 31 To 37 5Y 5/2 Sand 37 To 41 5Y 52 Sandy Clay Loam 41 To 61 10YR 52 Sand 61 To 66 1 OYR 62 Sandy Clay Loam 66 To 72 OBSERVED WATER TABLE: 51.00 INCHES [ ABOVE / EELOW ] EXISTING GRADE TYPE: I PERCHED / APPARENT ] ESTIMATED WET SEASON WATER TABLE ELEVATION: 13 INCHES [ ABOVE / PiLOW13 EXISTING GRADE HIGH WATER TABLE VEGETATION: [ ]YES [X]NO MOTTLING: [X]YES [ ]NO DEPTH: 13.00 INCHES SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: Sand/ DEPTH OF EXCAVATION: INCHES DRAINFIELD CONFIGURATION: [XI TRENCH [ ] BED [ ] OTHER (SPECIFY) REAAARKS/ADDITIONAL CRITERIA WSWT determined using USDA WSS and soil borings. 10YR5/8 CMN PROM RF mottling In 1OYR6/2 matrix>2% starting at 13" in SB7. SB1 10" below BM. SB2 7" below BM. SITE EVALUATED BY:/AL4DATE: 11/2812018 Ingram, Brian IT16 nvironmental Specialist IQ (ENVIRONMENTAL HEALTH) DH 4015, 08/09 (Obaoletee previous editions wMc may not be used) Incorporated: 64E-6.001, FAC Page 3 Of 4 AP1368472 EID1884080 v 1.0.2 Mission: To protect, promote 8 implore the health of all people in Florida through Integrated stale, county 8 community efforts. ® Ad HMTH Vision: To be the Healthiest State in the Nation Rick Scott Governor 1.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 • 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 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-WELLSO_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 Miner Dme Port St Lucie, FL 349a3 PHONE:, 772/873-4931 • FAX: 772/595-1306 FloridaHealth.gov FILE COP " Accredited Health Department = Public Health Accreditation Board GRANDE 2. STATE OF FLORIDA PERMIT APPLICATION TO CONSTRUCT, REPAIR, MODIFY, OR ABANDON A WELL ❑Southwest PLEASE FILL OUTALL APPLICABLE FIELDS ❑ Northwest (*Denotes Required Fields Where Appli ❑St. Johns River m South Florida, rnc"°'c"`Tnanoo.mrv,.nre,powonrormn prcnry this form mdkr riling rhepa ltnppllmdon to the ❑Suwannee River apprapdatedelegatedauthodtywhereapplicable ❑ DEP O Delegated Authority (If Applicable) PO BOX 881765 PORT ST LUCIE 'Address -City No. iv�l Unique ID Required (See Attached) Quad No. Delineagon No. UP Application No. FL 34988 772-336-7240 State 'ZIP Telephone Number 'Well Location - Address, Road Name or Number, City a. 321,1-701-0013-000/3 11 *Parcel ID No. (PIN) or Alternate Key (Circle One) Lot Block Unit 4, PLAT BOOK 46 ST LUCIE CARLTON COUNTRY EST Check if 62-524:0 Yes No 'Section or Land Grant 'Township *Range 'County Subdivision 5. J & J LEONARD'S WELL DRILLING 863-623-8903 JESSSLEONARD@GMAIL.COM 'Water Well Contractor *License Number `Telephone Number E-mail Address 6.5705 NE 9TH LN. OKEECHOBEE FL 34974 'Water Well Contractor's Address City State ZIP 7. *Type of Work: Q Construction Repair Modirmtion0 Abandonment *Number of Proposed Wells 2 'Specify Intended Use(s) of II s Domestic ✓ Landscape Imga Ion Bottled Water Supply a nigation ❑ Public Water Supply (Limited Use/DOH) Public Water Supply (Community or Non-Community/DEP)❑ Class I Injection ❑ -Reason for Repair, Agricultural Irrigation ® Site Investigations w U- U Uu %J Livestock Monitoring Nursery Irrigation Test Commercialflndustrial Earth -Coupled Geothermal OCT 3 1 2018 Golf Course Irrigation HVAC Supply e HVAC Return s V Injection: (J Recharge LJ Commercialflndustrial Disposal ❑ Aquifer Storage and Recovery ❑ DrainageFE OH in St LUCID iedia8on: Recovery❑ A(rSparge ❑ Other (Describe) C' IRONMENTiLAIC Other (Describe) 10.•Distance from Septic System if 5 200 ft. `0 0 11. Facility Description 5.1A 11,- y 12. Estimated Start Date 13.•Estimated We16Depth Ao—ft. -Estimated Casing Depth ft. Primary Casing Diameter„ 1. n. Open Hole: From TO ft. 14. Estimated Screen Interval: FromY—To,J0ft. 16.'Primary Casing Material: Black Steel ✓Galvanized PVC Stainless Steel Not Cased Other. 16. Secondary Casing: Telescope Casing liner SurfaceCasing Diameter in. 17. Secondary Casing Material: Black Steel Galvanized PVC Stainless Steel Other 18.•Method of Construction, Repair, or Abandonment: 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 (oesciba) 19. Proposed Grouting Interval for the Primary, Secondary, and Additional Casing: From_)_ To 10`/2_ Sea( Material (✓Bentonite Neat Cement Other 1 From To Seal Material ( Bentonite Neat Cement Other 1 From To Seal Material ( Bentonite Neat Cement Other )' From To Seal Material ( Bentonite Neat Cement Other 1 20. Indicate total number of ebsting wells on site List number of existing unused wells on site 21 'Is this well or any existing well or wafer withdrawal on the owner's contiguous property covered under a Consumptive/Water Use Permit (CUPAMIP) or CUP/WUP Application$ Yes No If yes, complete the following: CUP/WUP No. District Well ID No. 22. Latitude Lonaitude 23. Data Obtained From: GPS Approval Granted By Fee Received S Map Survey t/ 3G 3 'License No. Receipt Datum: NAD 27 _NAD 83 WGS 84 ) }wnerorAgent Expiration Check 'Date Hydrologist Approval Initlals THIS PERMIT IS NOT VAUD 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 CONSTRUCTION, REPAIR, MODIFICATION, OR ABANDONMENT ACTIVITIES. Date: - - --�_ WAGONWHEEL LANE (6(T RIGHT OF WAY) (20' ASPHALT PAVEMENT) ----- ----- 10' P.U.E. (PER PLAT) 4' PVC FENCE TER SYSTEM 42.'0' UMP iz0'o PROPOSED 1 STORY C.D,S. RESIDENCEPROPOSED F.F.E. 24.90 FIRRIGATION UNE`�I�'WATER SERVICE LINESN� I OSED IRRIGATION WELL® M D- r a ISED POTABLE WATER WELL i o w m F o � w 14' CONC. DRIVEWAY CONC. PORCH x �I PROPOSED SEPTIC DRAINFIELD AREA CONC. PA710 -x N8956'32"E 1 (BEARING BASE) ZFOUND 5/8" IRON ROD & CAP NO IDENTIFICATION CORNER 2.0' EAST 4' PVC FENCE LOT 1 (VACAN' r ri RECEIVED Rick Scott f Mission: i, `" „f -jiy Governor To protect, promote & improve the health:=t—�k?'1 of all people in Florida through integrated DEC 0 3 2018 -t �® Cele to Philip, MO, MPH state, county 8 community efforts. HEALTH �I StWeto Su eon General and Secretary HEALTH ST. Lucie County, Permitting Vision: To be the Healthiest State in the Nation Florida Department of Health in St. Lucie County Conditions for Issuance of Water Well Permits SCANNED Effective July 24, 2017 BY St. Lucie 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 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 • 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()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 Port St Lucie, FL 34983 PHONE: 772/873A931 • FAX: 772/595-1306 FloddaHealth.gov Accredited Health Department Public Health Accreditation Board 11 Key (Circle One) Lot Block Unit 4, PLAT BOOK 46 ST LUCIE CARLTON COUNTRY EST Check if 62-524:0 Yes ❑ No "Section or Land Grant 'Township 'Range 'County Subdivision 5. J & J LEONARD'S WELL DRILLING 863-623-8903 JESSSLEONARD@GMAIL.COM `Water Well Contractor 'License Number *Telephone Number E-mail Address 6.5705 NE 9TH LN. OKEECHOBEE FL 34974 'Water Well Contractor's Address City State ZIP 7. 'Type of Work: 0 Construction ❑ Repair ❑ Modification❑ Abandonment 8. 'Number of Proposed Wells 2 9. 'Specify Intended Uses) of ell s : Domestic Landscape Irriga Ion Bottled Water Supply as nigation Public Water Supply (Limited Use/DOH) ❑ Public Water Supply (Community or Non-Community/DEP)❑ ] Class I Injection ❑ STATE OF FLORIDA PERMIT APPLICATION TO CONSTRUCT, REPAIR, MODIFY, OR ABANDON A WELL D Southwest PLEASE FILL OUT ALL APPLICABLE FIELDS ❑ Northwest ('Denotes Required Fields Where Applicable) ❑St. Johns River [a South Florida , mpleting rhewareandfcon(ratmrisepermsiapplicmontothe chiprorm andeleg ardinythepermlmppllcatlan to the ❑Suwannee River apPropdatedeleyatedauthnrlrywhere applicable. ❑DEP ❑ Delegated Authority (If Applicable) No. III—OL-C, O ku t Unique ID Stipulations Required (See Attached) id No. Delineation No. Application No. 1. GRANDE CONSTRUCTI0% PO BOX 881765 PORT ST LUCIE FL 34988 772-336-7240 'Owner, Legal Name if Corporation 'Address 'City 'State 'ZIP Telephone Number 2.18101 WAGONWHEEL LN., FT. PIERCE 'Well Location -Address, Road Name or Number, City 3. 'Reason for Repair, Agricultural Irrigation EJ Site Investigations Livestock LJ Monitoring Nursery irrigation ❑ Test OCT 31 2018 Commercial/Industrial ❑ Earth -Coupled Geothermal Golf Course Irrigation HVAC Supply e HVAC Return Class V Injection: ❑ Recharge ❑ Commercial/Industrial Disposal ❑ Aquifer Storage and Recovery ❑ DrainageFE OH In St Lude COulttl Remediation: ❑ Recovery ❑ Air Sparge ❑ Other (Describe) CN IRONMEilllTf3loMEAL1 ❑ Other (Describe) 10.'Distance from Septic System if <_ 200 ft. 11. Facility Description Y14,51C P!4IrI,*1712. Estimated Start Date 13.'Estimated We16Depth,6_0_ft. r',�stEstimated Casing Depth `��ft. Primary Casing Diameter min. Open Hole: From _To ft. 14. Estimated Screen Interval: From -s c To (oO ft. 15.'Primary Casing Material: Black Steel ✓Galvanized PVC Stainless Steel Not Cased Other: Secondary Casing: Telescope Casing Liner Surface Casing Diameter in. Secondary Casing Material: Black Steel Galvanized PVC Stainless Steel 8.'Method of Construction, Repair, or Abandonment: 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 (Desrrl5e) 9. Proposed Grouting Interval for the Primary, Secondary, and Additional Casing: From_ To PI-2 Seal Material (V Bentonite Neat Cement Other ) From To Seal Material ( Bentonite Neat 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 27 'Is this well or any existin�well or water withdrawal on the owner's contiguous property covered under a Consumptive/Water Use Permit (CUP/WUP) or CUPAIVUP Application. Yes No If yes, complete the following: CUPANUP No. District Well ID No. Latitude 23. Data Obtained From: Approval Granted By Fee Received $_ Longitude GPS Map Survey Datum: _NAD 27 _NAD 83 WGS 84 ti. G *License No. 'Sign)/a of Ovmer or Agent *Date 1.1 � Issue Datefg3i Y Expiration Dateff,InPLv Hydrologist Approval �� Imnem Receipt No. Check No. THIS PERMIT 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 CONSTRUCTION, REPAIR, MODIFICATION, OR ABANDONMENT ACTIVITIES. DEP Form: 62-532.900(1) Incorporated in 62-532.400(1), F.A.C. Effective Date: October 7. 2010 Page 1 of 2 WAGONWHEEL LANE (60' RIGHT OF WAY) (20' ASPHALT PAVEMENT) �(2) II N8 '56`32"E ,. 416.00' a ^ 10' P.U.E. (PER PLAT) '4' PVC FENCE TER SYSTEM UMP PROPOSED i STORY C.D.S. RESIDENCE PROPOSED F.F.E. 24.90 FEET, IRRIGATION LINE WATER SERVICE LINE F 177.71' 'OSED IRRIGATION WELL )SED POTABLE WATER WELL' 14' CONC. DRIVEWAY CONC. PORCH F — —1 / PROPO ED 30'X50' SEPTIC SDRANFIELD AREA � I CONC. PATIO —� 'N89`56'32"E 16 (BEARING BASE) 8„ FOUND 5/8" IRON ROD & CAP NO IDENTIFICATION CE CORNER 2.0' EAST 4' PVC FENCE LOT 1 (VACAN' K APPLICATION a:AP1368472 STATE OF FLORIDA PERMIT #:56-SF-1884080 DEPARTMENT OF HEALTH 1 _ ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM DOCUMENT :F1 26(20 CONSTRUCTION INSPECTION AND FINAL APPROVAL DATE PAID:11/26/2018 FEE PAID:195.00 RECEIPT a:56-PID-3806293 APPLICANT: Grande Construction of Florida, INC AGENT: Greg Oldakowski (Grande Construction PROPERTY ADDRESS: 18101 Wagonwheel Ln Port Saint Lucie FL 34987 SLANNE _ dy LOT: 11 BLOCK: St. LU Cie COunty SUBDIVISION: Carlton Country Estates IDH: 3211-701-0013.000.3 CHECKED [X1 ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED. TANK INSTALLATION SETBACKS [ ] (01'1 TANK SIZE [11 1200.00 [2) 525.00 [ 1 [271 SURFACE WATER FT [ 1 [021 TANK MATERIAL Concrete [ ] [281 DITCHES FT [ ] [031 OUTLET DEVICE [ 1 [291 PRIVATE WELLS 94 FT FT [ 1 (041 MULTI -CHAMBERED [ Lk N ] [ 1 (301 PUBLIC WELLS [ ] [051 OUTLET FILTER Polylok PL-122 [ ] [311 IRRIGATION WELLS 92 FT ( ] [061 LEGEND 1. 01-011-120C3 2. 01-011-97SC4 [ 1 [321 POTABLE WATER 75 FT [ 1 [071 WATERTIGHT 1 1 -[331 BUILDING FOUNDATIONS 9 FT ( 1 1091 LEVEL [ 1 [341 PROPERTY LINES 100 FT [ 1 [09] DEPTH TO LID [ 1 [351 OTHER FT DRAINFIELD INSTALLATION FILLED / MOUND SYSTEM [ 1 [101 AREA [1] 576 [21 SQFT [ ] [361 DRAINFIELD COVER [ 1 1111 DISTRIBUTION BOX _ HEADER x 1 1 [37) SHOULDERS [ 1 [121 NUMBER OF DRAINLINES 1. 4.00 2. [ 1 [381 SLOPES [ 1 [131 DRAINLINE SEPARATION [ 1 [391 STABILIZATION 07/09/2019 [ 1 [141 DRAINLINE SLOPE [ ] [151 DEPTH OF COVER ADDITIONAL INFORMATION [ 1 [161 ELEVATION [ ABOVE / BELOW ]BM 1.00 [ 1 [401 UNOBSTRUCTED AREA 1] [171 SYSTEM LOCATION [ 1 [41) STORMWATER RUNOFF [ 1 1181 DOSING PUMPS 1.00 [ 1 [421 ALARMS [ 1 [191 AGGREGATE SIZE [ 1 [431 MAINTENANCE AGREEMENT [ 1. [201 AGGREGATE EXCESSIVE FINES [ ] [441 BUILDING AREA ( ] [21] AGGREGATE DEPTH [ ] [451 LOCATION CONFORMS WITH SITE PLAN £ILL / EXCAVATION MATERIAL [ 1 [461 FINAL SITE GRADING [ 1 [471 CONTRACTOR DAVID WHITESIDE(ACCUR [ 1 [221 FILL AMOUNT C 1 (481 OTHER INFILTRATOR Quick4 EQ36 (single c [ ] [231 FILL TEXTURE [ ] (241 EXCAVATION DEPTH ABANDONMENT [ 1 [25] AREA REPLACED [ 3 [491 TANK PUMPED [ 1' [261 REPLACEMENT MATERIAL [ ] [50] TANK CRUSHED 6 FILLED Comments: Comments are on page 2. / St. Lucie CHU DATE: 05/14/2019 CONSTRUCTION I APPROVED DISAPPROVED 1: E Iro mental Spec a is[II Br ram (ENVIRONMENTAL HEALTH) FINAL SYSTEM I APPROVED / DISAPPROVED 3: /v- VL Luce CHD DATE: 07/09/2019 E Ironmenml Specialistll Bd J Ingram (ENVIRONMENTAL HEALTH) (Explanation of Violations on following Page) DH 4016, 08/09 (Obsolates all previous editions which may not be used) Incorpgrated: 64E-6.003, FAC Page 2 of 3 EH Database v 1.0.1 AP1368472 ElD7884080 � tx STATE OF FLORIDA DEPARTMENT OF HEALTH 15 ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTIONINSPECTION AND: FINAL APPROVAL Al Violation Number Comment APPLICATION #:AP11368472 PERMIT #:56-SF-1884080 DOCUMENT #=FI1307841 DATE PAID.11/26/2018 FEE PAID; RECEIPT #: The system is sized for 5 bedrooms with a maximum occupancy of 10 persons (2per bedroom), for a total estimated Flow of 460 gpd. New ST, filter, DT, bames 113 hp pump, and 4x12 long trench DF installed. No violations, system ok to cover. Contractor notified by phone.; Needs final inspection for mound system, alarm check, and final site grading. Final system approved. Contractor and building department emailed final approval. DH 40161 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E-6.003, FAC Page 2 of 3 EH Database v1.0.1 AP1368412 EID1884060