HomeMy WebLinkAboutD O H PAPERWORK (2)JAN 0 0 2019 PERMIT #: 56-SF-1891227
STATE OF FLORIDA
���� COICATION :AP1372800
DEPARTMENT OF HEALTH DATE PAID:
ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID:
SYSTEM RECEIPT #:
RECEIVED
#: PR1193724
DEC 2 6 2018
CONSTRUCTION PERMIT FOR: OSTDS New SCANNED
APPLICANT: Yoan and Ta mi Rojas . Lucie County, Permitting BY
PROPERTY ADDRESS: TBD Briltain Ave Fort Pierce, FL 34945 util
LOT: 1, 2, 3, 10, 11, an BLOCK: A SUBDIVISION:
PROPERTY ID #: 2310-801-0001-000-4
[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 [
900 ] GALLONS / GPD Septic
CAPACITY
A [
1 GALLONS / GPD NIA
CAPACITY
N [
] GALLONS GREASE INTERCEPTOR CAPACITY
[MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [
] GALLONS DOSING TANK CAPACITY E
]GALLONS @[ ]DOSES PER 24 RRS #Pumps E
D [ 375 ] SQUARE FEET
R [ 1 SQUARE FEET
A TYPE SYSTEM: [ ]
I CONFIGURATION: Ex]
N
F LOCATION OF BENCHMARK:
SYSTEM
N/A SYSTEM
STANDARD E 1 FILLED EX] MOUND
TRENCH [ ] BED E 1
NED CL of Briltain Ave W property line extended S
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE
L
D I
0
T
H
E
R
E 10.001E INCHES FT ][ABOVE kBELOW'ji BENCHMARK/REFERENCE POINT
E 7.00 1E INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT
ie system is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total estimated flow of
0 9pd.
e licensed contractor installing the system is responsible for installing the minimum category of tank in accordance with
64E-6.013(3)(f), FAC.
SPECIFICATIONS BY: Brian J Ingra TITLE: Environmental Specialist
APPROVED BY: LE: Environmental Specialist II
Brian J Ingr _
DATE ISSUED: 12/06/201$ EXPIRATION DATE:
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC
II
St. Lucie CHD
06/06/2020
Page 1 of 3
v 1.1.4 AB1372800 SE1143536
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�'i r dW
HEALTH
PAYING ON:
.RECEIVED FROM:
PAYMENT FORM:
St. Lucie County Health Department
5150 NW Milner Dr Port Saint Lucie, FL 34983
PERMIT M 56-SF-1891227 GILL Doc #:56-BID-4015256 CONSTRUCTION APPLICATION H: AP1372800
Trefelner Construcion Inc. AMOUNT PAID: $ 515.00
CHECK 1672 PAYMENT DATE: 11/09/2018
MAIL TO: Yoan and Taymi Rojas
FACILITY NAME:
PROPERTY LOCATION:
TBD Brittain Ave
Fort Pierce, FL 34945
Lot:
1. 2, 3. 10, 11, and 12 Block: A
Property ID: 2310-801-0001-000-4
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-3791134
�r+a4 STATE OF FLORIDA
2, DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
APPLICATION FOR CONSTRUCTION PERMIT
APPLICATION FOR:
PERMIT NO. . ^t W 1
DATE PAID: II 01 19)
FEE PAID: CV-# I(D-1a
RECEIPT #: 404CO
[� ] New System [ ] Existing System [ ] Holding Tank [ ] Innovative
[ ] Repair [ ] Abandonment [ ] Temporary [ ]
APPLICANT: Yoan and Taymi Rojas
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: 1,2,3,1h BLOCK: A
SUBDIVISION: Doiran
PROPERTY ID #: 2310-801-0001-000-4
PLATTED:
ZONING: AR-1 I/M OR EQUIVALENT: [ No ]
PROPERTY SIZE: 2.54 ACRES WATER SUPPLY: [ ] PRIVATE PUBLIC [ ]G=2000GPD [,/]>2000GPD
IS SEWER AVAILABLE AS PER 381.0065, FS? [ No ] DISTANCE TO SEWER: FT
PROPERTY ADDRESS: BrittainAve -; 4gg5
DIRECTIONS TO PROPERTY: seeattached
BUILDING INFORMATION
Unit Type of
No Establishment
1 residence
2
3
4
[ ✓ ] RESIDENTIAL [ ] COMMERCIAL
No. of Building Commercial/Institutional System Design
Bedrooms Area Sqft Table 1, Chapter 64E-6, FAC
3 2321
[ ] Floor/Equipment Drains [ ,/ ] Other (Specify) Garbage grinders/ Disposals
SIGNATURE:
NO
DH 4015, 08/0 e(Obsoletes pre i,oUs editions which may not be used)
Incorporated 64E-6.001, FAC
DATE: 11/7/2018
Page 1 of 4
STATE OF FLORIDA APPLICATION # AP1372800
DEPARTMENT OF HEALTH PERMIT # 56-SF-1891227
ONSITE SEWAGE TREATMENT, AND DISPOSAL SYSTEM DOCUMENT # SE1143536
SITE EVALUATION AND SYSTEM SPECIFICATION
APPLICANT: Yoan and Taymi Rojas
CONTRACTOR / AGENT: Trefelner Construcion Inc.
LOT: 1, 2. 3. 10. 11. and 12 BLOCK: A
SUBDIVISION: Doiran ID#: 2310-801-0001-000-4
TO BE COMPLETED BY ENGINEER, HEALTH DEPARTMENT EMPLOYEE, OR OTHER QUALIFIED PERSON.
REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS.
ENGINEERS MUST PROVIDE
PROPERTY SIZE CONFORMS TO SITE
PLAN:
Ex ]YES [ ]NO NET USABLE AREA AVAILABLE: 2.54 ACRES
TOTAL ESTIMATED SEWAGE FLOW:
300
GALLONS PER DAY [ RESIDENCES -TABLET
/ OTHER -TABLE 2 ]
AUTHORIZED SEWAGE FLOW:
6349.98
GALLONS PER DAY [ 1500 GPD/ACRE
OR 2500 GPD/ACRE ]
UNOBSTRUCTED AREA AVAILABLE:
1008.00
SQFT UNOBSTRUCTED AREA REQUIRED:
750.00 SQFT
BENCHMARK./REFERENCE POINT LOCATxON: NO CL of Brittain Ave W property line extended S
ELEVATION OF 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: 40 FT
NORMALLY WET: [ ]YES
[X]NO
WELLS: PUBLIC: FT LIMITED USE:
FT PRIVATE:
FT NON -POTABLE:
FT
BUILDING FOUNDATIONS: 5 FT
PROPERTY LINES: 40 FT
POTABLE WATER LINES:
10 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:Pineda sand
Munsell #/Color Texture
Depth
1 OYR 4/2
Sand
0 To 12
10YR 6/1
Sand
12 To 19
1 OYR 6/1
Sand
19 To 25
1 OYR 6/1
Gravelly & Larger Mineral
25 To 48
10YR 4/3
Sand
25 To 48
1 OYR 5/2
Sandy Clay Loam
48 To 55
10YR 5/1
Sandy Clay Loam
55 To 61
10YR 5/1
Loamy Sand
61 To 67
10YR 5/2
Sand
67 To 72
USDA SOIL SERIES:Pineda sand
Munsell #/Color Texture
Depth
10YR 4/2
Sand
0 To 12
1 OYR 5/2
Loamy Sand
12 To 25
7.5YR 5/8
CMN/PRM RF
21 To 30
1 OYR 6/1
Sand
25 To 28
1 OYR 6/2
Sand
28 To 48
2.5Y 5/2
Sandy Clay Loam
48 To 63
2.5Y 5/1
Loamy Sand
63 To 72
OBSERVED WATER TABLE: 69.00 INCHES [ ABOVE / BELOW ] EXISTING GRADE TYPE: [ PERCHED / APPARENT ]
ESTIMATED WET SEASON WATER TABLE ELEVATION: 21 INCHES [ ABOVE / DELOW ] EXISTING GRADE
HIGH WATER TABLE VEGETATION: [ ]YES [X]NO MOTTLING: EX ]YES [ ]NO DEPTH: 21.00 INCHES
SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: Sand/0.80 DEPTH OF EXCAVATION: 49 INCHES
DRAINFIELD CONFIGURATION: [X] TRENCH [ ] BED [ ] OTHER (SPECIFY)
r REMARKS/ADDITIONAL CRITERIA
VT determined using USDA WSS and soil borings.
R5I8 CMN PROM RF mottling in IOYR5/2 and 10YR6/1 matrix>2% starting at 21" in SB2.
9" below BM. SB210" below RM. /7
SITE EVALUATED BY:
Ingram, Brian (Title: Envi (�i (mental Specialist II) (ENVIRONMENTAL HEALTH)
DH 4015, 08109 (Obsoletes previous editions which may not be used) Incorporated: 64E 6.001, PAC
DATE: 11/16/2018
Page 3 of 4
AP1372800 EID1891227 v 1.0.2
APPLIC UNT'S
LEGAL
,QosA
5�•sF_ ��q�2z�
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
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 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.
NOTE: MUST BE CERTIFIED BY A FLORIDA
REGISTERED SURVEYOR OR ENGINEER.
�.Kf(�rtit4'SCIIIIC¢$COIIC:1j1�1jIP::_ull]
CERTIFIED BY:
FLORIDA y PROFESSIONAL NO.: _
DATE:%"'Z•-' ,R 10BNO.:\