HomeMy WebLinkAboutFL D O H WELL PERMITMission:
To protect promote & improve the health
of all people in Florida through integrated
state, county. & community efforts.
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Vision: To be the Healthiest State in the Nation �rl %e
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
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(a)-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 - Dlvislon of Dlscase Control ana Health Protection
Bureau of Environmental Health
5150 NW Miner Drive
Port St Lucie. FL 34983
PHONE: 772/8734931 • FAX: 7721595-1306
FloridaHealth.gov
�or,1_a y6�9
JEA;hei�alih Department
Public Health Accreditation Board
STATE OF FLOR16A PERMITAPPLICATION TO CONSTRUCT
REPAIR;<MODIFY;ORABANDONAWEC! ......
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BOOK 46. PAGE 24
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PARCEL N 2334
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9701 n
PERMIT #:56-SF-1903130
APPLICATION #:AP1383979
4e STATE OF FLORIDA RFCFj` DATE PAID:
DEPARTMENT OF HEALTH OFF Fo
--ONSITE_SEWAGE TREATMENT AND DISPOS 28�FEE PAID:
lj
, 1 • SYSTEMS�tUn9 peed RECEIPT #: — —-
wfiP�"''7°' DOCUMENT #: PR1193604
CONSTRUCTION PERMIT FOR: OSTDS New
APPLICANT: Christopher and Sarah Monroe -
PROPERTY ADDRESS: TBD Muller Rd Fort Pierce, FL 34945
LOT: 3
PROPERTY ID #:
BLOCK:
SUBDMSION!
[SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
2334-700-0004-000-9 [OR TAR 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
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 I ]
D [ 500 1 SQUARE FEET Drainfield new SYSTEM
R [ ] SQUARE FEET N/A SYSTEM
A TYPE SYSTEM: [ ] STANDARD [ ] FILLED (XI MOUND [ I
I CONFIGURATION: [XI TRENCH [ I BED [ ]
N
F LOCATION OF BENCHMARK: FND 518 IRC LS #3435 NW Property comer
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE
L
D
0
T
H
E
R
[ 24.00 1 [ INCHES FT ] [ ABOVE BELOW ]BENCHMARK/REFERENCE POINT
[ 35.001[ INCHES FT ][ ABOVE BELOW] BENCHMARK/REFERENCE POINT
L REQUIRED: [ 29.UU] INCHES EXCAVATION REQUIRED: L ftI.uv J
ie system is sized for 4 bedrooms with a maximum occupancy of 8 persons (2 per bedroom), for a total estimated flow of
0 gpd.
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: rian J Ingram TITLE' Environmental Specialist II
A1?P120VED BY: ITLE: Environmental Specialist II 'St. Lucie CED
' Drim J Ingr
DATE ISSUED: 12/06/2018 �T I E: 06/06/2020
DH 4016, 08/09 (Obsoletes all previous editions Which a / f..
Page 1 of 3
Incorporated: 64E-6.003, FACv 1.1.4 AP1383979 43415
NOTICE OF RIGHTS
_ A party whose substantial interest is affected by this order may petition for an
administrative hearing pursuanfto 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.
` St. Lucie County Health Department
5150 NW Milner -Dr —Port -Saint -Lucie, FL 34R83
HEALTH — — —
PAYING ON: PERMIT#.56-SF-1903130 BILL DOCtr.56-BID-4030283 CONSTRUCTION APPLICATION M AP1383979
RECEIVED FROM: Trefelner Construcion Inc. AMOUNT PAID: $ 515.00
PAYMENT FORM: CHECK 1001 PAYMENT DATE: 11/19/2018
MAIL TO: Christopher and Sarah Monroe
FACILITY NAME:
PROPERTY LOCATION:
TBD Muller Rd
Fort Pierce, FL 34945
3
Lot: Block:
Property ID: 2334-700-0004-000-9
EXPLANATION or DESCRIPTION:
QUANTITY
FEE
128 - OSTDS Construction System Inspection Research Fee
1
$
5.00
-1 - Surcharge (All)
1
$
15.00
-1 - OSTDS New Permit Surcharge
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-3805578
`�� STATE OF FLORIDA
dy" ,
-DEPARTMENT-OF -HEAT
n ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
�a°°°' APPLICATION FOR CONSTRUCTION PERMIT
APPLICATION FOR:
[ ✓ ] New System [ ] Existing System
[ ] Repair [ ] Abandonment
APPLICANT: Christopher and Sarah Monroe
AGENT: James
.CCJ;- 2. V 171
PERMIT NO. l7F'��OJI3O
_ DATE PAID: II o1 g
FEE PAID: -
RECEIPT #: .'1044q
[ ] Holding Tank [ ] Innovative
[ ] Temporary [ ]
MAILING ADDRESS: 1760 Copenhaver Road Fort Pierce, Florida 34945
TELEPHONE. 772-201-9833
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: 3
BLOCK: SUBDIVISION:
Rogers Ranchettes
PLATTED:
PROPERTY
ID #: 2334-700-0004-000-9
ZONING: Ag
I/M OR EQUIVALENT: [ No ]
PROPERTY
SIZE: 2.5 ACRES WATER SUPPLY:
[,(] PRIVATE
PUBLIC [ ]<=2000GPD [ 1>2000GPD
IS SEWER AVAILABLE AS PER 381.0065, FSY [ No 1
DISTANCE TO SEWER: FT
PROPERTY ADDRESS.- Mueller Road 346149,
DIRECTIONS TO PROPERTY: see
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 Residence 4 2982
2
3
4
[ ] Floor/Equipment Drains [ ✓ ] Other (Specify) Garbage grinders/ Disposals
SIGNATURE: DATE:
11-19-2018
DH 4015, 08/0 (Obsoletes I revious editions which may not be used)
Incorporated 64E-6.001, FAC Page 1 of 4
STATE OF FLORIDA APPLICATION # AP1383979
DEPARTMENT OF HEALTH PERMIT # 56-SF-1903130
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM DOCUMENT # SF1143415
SITE EVALIIATION AND SYSTEM SPECIFICATION
APPLICANT: Christopher and Sarah Monroe
CONTRACTOR / AGENT: Trefelner Construcion Inc.
LOT: 3 BLOCK:
SUBDIVISION: ID#:2334-700-0004-000-9
TO BE COMPLETED BY ENGINEER, HEALTH DEPARTMENT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEERS MUST PROVIDE
REGISTRATION NUMBER AND SIGN AM SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS.
PROPERTY SIZE CONFORMS TO SITE PLAN: Ex ]YES [ ]NO NET USABLE AREA AVAILABLE: 2.60 ACRES
TOTAL ESTIMATED SEWAGE FLOW: 400 GALLONS PER DAY [ RESIDENCES -TABLET / OTHER -TABLE 2 ]
AUTHORIZED SEWAGE FLOW: 3750.00 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: FND 5/8 IRC LS #3435 NW F
ELEVATION OF PROPOSED SYSTEM SITE '24.00 L INCHES / FT ]
/ BELOW ] BENCHMARK/REFERENCE POINT
THE MINIMUM SETBACK WHICH CAN DE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES
SURFACE WATER: FT
DITCHES/SWALES: FT
NORMALLY WET: [ ]YES
[ ]NO
WELLS: PUBLIC: FT LIMITED USE: PT PRIVATE:
97 FT NON -POTABLE:
FT
BUILDING FOUNDATIONS: 40 FT
PROPERTY LINES: FT
POTABLE WATER LINES:
73 FT
SITE SUBJECT TO FREQUENT FLOODING?
[ ]YES Ix ]NO
10 YEAR FLOODING? L ]YES
[X]NO]
10 YEAR FLOOD ELEVATION FOR SITE:
FT [ MEL / NGVD ] SITE ELEVATION: FT [ MSL
/ NGVD
SOIL PROFILE INFORMATION SITE 1
SOIL PROFILE
INFORMATION SITE 2
USDA SOIL SERIES:Winder loamy sand
Munsell #/Color Texture
Depth
1 OYR 32
Sand
0 To 11
1OYR 412
Sandy Loam
11 To 20
10YR 518
CMN/PRM RF
13 To 20
1 OYR 52
Loamy Sand
20 To 27
1 OYR 62
Sandy Loam
27 To 47
N 7/
Fine Sand
47 To 72
USDA SOIL SERIF S:Winder loamy sand
Munsell #/Color Texture
Depth
10YR 3/2
Sand
0 To 11
1OYR 42
Sandy Loam
11 To 20
10YR 5/8
CMN/PRM RF
13 To 20
10YR 52
Loamy Sand
20 To 27
10YR 62
Sandy Loam
27 To 47
N 7/
Fine Sand
47 To 72
OBSERVED WATER TABLE: 50.00 INCHES [ ABOVE / HELOH
] EXISTING GRADE TYPE:
[ PERCHED /I APPARENT I]
ESTIMATED WET SEASON WATER TABLE ELEVATION: 13
INCHES
[ ABOVE / FELOW ]
EXISTING GRADE
HIGH WATER TABLE VEGETATION: L ]YES [X INO
MOTTLING:
[XIYES [ ]NO
DEPTH: 13.00 INCHES
SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING:
Sand/0.80
DEPTH OF EXCAVATION: 47 INCHES
DRAINFIRI.D CONFIGURATION: [X] TRENCH [ ] BED
[ ] OTHER
(SPECIFY)
REMARKS/ADDITIONAL CRITERIA
SWT determined using WSS and soil borings
OYR areCMN Prom RF mottling in 10YR 412 matrix> 2% starting at 13- in SB1
SB7 24" above BM SB2 25" above BM
SITE EVALUATED BY:
Ingram, Bdan (Tit{b: Environmental Specialist II) (ENVIRONMENTAL HEALTH)
DR 4015, 08/09 (Obsoletss previous editions which may not be used) Incorporated: 64E-6.001, FAC
DATE: 12/04/2018
Page 3 of 4
56-sf_ I 4'�5i30
?rill
APPLICANT'S :\PPLICANT'S NAME: Chr�sen /19or�1-oe�Ti�
LEGAL
PROPOSERSEP'IGS'ST'ES�TEIlYFO1t11AT10lW
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
t5 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.
Jncc G�mu'sepiicsScplieApppPag.a7
CERTIFIED BY:
FLORIDA PROFESSIONAL NO.:
DATE: I� i�--�P JOB NO..
A
f STATE OF FLORIDA.
—DEPARTMENT- OF —HEALTH-- - — ---
ONSZTE.SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION INSPECTION. AND FINAL APPROVAL
APPLICANT: Christopher and Sarah Monroe
APPLICATION g:AP-1383979
PERMIT x:56-SF-19=30
DOCUMENT n>F11324.025
DATE VAM:12/27/2018
FEE PAID:25.00'
RECEIPT a.:56-PID-3834938
AGENT;
James Trefeiner(Ttefelner Construcion lna). _ _
-
PROPERTY- ADDRESS.- 10055 Muller Rd FortPierce, FL 34945
LOT: 3
BLOCK:,
SUBDIVISION:
IDO: 2334=700-0004.000-9
CHECKED rXl ITEMS ARE NOT IN COMPLIANCE; WITH STATUTE OR RULE AND MUST BE CORRECTED.
TANK INSTALLATION
SETBACKS
[
1
[OL]
TANK SIZE [1] 1090:00 [21
(
] (271
SURFACE WATER
FT
[
]
[021
TANK MATERIAL Polypropylene
[
] [281'
DITCHES 100'
FT
[
1
[03 I
_.. _. - _.._
OUTLET DEVICE
[ ,
I E291,
.PRIVATE WELLS, 97
FT
[.
1
[041
MULT2-CHAMBERED. ( Y N ]
[
1 (30],
PUBLIC WELLS
FT
I
1
[053
OUTLET FILTER POIy[Ok PL-68
[
] [3l]
IRRIGATION WELLS _
FT
(
11
1063
LEGEND, 1. 70-143.11 DC4 2.
[
1 [321
POTABLE WATER _—_ _ 84_. - -_-_
FT
[
]
[071
WATERTIGHT
[
I [331
BUILDING FOUNDATIONS 5
FT
E.
I
[OS]
LEVEL
C
I r347
PROPERTY LINES 37
PT
[.
1.
(091
DEPTH TO LID
[
I [351
OTHER
FT
DRAINFIELDINSTALLATION
FILLED / MOUND SYSTEM
[
l
1101
AREA. [11 679.2 '(21 S4FT
[
1 [36]
DRARIFIELD COVER,
C
1
[111
DISTRIBUTION BOX' _HEADER _ }(
—^
('.
1 [371
SHOULDERS
[
]
(121
.NUMBER OF DRAINLINES 1, 6.00 2.
[
] [391
SLOPES
[
1'
[131
DRAINLINE SEPARATION
[
1 [391
STABILIZATION 09/27/2019
[
1
(141
DRAINLINE SLOPE
I
]
[15]
DEPTH OF COVER
ADDITIONAL INFORMATION';
[
]
[I61
ELEVATION [ ABOVE_. / SELO.W IBM.35._00
[
] [401
UNOBSTRUCTED AREA
I
1
1171
SYSTEM LOCATION
[
1 1411
STORMWATER RUNOFF
[
]
(181
DOSING PUMPS
[
] 1421
ALARMS
I
1
[191
AGGREGATE SIZE'
[
I [437
MAINTENANCE AGREEMENT
[
I
[201
AGGREGATE EXCESSIVE FINES.
[:
1 I441
BUILDING AREA.
[
]
(21I
AGGREGATE bEBTH
[
1 [451,
LOCATION CONFORMS WITH SITE PLAN
FILL
/EXCAVATION MATERIAL
I.
1 [46]
FINAL SITR GRADING
(.
I
[22]
FILL AMOUNT -'
[-
1 [471
CONTRACTOR MICHAEL W3T[IHR(ASHTO
- [
1
[231
FILL TEXTURE
[
1 [483
OTHER INFILTRATOR Quick4 Plus EQ35 LP
[
1.
(241
EXCAVATION DEPTH
ABANDONMENT
[.
1
[25]
AREA REPLACED
[ ']
[491
TANK PUMPED
E.
1
[261
'REPLACEMENT MATERIAL
[
] [501
TANK CRUSHED & FILLED
Comments: Comments areon-page-2.
CONSTRUCTION I. APPROVED / - r - St. Lucie CHD DATE: '0812112019
DISAPPROVED 1 ° Envlr ntal Specialist ll sel Ingram (ENVIRONMENTAL HEALTH) 'r
FINAL SYSTEM [ AppROVED / DISAPPROVED ) : - ' - _ -. _. St. Lucie -CAD DATE:. 09/27/2019 -.
Environmental Specialistil 8n J Ingram (ENVIRONMENTAL HEALTH)
Rb pleaation of violations on £olloviny page)
ON 4016y. 08/09 (Obsolatesall previous editions which may not be used)
Incorporated: 64E-6_003, PAC Page 2 of 3
EH Database v 1.0.1 AP1383979 EID1903130
.•.• STATE OF FLORIDA
DEPARTMENT OF HEALTH
. ONSITE SEWAGE TREATMENT AND DISPOSAL: SYSTEM
CONSTRUCTION INSPECTION AND FINAL APPROVAL
Violation Number Comment
Comments
AmicATzat; p:AP138397,9
Pzmai' ff156-SF'-lg03130
Docubmirr 041324o25
DATE. PAID: VZ7720.r8 .
ESE PAID' 2&00'
The system. is sizedfor4 bedrooms witha maximum occupancy of 8 persons (2 per bedroom), for atotal estimated flow of 40D
9pd.
New ST, filter, and.6x1 o long DF installed,. No viotatlons,system ok to cover. Contractor notified onsite: Needs finatinspectionfor
mound system, gutters, and final site grading.
Final system approved: Contractor.and`building department emalled final approval.
DR 4016,.. 08/09 (Qbsoletes all previous editions Such may not be used)
Incoz'Porat:ed: 64E--6.003, FAG Page 2 of 3
EN Database v 1.0.1 AP1363979 EID1903130