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HomeMy WebLinkAboutD O H PAPERWORKSTATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM PERMIT #:66-SF-1907904 APPLICATION #:AP1387039 DATE PAID: FEE PAID: RECEIPT # DOCUMENT #: PR1196604 CONSTRUCTION PERMIT FOR: OSTDS New FILE COPY . SCANNED BY APPLICANT: Raphael Henri ,St. Lurude G6tfft Y PROPERTY ADDRESS: 12103 Riverbend Rd Port Saint Lucie, FL 34984 LOT: 6 BLOCK: SUBDIVISION: Bay St. Lucie [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] PROPERTY ID #: 44ZZ-$02-0010-000-2 [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 [ 1,350 ] 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 8[ ]DOSES PER 24 HRS. #Pumps [ D [ 650 ] SQUARE FEET Drainfield new SYSTEM R [ ] SQUARE FEET N/A SYSTEM A TYPE SYSTEM: [ ] STANDARD '[x] FILLED [] MOUND I CONFIGURATION: []c] TRENCH [ ] BED' I ] N F LOCATION OF BENCHMARK: NID In cut-out, CL of Rd, BE of system. I ELEVATION OF PROPOSED SYSTEM SITE E BOTTOM OF DRAINFIELD TO BE L D FILL REQUIRED: 117.001 O T H E R 2.00 it INCHES FT ][ABOVE BELOW I BENCHMARK/REFERENCE POINT 1.00 ][INCHES FT ]I 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 A gpd. ie licensed contractor installing the system is responsible for installing the minimum category of tank in accordance with 64E-6.013(3)(0, FAC. UST MAINTAIN 75' SETBACK TO MEAN ANNUAL FLOOD LINE OF SURFACE WATER BODY. SPECIFICATIONS BY: _ Brian J Ingreyh TITLE: Environmental Specialist II APPROVED BY: / AP"`'1-TITLE: Environmental Specialist II St. Lucie CUD Brian B Ingra DATE ISSUED: 01/03/2019 EXPIRATION DATE: 07/03/2020 DH 4016, 08/09 (Obsolates all previous editions which may not be used) Incorporated: 64E-6.003, FAC Page 1 of 3 v 1.1.4 AP1397039 SE1146386 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. St. Lucie County Health Department FORM 5150 NW Milner Dr Port Saint Lucie, FL 34983 HEALTH PAYING ON: PERMIT M56-SF-1907904 13IiLDOCP56-BID-4050103 CONSTRUCTION APPLICATION S. AP1387039 RECEIVED FROM: Scientific Construction AMOUNT PAID: $ 515.00 PAYMENT FORM: CREDIT CARD PAYMENT DATE: 12/10/2018 MAIL TO: Raphael Henri FACILITY NAME: PROPERTY LOCATION: 12103 Riverbend Rd Port Saint Lucie, FL 34984 Lot: 6 Block: Property ID: 4422-502-0010-000-2 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-PID3826052 1e 9 STATE OF FLORIDA PERMIT NO.rj�p—SF-IqO—ILiO� h DEPARTMENT OF HEALTH DATE PAID: • ONSITE SEWAGE TREATMENT AND DISPOSAL. FEE PAID: ���wcti SYSTEM RECEIPT (): APPLICATION FOR CONSTRUCTION PERMIT APIC LATION FOR: C ;] New System [ ] Existing System [ ] HoldingTank [ ] Innovative [ ] Repair [ ] Abandonment C 7 Tempo ry [ ] V APPLICANT: , AGENT: 1^ rl CtQ:/ N]„r•( axs TELEPHONE: ""-799 7/d� MAILING ADDRESS: 6 737 5W f r4 � � 1� ��Yd -� M 34q63 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 G p LOT: BLOCK: SUBDIVISION: J , (, %� V PLATTED: PROPERTY ID 0/®-04 b ZONING: I/M OR EQUIVALENT: C Y /- N I PROPERTY SIZE: zj�-�ACRES WATER SUPPLY: [ ] PRIVATE PUBLIC [x]<=2000GPD [ ]��>//2000GPD IS SEWER AVAILABLE AS PER 3B1.0065, FS? [ Y /©] DISTANCE TO SEWER: /�, t FT PROPERTY ADDRRSR- BUILDING INFORMATION Unit Type of No Establishment 1 2 — 3 4 IX] RESIDENTIAL [ ] COMMERCIAL No. of Building Commercial/Institutional System Design Bedrooms Area Sqft Table 1, Chapter 64E-6 FAC [ ] Floor/Equipment Drains [ ]Other (Specify) SIGNATURE: � Jeri10/1 f'l . I/ _ � •n l . �. DH 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated 64E-6.001, FAC DATE:K /a/67 1,& Page I of 4 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATION APPLICANT: Raphael Henri CONTRACTOR / AGENT: Scientific Construction LOT: 6 BLOCK: APPLICATION 0 AP1387039 PERMIT # 56-SF-1907904 DOCUMENT # SE1146386 SUBDIVISION: Bay St. Lucie ID#: 4422-502-0010-000-2 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: 1.48 ACRES TOTAL ESTIMATED SEWAGE FLOW: 520 GALLONS PER DAY [ RESIDENCES-TABLEI / OTHER -TABLE 2 ] AUTHORIZED SEWAGE FLOW: 3700.01 GALLONS PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE ] UNOBSTRUCTED AREA AVAILABLE: 1800.00 SQFT UNOBSTRUCTED AREA REQUIRED: 975.00 SQFT BENCHMARK/REFERENCE POINT LOCATION: ELEVATION OF PROPOSED SYSTEM SITE 2.00 [ INCHES / FT ] [ ABOVE / BELOW ] BENCHMARK/REFERENCE POINT THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES SURFACE WATER: 75 FT DITCHES/SWALES: 15 FT NORMALLY WET: [ ]YES [X]NO WELLS: PUBLIC: FT LIMITED USE: FT PRIVATE: FT NON -POTABLE: FT BUILDING FOUNDATIONS: 57 FT PROPERTY LINES: 10 FT POTABLE WATER LINES: 100 FT SITE SUBJECT TO FREQUENT -FLOODING? [ ]YES [X]NO 10 YEAR FLOODING? [ ]YES IX]NO] 10 YEAR FLOOD ELEVATION FOR SITE: FT[ MSL / NGVD ] SITE ELEVATION: FT [ MSL / NGVD SOIL PROFILE INFORMATION SITE.1 snrT. PRnarr.E TNPnmR MrnN Irma 9 USDA SOIL SERIES:Canavoral fine sand, Munsell #/Color Texture 0 to 5 pare Depth 1 OYR 5/4 Sand 0 To 17 10YR 4/2 Sand 17 To 33 10YR 5/8 CMN/PRM RF 25 To 33 1 OYR 3/1 Organic & Mineral 33 To 37 10YR 4/2 Loamy Sand 37 To 44 10YR412 Fine Sand 44 To 53 10YR 512 Sand 53 To 58 10YR 712 Sand 58 To 72 USDA SOIL SERIES:Canaveral fine sand, Munsell #/Color Texture 0 to 5 pare Depth 1 OYR 5/4 Sand 0 To 18 10YR 4/3 Sand 18 To 24 1 OYR 512 Sand 24 To 35 10YR 5/8 CMN/PRM RF 25 To 35 1 OYR 311 Organic Soil 35 To 38 1 OYR 412 Loamy Sand 38 To 43 10YR 412 Fine Sand 43 To 55 1 OYR 612 Fine Sand 55 TO 69 1 OYR 7/2 Fine Sand 59 To 72 OBSERVED WATER TABLE: 72.00 INCHES [ ABOVE / BELOW ) EXISTING GRADE TYPE: [ PERCHED / APPARENT ] ESTIMATED WET SEASON WATER TABLE ELEVATION: 25 INCHES [ ABOVE / BELOW ] EXISTING GRADE HIGH WATER TABLE VEGETATION: [ ]YES [X]NO MOTTLING: [X]YES [ ]NO DEPTH: 25.00 INCHES SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: Sand/0.80 DEPTH OF -EXCAVATION: 38 INCHES DRAINFIELD CONFIGURATION: [X ] TRENCH [ ] BED [ ] OTHER (SPECIFY) 7 REMARKS/ADDITIONAL CRITERIA IWSWT determined using USDA WSS and soil borings. 10YR518 CMN PROM RF mottles in 10YR4/2 Matrix >2%starting at 26" In'SB1. S131 2" above BM. S132 1" above BM. 117 SITE EVALUATED BY: Ingram, Brian(TIHe: povironmental Specialist II)(ENVIRONMENTAL HEALTH) OH 4015, 08/09 (Obsoletes Previous editions which may not be used) Incorporated: 64E-6.00L, FAC DATE: 12/17/2018 Page 3 of 4 AP1387039 EID1907904 v 1.0.2 APPLICANT:_ LOT: 6 PROPERTY ID #: STATE OF FLORIDA PERMIT #• S� S�-(�/0 790� DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS BLOCK: SUBDIVISION: AGENT: No. or Tax ID Number TO BE COMPLETED BY ENGINEER, HEALTH DEPARTMENT EMPLOYEErOR OTHER QUALIFIED PERSON. ENGINEERS MUST PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS. PROPERTY SIZE CONFORMS TO SITE P [ YES [ ] NO NET USABLE AREA AVAILABLE: ©e9% ACRES TOTAL ESTIMATED SEWAGE FLOW: - GALLONS PER DAY [RESIDENCES -TABLE I/OTHER-TABLE2 ] AUTHORIZED SEWAGE FLOW: GALLONS PER DAY [ 1500 GPD/ACRE OR 2500 GPD/AgC'RE ] UNOBSTRUCTED AREA AVAILABLE: t'I SQFT UNOBSTRUCTED AREA REQUIRED: ,/0 Q SQFT BENCHMARK/REFERENCE POINT LOCATION:/Yo ft Auw \ % D / e, %S. 6S 04 d0 ELEVATION OF PROPOSED SYSTEM SITE IS:*fz_ [ INCHES I FF ] [ABOVE/BELOW? NCER4ARK/REFERENCE POINT THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THPE OPOSED SYSTEM TO THE FOLLOWING FEAT���UURES SURFACE WATER: Ab FT DITCHES/SWALES: FT NORMALLY WET? [ [ YES NO BLIC: 00 UFOUNDAT FOUNDATIONS: FT �d / FT PROPERTY LINES: �FE FT O FT NON —POTABLE: 0 FT BUILDING f0TABLE WATER LINES: . O FT SITE SUBJECT TO FREQUENT FLOODING: ( ] YES [(iC] NO 10 YEAR FLOODING? [ ] YES [vy NO 10 YEAR FLOOD ELEVATION FOR SITE: FT MSL/NGVD SITE ELEVATION: FT MSL/NGVD SOIL PROFILE INFORMATION SITE 1 MUNSELL #/COLOR TEXTURE USDA SOIL SERIES: SOIL PROFILE INFORMATION SITE 2 MUNSELL #/COLOR TEXTURE USDA SOIL SERIES: DEPTH TO TO TO TO TO TO TO TO TO OBSERVED WATER TABLE: INCHES [ABOVE/BELOW r] EXISTING GRADE. TYPE:[ PERCHED/ APPARENT ] ESTIMATED WET SEASON 'NMTER TABLE ELEVATION: INCHES [.ABOVE/BELOW ] EXISTING GRADE HIGH WATER TABLE VEGETATION: [ ] YES 7 ' NO MOTTLING: I ] YES [ ] NO DEPTH: INCHES SOIL.TEXTURE/LOADING RATE FOR SYSTEM SIZING: DEPTH OF EXCAVATION: INCHES DRAINFIELD CONFIGURATION: I ] TRENCH [ ] BED [ ] OTHER (SPECIFY) SITE EVALUATED BY DR 4015 M which may not be -used) Incorporated: 64E-6.001, FAC Page 3 of 4