HomeMy WebLinkAboutD O H WELL PERMITSx
Mission:
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an3,��,,!}
Rick Scott
Governor
To protect promote & Improve the health
- - - — -of all people In Florida through integrated---
- -- - - �/
_
Celeste Philip,
state, county& community efforts.
0.6
_
HEALTHState
Surgeon General and Secretary
vision: To be the Healthlest State In the Nation
Florida Department of Health in St. Lucie
Conditions for Issuance of Water Well F
JAN 0 9 2019
Effective July 24, 2017 sr. Luciecounty, PermiWng
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
S LC DO H-W E LLS O FL H EALTH. 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 SLC DOH-WELLS(o)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: 772/873-4931 • FAX: 772/595-1306
FloridaHealth.gov
FILE COPY
Accredited Health Department
Public Health Accreditation Board
• _
STATE OF FLORiDA PERMITAPPLiCA3,71ON TO COAtSTRUCT,
_
REPAIR, 11100DIFY, ORABANOONA WELL
t'
r xv
r
❑Southwest PLEASE FILL OUT r.LLAPPUCAaLE FIELDS
-]Northwest
5.Y
(•Danates /
Required Fields Where v
DSI. Johns River Applicable)
•va'
t Y��yt l
C'South Florida McHV''/'M'emCnriorrs mp;waoin(Dr nmprafrh
rlasfmand rw:arrltigma pn�lnprriwfian to its
❑SUWannee River
appmAisc dekfw autlnriy r.Aemppp0.aexc.
170EP
❑Oelegafed Authority (IfAppricable)
ho• 5(P-Sr-1Cj0 gga
Unique
Quad Ido. _Deffmation rlo.
UP Aoplitallon No. .
I, ouuuy C. udulea 2824 Boston Court Lantana FL 33462
ov,n r L g INimeit; rpOrollon Address 'City
2. 12331 Bay Tree Road, Jensen Beach 3495i State ZIP 'Telephone Number
'Weil Location- Address, Road Nameor Numbeq City
3: 4504.602-0023.0004
::11:7 iID Mo•(PIN)orNt=_rnato Key(G1mlo ono)
4. 04 37S 41E St Lucie Lot Block Unit
Section or Land Grant 'Township 'Range 'County Subdidsion Checlr1162-524: yes _No l S. Ah'In Wooster/ WDoste_r IA1811 Drilling 1759 So"1-775-9855 flGflGp
8fl-Ir I IW Contractor 'License Number -Telephone Number woostErdmss ill(dbell-outh ne'
G. Bg7R dlorh Te"-,.... nr_-.,- p E-mad Atldress
18.1,lumberof Proposed Wells 1
9t
'F¢2m1 A. Hepiq 1.'MF�Oan, nrAb
9.'Speclfy Intended Use(s) of Well(s):
_B% Doftled Landscape Irrigation Agricultural felgation _Site Investigation
ottled Water Supply _Recreation Area Irrigation _ Livestock I_TosMonitoring
—Public Water Supply (Limited Use/DOH) m_Nursed lmigadon _TSF '7I
—Public Wal-SupP!y(Community or Piton-Comlmlly;DEP)--Commerdal/industrial _Earth -Coupled Geothermal tit JAN _Class l Injection. _Golf Course lmigalion _HVAC Supply � 3
Class V Injection: Pecha a _ HVAC pleura
r5 _ConrmemiaUln then f l fi.) Disposal Storage and Recoved_Drainage g
P.emedia8on: _P.ewvery _Air Sparge _—Other ro.ruwl gnnu 6, 0411...
.'Distance from SON' System if S200 A. 75 fL 11. Facility Dascdr
FsYmated Nall Depth 135 ;; -Estimated Casing Depth 115 It.
Estimated Screen interval: From 115 -IOL 135 it.
'Primary Casing roateriaL• ___Bloch Steel
_Galvanized
_Not Cased _other._
Secondary Casing: Tales
12 Estimated Star! Date ASAP
Primary Costae Dionne ar_In. Open Hale: Fmnt To__@,
X PVC _Stainless Sleal
cope Casing —Liner _` Sur, -
ace Casing Di uneter__in.
18.. Secondary Casing Rgaterizl: _Slacl: Steel __Galvanized _PVC —Stainless Steel 18.'Mslhod of ConsWction,Repair-orAboadonment: Auger —Other
Combination (Two or Mote Methods —Cable 7001 _Jaded j Rotan _Sonic
-_Horizontal DrilUn J .Hand Driven (vJell Point, Sand Point) __Hydraufiu point (Direct _Sonic
0 9 __PIU9ged by Approved Method _Other Inu-abet
19.. ropn5eri Groulinatlon!arval for the Primary. Secondary, an' 1ddillonal Casing; From D t—loin To P Seal Material (__Bentonile � Ideal Cement Other Fmm To Seal Nlaterial f Bentonl _Neat Cement —Other t i From= 7-0 _Seal r4atedal I Sentanile Neat Cament Other !
9t From To Soal Aialedal ( �Bentonite_Neal Coment
(20. indicate total numberofexrsting wells on site 08ter )
dot .'Is 9 Llst numberofexisang unused trolls on site
this well crony existing vr;li orwalerwithdmwal on the ovmers contiguous property covered undera ConsumpGverWaler Use Permit(CUP!!NUPJ
or CUMMILIPApplication? __yes X h'o If yes, conPlete the rWiocdna: CUPAn.4)P No. r
22. Lalilude—Longitude
. District Well 10 No.
_
23. Data Obtained Fmn:_GPS '
rbrxbrmvrnm r.r,vnr..•r•x:^�Y-aau:..,�r..rn.y rrrx,na"a:u[:.Smn,,,-.,..,.a-._ Datum:-__NAD 27__MAD 83 _WG584
'Dale
Approval Granisd
3 Expireas Dare di drolo pp Fee Received Issue Dale s� Y 9r51A royal
Receipt Pro, nw,
THIS P[P.f:l1T la' NOT VAUO UFIT p Chock N.a.
PEPa111T SHALL 6EAr L ROPERU'SIGIJED SYAN{yUTHORiZED OFFICER OR REPRESENTATIVE OF TFIE A7,i13 OP, DELEGATED
AIWBLEATTHE In/EI.LSITE DURINGALL CONSTRUCTION.REPAIR.MODIFICATION.OP.AaANDGVAIeNTACrnATfES. �HORRY. THE
OL"P Forth: a2-S32.a0o(I) Incorporated in 82.532,<0a(Q. FA.C. Effective Dine: Dcober 7. lain
face 1 or 2
i
y
NOTE: FF TO BE
MINIMUM 18"
ABOVE CROWN
OF ROAD
WATER SYSTEM,
PUMP HOUSE,
METER
WELL
I\r\UIUJ LHAL
I
TWO STORY
RESIDENCE
ELV ? NVGD, T0;
GRAVEL
--- lmlEWAY----
INFORMATION ON THIS PLAN
OBTAINED FROM BOUNDARY SURVEY
BY MCLAUGHLIN LAND SURVEYING,
INC DATED 5/26/92.
AND HAYHURST LAND SURVEYING,
DATED 11-29-1.8
PROPOSED NEW
1000 GAL
SEPTIC TANK
dI I
I
I
I
I
I
i
i
PROPOSED NEW
375 SQ FT TRENCH
DRAIN FIELD
---- io' SIDE
SET ACK--------
273
j 15' ROADWAY
STATE OF FLORIDA PERffarrAPPLICATION TO CONSTRUCT,
REPAIR, MODIFY, OR ABAMDON A WELL
uc , i•,L _=L
PLEASE FILL OUT ALL APPLICABLE FIELDS
L7 Northwest ( Denies Required Fields Where Applicable)
q
_
❑St. Johns River
Tl�e
rster.:efr rollke,a is 111PmahL lccompwit
: i, I�Souih Florida P•
this form and,' ., Mrng lhuPcrrnt apcGcanon fo ll•_
❑$UVlagoee River APPMP•'iira'�eL:.gatc•J=11.rrily rtJ:c2 apr,.:,e.
❑ Delegated Authority (if Applicable)
E. Garnett 2824 Boston Court Lantana
Unique 10__
Slipula!ions Required (See Allacl!ed)
tuo._—Delinealion No. _,.
FL 33462
-- !State `2IP' `Telephoto Number
2.12331 Bav Tree Road Jensen Beach
Well Location _Address, Road IJame or Plumber, City -- -----
4. 04 37S 41E y/ St Lucie
Cot Block Unit ----
Section or Land Grant 'To:'mship 'Range County Subdivision Check if 62-524:_Yes No
5. Alvin Wooster/ 6Vooster Well Drifting 1759 561-775-9855 WoosterwelldNif@bellsouth.nei 1^later Well Contractor 'License Number •7elephone Number Etrfail Address G. 8936 112th Terrara hlndh
L7. 'Type of Wedc: X Construction _Repair Modhfcation __ Abandonment L r
8. 'Number of Proposed Wells 1 'Pers;o 4r. noq.h, t:Mu9ca!bn mA]zvco]nm: —
9.'Specify Intended Use(s) of Well(s): Date Stamp
Domestic Landscape Irrigation _Agricultural Irrigatior. _Site Investigation
_Bottled vVater Supply _Recreation Area Irrigation _Livestock Monitoring
_Public li✓aler Supply (Limited Use/DOH) _Plursery Irrigation Test pp
_Public Water Supply (Community or Non-CommunitylDEP)—Commerciallindusirial —Earth-Coupled Geothermal p
Class I Injection Course lrrigalion MJAC Supply N¢@
__HVAC Return
Class Injection: Recharge _Commemialflndustriat Disposal _Aquifer Storage and Recovery —.Drainage
Remediation: _Recovery _Air sparge _Other!o-su:e.3f
—Other w.ssiue)1 official Use Only
iwn:e: 0l01 al l�nas w,veiie Ye oe,-ri!:ea py a e:vea peemining au:hoilil
10.-Distance from Septic System r :200 R. 75 ft. ii. Facility Descripiion Residence 12. Estimated Start Date ASAP
13. Estimated `Nell Depth 135 g. -Estimated Casing Depth 115 ft. Primary Casing Diameter Open Hole: From_To_ft,
q14. Estimated Screen Interval: Front 115 70 135 ft.
d 15.`Primay Casing Material: _Black steel _Galvanized X __PVC ,_Stainless Steal
4 _Not Cased _Other: _
16. Secondary Casing: _Telescope Casing _ Liner _ Sur=ace Casing, Diameter in.
17. Seconder, Casing Material: _Black Steel _Galvanized _PVC _Stainless Seel _Other _
18.1lethod of Construction. Repair. crAbandonment Auger _Cable Tool Jetied X Rotary _Sonic
_Combination (Two or More Methods) Hand Duren (Wall Point, Sand Point) _Hydraulic Point (Direct Push)
_Horizontal Drilling _._Plugged by Approved Me(hod Other
19. Proposed, Grout"' Interval for the Prima Seconda
D U q'. ry, anckldditignal Casing: {
From To VtoP Seal l'MaterialC Bentonite Neal Cement Other
From To Seal Material (—_Bentonite—(Cleat Cement_Other J)
From T
Fromo Seal Material (_Sentoni[e_Pleat Cement_Other
_)
To_Saa1 Material (__Bon'Onite_Neak Cemenl_Olher )
20. Indicate total number of existing wells on site List number of existing unused walls on site
21.'is this well or any existing svell or waterwithdrawal on the oimer's contiguous properly covered under a Consum IivePAl i
p star Use Permit
or de P Application? __Yes X No If Yes, complete the following: CUPA `VUP No._ District Well ID No.
22. Latitude Longitude -_
23. Data Obtained From: _GPS _hilap _Survey Datum: _NAD 27 PIAD 83
'IA''WCI'Ss']h-D.ryaLa!pgn:netrdrn4Yovo•utlTa+lRv:'t [•WcV/naernaRn1lKrrvr]geGr}.:n19aIor1vuI¢'ai'1:CGrI.'CM•:nOe[ilitdn.!1:e.vLm;rt:y-rCWcdm:i-r:r! 11Cp_[BorNE1x!yY1nSY rn:1d.,:1--1rOrC1rt!o➢i.T�m•ry.tiCr :u+nV..'e:Lrt:rnricndn+S.V—L,•i:Y:vC]IICtn(--.ci:..Eh,ut3Lai:P:YI,_xI- -[C--Y.-a3:DLp"h,•\:m.l:nuu•r+lv-.ul•..lealpnMiwahn.aric.g3y�.rr:rc.P'}¢•v:L,:r:e n.f]v:!l]iInv'iMl.G,'':�F_y�-OI'Yo3IlI_rcr0a'RS,I_•In:n-.4:o—M.Au1L-iV[Nr-.-•J]r.I..rn:-n:V:eln._ra:rae_tl'FCL'aeDfU_e3lY_x::c::e'.eb-:rn rLSxuGi1-T'4sqetl7e4UCtil.5,•v:ie['vl+9:Srt:ir.a,-�i e:^.;Uueta_+. ,n_'s: n'I•' :I-
':rL!nt.C.n%Vn,nyyu f.-�+ i^lni•p]uyih:LI:f-YLJa-al'n'NInrLe:it—:r'n'Yc!nc0 '-peL:1:'"Te.Ca-'!,r.< C•Jle.r:nil,'Vb.wL"9y3bE2r'l-[^fl(rY .C;.1'e
V•Ivr1>:i?AiY_'y:uFg.<-v.:pa3rm r[):it..ntl�r__G.t)i:]n�.9'le'..Rm+1an1�''::-.%(@.it.!.Svol',audI:2niPnl.'iJ.a'r:T:[:]Jrcr.a..1'.niine50:'fCS.Yvr[CS::J.:TxM
l
GS
84
.wtW
L
1,2-19
Issue DaleErpimlin OFee Received S pr:o:Ywrla
]!vaJta,:ln::_—
Receipt C:rrn1rI¢::c•An
vi:nllt,y}':iO
]v:xJ.:t/•rn iiD!oCheck No.
THIS PERMIT IS NOT VALID UNTIL PROPERLY SIGNED BYAN AUTHORIZED OFFICER OR REPRESENTATIVE OF THErr4NID OP. DELEGATEDAUTHORITY. THE
PERMIT SHALL BE AVAILABLE AT THE WELL SITE DURING ALL CONSTRUCTION. REPAIR. MODInCA'nON. OR ABANDONNIENTACTIVITIES. 1
DEP Form: 62.532.900(1) Inoorporaled i,62-512.400(1). RA.C. E(teclive Cafe: October. 2010
Pace 1 of 2
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND
SYSTEM
ry
4'B
CONSTRUCTION PERMIT FOR:
APPLICANT: Bobbv Garnet
OSTDS New
PROPERTY ADDRESS: 12331 Bay Tree Rd Jensen Beach FL 34957
LOT: 16 & 19 BLOCK: SUBDMSION:
PROPERTY ID #: 4504-602-0023-000-4
PERMIT #:56-SF-1908882
JA N 0 9 2019 (DATE PAID:
County, permitting j
FEE PAID.
RECEIPT #:
DOCUMENT #: PR1196614
[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 AMD 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]
K [
7
GALLONS DOSING TANK CAPACITY [
]GALLONS @[ ]DOSES PER 24 MRS #Pumps
D [ 250 ] SQUARE FEET Drainfield new SYSTEM
R [ ] SQUARE FEET N/A SYSTEM
A TYPE SYSTEM: [XI STANDARD [ ] FILLED [] MOUND [ ]
I CONFIGURATION: [x] TRENCH L 7 BED [ ]
N
F LOCATION OF BENCHMARK: Nail in newer PP, SE of system. Elev 37.31
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE
L
D I
O
T
x
E
R
( 31.00 ] [1 INCIIES FT ] [ ABOVE BELOW BENCHMARK/REFERENCE POINT
[ 61.00 ] [ INCnF.S FI' ] [ ABOVE BELOW HENCDMARK/REFERENCE POINT
I" RCQu1RCD: t U.UUI INCHES EXCAVATION REQUIRED: t 11NUNNS
The system is sized for 2 bedrooms with a maximum occupancy of 4 persons (2 per bedroom), for a total estimated flow of
200 gpd.
The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance with
s. 64E-6.013(3)(0, FAC.
NO WSWT. BOTTOM OF DRAINFIELD NOT TO BE GREATER THAN 30" BWLOW FINISHED GRADE.
SPECIFICATIONS BY: Brian J Ingram TITS: Environmental Specialist II
APPROVED BY: ` TLE: Environmental Specialist II St. Lucie CHD
Brian J Ingr
DATE ISSUED: 61/03/2019 - EXPIRATION DATE: 07/03/2020
DH 4016, 08/09 (Obsoletes all previous editions which may notFaas11
Incorporated: 64E-6.003, FAC �® � ge 1 of 3
1.1.4 A 1387666 e COPY
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 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 St :!Liles. Review proceedings are
governed by the Florida Rules of Appellate Procedure. `,'uch proceedings may be commenced
by filing one copy of a Notice of Appeal with the Agency C:lerl< 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.
0
a
-- St -Lucie -County -Health -Department - -----------------
• H5150 NW Milner Dr Port Saint Lucie, FL 34983
MTH
PAYING ON: PERMIT* 56-SF-1908882 BILL DOC # 56-1]1I13-4051753 CONSTRUCTION APPLICATION #: AP1387666
RECEIVED FROM: Bob Garnett Construction Inc AMOUNT PAID: $ 515.00
PAYMENT FORM: CHECK 1916 PAYMENT DATE: 12/12/2018
MAIL TO: Bobby Garnett
FACILITY NAME:
PROPERTY LOCATION:
12331 Bay Tree Rd
Jensen Beach, FL 34957 -
18 & 19
Lot: Block:
Property ID: 4504-602-0023-0004
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. 66-PID-3828138
STATE OF FLORIDA
F^� DEPARTMENT OF HEALTH
p ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
APPLICATION FOR CONSTRUCTION PERMIT
APPLICATION FOR:
[,/] New System [ ] Existing System [ ] Holding Tank
[ ] Repair [ ] Abandonment [ ] Temporary'
Well r]a bq-a`lo-1a
PERMIT NO. rj 'S190$$$"d
DATE PAID: ]7 [
FEE PAID: Cy- MILD
RECEIPT #: amto
[ ] Innovative
APPLICANT:ry�� AGENT: _ ( I0JNLG- / 9:t L 1 Fjf- TELEPHONE: 5-6 I - 6 3 )! -1i7 Z
MAILING ADDRESS:
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: iq BLOCK: _ SUBDIVISION: -
PLATTED:
PROPERTY ID #:Oy-6oZ-bUZ3 `(, � ZONING: I/M OR EQUIVALENT: [ YIN ]
PROPERTY SIZE: 11 A ACRES WATER SUPPLY: [y,3 PRIVATE PUBLIC [ ]<=2000GPD [ 1>2000GPD
IS SEWER AVAILABLE AS PER 381.0065, FS? [ Y�N ] DISTANCE TO SEWER: FT
PROPERTY ADDRESS: 0 32 l l��r 1 EG, PU
DIRECTIONS TO PROPERTY: ,�j W A z �V2,v IZO CAS /
INFORMATION
[t4 RESIDENTIAL
Unit Type of No. of
No Establishment Bedrooms
1 IS a..
2
3
4
[ ] Floc
SIGNATURE:
] COMMERCIAL
Building Commercial/Institutional System Design
'Area'Sgft _Table 1, Chapter 64E-6, FAC
y.Efa /0@d.ic! A,,jK l ,�79-5kj* a�
Drains [ ] Other (Specify)
DATE: /0t-A-/8
DH 4015, 08/09 (Obsoletes previous editions which may not be used)
Incorporated 64E-6.001, PAC Page 1 of 4
AUTHORIZED SEWAGE FLOW:
UNOBSTRUCTED AREA AVAILABLE:
BENCHMARK/REFERENCE POINT LOCATION:
ELEVATION OF PROPOSED SYSTEM SITE
STATE OF FLORIDA
E TREATMENT
AND DISPOSAL
• 3 ] A .f SITE EVALUATION AND STEM SPECIFICATIONTEM
APPLICATION # AP1387666
-----------------------
PERMIT # 56-SF-1908882
DOCUMENT # SE1146305
APPLICANT: Bobby Garnett
CONTRACTOR / AGENT: Bob Garnett Construction Inc
LOT: 18-&19 - BLOCK: - - -
SUBDIVISION: ID#: 4504-602-0023-000-4
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: 1.28 ACRES
TOTAL ESTIMATED SEWAGE FLOW: 200 GALLONS PER DAY [ RESIDENCES -TABLET / OTHER -TABLE 2.1
1920.01 GALLONS PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE ]
2000.00 SQFT UNOBSTRUCTED AREA REQUIRED: 375.00 SQFT
Nail in newer PP, SE of system. Elev 37.31
31.00 [ INCses / F ] [ ABOVE
BENCHMARK/REFERENCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES
SURFACE WATER: FT DITCHES/SWALES: FT NORMALLY WET: [ ]YES [X]NO
WELLS: PUBLIC: FT LIMITED USE: FT PRIVATE: 75 FT NON -POTABLE: FT
BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: 25 FT POTABLE WATER LINES: 35 FT
SITE SUBJECT TO FREQUENT FLOODING? r ]YES [X]NO 10 YEAR FLOODING? [ .]YES [X]NO]
10 YEAR FLOOD ELEVATION FOR SITE: FT[ MSL / NGVO ] SITE ELEVATION: FT [ MSL / NGVD
SOIL PROFILE INFORMATION SITE 1 SOIL PROFILE INFORMATION SITE 2
USDA SOIL SERIES:St.
Munsell#/Color
Lucie Band
Texture
Depth
10YR 511
Sand
O To 7
10YR 5/2
Sand
7 To 20
10YR 7/2
Sand
20 To 27
10YR 7/1
Sand
27 To 72
USDA SOIL SERIES:St.
I•,lunsell#/CDlor
Lucie sand
Texture
Depth
10YR 511
Sand
0 To 12
10YR 5/2
Sand
12 To 23
10YR 6/2
Sand
23 To 35
10YR 711
Sand
35 To 72
OBSERVED WATER TABLE: 72.00 INCHES I ABOVE / BELOW ] P.XISTING GRADE TYPE: [ PERCHED / APPARENT 1
ESTIMATED WET SEASON WATER TABLE ELEVATION: 72 INCHES [ ABOVE / SELOW ] EXISTING GRADE
HIGH WATER TABLE VEGETATION: [ ]YES [X]NO MOTTLING: [ ]YES [X]NO DEPTH: INCHES
SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: Sand/O.80 DEPTH,OF EXCAVATION: INCHES
DRAINFIELD CONFIGURATION: [X ] TRENCH [ ] BED [ ] OTHER (SPECIFY)
r REMARKS/ADDITIONAL CRITERIA -
WT determined using USDA WSS, soil borings, and local topographic observations.
WSWT Indicators present. WSWT determined to be below 72".
131" below SM. SB2 29" below SM. —�7
SITE EVALUATED BY:
Ingram, Brian (Title: Ed�ironmental Specialist 11) (E::VIRONMENTAL HEALTH)
OE 4015, 08/09 (Obsoletes previous editions which
may, not be used) Incoz ocatod: 64E-6.001, FTC
DATE: 12/19/2018
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