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Home My WebLink AboutD O H PAPERWORKSTATE OF FLORIDA DEPARTMENT OF HEALTH SYSTEM CONSTRUCTION PERMIT FOR: APPLICANT: PROPERTY ADDRESS: TBD OSTDS New Fort Pierce. FL 34982 PERMIT #:56-SF-1910445 APPLICATION #:AP1388751 DATE PAID: FEE PAID: RECEIPT # DOCUMENT #: PR1197569 LOT: 4 BLOCK: C E sUBnxvxsxoN: White City St. Lucie County PROPERTY ID #: 3410-602-0017-000-8 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] [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 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 [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 SHE #Pumps [ D [ 500 1 SQUARE FEET Drainfield new SYSTEM R [ ] SQUARE FEET N/A SYSTEM A TYPE SYSTEM: [ ] STANDARD [x] FILLED [ ] MOUND I CONFIGURATION: [ ] TRENCH [x] BED [ ] H F LOCATION OF BENCHMARK: Site BM Orange painted X CL Of Olive, center of I ELEVATION OF PROPOSED SYSTEM SITE [ 2.00 1d INCHES V FT I POINT E BOTTOM OF DRAINFIELD TO BE [ 4.00 1[ INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT L D I 0 T H E R system is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total estimated flow of gpd. SPECIFICATIONS BY: Brian J Ing ..-- TITLE: Environmental Specialist II APPROVED BY: AULE: Environmental Specialist II St. Lucie CED Brian J Ingram DATE ISSUED: 01/09/2019 EXPIRATION DATE: 07/09/2020 DR 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 AP1388751 SE1147330 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 H5150-NW-Milner nl er D� Por SamfOucie, FL 34983 MTH PAYING ON: PERMIT#'56-SF-1910445 eILLDOC#56-BID-4054406 CONSTRUCTION APPLICATION#:AP1388751 RECEIVED FROM: Benjamin Drew"s Plumbing & Drain Ser AMOUNT PAID: $ 515.00 PAYMENT FORM: CREDIT CARD PAYMENT DATE: 12/19/2018 MAIL TO: Christopher Carter FACILITY NAME: PROPERTY LOCATION: TBD Olive St Fort Pierce, FL 34982 Lot: Block: CE Property ID: 3410-602-0017-000-8 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-3831549 STATE OF FLORIDA v ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM �� APPLICATION FOR CONSTRUCTION PERMIT APPLICATION FOR: lw%k vu.. ri't - `v5"iC15i'+ PERMIT NO. 5�-SF-19 04qS DATE PAID: FEE PAID: '{ RECEIPT #: [v/] New System [ ] Existing System [ ] Holding Tank [ ] Repair [ ] Abandonment [ l Temporary APPLICANT: Christopher Carter [ ] Innovative AGENT: Benjamin Drews Plumbing & Drain Service Inc TELEPHONE • 772 - 247 4229 77251! MAILING ADDRESS: 15965 west park lane. Ft pierce 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: 4/5/6 BLOCK: ce SUBDIVISION-. whitecityplaza PLATTED: PROPERTY ID #: 3410-602-0017-000-8 ZONING: rs-3 I/M OR EQUIVALENT: [ No ] PROPERTY SIZE: .28 ACRES WATER SUPPLY. [,I] PRIVATE PUBLIC [,(]<=2000GPD [ ]>2000GPD IS SEWER AVAILABLE AS PER-381.0065, FS? [ No ] DISTANCE TO SEWER: n/a FT PROPERTY ADDRESS: Olive Street. Ft DIRECTIONS TO PROPERTY: WHITE CITY PLAZA BLK C E 30 FT OF LOT 4, ALL LOT 5 AND W 15 FT OFLOT 6 BUILDING INFORMATION [,/] [ ] COMMERCIAL Unit Type of No, of Building Commercial/Institutional System Design No Establishment Bedrooms Area Sgft Table 1, Chapter 64E-6, FAC I New home 3 1833 300 GPD 2 3 4 [ ] Floor/Equipment Drains [ ] Other (Specify) SIGNATURE: r / DATE: DH 4015, 08/0 (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 APPLICANT: Christopher Carter CONTRACTOR / AGENT: Benjamin Drew"s Plumbing & Drain Services LOT: 4 BLOCK: C E SUHDxVISION: WhiteCity ID#:3410-602-0017-000-8 APPLICATION # AP1388751 PERMIT # 56-SF-1910445 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: 0.28 ACRES TOTAL ESTIMATED SEWAGE FLOW: 300 GALLONS PER DAY [ RESIDENCES-TABLEI / OTHER -TABLE 2 ] AUTHORIZED SEWAGE FLOW: 420.01 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: Site BM Orange painted X CL of Olive, center of ELEVATION OF PROPOSED SYSTEM SITE 2.00 CLENCHES / FT ] ( ABOVE /C 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: 5 FT POTABLE WATER LINES: 65 FT SITE SUBJECT TO FREQUENT FLOODING? 10 YEAR FLOOD ELEVATION FOR SITE: SOIL PROFILE INFO RMATInN Srmc I [ ]YES [X INO 10 YEAR FLOODING? C ]YES [X]NO) FT [ MSL / NGVD ] SITE ELEVATION: FT [ MSL / NGVD USDA SOIL SERIES:Tant.ile sand Munsell #/Color Texture Depth 10YR 5/1 Fine Sand 0 To 6 10YR 6/2 Fine Sand 6 To 38 1 OYR 7/1 Fine Sand 26 To 38 10YR 212 Spodic Material 38 To 50 10YR 3/3 Sand 50 To 57 1 OYR 3/1 Sand 57 To 72 SOIL PROFILE INFORMATION SITF. 2 USDA SOIL SERIES:Tantile sand Munsell #/Color Texture Depth 10YR 511 . Sand 0 To 5 10YR 6/1 Sand 5 To 35 10YR 7/1 Sand 28 To 38 7.5YR 3/1 Spodic Material 38 To 48 7.5YR 3/3 Sand 48 To 55 10YR 311 Fine Sand 55 To 72 OBSERVED WATER TABLE: 67.00 INCHES [ABOVE / BELOW ] EXISTING GRADE TYPE: [ PERCHED / APPARENT ] ESTIMATED WET SEASON WATER TABLE ELEVATION: 26 INCHES [ ABOVE / BELOW ] EXISTING GRADE HIGH WATER TABLE VEGETATION: [X]YES [ ]NO MOTTLING: [X]YES [ ]NO DEPTH: 26.00 INCHES SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: Fine Sand/0.60 DEPTH OF EXCAVATION: 50 INCHES DRAINFIELD CONFIGURATION: [ ] TRENCH [X] BED [ ] OTHER (SPECIFY) REMARKS/ADDITIONAL CRITERIA VT determined using USDA WSS and soil borings. 27/1 stripping in 10YR6/2 matrix >10% with diffuse boundaries starting at 26" in SB7. 2" below BM. S62 3" below BM. SITE EVALUATED BY: Ingram, Brian f�itie: Environmental Specialist IO (ENVIRONMENTAL HEALTH) DR 4015, 08/09 (Obsolete. previous editions ch may not be used) Incorporated: 64E-6.001, £AC DATE: 12/26/2018 Page 3 of 4 AP1388751 EID1910445 v 1.0.2 Mission: TgprotecL promote & improve the health of all people in Florida through integrated Vision: To be the Healthiest State in the Nation Rick Scott Governor 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-WELLSa.FLHEALTH.GOV b. Provide the following information: i. Permit number ii. Driller name ill. 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(DFLHEALTH.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 NUner Drive Port St Lucie, FL 34983 PHONE: 772/873-4931 • FAX: 772/595-1306 FloridaHealth.gov Accredited Health Department Public Health Accreditation Board STATE OF FLORIDA PERMIT APPLICATION TO CONSTRUCT, .REPAIR, MODIFY, OR ABANDON A WELL 1=Southwest ,.,11 LJ St. Johns River Osouth Florida Thom. wit u;mcorisn yxmsiislr luu vIi,01wo ,his rains and119 w0,rring 6" pennit'rli,cIAsn ro the ❑Suwannee River appropriate delegaredaudmrirynhere onpsieeGle. 0 DEP G Delegated Authority (If Applicable) 5610 Smith Lane Ft. Pierce, FI 34982 2. TBA/Olive Street Ft. Pierce. Ft 34982 6U - SF-10110i No. 59-29094 Unique ID Stipwa4ans Required (See Attached) Quad No. Delineation No. 'Well Location - Address, Road Name or Number. City 3. 3410-602-0017-000-8 4 & 5 C E 'Parcel ID No. (PIN) or Alternate Key (Circle One) Lot Block U it 4.10 36S 40E St Lucie White City Plaza Check if 62-5240 Yes` No "Section or Land Grant 'Township 'Range 'County Subdivision 5. James P. Tyson 11352 954-818-4269 downthehole@att.net 'Water Well Contractor 'License Number 'Telephone Number E-mail Address 6. PO Box 881496 Port St Lucie FI 34988 'Water Well Contractor's Address city State ZIP 7. 'Type of Work: ff Construction ❑ Repair ❑ Modification❑ Abandonment 8. 'Number of Proposed Wells I 'Ressonror, Repav, MeyGcallon, mAheManment fl, 'Specify Intended Uses) of Weand Domestic Landscape irrigation ❑ � Date l a r--ems--� "'rr rrr ILfD-)ILfolllU V p g Agricultural Irrigation ❑ Bottled Water Supply 8 Site Investigations L Recreation Area Irrigation ❑ Livestock - ❑ Monitoring Public Water Supply (Limited Use/DOH) ❑ Nursery Irrigation ❑ Test ] Public Water Supply (Community or Non-Community/DEP)❑ CommerciaVlndustrial ❑ Earth -Coupled Geothermal JAN 9 2019 ] Class I Injection ❑ Golf Course Irrigation B HVAC Supply HVAC Return :lass V Injection:❑ Recharge ❑ Commercial/industrial Disposal ❑ Aquifer Storage and Recovery ❑ Drainage Remediatlon: ❑ Recovery ❑ Air Sparge ❑ Other (Describe) DOH u e C,OUI ❑ Other (Describe) 10."Distance from Septic System if <200 fL 5+ 11. Facility Description Proposed Residence 12. Estimated Start Date ASAP 13.'Estimated Wel(Depth 120 ft. `Estimated Casing Depth 100 a. Primary Casing Diameter 2 in. Open Hole: From To =ft. 14. Estimated Screen Interval: From 100 To 120 fL az 15.'Pdmary Casing Material. Black Steel Galvanized : Stainless Steel Not Cased Other: 16. Secondary Casing: Telescope Casing Liner Surface Casing Diameter in. 17. Secondary Casing Material: Black Sleet Galvanized PVC Stainless Steel Other 18.•Methcd of Construction. Repair, or Abandonment' Auger Cable Tool Jetted ' _ Row;; , Sonic Combination (Two or More Methods) Hand Driven (Well Point, Sand Point) Hydrau Ic olnt (Direct Push) Horizontal Dulling Plugged by Approved Method Other toescnbe) 19. Proposed Grouting Interval for the Primary, Secondary, and Additional Casing: From 0 To 95 Seal Material ( Bentonite e;tl-t;e� t Other ) Fmm To Seal Material( Bentonite Neat ement Other ) From To Seal Material ( Bentonite Neat Cement Other ) From To Seal Material ( Bentonite Neal Cement Other ) 20. Indicate total number of existing wells on site 0 List number of existing unused wells on site 21.1s this well or any existin well or water wilhdrayaaid)n the owner's contiguous property covered under a ConsumptivelWater Use Penult (CUPANLIP) or CUPANIJP Application. Yes ;No , fyes, complete the following: CUPM/UP No. District Well ID No, 22. Latitude Longitude 23. Data Obtained From: GPS Map Survey Dalum: NAD 27 _NAD 83 _WGS 84 11'oeby �uWr e,nll,xl NmV1Y'Nee'e ppG:ffiIe,ulb a Tor 40. FW6b MIn:nrvTa4ve CVW. Me T:InwNly Ise,M/Wx11 mnIM M,c ofNep,apaty. WA NeegWnnalimlWW✓lnlnvnurab :MNan amna�f Wny WaV0,r:10: WJl4olrtota,ex peuVl.ir�ue,lea ne: 4e ..11"Nvpie0 V0:'�Ip ^vvump[WneM olwW �nl'N,xb%ees woo Gu[Yn Ji],Fla.Ne 5raW44 bnvmtld'mapiepnfy aENEan OiavtY: W.I:tMN Wllxn 11352 'Signature of Contractor !) license No.-SignaI,s rOw Vror A_ nt 'Date aELOW THIS LINE -FOR OFFICIAL IJ5E • Approval Granted By Issue Dale Expiration Date 7 %Qlydrologist Approval el nJ Fee Received S Receipt No. Check No. THIS PERMIT IS NOT VALID UNTIL PROPERLY SIGNED BY AN AUTHORIZED OFFICER OR REPRESENTATIVE OF THE INMD OR DELEGATED AUTHORITY. THE PERMIT SHALL BE AVAILABLE AT THE WELL SITE DURING ALL CONSTRUCTION, REPAIR, MODIFICATION. OR ABANDONMENT ACTIVITIES, DEP Ferm:62-532.900(1) Incorporated in 62.532.400(1). F.A.C. Effective Dale: October 7, 2010 Pace 1 of 2 J Olt ul) ll� It X (NA 3 tA vtri 13, VIA Cl ILIL his 151— C �-TIPJVW GAL a, 00 1.00 1 H