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Home My WebLink AboutD O H PAPERWORKSTATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FTI i= rnbv, PERMIT #:56-SF-1921467 APPLICATION #:AP1396056 DATE PAID: FEE PAID: RECEIPT #: DOCUMENT #: PR1202685 CONSTRUCTION PERMIT FOR: OSTDS NiW SCANNED APPLICANT: Nathan Myers C+• I uej c liuw rr._.. �.wwAY PROPERTY ADDRESS: 19701 Kelly Rd Fort Pierce, FL 34945 LOT: 6 BLOCK: SUBDIVISION: PROPERTY ID #: 2222-600_000g_QQQ_2 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] [OR TAX ID NUMBER] SYSTEM MOST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION 381.0065, F.S., AND CHAPTER 64E-61 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 [ 1,050 ] GALLONS / GPD Septic new CAPACITY A [ ] GALLONS / GPD N/A CAPACITY N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANX:1250 GALLONS] K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS 0[ ]DOSES PER 24 HRS #Pumps [ ] D [ 500 ] SQUARE FEET R [ ] SQUARE FEET A TYPE SYSTEM: [ ] I CONFIGURATION: [X] N F LOCATION OF BENCHMARK: Drainfield new SYSTEM N/A SYSTEM STANDARD [ ] FILLED [X] MOUND [ ] TRENCH [ ] BED [ ] Site BM I ELEVATION OF PROPOSED SYSTEM SITE E BOTTOM OF DRAINFIELD TO BE L D 1 0 T H E R pped IR N [ 12.00 ] [1 INCHES FT ] [ [ 5.00 ] [INCHES FT ] [ BENCHMARK/REFERENCE POINT BENCHMARK/REFERENCE POINT I" H WU1NEU: rLO.VVJ INCHES NXGAVATIUN MVU1HEU: 1 J 1gl:mL'J The system is sized for 4 bedrooms with a maximum occupancy of 8 persons (2 per bedroom), for a total estimated flow of 400 gpd. SPECIFICATIONS BY-: Brian J Inj3jast TITLE: Environmental Specialist II APPROVED BY: r✓r"~^' TITLE: Environmental Specialist II St. Lucie CBD Brian J Tam DATE ISSUED: 02/13/2019 EXPIRATION DATE: 08/13/2020 DH 4016, 08/09 (Obsoletes all previous editions Which may not be used) Incorporated: 64E-6.003, FAC Page 1 of 3 v 1.1.4 A 1396056 SC1152435 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. 1�0: HEALTH PAYING ON: RECEIVED FROM PAYMENT FORM: St. Lucie County Health Department 5150 NW Milner Dr Port Saint Lucie, FL 34983 PERMIT* 56-SF-1921467 BILL DOC*56-BID-4075324 CONSTRUCTION APPLICATION*AP1396056 Beniamin Drew"s Plumbing & Drain Ser AMOUNT PAID: $ 515.00 CHECK 117 PAYMENT DATE: 02/04/2019 MAIL TO: Nathan Myers FACILITY NAME: PROPERTY LOCATION: 19701 Kelly Rd Fort Pierce, FL 34945 6 Lot: Block: Property ID: 2222-600-0006-000-2 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-3853417 Fes.: STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE "SEWAGE TREATMENT AND DISPOSAL SYSTEM APPLICATION FOR CONSTRUCTION PERMIT APPLICATION FOR: [X] New System [ ] Repair APPLICANT: AGENT: \yell 14o.5a-2gig9 PERMIT NO SL5 `I DATE PAID: A � FEE PAID: [�-[ RECEIPT #:• [ ] Existing System [ ] Holding Tank [ ] Innovative Temporary [ ] MAILING ADDRESS-. 917 &E!�4 Myb, F4 !�i Wct ,'F L _ 14991 TELEPHONE: -I) at &-)7 -aq (pa) 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 APPLICANTS 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: t— BLOCK: SUBDIVISION: PLATTED: PROPERTY ID #: 2222.-t0M - D*M C) b-20NING: -AG-S I/M OR EQUIVALENT: [ Y / N ] PROPERTY SIZE: ACRES WATER SUPPLY. [X] PRIVATE PUBLIC [ <=2000GP [ j>2000GPD IS SEWER AVAILABLE AS PER 381.0065, FS? [ Y DISTANCE TO SEWER: + FT PROPERTY ADDRESS: IQ%oi )Leib/ 1 rfytrr., FL i�444s DIRECTIONS TO PROPERTY: -e BUILDING INFORMATION [ x] RESIDENTIAL [ ] COMMERCIAL Unit Type of No. of Building Commercial/Institutional System Design No Establishment Bedrooms Area Sgft Table 1, Chapter 64E-6, FAC 2 3 SIGNATURE: [ ]/ffther (Specify) DATE: DH 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated 64E-6..001, FAC Page 1 of 4 STATE OF FLORIDA APPLICATION # AP1396056 DEPARTMENT OF HEALTH PERMIT # 56-SF-1921467 ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM DOCUMENT # SE1152435 SITE EVALUATION AND SYSTEM SPECIFICATION APPLICANT: Nathan Myers CONTRACTOR / AGENT: Benjamin Drew"s Plumbing & Drain Services LOT: 6 BLOCK: SUBDIVISION: ID#: 2222-600-0006-000-2 TO BE COMPLETED BY ENGINEER, HEALTH DEPARTMENT EMPLOYEE, OR 'OTHER QUALIFIED PERSON. ENGINEERS MUST PROVIDE REGISTRATION NUMEEA AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS. PROPERTY SIZE CONFORMS TO SITE PLAN: [X]YES [ ]NO NET USABLE AREA AVAILABLE: 5.10 ACRES TOTAL ESTIMATED SEWAGE FLOW: 400 GALLONS PER DAY [ RESIDENCES-TABLEI / OTHER -TABLE 2 ] AUTHORIZED SEWAGE FLOW: 7650.00 GALLONS PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE ] UNOBSTRUCTED AREA AVAILABLE: 2000.00 SQFT UNOBSTRUCTED AREA REQUIRED: 1000.00 SQFT BENCHMARK/REFERENCE POINT LOCATION: Site BM orange capped IR N of system ELEVATION OF PROPOSED SYSTEM SITE 12.00 [ INCHES / FT 1 L ABOVE / BENCHMARK/REFERENCE POINT THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES SURFACE WATER: 94 FT DITCHES/SWALES: 94 FT NORMALLY WET: [ ]YES [X]NO WELLS: PUBLIC: FT LIMITED USE: FT PRIVATE: 97 FT NON -POTABLE: FT BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: 94 FT POTABLE WATER LINES: 97 FT SITE SUBJECT TO FREQUENT FLOODING? L ]YES [X]NO 10 YEAR FLOODING? I ]YES IX]NO] 10 YEAR FLOOD ELEVATION FOR SITE: FT L MSL / NGVD ] SITE ELEVATION: FT [ MSL / NGVD SOTT. PROFILE INFORMATTON STW.. I SOIL PROFILE INFORMATION SITE 2 USDA SOIL SERIES:Riviera fine sand Munsell #/Color Texture Depth 1 OYR 6/3 Sand 0 To 25 10YR 72 Sand 17 To 37 I OYR 52 Sandy Clay Loam 37 To 43 10YR 5/8 Loamy Sand 43 To 50 10B 6/1 Sandy Clay Loam 43 To 62 HOLE CAVING Refusal 62 To 72 USDA SOIL SERIES:Riviere fine sand Munsell #/Color Texture Depth 1 OYR 6/3 Sand 0 To 27 10YR 62 Sand 20 To 38 1 OYR 52 Sandy Clay Loam 38 To 46 10B 6/1 Sandy Clay Loam 46 To 62 HOLE CAVING Refusal 62 To 72 OBSERVED WATER TABLE: 48.00 INCHES [ ABOVE / rBFLOW11 EXISTING GRADE TYPE: [ PERCHED / APPARENT ] ESTIMATED WET SEASON WATER TABLE ELEVATION: 17 INCHES L ABOVE / BELOW ] EXISTING GRADE NIGH WATER TABLE VEGETATION: [ ]YES IX]NO MOTTLING: [X]YES I ]NO DEPTH: INCHES SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: Sand/0.80 DEPTH OF EXCAVATION: INCHES DRAINFIELD CONFIGURATION: [XI TRENCH I ] BED [ ] OTHER (SPECIFY) i- RF.NLPKS/ADDITIONAL CRITERIA --- - V7 determined using USDA WSS and soil borings. t7/2 stripping in 10YR6/3 Matrix>10% with diffuse boundaries starting at 17"'In SB1. 12" below BM. SB2 10" below BM. SITE EVALUATED BY: � Ingram, Brian DR 4015, 08/09 (Obsoletes previous editions w DATE: 02108/2019 nvironmental Specialist II) (ENVIRONMENTAL HEALTH) may not be used) Incorporated: 64E-6.001, FAC Page 3 of 4 AP1396056 EID1921467 v 1.0.2 Mission: To protect, promote & improve the health of all people in Florida through integrated state, county & community efforts. FORM - HEALTH Vision: To be the Healthiest State In the Nation 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 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-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-WELLSa.FLHEALTH.GOV • Submit revisions to permit and/or site map and associated fee within 48 hours of well construction or abandonment. Fiorida Department of Health St. Lucie County • Division of Disease Control and Health Protection Bureau of Environmental Health 5150 NIMM1ner Drive Port SL 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 L1.SDuthwest PLEASE FILL OUT ALL APPLICABLE FIELDS ❑Northwest (`penotes Required Fields When Applicable) ❑St. Johns River LISouth Florida The.wtcrieil contmctoris responsible rar compremg :]Suwannee River fhrs faun andf fording die perma eppb'carmn to (he ❑ DEP appropriate delegated authority rAom applicable. ❑ Delegated Authority (If Applicable) I=11111111r�ma M SGPTLC N0.5Un SF-Ig), LQFI Permit Na. 59-29199 FlaNda Unique ID_, _ ____ — Permit SlipWations Required (See Attached) Quad No. Delineation No. Application No..._ . , _ . _- Number 'Parcel ID No. (PIN) or Alternate Key (Circle One) Let Block Unit 4. Sr Lout= Check if 62S24,1 Yes No 'Section or Land Grant 'Township 'Range 'County _ Subdivision .1 ,; 5. 1 d� LPa-r�r1t L.v L_lI %lr5_'- 6 'S 'Water g6-7 "J 3�12 . Well Contractor License Number 'Telephone Number E-mail Address 6.? N;__I/A �A/I {-.___.._____—___.—_ _ 'Water Well Contractor's Address City State ZIP 7. 'Type of Work: (".` Construction r I Repair j, Modification;] Abandonment B. *Number of Proposed Wells 'Reason to. Repair. orAb^andofeonetnn:E__ _L,__ 9. 'Soecify Intended Use(s) of Well(s): /A1 ' uJ'ru f 1 thy/ I Domestic , Landscape Irrigation j I Agricultural Irrigation 1- Site Investigations (rJ bottled � Lf— Llll`�+J \/ Water Supply . Recreation Area Irrigation � I Livestock ; Monitoring �-' r, Public Water Supply (Limit'ed Use0OH) r Nursery Irrigation ;1 Test ty r F E B 1 3 2019 Public Water Supply (Commo or Non-Community/DEP)!j CommerciaUlndustrial ] Earth -Coupled Geothermal Class I Injection f Golf Course Irrigation HVAC Supply .. 119 HVAC Return Class V Injection:'-,—; Recharge ['] Commercialllndustrial Disposal ` J Aquifer Storage and Recovery 1 ; Drainage OH �LOdB cool Remediation:;_ j Recovery_i Air Sparge 0 Other (oesrnee) ENJU nl E] Other (Descnle) 10.'Distance from Septic System if 5 200 ft. 7 5 11. Facility Description �r.'AJ je r-.r, 12. Estimated Start Date 13.'Estimated Well Depth.& X. ft. -Estimated Casing Depth_ 6 -'Y-ft. Primary Casing Diameter __._rZ_in. Open Hole: From -__:To- ,,.___JL 14. Estimated Screen Interval: From (,-7To 5+'! it, 15.'Primary Casing Material: Black Steel 1/Galvanized PVC Stainless Steel Not Cased Other:___ 16. Secondary Casing: Telescope Casing Liner Surface Casing Diameter_ __in. 17. Secondary Casing Material: Black Steel Galvanized VPVC Stainless Steel Other_ IB.'Method of Construction; Repair. or Abandonment Auger vCable Tool Jetted Rotary Sonic Combination (Two or More Methods) Hand Driven (Well Point, Sand Point) Hydraulic Point (Direct Push) Horizontal Drilling Plugged by Approved Method Other 19. Proposed Grouting Interval forthe Primary, Secondary, and Additional.Casing: Fromm To G 3 Seal Material ( Bentonhe Neat Cement Other l From To Seal Material ( sentanite Neat Cement Other!___,) From To Seal Material( Bentonite Neat Cement Other_______________, From To Seal Material ( Benlonite Neat Cement Other ) 20. Indicate total numberof existing wells on site List number of existing unused wells on site______ 21.'Is this well or any exisdn9well or water withdrawal an the owners contiguous prope��,vy covered under a Cr nsumoliverWater Use Permit (CUPPNUP) or CUPIWUP App9cation. Yes No If yes, complete the following: CUPNVUP No.. District Well ID No. Longitude__ 23. Data Obtained From: GPS Map Survey Datum: NAD 27 AL_NAD 83 _WGS 84 J-J-ik_3--- 'License No. Approval Granted By �iM^'ti• Issue Date .L//.;/�7 EspicdGon I Fee Received S_ Receiol No. Check inrx: aeoeo THIS PERMIT IS NOT VALID UNTIL PROPERLY SIGNED BY AN AUTHORIZED OFFICER OR REPRESENTATIVE OF THE WMD ORDELEGATED AUTHORITY. THE PERMIT SHALL BE AVAILABLE AT THE WELL SITE DURING ALL CONSTRUCTION. REPAIR. MODIFICATION. OR ABANDONMENT ACTIVITIES. aMri i Irrhmnra(rA in A%s37 Anil F A C Ftfx. ivw Dale Octnher 7 71110