No preview available
HomeMy WebLinkAboutD O H PAPERWORKRECEIVED W L [� �� PERMIT #:AP140193374 j�� AIR 17 2019 Ap LIGATION #:AP1401633 STAT --E�-,L-ORI�A� ONSITE SYSTEM CONSTRUCTION PERMIT FOR: —APPLICANT: Donald ENT OF HEALTH ST. Lucie County, Permitting DATE PAID: SEWAGE TREATMENT AND DISPOSAL FEE PAID: KAREN S. NIELSEN tate of Florida -Notary PuDG Commission # GG 207484 My Corn mission Expires PROPERTY ADDRESS: TBD Seminole Rd Fort Pierce, FL 34951 LOT: 6 BLOCK: SUBDIVISION: Seminole Acres #: #: PR1212295 PROPERTY ID #: 1323-800-0007-000-0 [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 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 [ 900 ] GALLONS / GPD SentiC New CAPACITY A [ ] GALLONS / GPD N/A CAPACITY N t ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps D [ 375 ] SQUARE FEET Drainfield New SYSTEM R [ ] SQUARE FEET N/A SYSTEM A TYPE SYSTEM: [ ] STANDARD [ ] FILLED [X] MOUND [ ] I CONFIGURATION: [X] TRENCH [ ] BED [ ] N F' LOCATION OF BENCHMARK: Site BM 5/8 IR ELEV = 22.83 I ELEVATION OF PROPOSED SYSTEM SITE E BOTTOM OF DRAINFIELD TO BE L D 0 T H E- R [ 6.00 ][ INCHES FT ][ABOVE A BELOW BENCHMARK/REFERENCE POINT [ 4.00 ][ INCHES FT ][ ABOVE BELOW] BENCHMARK/REFERENCE POINT REQUIRED: 128.001 INCHES EXCAVATION REQUIRED: t I1 1NUnnb system is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total estimated flow of gpd. SPECIFICATIONS{ Hupter A Collier TITLE: Environmental Specialist I APPROVED BY: f � �y. \r QV TITLE: Environmental Specialist I St. Lode CHO V canter Mier DATE ISSUED: 04/16/2019 EXPIRATION DATE: 10/16/2020 DH 4016, 08/09 (Obseletes all previous editions which may not be used) Incorporated: 64E-6.003, FAC Page 1 of 3 v 1.1.4 AP1401633 SE1161935 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 avla 5150 NW Milner Dr Port Saint Lucie, FL 34983 HEALTH PAYING ON: # 56-SF-1930074 eILL DOC#•56-BID-4091904 CONSTRUCTION APPLICATION#.AP1401633 RECEIVED FROM: Dave Golden Homes AMOUNT PAID: $ 515.00 PAYMENT FORM: CHECK 26238 PAYMENT DATE: 03/06/2019 MAIL TO-Donald--Pauley FACILITY NAME: PROPERTY LOCATION: TBD Seminole Fort Pierce, FL 34951 6 Lot: Block: Property ID: 1323-800-0007-000-0 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-PID-3869696 �Ne STATE OF FLORIDA s DEPARTMENT OF HEALTH g ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM APPLICATION FOR CONSTRUCTION PERMIT APPLICATION FOR: New System [ ] Existing System [ ] Holding Tank [ ] Repair [ ] Abandonment [ ] Temporary APPLICANT: AGENT: MAILING ADDRESS: PERMIT NO. ✓4''SF' H 3(�Cjq DATE PAID: U FEE PAID: RECEIPT #: [ ] Innovative TELEPHONE: V� L Zle S"`%•7S I 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 y PLATTED (MM/DD/YY) IF REQUESTING CONSIDERATION OF STATUTORY GRANDFATHER PROVISIONS. PROPERTY INFORMATION / LOT: 4_ BLOCK: SUBDIVISION: _�ellnl&,, /11, ele PLATTED: PROPERTY ID #: /3*1,; !'00 1100'? 000 L1 ZONING: /j(-' l I/M OR EQUIVALENT: [ Y/N ] PROPERTY SIZE: S ;%�1 ACRES WATER SUPPLY: [>C] PRIVATE PUBLIC [ ]<=2000GPD [ ]>2000GPD IS SEWER AVAILABLE AS PER 381.0065, FS? [ Y/N DISTTAANCE TO SEWER: FT PROPERTY ADDRESS: _ ,Ce %M / II. L 4 (]/�7 ✓� �� // 4,17AC% �1' / �; DIRECTIONS TO BUILDING INFORMATION 66/ - AlOX >'1— i s 7�/v0 /lic lfd/ID - / 0 1�4 RESIDENTIAL [ ] COMMERCIAL Unit Type of No. of Building Commercial/Institutional System Design No Establishment Bedrooms Area Sqft Table 1, Chapter 64E-6, FAC 1 JlrAfi 2 3 4 [ ] Floc SIGNATURE: Other (Specify) // G DATE: W / 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 # AP1401633 DEPARTMENT OF HEALTH PERMIT # 56-SF-1930074 ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATION DOCUMENT # SE1161935 APPLICANT: Donald Pauley CONTRACTOR / AGENT: Dave Golden Homes LOT: 6 BLOCK: SUBDIVISION: Seminole Acres ID#:1323-800-0007-000-0 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: 5.79 ACRES TOTAL ESTIMATED SEWAGE FLOW: 300 GALLONS PER DAY [ RESIDENCES -TABLET / OTHER -TABLE 2 ] AUTHORIZED SEWAGE FLOW: 8684.99 GALLONS PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE ] UNOBSTRUCTED AREA AVAILABLE: 500.00 SQFT UNOBSTRUCTED AREA REQUIRED: 500.00 SQFT BENCHMARK/REFERENCE POINT LOCATION: Site BM 518 IR ELEV = 22.83 ELEVATION OF PROPOSED SYSTEM SITE 6.00 [ INCHES / FT ] [ ABOVE / EE3 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 [ ]NO WELLS: PUBLIC: FT LIMITED USE: FT PRIVATE: 100+ FT NON -POTABLE: FT BUILDING FOUNDATIONS: 10 FT PROPERTY LINES: 20 FT POTABLE WATER LINES: 64 FT SITE SUBJECT TO FREQUENT FLOODING? [ ]YES [X]NO 10 YEAR FLOODING? [ ]YES [X]N01 10 YEAR FLOOD ELEVATION FOR SITE: FT[ MSL / NGVD] SITE ELEVATION: FT [ MSL / NGVD SOIL PROFILE INFORMATION SITE 1 SOIL PROFILE INFORMATION SITE 2 USDA SOIL SERIES:Riviera fine sand Munsell #/Color Texture Depth 10YR 711 Fine Sand 0 To 15 1 OYR 8/1 Fine Sand 15 To 35 1 OYR 5/3 Sandy Loam 35 To 52 7.5YR 5/8 CMN/PRM RF 35 To 72 1OYR 5/3 Hardpan 52 To 72 USDA SOIL SERIES:Riviera Munsell #/Color fine sand Texture Depth 1OYR 6/1 Fine Sand 0 To 14 10YR 711 Fine Sand 14 To 17 1 OYR 8/1 Fine Sand 17 To 35 10YR 5/3 Sandy Loam 35 To 52 7.5YR 5/8 CMN/PRM RF 35 To 72 1OYR 5/3 Hardpan 52 To 72 OBSERVED WATER TABLE: INCHES [ ABOVE / BELOW ] EXISTING GRADE TYPE: ESTIMATED WET SEASON WATER TABLE ELEVATION: 14 INCHES [ ABOVE / BELOW ] HIGH WATER TABLE VEGETATION: [ ]YES [X]NO MOTTLING: [X]YES [ ]NO [ PERCHED / APPARENT ] EXISTING GRADE DEPTH: 14.00 INCHES SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: Fine Sand/0.80 DEPTH OF EXCAVATION: DRAINFIELD CONFIGURATION: [X ] TRENCH [ ] BED [ ] OTHER (SPECIFY) r REMARKS/ADDITIONAL CRITERIA material encountered in hardpan layer starting at 52". WSWr determined using USDA WSS and soil borings. 10YR 711 ling in 10YR 611 matrix> 10% with diffuse boundaries starting at 14" in'SB2. SB2 6" below BM. Sat 6" below BM. SITE EVALUATED BY: Collier, HunterrTrhle: Environmental Specialist 1) (Florida Department of Health In St. L DH 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated: 64E-6.001, FAC INCHES DATE: 04/10/2019 Page 3 of 4 AP1401633 EID1930074 v 1.0.2 51Q-SF 19�J 4 STATE OF FLORIDA'PERMITAPP[ICATION TO CONSTRUCT, 'REPAIR; MODIFY, OR ABANDON _A WELL 'OSouthwast PLEASE FILL OUT ALL ApPUCAELE FIELDS ❑ Northwest ,('0enotes Required Fields Where Applicable; St. Jo hns'River Tberwtn rvellmotro[rorinetpaelblelo•aamplerLia. 'A 50U1I1 Florida ihhhan..d/,w.,di'rg the➢oadleppli(mloit to the: []SuwanneeRiver cppmpdarectelegaredoaflioleywherdopplIcable. ODEP - ,,p Delegated Authority(f'Applicable) -wen Location-:Appress, HOaa Name or Numoer,.cey: _ 3. 1323-800-0007-000-0 .. -._ _ __ _ -_ _ 6.. *Parcel ID No. (PIN) -or Alternate Key (Circle One)_ - -Lot '.Block- - --Unit 4.23 • -345 39E-. _ St Lucie Seminole Acres Check if62-8z4:❑ Yes 21 No 'Section or Land Grant 'Township 'Range. - -'County _ ,Subdivision 6• James ;P. Tyson _ - _-_ 11352- 954-818-4269.. downthehole@att.net,. _. 'Water Well Contractor _ - - 'License Number -•Telephone Number - E-m_ail Address' - 6. Po BOX 881496- __.. _ _ _ Port St Lucia __ -__ FI 34988 'Water Well Contractor's Address- -- - - - - ciry, -- ,State. ZIP 7. 'Type of Work: Q :Construction Repair [] Modification[] Abandonment - _ - - - A 'NumhPrnf Prnnnserf WPlle 1 -Reason for RopBtr, modoiwuon• or Abanaoaneni [] Oomasao Lanescape irrigation Agricultural Irrigation ❑ Site7invesilgationa/A\10./ ❑ B ®,.Livestock- 4�i(J'� o o OW1 Bottled Water Supply Recreation Area Irrigation ❑ Monitoring v ❑ Public Water Supply (Limited. Use/DOH) Nursery Irrigation Test 8 Public Water Supply (Community or Nan-Community/DEP)[ CommerclatllndusMal Earth -Coupled Geothermal � 3 1— 2A 6Cb Class I Injection Golf Course Irrilgation'Ll ` HVAC Supply , HVAC Return A • R 6 2019 Class V,Injection: ❑ Recharge '❑ CommerclaUlnduslrial Disposal ❑ Aquifer Storage and Recovery ❑ Drainage. Remedlagon:❑ Recovery[], AirSperge ❑ Olhor (o•=^ne➢) _-- - -.- -- - Official Use Only, U D. 00R ❑ Other loeauael - FC15. 13.'Estimated Well Depth-_ 100 R... 'Estimated Casing Depth 80 _ f . Primary Casing Diameter 2 In. Open Hole: From I To "' fl. 14. Estimated Screeminterval:'From 80 To 100 Q. - 15.'Primary Casing Materlal: Black Steel. Galvanized (r;,iPVC Stainless Steel Nol'Cased Other, _ 16. Secondary Casing: Telescope Casing Liner Surface Casing Diameter _ In. 17• Secondary Casing, Material: Black Steel Galvanized PVC Stainless Steel Other- - '- 18,•Method of Construction. Repair, or Abandonment:. Auger _.Cable Tool Jetted, ;[]:`Rotary Sonic Comb[ nation (Two or. More Methods) Hand Driven (Well Point, Sand Point) Hydraulic-Froint (Direct Push) Horizontal Drilling Plugged by Approved Method. Other Desmpel... 19. Proposed Grouting Interval for the Primary, Secondary, and Ao4itional Casing: - From 0 ,To -75 Seal Material ( Hentonile-%N_eat Cement Other 1 From To ' Seal Material( ,Bentonite Neat Cement Other From... To -.. - Seat Material ( Bentonite Neat Cement OtherFrom To -. - Seal Material ( BentoniteNeat Cement Other..... 20. Indicate total number of existing: wells. on Site 0- List number of existing unused wells. on site 0 21.'Is this well or any exlsdngg well or water withdrawal on the owners contiguous property covered under a ConsumpliveMater Use Permit(CUPIWUP) or CUPNV(JP Application,$ Yes yr No Ifyes, complete the. following: CUPiW JP_No: District Well ID No. 22. Latitude - _ Longitude 23, Data Obtained From: GPS Map Survey Datum: _NAD 27 _NAD, 83 =WGS 84 , w Approval Granted By_���'k�\l, .e � 111-- Issue Date M ply. E. Fee. Received S. - _ Receipt No. - - THIS PERMIT IS NOT VALID UNTIL PROPERLY SIGNED BY AN AUTHORIZED OFFICER OR REPRESENI PERMIT SHALL BE AVAILABLE AT THE WELL SITE DURING ALL. CONSTRUCTION. REPAIR. MODIFICAT ration Date VL(,WJ I�U.'HydmloglstApproval - wvm. Check No. 'IVE OF THE WMO OR DELEGATED AUTHORITY. THE Date! October 7, 2010 Page 1 of 2 -119 ,f g STATE OF FLORIDA b DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM ate. CONSTRUCTION INSPECTION AND FINAL APPROVAL /goy -a APPLICATION n:AP1401633 PERMIT 4:56-SF-1930074 DOCUMENT a:F11322132 DATE PAID:03/06/2019 PEE pAID;515.00 RECEIPT e:56-PID-3869696 APPLICANT: Donald Pauley AGENT: Dave Golden Dave Golden Homes PROPERTY ADDRESS: TBD Seminole Rd Fort Pierce, FL 34951 BY LOT: 6 BLOCK' St. Lucie County SUBDIVISION: Seminole Acres IDk: 1323.800.0007-000-0 ' CHECKED [XI ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MOST BE CORRECTED. TANK INSTALLATION [O1] TANK SIZE [1] 1090.00 [21 [021 TANK MATERIAL Polypropylene [031 OUTLET DEVICE [041 MULTI -CHAMBERED [051 OUTLET FILTER Polylok PL-68 [061 LEGEND 1. 70-143-11DC4 2. [071 WATERTIGHT [081 LEVEL (091 DEPTH TO LID DRAINFIELD INSTALLATION [101 AREA [1] 509.4 [21 SQFT (111 DISTRIBUTION BOX HEADER X [121 NUMBER OF DRAINLINES 1. 5.00 2 [131 1141 1151 [161 [171 118] 1191 [201 [211 DRAINLINE SEPARATION DRAINLINE SLOPE DEPTH OF COVER ELEVATION [ ABOVE / BELOW IBM 7.00 SYSTEM LOCATION DOSING PUMPS AGGREGATE SIZE AGGREGATE EXCESSIVE FINES AGGREGATE DEPTH I SETBACKS [271 SURFACE WATER 100 FT 1281 DITCHES FT [291 PRIVATE WELLS 77 FT [301 PUBLIC WELLS FT [311 IRRIGATION WELLS PT [321 POTABLE WATER 40 FT [331 BUILDING FOUNDATIONS 7 FT [341 PROPERTY LINES 50 FT [35) OTHER FT FILLED / MOUND SYSTEM [361 DRAINFIELD COVER [371 SHOULDERS (381 SLOPES [391 STABILIZATION 09/27/2019 ADDITIONAL INFORMATION [40] UNOBSTRUCTED AREA [411 STORMWATER RUNOFF [421 ALARMS [431 MAINTENANCE AGREEMENT [441 BUILDING AREA (451 LOCATION CONFORMS WITH SITE PLAN [461 FINAL SITE GRADING FILL / EXCAVATION MATERIAL [ ] [471 CONTRACTOR MICHAEL W STUHR(ASHTO [ ] [22] FILL AMOUNT [ ] 1481 OTHER INFILTRATOR QUICk4 Plus EQ36 LP [ 1 21 FILL TEXTURE [ 1 [241 EXCAVATION DEPTH ABANDONMENT [ 1 [251 AREA REPLACED [ ] 1491 TANK PUMPED [ 1 1261 REPLACEMENT MATERIAL [ ] [501 TANK CRUSHED 6 FILLED Comments: Comments are on page 2. CONSTRUCTION I APPROVED -1 t. LUC]e CHI' DATE: 09/19/2019 / DISAPPROVED 1" Env roy en`I Spaclallst ll Bri n m IENVIRONMENTAL HEALTH) FINAL SYSTEM [ APPROVED / DISAPPROVED 1: St. Lucie CHD DATE: 10/01/2019 Environmental Specialist 11811a ngram [ENVIRONMENTAL HEALTH) (Explanation of Violations on following page) DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Page 2 of 3 Incorporated: 64E-6.003, FAC EH Database v 1.0.1 AP1401633 EID1930074 Le APPLicATIoN u:AP1401633 STATE OF FLORIDA PERMIT a:56-SF-1930074 DEPARTMENT OF HEALTH DocumEsT n:FI1322132 ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM 03/06/2019 CONSTRUCTION INSPECTION AND FINAL APPROVAL DATE PAID: ``wawa+•`'`` FEE PAm:515.00 RECEIPT n:56-PID-3869696 Violation Number Comment The system is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total estimated flow of 300 N ST, filter, and 5x9 long DF installed. No violations, system ok to cover. Contractor notified onsite. quested"as built" from contractor and homeowner as DF orientation has changed and well location is now inside 100'. al inspection required for mound system, as built site plan, and final site grading. built received 10/1/19. Final system approved. Contractor and building department emalled final approval. DH 4016, 0a/09 (obsoletes all previous editions which MY not be used) Page 2 of 3 Incorporated: 64E-6.003, FAC EH Database v 1.0.1 AP1401633 EID1930074