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Home My WebLink AboutD O H PAPERWORKSTATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM PERMIT #:56SF-1939323 APPLICATION #:AP1407689 DATE PAID: FEE PAID: RECEIPT #: DOCUMENT #: PP`R�e12213435 FILE CONSTRUCTION PERMIT FOR: OSTDS New � ® y I APPLICANT: Scott Van Den Braden SCANNED ANNF ED PROPERTY ADDRESS: TBD Sunset Blvd Fort Pierce, FL 34982 C+ [ ude County LOT: 15 BLOCK: 47 SUBDIVISION: Indian River Estates PROPERTY ID #: 3402-608-0245-000-8 [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 SPECIFICATIONS T [ 900 ] GALLONS / GPD Sentic 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 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 #1 on site plan set mag nail & disc far side Of road I ELEVATION OF PROPOSED SYSTEM SITE [ 16.00It INCHES FT ][ ABOVE HELOW BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 8.00 ][ INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT D F 0 T H E R ILL system is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total estimated flow of gpd. SPECIFICATIONS Hunter A Colli r TITLE: Environmental Specialist I APPROVED BY: TITLE: Environmental Specialist I St. Lucie CHU F n er A Col ler DATE ISSUED: 04/29/2019 EXPIRATION DATE: 10/24/2020 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 AP1407689 SE1163049 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. STATE OF FLORIDA PERMIT NO. DEPARTMENT OF HEALTH DATE PAID: 0 ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID: SYSTEM RECEIPT #:-�5"�.� APPLICATION FOR CONSTRUCTION PERMIT APPLICATION FOR: [ X] New System [ ] Existing System [ 1 Holding Tank [ ] Innovative [ ] Repair [ ] Abandonment [ ] Temporary [ ] APPLICANT: AGENT: 02N/-1 TELEPHONE: QSrQI MAILING ADDRESS: 53LCl 5 MITL.]4t: LL_ LA'1.IS �1�lAcz: P1 3-L4 cig7 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: 1— BLOCK: H-7 SUBDIVISION: I WIA)J {�-\V�;,Z C-T AjT(' 5 PLATTED: PROPERTY ID #: 3L4oZ-too&-OZNS-!A�1-1& ZONING: I/M OR EQUIVALENT: [ Y / N ] .a-6 PROPERTY SIZE: -A ACRES WATER SUPPLY: [ ] PRIVATE PUBLIC [ ]<=2000GPD [ 1>2000GPD IS SEWER AVAILABLE AS PER 381.0065, FS? [ Y / N, DISTANCE TO SEWER: N/�/ PROPERTY ADDRESS: \ Q-�Z) ( /d32\Orp %IvaL VS16Tar5 - LoA%TU1 - %3Ik 4 1 UT1 S (/yIP�3 y107.M, DIRECTIONS TO PROPERTY: iaRL 71A4"5W Y�L..V� C-r� 7o`�T�1 [�ZI 'u., BUILDING INFORMATION [XI RESIDENTIAL [ ] COMMERCIAL Unit Type of No. of Building Commercial/Institutional System Design No Establishment Bedrooms Area Sqft Table 1, Chapter 64E-6, FAC I 4/lua. Ap-^%LlY (owL � rvO�SF 2 IT14 Unjer Air 3 4 [ ] Floor/Equip t Drains [ ] Other (Specify) DATE: SIGNATURE: DH 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated 64E-6.001, FAC Page 1 of 4 3 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATION APPLICANT: Scott Van Den Braden CONTRACTOR / AGENT: Scott Van Den Branden LOT: 15 BLOCK: 47 SUBDIVISION: Indian River Estates ID#:3402-608-0245-000-8 APPLICATION # AP1407689 PERMIT # 56-SF-1939323 DOCUMENT # SE1163048 TO BE COMPLETED BY ENGINEER, HEALTH DEPARTMENT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEERS MUSTPROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS. PROPERTY SIZE CONFORMS TO SITE PLAN: IX ]YES [ ]NO NET USABLE AREA AVAILABLE: 0.23 ACRES TOTAL ESTIMATED SEWAGE FLOW: 400 GALLONS PER DAY [ RESIDENCES -TABLET / OTHER -TABLE 2 ] AUTHORIZED SEWAGE FLOW: 575.01 GALLONS PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE ] UNOBSTRUCTED AREA AVAILABLE: 1000.00 SQFT UNOBSTRUCTED AREA REQUIRED: 1000.00 SQFT BENCHMARK/REFERENCE POINT LOCATION: Site BM #1 on site plan set mag nail R disc far side of road ELEVATION OF PROPOSED SYSTEM SITE 16.00 [ INCHES / FT ] [ ABOVE / BELOW ] BENCHMARK/REFERENCE POINT THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES SURFACE WATER: FT DITCHES/SWALES: 75 FT NORMALLY WET: [ ]YES [ ]NO WELLS: PUBLIC: FT LIMITED USE: FT PRIVATE: FT NON -POTABLE: FT BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: 5 FT POTABLE WATER LINES: FT SITE SUBJECT TO FREQUENT FLOODING? [ ]YES [X]NO 10 YEAR FLOODING? I ]YES [X]NO] 10 YEAR FLOOD ELEVATION FOR SITE: FT[ MSL / NGVD ] SITE ELEVATION: FT [ MSL / NGVD SOTT. PROFTT.F. TNFORMATTON STTF. I SOIL PROFILE INFORMATION SITE 2 USDA SOIL SERIES:Lawnwood sand Munsell#/Color Texture Depth 1 OYR 4/1 Fill - Sand 0 To 14 1 OYR 5/1 Sand 14 To 19 10YR 611 Sand 16 To 19 1 OYR 2/1 Spodic Material 19 To 32 1 OYR 212 Sand 32 To 36 I OYR 413 Sand 36 To 53 10YR 6/3 Sand 53 To 72 USDA SOIL SERIES:Lawnwood sand Munsell #/Color Texture Depth 1 OYR 4/1 Fill - Sand 0 To 14 10YR 511 Sand 12 To 20 1OYR 6/1 Sand 18 To 22 1OYR 211 Spodic Material 22 To 31 1 OYR 413 Sand 31 To 51 10YR 6/3 Sand 51 To 72 OBSERVED WATER TABLE: 50.00 INCHES [ ABOVE / BEE ] EXISTING GRADE TYPE: [ PERCHED / APPARENT ] ESTIMATED WET SEASON WATER TABLE ELEVATION: 16 INCHES I ABOVE / EELOW ] EXISTING GRADE HIGH WATER TABLE VEGETATION: [ ]YES [X]NO MOTTLING: [X]YES [ ]NO DEPTH: 16.00 INCHES SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: Sand/0.80 DEPTH OF EXCAVATION: DRAINFIELD CONFIGURATION: [XI TRENCH [ ] BED [ ] OTHER (SPECIFY) - REMARKS/ADDITIONAL CRITERIA iWT determined using USDA WSS and soil borings. 10YR 611 stripping in 10YR 5/1 matrix > 10%with diffuse boundaries starting 16" in SB1. SBt 7" below BM. SB2 6" below SM. SITE EVALUATED BY: 1 Ca7lieYWuunter (Title: Environmental Specialist 0 (Florida Department of Health in St. L De 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated: 64E-6.001, FAC 32 INCHES DATE: 04/23/2019 Page 3 of 4 AP1407689 EID1939323 v1A.2