HomeMy WebLinkAboutD O H PAPERWORKSTATE OF FLORIDA
_ DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
'.Y CONSTRUCTION INSPECTION AND FINAL APPROVAL
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APPLICATION #: API 159393
PERMIT #:56-SF-1559475
DOCUMENT #:FI1044493
DATE PAID:09/10/2014
FEE PAID:515.00
RECEIPT #:56-PID-2511810
APPLICANT: Rodolfa Vega and Carmen Hernandez
AGENT: Roland Rollins SGAAINEE).
PROPERTY ADDRESS: 904 Osceola Dr Fort Pierce, FL 34982 p�7 RV
LOT: BLOCS: St Lucie Count •
SUBDIVISION: xD#: 3409-411-0004.000-4 'lJ 11/
CHECKED [Xl ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED.
TANK INSTALLATION
SETBACKS
[ ]
[011
TANK SIZE [1] 1537.00 [23
[
] [271
SURFACE WATER
FT
[ ]
[021
TANK MATERIAL Polyethylene
[
] [281
DITCHES
FT
[ ]
[031
OUTLET DEVICE
[
1 1291
PRIVATE WELLS 90
FT
[ ]
[043
MULTI -CHAMBERED [L_12 N ]
[
] (301
PUBLIC WELLS
FT
[ 1
[053
OUTLET FILTER Polylok PL-68
[
] [311
IRRIGATION WELLS
FT
I 1
[061
LEGEND 1. 70VA43-16DC4 2.
[
] [321
POTABLE WATER 25
£T
[ ]
[071
WATERTIGHT
[
1 [331
BUILDING FOUNDATIONS 7
FT
[ ]
(081
LEVEL
[
1 [341
PROPERTY LINES 18
FT
[ ]
[091
DEPTH TO LID
[
1 [351
OTHER
FT
DRAINFIELD INSTALLATION
FILLED / MOUND SYSTEM
[ ]
[101
AREA [1] 1080 [21 SQFT
[
] [361
DRAINFIELD COVER
[ ]
(113
DISTRIBUTION BOX HEADER x
[
] [371
SHOULDERS '
[ ]
[123
NUMBER OF DRAINLINES 1. 15.00 2.
[
1 [381
SLOPES
[ 1
[131
DRAINLINE SEPARATION
[
] [391
STABILIZATION 03/18/2016
[ 1
1143
DRAINLINE SLOPE
[ 3
[157
DEPTH OF COVER
ADDITIONAL INFORMATION
[ ]
[161
ELEVATION [ ABOVE / BELOW ]BM 16_00
[
] 1403
UNOBSTRUCTED AREA
I 1
[171
SYSTEM LOCATION
[
] [413
STORMWATER RUNOFF
[ 1
[181
DOSING PUMPS 1.00
[
] [421
ALARMS
[ 1
[191
AGGREGATE SIZE
[
1 [431
MAINTENANCE AGREEMENT
[ 1
[20]
AGGREGATE EXCESSIVE FINES
[
] 1441
BUILDING AREA
[ ]
[211
AGGREGATE DEPTH
[
] [451
LOCATION CONFORMS WITH SITE PLAN
FILL
/ EXCAVATION MATERIAL
1
1 [463
FINAL SITE GRADING
[ 1
[221
FILL AMOUNT
[
] [471
CONTRACTOR Abner Leyva(Leyva Plumbin
[ 3
1231
FILL TEXTURE
[
1 1481
OTHER INFILTRATOR Quick4 EQ36 (single
[ ]
[241
EXCAVATION DEPTH
ABANDONMENT
[ ]
[253
AREA REPLACED
[
1 [491
TANK PUMPED
[ ]
[261
REPLACEMENT MATERIAL
[501
TANK CRUSHED G FILLED
Cc —ants:
Comments are on pass 2.
CONSTRUCTION I APPROVED /
DISAPPROVED ):
FINAL SYSTEM [ AppROVED / DISAPPROVED ];
(Explanation of violations on fallowing page)
St. Lucie CHU DATE: 11/09/2015
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, SAC
EH Database v 1.0.1 AP1159393 EID1559475
CUD DATE: 03/18/2016
Page 2 of 3
n+ssr+F APPLICATION #.AP1159393
STATE OF FLORIDA PERMIT #:56-SF-1559475
DEPARTMENT OF HEALTH DOCUMENT #:FI1044493
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION INSPECTION AND FINAL APPROVAL DATE PAID:09/10/2014
FEE PAID:515.00
RECEIPT #:56-PID-2511810
Violation Number Comment
Comments
The system is sized for 5 bedrooms with a maximum occupancy of 10 persons (2 per bedroom), for a total estimated Flow of
580 gpd.
No violations, system ok to cover. Contractor notified onsite.
NEEDS FINAL INSPECTION FOR STABILIZATION AND ALARMS.
Final inspection ok
emailed.to contractor and to SLC building
DR 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC Page 2 of 3
EH Dambnso v 1.0.1 AP1159393 EID1559475
STATE OF FLORIDA /�7C
DEPARTMENT OF HEALTH PERMIT ] . -� - 1 �yq T J
"' ^! ONSITE SEWAGE ij1RF'a1 MElNT AND DISPOSAL SYSTEM
^�yc' SITE EVALUATION AND SYSTEM SPECIFICATIONS
• . ....U": SUBDIVISION: I
:OPERTY ID a:�4f fl-, i (I "&oYl'opn^[Section/Township/Parcel No. or Tax ID Number]
BE COMPLETED BY ENGINEER, HEALTH'DEPARTMENT EMPLOYEE, OR OTEER QUALIFIED PERSON. ENGINEERS
ST PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE AT,L ITEMS
DPERTY SIZE CONFORMS TO SITE PLAN: YES [ ] NO NET USABLE AVl+TT•AnLE: SS ACRES
TAL ESTnQaRD SEWAGE FLOW: GALLONS PER DAY SIDENCEA=LE _/OTHER-TAIME2]
THORIZED SERAGE BLOW: GALLONS PER DAY • FIB 'ACNE OR GPD A
DBSTRIICTED AREA AVAIL -ABLE: �,5(L}ij SQFT UNOBSTRUCTED AREA REQUIRED: SQFT
:2CHMARK/REFERENCE POIrIT LOCATION: „kA vM. " Ii M
'sVATION., OF PROPOSED SYSTEM SITE IS_ 1(o [Il4 /FT]
MINIMUM SETBACK WHICH CAN BE igyINmAXNED PROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES
MACE mama:�_FT DITCHES/SRAIES:. 1�] FT NORMALLY WET? [ ] YES _[ ] NO
ME: PUBLIC: FT LIMITED USE: FT PRIV-ZM. `75 FT NON. -POTABLE: V
CEDING FOUNDATIONS: _FT PROr.m _inns: 1,C) FT POTABLE WATER Ln'zis:Lji�y FT
Ti SUBJECT TO FREQUENT EZOODING: [ ] YES [st/ NO 10 YEAR FLOODING? [ ] YES NO
YEAR FLOOD ELEVATION FOR SITE: - FT MSL/NGVD SITE ELEVATION: FT'MSL/NGVD
1
ISDA SOIL SERIES:'
TO
TO
USDA SOIL
R`Fl4Ya�5-
Y 1 1
�I.L nil�� • •
TO
ERVED WATER TABLE: 50_ INCHES [ABOVE / O EXISTING GRADE: Tim:[PERCHED / • ARENT
T1omD-WET SEASON WATER TABLE ELEVATION: INCHES [ABOVE / LO .EXISTING GRADE
H WATER TABLE VEGETATION: [ ] YES [ ] NO MOTTLING: [,�f YES [ ] NO DEPTH:94INCHES
L TEXTURE/LOADING RATE FOR SYSTEM SIZING:DEPTH OF EXCAVATION: INCHES
INFIELD CONFIGURATION: [ ] TRENCH 1A BED [ ] OTHER (S ECIM
ARKS/ADDITIONAL CRITERIA: Vt/Q j V •'I'A I.P
1Z ■•_YR
ME
101S, D8/09 (obsoletev Previous editions wbich may not be used) Ineotpmated: 64E6.007,FAC
Page 3 of 4
0p 5t, STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
PERMIT #. 1 ss4147 5
APPLICANT:RODOLFO VEGA AGENT:RODOLFO VEGA
LOT: BLOCK: SUBDIVISION:
PROPERTY ID # : 9/36/3409-411-0004-000-4 [ SectionlTownsh]p/Parcel No. or Tax ID Number
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:
[✓] YES [ ]
NO NET USABLE AREA AVAILABLE: 2.285
ACRES
TOTAL ESTIMATED SEWAGE FLOW:
GALLONS
PER DAY [RESIDENCES-TA13LE1/OTBER-TABLE2
]
AUTHORIZED SEWAGE FLOW:
GALLONS
PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE
]
UNOBSTRUCTED AREA AVAILABLE:
SQFT
UNOBSTRUCTED AREA REQUIRED:
SQFT
BENCHMARK/REFERENCE POINT LOCATION: SITE BENCHMARK ONE (SEE SURVEY)
ELEVATION OF PROPOSED SYSTEM SITE IS1.5 [PT ] [ABOVE ] BENCHMARK/REFERENCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES
SURFACE WATER: 75 FT DITCHES/SWALES:15 FT NORMALLY WET? [ ] YES [ ] NO
WELLS: PUBLIC: 200 FT LIMITED USE:100 FT PRIVATE: 75 FT NON -POTABLE: 50 FT
BUILDING FOUNDATIONS:5 FT PROPERTY LINES:10 FT POTABLE WATER LINES:10 FT
SITE SUBJECT TO FREQUENT FLOODING: [ ] YES [ ] NO 10 YEAR FLOODING? [ ] YES [ ] NO
10 YEAR FLOOD ELEVATION FOR SITE: FT MSL/NGVD SITE ELEVATION: FT MSL/NGVD
TEXTURE DEPTH
TO
mo
1V
TO
TO
TO
TO
USDA SOIL SERIES:
A'V1L exyz'1LCi 1nzm�xiya "X& G
MUNSELL #/COLOR TEXTURE
USDA SOIL SERIES:
DEPTH
TO
TO
TO
TO
TO
TO
TO
TO
TO
OBSERVED WATER TABLE: INCHES [ABOVE/BELOW 11 EXISTING GRADE. TYPE: I PERCHED /APPARENT ]
ESTIMATED WET SEASON WATER TABLE ELEVATION: INCHES [.ABOVE/BELOW ] EXISTING GRADE
HIGH WATER TABLE VEGETATION: [ ] YES [ ] NO MOTTLING: [ [ YES [ ] NO DEPTH: INCHES
SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: DEPTH OF EXCAVATION
DRAINFIELD CONFIGURATION: [ ] TRENCH [ ] BED ] OTHER (SPECIFY)
REMARKS ADDITIONAL CRITERIA'
SITE EVALUATED BY:
09/O8/2014
INCHES
DH 4015, 12/11 (Obsoletes previous editions rhich may not be used) Incorporated: 64E-6.001,FAC Page 3 of 4
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRVCTION PERMIT
CONSTRUCTION PERMIT FOR: OSTDS New
APPLICANT: Rodolfa Vega and Carmen Hernandez
PROPERTY ADDRESS: 904 Osceola Dr Fort Pierce, FL 34982
LOT:
BLOCK:
PROPERTY xD #: 3409-411-0004-000-4
SUBDMSION:
PERMIT #:56-SF-1559475
APPLICATION #:AP1159393
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR960454
[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 [ 1.350 1
GALLONS / GPD
Septic
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 [ 967 ] SQUARE FEET
SYSTEM
R [ ] SQUARE FEET
N/A
SYSTEM
A TYPE SYSTEM: [ ] STANDARD
[ ] FILLED
[X] MOUND [ ]
I CONFIGURATION: [ ] TRENCH
EX] BED
[ ]
N
F LOCATION OF BENCHMARK: nail In washer In
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE
L
D E
O
T
H
E
R
[ 16.0011 INCHES FT ][ ABOVE BELOW] BENCHMARK/REFERENCE POINT
[ 16.0011 INCHES FT ][ ABOVE P BELOW] BENCHMARK/REFERENCE POINT
ai,i, „ Wuln w: L-lo.uul +Vuncc r;AUJv"X' un uYUiuU: L OO.uu J im.nac
The system is sized for 5 bedrooms with a maximum occupancy of 10 persons (2 per bedroom), for a total estimated flow
of 580 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.
excavated material.
SPECIFICATIONS BY: Ch tale Potts TITLE: Environmental Specialist II
APPROVED BY: Sup 11
Victor Faconti
DATE ISSUED: 09/15/2014 L , EXPIRATION DATE:
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC
v 1.1.4 M1159393 SE938419
St. Lucie CHD
03/15/2016
Page 1 of 3
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 # A02, Tallahassee, Florida 32399-1703. The
Agency Clerk's facsimile number is 850-410-1448.
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.
DOCUMENT ft: PR950454
The bottom of the tank shall be opened or ruptured, or the entire tank collapsed so as to prevent the tank from retaining
ter, and(c) The tank shall be filled with clean sand or other suitable material, and completely covered with soil.Have the
stem inspected by the health department after it has been pumped and ruptured but before it is filled with sand and covered.
must be abandoned in conjunction with new system installed to avoid reinspection fees
STATE OF FLORIDA
r DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
APPLICATION FOR CONSTRUCTION PERMIT
APPLICATION FOR:
PERMIT NO.
DATE PAID:
FEE PAID:
RECEIPT #:
[✓] New System [ ] Existing System [ ] Holding Tank [ ]
[ ] Repair [ ] Abandonment - [ ] Temporary [ ]
APPLICANT: RODOLFO VEGA AND CARMEN HERNANDEZ
AGENT: RODOLFO VEGA
14AILING ADDRESS: 712 NW GRENADA STREET, PORT ST. LUCIE, FLORIDA 34983
Innovative
TELEPHONE: 772-240-3648
TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. SYSTEMS 1
BY A PERSON LICENSED PURSUANT TO 489.105(3)(m) OR 489.552, FLORIDA STATI
APPLICANT'S RESPONSIBILITY TO PROVIDE DOCUMENTATION OF THE DATE THE LOT
PLATTED (MM/DD/YY) IF REQUESTING CONSIDERATION OF STATUTORY GRANDFATHER
PROPERTY INFORMATION
LOT: BLOCK: SUBDIVISION:
PROPERTY ID #: 3409-411-0004-000-4
PLATTED:
ZONING: I/M OR EQUIVALENT: [ No ]
PROPERTY SIZE: 2.285 ACRES WATER SUPPLY: [ ] PRIVATE PUBLIC [✓]<=2000GPD [ ]>2000GPD
IS SEWER AVAILABLE AS PER 381.0065, FS? [ No ] DISTANCE TO SEWER: FT
PROPERTY ADDRESS: 904 OSCEOLA DRIVE, FORT PIERCE, FLORIDA 34982
DIRECTIONS TO PROPERTY: GO TO U.S. HIGHWAY NO. ONE TO MIDWAY ROAD AND GO WEST TO CITRUS AVE.
AND GO SOUTH TO OSCEOLA DRIVE AND GO EAST TO THE END OF THE CUL-DE-SAC AND CONTINUE EAST
ALONG A ROCK ROAD TO THE PROPERTY ON THE LEFT.
BUILDING INFORMATION [✓] RESIDENTIAL [ ] COMMERCIAL
Unit Type of
No Establishment
1 SINGLE
2
3
4
No. of Building Commercial/Institutional System Design
Bedrooms Area Sqft Table 1, Chapter 64E-6, FAC
5 5071
[ ] Floor/Equipment Drains [ ] Other (Specify
SIGNATURE:
WNWITi
`~W'. g„ f
rt
DATE: 09/08/2014
DH 4015, 08/09 (Obsoletes previous editions which may not be used)
Incorporated 64E-6.001, PAC
Page 1 of 4