HomeMy WebLinkAboutD O H PAPERWORK,A NJ i a 1019
STATE OF FLORIDA Perstent PERMIT #:
tLuc�0pm'mAPPLICATION #:AP 404163956
DEPARTMENT OF HEALTH DATE PAID:
ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID:
SYSTEM
SCANNED
RECEIPT #:
07 DOCUMENT #: PR1212368
. Lude County :ILE copy
CONSTRUCTION PERMIT FOR: OSTDS New
APPLICANT: Amanda Allih
PROPERTY ADDRESS: 4705 Elm Ave Fort Pierce, FL 34982
LOT: 17 BLOCK:
PROPERTY ID #: 3404-501-0632-000-6
SUBDIVISION: White City
[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 [
1,050 ] GALLONS / GPD SeDtiC New
CAPACITY
A [
] GALLONS / GPD N/A
i CAPACITY
N [
] GALLONS GREASE INTERCEPTOR CAPACITY
[MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [
] GALLONS DOSING TANK CAPACITY [
]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ]
D [ 500 ] SQUARE FEET Drainfield New SYSTEM -
R [ ] SQUARE FEET N/A SYSTEM
A TYPE SYSTEM: [ ] STANDARD [ ] FILLED (XI MOUND
I CONFIGURATION: [XI TRENCH [ I BED [ I
N
F LOCATION OF BENCHMARK: Site SM NW comer of concrete slab orange sl
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DBAINFIELD TO BE
L
D I
0
T
H
E
R
[ 1.00 I[ INCHES FT I[ ABOVE BELOW] BENCHMARK/REFERENCE POINT
[ 13.0011 INCHES FT I[ ABOVE BELOW] BENCHMARK/REFERENCE POINT
LtC.tiUlnl.U: 1Ju.uuf lnu: J YA( VA'11V1V M Wult w: 1 J l3Y l.aGJ
system is sized for 4 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total estimated flow of
gpd.
ve the tank abandoned in accordance with the following procedures:(a) The tank shall be pumped out.(b) The bottom of
tank shall be opened or ruptured, or the entire tank collapsed so as to prevent the tank from retaining water, and(c) The
ik shall be filled with clean sand or other suitable material, and completely covered with soil. Have the system inspected
the health department after it has been pumped and ruptured but before it is filled with sand and covered.
SPECIFICATIONS
Hunter A Collie
TITLE: Environmental Specialist I
APPROVED BY:
N
TITLE: Environmental Specialist I
St. Lucie CHD
Hunter A C ley
DATE ISSUED:
04/17/2019
EXPIRATION DATE:
10/17/2020
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 1404163 SE1161985
NOTICE OF RIGHTS
A partywhose 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.
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St. Lucie County Health Department
H 5150 NW Milner Dr Port Saint Lucie, FL 34983
PAYING -ON: a:56-SF-1933956 BILL Doc a:56-BID-4109284 CONSTRUCTION APPLICATION At: AP1404163
RECEIVED FROM: RJM Custom Homes, Inc AMOUNT PAID: $ 515.00
PAYMENT FORM: CREDIT CARD PAYMENT DATE: 03/20/2019
MAIL TO: Amanda Allih
FACILITY NAME:
PROPERTY LOCATION
4705 Elm Ave
Fort Pierce, FL 34982
17
Lot: Block:
Property ID: 3404-501-0632-000-6
-
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-3887020
IE
9'J.'11
STATE OFFLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
// APPLICATION FOR CONSTRUCTTON PERMTT
APRh.ICATION FOR:
[ /] New System
[ ] Repair
V jj too. 6`- wsLt2)
PERMIT NO.'5(fi-SF-g3-'15154
DATE PAID:
FEE PAID: C
RECEIPT #:
[ ]] Existing System [ ] Holding Tank [ ] Innovative
[ ] Abandonment [ ] Temporary [ ]
APPLICANT: [}'>A .P-U—[
AGENT: —1� 4 C ��5i� H.oir� we TELEPHONE:5(pi—U_� 7--L+
MAILING ADDRESS: Niog--jj S)ITb44! A]Q$ V '3�
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: BLOCK: SUBDIVISION:
PLATTED: UNPLA lrb
PROPERTY ID #: C `L-(-00-40ZONING: I/M OR EQUIVALENT: [ Y /Q]
PROPERTY SIZE: O.Z G, ACRES WATER SUPPLY: [ ] PRIVATE PUBLIC [k ]<=2000GPD [ .]>2000GPD
IS SEWER AVAILABLE AS PER 381.0065, FS? [ Y /Q] DISTANCE TO SEWER: 100 FT
PROPERTY ADDRESS: .!t:7QS ELM
70� Pi'CAE 'E� ��f�,S,
DIRECTIONS TO PROPERTY: 'l'U [ (-�- ��,�j
�r, lAA3��i.(S
EL
�o � Pl��r�E2� 6DRc_�
BUILDING INFORMATION
Unit Type of
No Establishment
1
5Fa
2
3
4
[ ] Floor/Equipment Drains
SIGNATURE:
[x) RESIDENTIAL [ ] COMMERCIAL
No. of Building Commercial/Institutional System Design
Bedrooms Area Sqft Table 1, Chapter 64E-6 FAC
h7Z
L1 per 6 ►p an
[ ] Other (Specify)
DH 4015, 08/09 (Obsoletes previous editions which may not be used)
Incorporated 64E-6.001, FAC
DATE: _21! 6 0
Page 1 of 4
DDcuSign Envelope 10: 8893EC39-E1AD4584-9D95-65A'95D8DA80
REGEIVE�
Page 16of16VQ
��1059
Mp oepa��eot
• Letter of Authorization Vat St. `�'e. Cp0ncY
• FIB.` ��r�
This letter shall serve as certification that the Owners of the property listed below have authorized
RJM Custom Homes, Inc. to apply for any and all applicable permits for the construction of a
new single-family residence.
Lot/PCN #: 3404-501-0632-000-6
Address: 4705 Elm Ave, Fort Pierce, FL 34982 SCANNED
--- --- BY
M Luclp County
eD.IcneQdUbyi:
Buyer
� --
�eezcnsTFes�asz..
Date: 2/5/2019
DxuSyxtl by: ((..
eoBtlye T882CASTFfi91<BY...
Date: 2/5/2019
aus LI
MER(5)
REVISED 06.08.18
CONTRACI"OR NITIALS
DOCuSign Envelope ID: 8893EC39-E1AD-4584-9095-65:i795DSDASO
Page 16 of 16
Letter of Authorization
This letter shall serve as certification that the Owners of the property listed below have authorized
RYM Custom Homes, Lie. to apply for any and all applicable permits for the construction of a
new single-family residence.
Lot/PCN It: 3404-501-0632-000-6
Address: 4705 Elm Ave, Fort Pierce, FL 34982
oocLusleoege/by:
ivu
Buyer i882CA51F891482.
Dato: 2i 5/2019
e sig�.d by
WaeF�QUiG
CoBuy*-7881CA57F8Q.4.2...
Date: 2/5/2019
a
as
R(S)
REVISED 06MAR
CDNTRACTOfl NITIALS
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATION
APPLICANT: Amanda Allih
CONTRACTOR / AGENT:
LOT: 17
RJM Custom Homes. Inc
BLOCK:
SUBDIVISION: White City ID#: 3404-501-0632-000-6
APPLICATION # AP1404163
PERMIT # 56-SF-1933956
DOCUMENT # SE1161985
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: 0.86 ACRES
TOTAL ESTIMATED SEWAGE FLOW: 400 GALLONS PER DAY [ RESIDENCES -TABLET / OTHER -TABLE 2 ]
AUTHORIZED SEWAGE FLOW: 2150.02 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 SM NW
j
ELEVATION OF PROPOSED SYSTEM SITE 1.00 [I
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: FT NORMALLY WET: [ ]YES [X]NO
WELLS: PUBLIC: FT LIMITED USE: FT PRIVATE: FT NON -POTABLE: 50 FT
BUILDING FOUNDATIONS: 10 FT PROPERTY LINES: 15 FT POTABLE WATER LINES: FT
SITE SUBJECT TO FREQUENT FLOODING? [ ]YES [X]NO 10 YEAR FLOODING? [ ]YES [X]NO]
10 YEAR FLOOD ELEVATION FOR SITE: FT MSL / NGVD ] SITE ELEVATION: FT [ MSL / NGVD
SnTT. RRnFTT.E TNEnRMATTON SITE 1 SOIL PROFILE INFORMATION SITE 2
USDA SOIL SERIES:Ankona sand
Munsell #/Color Texture
Depth
1 OYR 4/1
'Sand
0 TO 18
7.5YR 4/6
CMN/PRM RF
12 To 35
10YR 4/1
Sandy Loam
18 To 35
1OYR 2/2
Spodic Material
35 To 39
7.5YR 4/2
Loamy Fine Sand
39 To 43
7.5YR 416
CMN/PRM RF
39 To 68
7.5YR 4/2
Sandy Clay Loam
43 To 54
I OYR 611
Sandy Loam
54 To 68
10YR 4/1
Fine Sand
68 To 72
USDA SOIL SERIES:Ankona sand
Munsell#/Color Texture
Depth
1 OYR 4/1
Sand
0 To 9
1 OYR 711
Fine Sand
9 To 20
10YR 6/1
Fine Sand
20 To 41
10YR 212
Spodic Material
41 To 46
7.5YR 4/2
Loamy Fine Sand
46 To 54
7.5YR 4/6
CMN/PRM RF
46 To 68
7.5YR 4/2
Sandy Clay Loam
54 To 61
1 OYR 6/1
Sandy Loam
61 To 68
1OYR 411
Fine Sand
68 To 72
OBSERVED WATER TABLE: INCHES [ ABOVE / BELOW ] EXISTING GRADE TYPE: [ PERCHED / APPARENT ]
ESTIMATED WET SEASON WATER TABLE ELEVATION: 12 INCHES [ ABOVE / BELOW ] EXISTING GRADE
HIGH WATER TABLE VEGETATION: [ ]YES IXINO MOTTLING: [X]YES [ ]NO DEPTH: 12.00 INCHES
SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: Sand/0.80 DEPTH OF EXCAVATION:
DRAINFIELD CONFIGURATION: [X ] TRENCH [ ] BED L ] OTHER (SPECIFY)
REMARKS/ADDITIONAL CRITERIA
WSWT determined using USDA WSS and soil borings. 7.5YR 416 CMN Prom RF mottling in 10YR 4/1 matrix > 2% starting at 12" in
9B1. SB1 1" above BM. S62 3" below BM.
SITE EVALUATED BY:
-Collier, Hunter (Title: Environmental Spe`c(a(ist Q?Mrida Department of Health in St L
DH 4015, 08/09 (Obsoletea previous editions which may not he used) Incorporated: 64E-6.001, FAC
INCHES
DATE: 04/16/2019
Page 3 of 4
AP'1404163 EID1933956 V 1.0.2