HomeMy WebLinkAboutD O H PAPERWORKSTATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
PERMIT #:56-SF-1947619
SeCojEo APPLICATION #:AP1413003
DATE PAID:
FEE PAID:
Pevmje
je
on p' '- RECEIPT #:
St.St.St.je DOCUMENT #: PR1227573
NOV ,I 1 q0 %
CONSTRUCTION PERMIT FOR: OSTDS New SCANNED
APPLICANT: (Adams Homes of Northwest Florida, Inc) BY
PROPERTY ADDRESS: 5913 Balsam Dr Fort Pierce, FL 34982 sthibleemit
LOT: 23 & 24 BLOCK: 87 SUBDIVISION: Indian River Estates
PROPERTY ID #: 3402-610-0519-000-7 [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 Septic 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 ERE #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 DO MOUND [ ]
TRENCH [ ] BED [ ]
site BM -paint "X" CL of rd, center of
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE
L
D FILL REQUIRED: [23 00, INCHES
[ 6.00 1 [1 INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT
[ 1.00 ][ INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT
.n .Vv XlUN x S4UIM u: L II.VV J INCHES
The system is sized for 4 bedrooms with a maximum occupancy of 8 persons (2 per bedroom), for a total estimated flow of
0 400 gpd.
T
E 1•�
R \rn
SPECIFICATIONS BY: I
Brian J In r
g V
E:
TITLE: Environmental Specialist
I
.A,
APPROVED BY:
Brian J In
TLE: Environmental Specialist II
St.
Lucie CHU
DATE ISSUED: 05/22/2019
EXPIRATION DATE:
11/22/2020
DH 4016, 08/09 (Obsolates all previous editions which may not be used)
Incorporated: 64E-6.003, PAC Page 1 of 3
v 1.1.4 AU1413003 SE1176935
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
ort a 5150 NW Milner Dr Port Saint Lucie, FL 34983
HEALTH
PAYING ON: #:56-SF-1947619 13ILLDOC#:56-BID-4181650 CONSTRUCTION APPLICATION #: AP1413003
RECEIVED FROM: Atlantic Land Designs of the TC AMOUNT PAID: $ 515.00
PAYMENT FORM: CHECK 165959 PAYMENT DATE: 05/08/2019
MAIL TO: (Adams Homes of Northwest Florida, Inc)
FACILITY NAME: _
PROPERTY LOCATION:
5913 Balsam or
Fort Pierce, FL 34982
23 & 24 87
Lot: Block:
Property ID: 3402-610-0519-000-7
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-3934930
4 STATE OF FLORIDA
DEPARTMENT OF HEALTH
pi ONSITE SEWAGE TREATMENT AND DISPOSAL
.� SYSTEM
APPLICATION FOR CONSTRUCTION PERMIT
PERMIT NO.Q- -�����`�
DATE PAID: rj 1.1
FEE PAID: -461,vs
RECEIPT #: a 'j9a
APPLICATION FOR:
I✓] New System [ ] Existing System [ ] Holding Tank [ 1 Innovative
I 1 Repair [ 1 Abandonment [ 1 Temporary [ ]
APPLICANT: Adams Homes of Northwest Florida, Inc
AGENT: Atlantic Land Designs of the Tc, Inc. TELEPHONE: 772-398-4290
MAILING ADDRESS: PO Box 1421 Jensen Beach, Florida 34958 Email - ALD5543@Gmail.com
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: 23 BLOCK: 87 SUBDIVISION: Indian River Estates Unit 9
PROPERTY ID #: 3402-610-05I9-000-7
PLATTED: 1956
ZONING: RS-4 I/M OR EQUIVALENT: [ No ]
PROPERTY
SIZE: 0.24
ACRES WATER
SUPPLY:
[
] PRIVATE
PUBLIC [,/]t=2000GPD [
1>2000GPD
IS SEWER
AVAILABLE AS
PER 381.0065,
FS? [
No
1
DISTANCE TO SEWER:
N/A FT
PROPERTY ADDRESS: 5913 Balsam Drive
DIRECTIONS TO PROPERTY: See attached
BUILDING INFORMATION
Unit Type of
No Establishment
1 Residential
2
3
4
I 1 Floor/Equipment Drains
SIGNATURE:
DH 4015, 08/0 —0dbsoletes
Incorporated 64E-6.001, FAC
[✓] RESIDENTIAL [ ] COMMERCIAL
No. of Building Commercial/Institutional System Design
Bedrooms Area Scrft Table 1, Chapter 64E-6 FAC
4 1760 UA
[ ] Other (Specify)
DATE:
editions which may not be used)
Page 1 of 4
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATION
APPLICANT: Adams Homes of Northwest Florida, Inc
CONTRACTOR / AGENT: _Atlantic Land Designs Of the TC
LOT: 23 & 24 BLOCK: 87
SUBDIVISION: Indian River Estates ID#:3402-610-0519-000-7
APPLICATION # AP1413003
PERMIT # 56-SF-1947619
DOCUMENT #SE1176935
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: 0.23 ACRES
TOTAL ESTIMATED SEWAGE FLOW: 400 GALLONS PER DAY [ RESIDENCES-TABLEI / 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
ELEVATION OF PROPOSED SYSTEM SITE 6.00
center of
/ FT ] [ ABOVE /I BELOW I] 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 [X]NO
WELLS: PUBLIC: FT LIMITED USE: FT PRIVATE: 75 FT NON -POTABLE: 75 FT
BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: 5 FT POTABLE WATER LINES: 63 FT
SITE SUBJECT TO FREQUENT FLOODING? [ ]YES EX ]NO 10 YEAR FLOODING? [ ]YES [X]NO]
10 YEAR FLOOD ELEVATION FOR SITE: FT[ MSL / NGVD ] SITE ELEVATION: FT [ MSL / NGVD
1TE
USDA SOIL SERIES:WaV11and Fine send
Munsell #/Color
Texture
Depth
10YR 211
Organic & Mineral
0 To 6
10YR 3/1
Sand
6 To 11
10YR 5/1
Sand
11 To 29
1 OYR 6/1
Sand
19 To 29
10YR 52
Sand
29 To 52
HOLE CAVING
Refusal
52 To 72
AnTT. PPnFTT.R TTIPnPMTmrnv c
USDA SOIL SERIES:Waveland fine send
Munsell #/Color Texture
Depth
1 OYR 311
Loamy Sand
0 TO 11
10YR 5/1
Sand
11 To 33
10YR 611
Sand
22 To 36
1 OYR 6/3
Sand
36 To 54
HOLE CAVING
Refusal
54 To 72
OBSERVED WATER TABLE: 27.00 INCHES [ ABOVE
/
BELOW
] EXISTING GRADE TYPE:
[ PERCHED / APPARENT ]
ESTIMATED WET SEASON WATER TABLE ELEVATION:
19
INCHES [ABOVE /
eELOW
]
EXISTING GRADE
HIGH WATER TABLE VEGETATION: EX ]YES [
]NO
MOTTLING: [X]YES [ ]NO
DEPTH: 19.00 INCHES
SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING:
Sand/0.80 DEPTH OF EXCAVATION: 11
DRAINFIELD CONFIGURATION: [X] TRENCH [
] BED
[ ] OTHER (SPECIFY)
INCHES
REMARKS/ADDITIONAL CRITERIA
WSWT determined using USDA WSS and soil borings.
S6 stripped matrix. 10YR6H stripping in 10YR511 matrix>10% with diffuse boundaries starting at 19" in S61.
SB1 6" below SM. SB2 3" below BM.
IITE EVALUATED BY:
Ingram, Brian
H 4015, 08/09 (Obsoletes previous editions v
ronmental Specialist 11) (ENVIRONMENTAL HEALTH)
not be used) Incorporated: 64E-6.001, FAC
DATE, 05114/2019
Page 3 of 4
AP1413003 EID1947619
v 1.0.2
. 4i: ' �e� STATE OF FLORIDA PERMIT #. 56-Si-►y47lo14
r DEPARTMENT OF HEALTH
' ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
. K SITE EVALUATION AND SYSTEM SPECIFICATIONS
APPLICANT: Adams Homes of Northwest Florida, Inc AGENT: Altnatic Land Designs of the TC Inc
LOT: 23 BLOCK: 87 SUBDIVISION: Indian River Estates Unit 9
PROPERTY ID # : 3402-610-0519-000-7 [ Section/Township/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: VI YES [ ] NO NET USABLE AREA AVAILABLE: 0.24 ACRES
TOTAL ESTIMATED SEWAGE FLOW: GALLONS PER DAY [RESIDENCES -TABLE I/OTHER-TABLE2 ]
UNOBST
AUTHORIZED UCT SEWAGE FLOW: GALLONS PER DAY [I500 GPD/ACRE OR 2500 GPD/ACRE ]
UNOBSTRUCTED AREA AVAILABLE: 2000 SQFT UNOBSTRUCTED AREA REQUIRED: SQFT
BENCHMARK/REFERENCE POINT LOCATION: Center Line of Lot Centerline of Road
ELEVATION OF PROPOSED SYSTEM SITE IS [ INCHES/FT ] [ABOVE/BELOW] BENCHMARK/REFERENCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES
SURFACE WATER: 100 FT DITCHES/SWALES: 15 FT NORMALLY WET? [ ] YES [✓] NO
WELLS: FT LIMITED USE: 100 FT PRIVATE: 75 FT NON -POTABLE: 50 FT
BUILDINGG FOUN FOUNDATIONS: 7 FT PROPERTY LINES:I1 FT POTABLE WATER LINES:100 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
SOIL PROFILE INFORMATION SITE 1
MUNSELL #/COLORiaTO
TO
USDA SOIL SERIES: TO
MUNSELL #/COLOR TEXTURE DEPTH
TO
TO
TO
TO
TO
TO
TO
TO
USDA SOIL SERIES: TO
OBSERVED WATER TABLE: INCHES [ABOVE/BELOW '] EXISTING GRADE. TYPE: [PERCHED/APPARENT ]
ESTIMATED WET SEASON WATER TABLE ELEVATION: INCHES [.ABOVE/BELOW ] EXISTING GRADE
HIGH WATER TABLE VEGETATION: I ] YES I ] NO MOTTLING: [ ] YES I ] NO DEPTH: INCHES
SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING:
DRAINFIELD CONFIGURATION: I ] TRENCH [ ]
REMARKS/ADDITIONAL CRITERIA:
SITE EVALUATED BY
BED
DEPTH OF EXCAVATION: INCHES
[ ] OTHER (SPECIFY)
DH 4015, 08/09 (Obsoletes Previous editions which may not be used) Incorporated: 64E-6.001, FAC
Page 3 0£ 4
Property Card -1 Page 1 of 1
56-51=— I°147,(i
Michelle Franklin, CFA -- Saint Lucie County Property Appraiser -- All rights reserved.
Property Identification
Site Address: 5913 Parcel ID: 3402-610-0519- Account #: 38625 Sec/Town/Range:
BALSAM DR 000-7
Map ID: 34/12S Zoning: RS-4
12/36S/40E
Use Type: 0000 Jurisdiction: Saint
Lucie
County
Ownership
Legal Description
Adams Homes of Northwest Florida Inc
INDIAN RIVER ESTATES -UNIT 09- BLK 87 LOT 23 (MAP
3000 Gulf Breeze PK W Y
34/12S)
Gulf Breeze, FL 32563
Current Values
Historical Values 3-year
Just/Market: $10,000 Assessed: $7,245
Year Just/Market Assessed Exemptions
Taxable
Exemptions: $0 Taxable: $7,245
2018 $10,000 $7,245 $0
$7,245
2017 $9,400 $6,587 $0
$6,587
2016 $9,400 $5,989 $0
$5,989
Date
12-14-2018
07-13-2005
08-22-2003
View:
Year Built: N/A
Primary Wall:
Bedrooms: 0
Full Baths: 0
Half Baths: 0
Book/Page
4215/1418
2302/2461
1793/0890
Type
Roof Cover:
Frame:
Story Height.
Sale History
Sale Code Deed Grantor
0001 WD Minotti Homes Inc
XX00 WD Barlow Kimberly C
XX01 QC Barlow Kimberly C
Primary Building Information
Finished Area of this building: 0 SF
Gross Sketched Area: 0 SF
Exterior Data
Roof Structure:
Grade:
No. Units: 0
Interior Data
A/C %: 0%
Electric:
Heated %: N/A%
Heat Type:
Sprinkled %: 0%
Heat Fuel:
Price
$18,000
$53,000
$4,300
Building Type:
Effective Year: 2014
Secondary Wall:
Primary Int Wall:
Avg HgttFloor: 0
Primary Floors:
Total Areas
t''• Finished/UnderAir 0
(SF):
Area 0 j
Gross Sketched (SF):
Land Size (acres): 0.23
Land Size (SF): 10,000
Total Building Count: I
Special Features and Yard Items
Qty Units Year Blt
All information is believed to be correct at this time, but is subject to change and is provided without any warranty.
Co
® Copyright 2019 Saint Lucie unty Property Appraiser. All rights reserved.
)S://paslc-dev.org/RECard/ 5/8/2019