HomeMy WebLinkAboutD O H PAPERWORKSTATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DIS
SYSTEM
SCANNED
BY
St. Lucie c®UPliv
CONSTRUCTION PERMIT FOR: OSTDS New
APPLICANT: (Groza Builders, Inc)
PROPERTY ADDRESS: 4419 Pressler Ln Fort Pierce. FL 34982
PERMIT #:56-SF-1984271
APPLICATION #:AP1429741
DATE PAID:
PAID:
S E P 10 'J;y DOCUMENT #: PR1250355
ST, woe? Eount.y, Perm Itting
LOT: 4 & 5 BLOCK: 1 SUBDIVISION: Cardinal Glades
PROPERTY ID #: 2434-802-0004-000-9 [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 I 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 [ 500 ] SQUARE FEET Drainfleld New SYSTEM
R [ ] SQUARE FEET N/A SYSTEM
A TYPE SYSTEM: [ ] STANDARD [ ] FILLED [x] MOUND
I CONFIGURATION: [ ] TRENCH [x] BED [ ] _
N
F LOCATION OF BENCHMARK:
Site BM set nail near east EoP (a) the south PL
I ELEVATION OF PROPOSED SYSTEM SITE
[ 0.00 1 [1 INCHES
FT I [I ABOVE
BELOW] BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE
[ 17.0011 INCHES
FT ][ABOVE
BELOW] BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: [35.001 INCHES
EXCAVATION REQUIRED: [
] INCHES
The system is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total estimated Flow of
0 300 gpd.
T
H
E
R
File COPY
SPECIFICATIONS BY: Brian Davis
� TITLE: Master Septic Tank Contractor
pJJ APPROVED BY: Y`ri J�V. k TITLE: Environmental Specialist I St. Lucie CHD
Hunter A Collier
DATE ISSUED: 08/2812019 EXPIRATION DATE: 02/28/2021
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 AP1429741 SE1199563
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.
`t�Ptota
HEALTH
PAYING ON:
RECEIVED FROM
PAYMENT FORM:
St. Lucie County Health Department
5150 NW Milner Dr Port Saint Lucie, FL 34983
#: 56-SF-1984271 BILL DOC #:56-BID-4362303 CONSTRUCTION APPLICATION #: AP1429741
Brian Davis Septic AMOUNT PAID: $ 545.00
CREDIT CARD 041751 PAYMENT DATE: 08/2012019
MAIL TO: (Groza Builders, Inc)
FACILITY NAME:
PROPERTY LOCATION:
4419 Pressler Ln
Fort Pierce, FL 34982
4&5
Lot:
Property ID: 2434-802-0004-000-9
EXPLANATION or DESCRIPTION:
1
Block:
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
$
45.00
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-4065107
St. Lucie County Health Department
HEALTH 5150 NW Milner Dr Port Saint Lucie, FL 34983
PAYING ON: a: BILL Doc#:56-BID-4335997
RECEIVED FROM: American Drilling AMOUNT PAID: $ 230.00
PAYMENT FORM: CREDIT CARD 0022427 PAYMENT DATE: 08/12/2019
MAIL TO: American Drilling
405
Okeechobee FL 34974
FACILITY NAME: American Drilling
PROPERTY LOCATION:
405
Okeechobee FL 34974
Lot:
Property ID: _
-1 - Well Construction
EXPLANATION or DESCRIPTION:
Block:
QUANTITY FEE
2 $ 230.00
RECEIVED BY: VanceMH AUDIT CONTROL NO. 56-PID-4052279
Note:59-29845 59-29846
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM `
APPLICATION FOR CONSTRUCTION PERMIT
-A ION FOR:
] New Syst
[ ] pair
[ ] Existing System
[ ] Abandonment
WELL No. 501-a`%45
PERMIT NO.�-II
DATE PAID:
FEE PAID: G
RECEIPT #:
[ ] Holding Tank
[ ] Temporary
[ ] Innovative
[ ]
APPLICANT: _ - GROZA BIIIT,DRRS. ine. -
AGENT: _ />/('AL/ Uikl-%Z Alexander J. Piazza PSM, Inc. TELEPHONE: 772-340-7770
MAILING ADDRESS: 619 SW Biltmore Street, Port St. Lucie, Florida 34983
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: 4 & 5 BLOCK: 1 SUBDIVISION: CARDINAL GLADES PLATTED: 1957
PROPERTY ID #:
2434-802-0004-000-9 ZONING: R
I/M OR EQUIVALENT:
[ � ]
PROPERTY SIZE: 0.739
ACRES WATER SUPPLY: [ ✓] PRIVATE
LIC [ ]<-2000GPD [
1>2000GPD
IS SEWER AVAILABLE AS
PER 381.0065, FS7 []
DISTANCE TO SEWER:
PROPERTY ADDRESS;
4419 PRvESSLER LANE FT.PMRCE, FL 34982
DIRECTIONS TO PROPERTY: SEE MAP
BUILDING INFORMATION
Unit Type of
No Establishment
1 RESIDENCE
F
3
4
1✓] RESIDENTIAL [ ] COMMERCIAL
No. of Building Commercial/Institutional System Design
Bedrooms Ar�ea�jSgft Table 1, Chapter 64E-6, PAC
3
[. ] Floor/Equipment Drains [ /] Other (Oppoify)+ GARBAGE GRINDERS/DISPOSALS
} aJm,MdbyA.o JP�
Alexander JPiazza
SIGNATURE: :' "o.kmvm.inLmwum DATE: 7-17-19
DH 4015, 08/09 (Obsoletes previous editions which may not be used)
Incorporated 64E-6.001, FAC Page 1 of 4
c
ST-
CL
U�
F.
6.
STATE.OF FLORIDA `PERMIT APPLICATION 'TO CONSTRUCT,
.REPAIR, MODIFY, OR
ABANDON WELL
OSOuthWest
8N
rihwest
PLEASE FILL OUT'ALL APPLICABLE FIELDS
('Denotes Required Fields Where. Applicable)
0St
Johns River
tflF6
Uth Floritla
Rm irarerwenrwma[ronsra;,ammk rartndrA<aea
DSUwannee.River
tlrs rmm�mrpnvp:rAn,)rnepeumriy)ps[arammctie
❑D5P
onA,w/.arrder:vmM our1a.:n saneeyysrde¢
D Delegated Authority (if Applicable)
sEP-nc< No. SU-SF-MLIDII
No Da-LaC90. - Unique It)
lD _
SnpWnitpos Rogwred (See Attached)
Ound No., .Delineation No..
Telephone Number
Yes 0 No
7. 'Type of Work: �}(( Construction ❑ Repair h:odificallon0 Abandonment /A\ t.•+Jf CJI Cti owl
1 a I
8. 'Number of Propo_siod Wells �. _ 'Reason Iw R ,,, - yceJ a. L
B, -Specify Intended Use(a) of Wallis): ate 6wrnp
Domestic e Landscape irrigation a Agricultural Site Investigations 5`k-Tq%`15
Battled Water Supply Recreation Area Irrigation Livestock ® Monitoring At G 2 82019 L ,❑ Public Water Supply (Limited Use/DOH). Nursery Irrigation Teslh-Coupled Geothermal
Public Water Supply (Community or Non•CommunitylDEP)�. CommerciallliWustdal � Eart
Class I injection Golf Course Irrigation HVAC Supply F - In St Lucie Qp{(mty
HVAC Return R MENTAL HEALTH
Class V Injection:Recharge ❑ Commerclattlndustrlal Disposal ❑ Aquifer Storage and Recovery. D In e
Remediation:E1 Recovery El Air Sparge ❑ Other loescaol official Use Only
Other S?a:mad}
10.'Dislance from Septic System if 5 200 ft.. 11. Facility Description 12. Estimated Start -Date rel
13.•Fstimated WalhDepih QR. 'Estimated Casing Depth!6L)_ft. Primary Casing Diameter m. Open Hole: From �T0 _ft
14. Estimated Screen Interval: From U ToOQ- fl.
15.'Pfimary Casing Material: Black Sleep Galvanized 'PVC Stainless Steel
Not Cased Other
16. Secondary Casing: Telescope Casing, Liner SurfaceCasing Diameter - m.
17. Secondary Casing Material: Black Steel Galvanized PVC Stainless Steel tp r
18.'h1ethod Of Construction, Repair. or Abandonment: Auger Cable Tool Jelled Rotary, Sortie
Combination or More. Methods) Hand Driven (Well Point, Sand Point), Hydra - int (Direct Push)
Horizontal Drilling Plugged by Approved Method Other mre o,,oei
10. Propose routing I e for the Primary, Secondary. and Ad
From, To = Seal Material.( Bentonlle Neat Conant Other 1
From_ To Seal Molerial ( Belnonite Mn5 Other 1
From - To Seal Material (.Bentonite Neat Cement Other 1
From To Seal Materiel ( 8enlonito. Neat Cement Other 1
20. Indicate total number of existing wells on site List number of existing unused wells on site
21 'Is this well or any exislinyPvrell or water withdr we o .81e owner's contiguous propertyy covered under a Consumptive/Water Use. Permit (CUPANUP)
or CUPANUP Application. Yes No yes, complete the following. GUPNdUP No. District Well ID No.
22. Latitude L nude
23. data obtained From: GPS Mai Survey Datum:=_NAD 27 _NAD 83 _WGS 84
/. _L/I� _ A
ip aWreo onvedor •4conseNo. •S,pnelura al woe 'or pant—^
D to
Approval Grenled BY ,aria Data. 1at EzPlmoon Dato HydmlogistAppmval
Fee Received a Receipt No. Check No: woos
THIS PERMIT IS NOT VAUD UNTIL PROPERLY SIGNED BY AN AUTHORIZED OFFICER OR REPRESENTATIVE OF THE WMD OR DELEGATED AUTHORITY. THE
PERMIT SHALL BE AVAILABLE AT THE WELL SITE DURING ALL CONSTRUCTION, REPAIR. MODIFICATION, OR ABANDONMENT ACTNITIES.
RECEIVED
STATE OF FLORIDA S�� ` 3,9 PERMIT
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT = ��S4L�POH . 5A A I M
a SITE EVALUATION AND SYS
APPLICANT: GROZA BUILDERS, Inc. AGENT:_ Alexander J.P] PSM.Inc.
LOT: 4 & 5 BLOCK: I SUBDIVISION: CARDINAL GLADES
PROPERTY ID #: 2434-802-0004-000-9[TaxIDNumber
TO BE COMPLETED BY ENGINEER, HEALTH DEPARTMENT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEERS
MUST PROVIDE REGISTRATION NUMBER AND SIGN AND HEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS.
PROPERTY SIZE CONFORMS TO SITE PLAN: [✓) YES [ j NO NET USABLE LE: 0.739 ACRES
TOTAL ESTIMATED SEWAGE FLOW: GALLONS PER DAY [ CES• ABLB THER TABLE2 ]
AUTHORIZED SEWAGE FLOW: GALLONS PER DAY 1500GPD/AC R250OGPDIACRE ]
UNOBSTRUCTED AREA AVAILABLE: 750 SQL°1' VNOHSTRUC REQUIRED: 750 9QFT
BENCHMARK/REFERENCE POINT LOCATION: 45 /t--i ��.05
ELEVATION OF PROPOSED SYSTEM SITE I9 S j [AEgyg�BEbgW'j BENCHMARK/REFERENCE POINT
THE MINIMUM SET�����B''''',,,,,tttAttC11�� WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES
SURFACE WATER:''FT DITCHES/SWALES:15 FT NORMALLY WET? [ [ YES [✓ NO
WELLS: PUBLIC: FT LIMITED USE:. IV FT PRIVATE: 7_,57 FT NON -POTABLE: FT
BUILDING FOUNDATIONS:` % FT PROPERTY LINES: ',/U iT POTABLE WATER LINES: FT
SITE SUBJECT TO FREQUENT FLOODING: [ YE8 14 NO 10 YEAR FLOODING? [ j YES [✓] NO
10 YEAR FLOOD ELEVATION FOR SITE: &/ fFT MSL/NGVD SITE ELEVATION:_ T MSL/NGVD
F)YY�q
USDA SOIL SERIES:
USDA SOIL SERIES:
TEXTURE
OBSERVED WATER TABLE: Ld INC HE9 tS LOW f] EXISTING GRADE. TYPE:[PERCHE PP NT j
ESTIMATED WET SEASON WATER TABLE ELEVATION: INCHES [.ABOV� ] EXISTING GRADE
HIGH WATER TABLE VEGETATION: [ I YES [ANO TILING: [A YES [ ) NO DEPTH: 7 INCHES
SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: 1 v DEPTH OF EXCAVATION: (Q INCHES
DRAINFIELD CONFIGURATION: [ TRENCH ,/ [ )/ OTHER (SPECIFY)
SITE EVALUATED HY:UjN,VC ,y 5/Lt.UOoZ, I �ll DATE:
DH 4015, 12/11 (Obsoletes Predicus editions which may not be used) Incorpore)dd:84E-8.001, FAC Page 3 of 4
APPLICANT's P
GROZA BUILDERS, Inc.
LEGAL DESCRIPTION:' LOTS 4'& 5, BLOCK 1, CA�DINAL GLADES (PB 11, PG 14)
RECEIVED..
P.M P:R;i' M!C,•J�./1�4iM111�J.
SUP i 0 " M9
ST. wci = ti tl e are no potable private wells. within 75 feet of.the available area for the
proposed septic system; that there are no non -potable wells within 50 feet of the available area
for the proposed septic system,. that there are no wells within 25 feet of a pesticide -treated
building foundation; that there are no public wells that serve less than 25 people or less than
15.'homes or businesses within :100-feet of the proposed septic system, that there are no public
wells that serve more than 25 people or more than 15 homes or businesses within 200 feet of
the. proposed septic system, that the water line from the water meter or well to the structure is
at least l0, feet from the available area for the proposed septic system unless the plans show
the line to. be double sleeved,. that there is not a gravity sewer line, low pressure sewer line or
vacuum sewage line in apublic easement or right-of-way that abuts the property, that there
are no lakes, streams, wetlands, or surface water within 75 feet of the available area for the
proposed septic 'system unless the. property was created prior to 1972, that the septic system is
proposed.on tlle.side of the lot farthest from.surface water; that all private wells, septic
systems and surface. water on adjacent or contiguous land within 75 feet of the applicant's lot
are shown on the site plan, that all public wells within 200 feet of the applicant's lot are
sl own on the site plan, and'that the location of building or residences, swimming pools,
•recorded easements, paved. areas or driveway's, sidewalks, the general slope of the property,
filled areas, drainage features, and. surface waters such as lakes, ponds, streams, canals, or
Wetlands are shown on the applicants lot.
The natural grade elevation in. the'area of theproposed septic system and. the benchmark must
be shown on the site plan. Please locate the benchmark within 200 feet of the proposed septic
System.
NOTE: MUST BE CERTIFIED BY A FLORIDA
REGISTERED SURVEYOR OR ENGINEER.
does/forms/septicstSepticApppPage207 ..
AlexanderJ Piazza:m„
CERTIFIED BY: m.mum.manae.aav
FLORIDA PROFESSIONAL NO.: . 6330:
DATE: 07/17/19 JOS WO.: ' 19 @87
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VERIFY THE ELEVATIONS
HODS: (FOOPNGS DEF
WITH THE ENGINEERED SD
NOTE: 9EE T 55 HANIFd WN F1A!
ALL ABOVE CEILING FASTERNERS/LOIN
PILWDEa 1WLhSTR1155. GI.®ER-1RW5.
GiRDERbIROFR CANNKISONS
WATER -AIR -LAN
C
74�01
1'
LOT 5
BLOCK 1
lJ
CAP m-M
co
o'^m NOT PLATTED
Fo a E= 14.39 I "N
iNO EVIDENCE OF SEPTIC
STIC J %
4419 PRESSLER LANE �� o
f PLAN U C TIE INI FINAL TOPOGRAPHIC
7-19 1 1__
w. M%f A I,n1rn I nI A 702A 12OU [Uf%
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6
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NOW 190.00' �30.000'
to o
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LOT 5 BLOCK 1
WEL & SEPTIC
>75' NO INTERFERENCE
FND 6.1
CONC MONUMM ENT
0.18'E
LAST FIELD DATE:
CAD K:\BUILDERS\DWG2019\19-4887.DWG
C
LEGAL DES
LOTS 4 at5 BLOG
THE PLAT EREOF A'
co
OFLBLICSJ
2. NO UNDERGROUND
LOCATED UNLESS
3. THIS SITE LIES
ro
THE FLOOD INSUR
°i
12111COISS J, E
. FLOOD ZONE SHOW
SURVEYOR AND IS
Y
Z
ZONE SHOULD BE
5. BEARINGS SHOWN
_
OF LOT 4 ASSUME
Z�^
6. ALL LOT DIMEN
OTHERWISE NOTEC
mZ 11
FEET.
F>
7. ALL MAPPED FEA
do hu)w
DIRJ.PCIAZZAPPSMIS
8. SURVEY MAP AND
VALID WITHOUT 1
q
FLORIDA LICENSE
9. ADDITIONS OR DE
BY OTHER THAN
PROHIBITED WITF
PARTIES.
CERTIFIED TO:
GROZA BUILDERS,