HomeMy WebLinkAboutD O H PAPERWORKIN
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM tyune7 atbu u�Wrad
aOaUlNBdaO
tltj 61. 330
SCANNED
BY
St. Lucie County
CONSTRUCTION PERMIT FOR: OSTDS New
APPLICANT: Da I & Marie Clark
PROPERTY ADDRESS: Pulitzer Rd Fort Pierce, FL 34945
LOT: BLOCK: SUBDIVISION:
PROPERTY ID #: 2318-131-0001-000-2
PERMIT #:56-SF-2012780
APPLICATION #:AP1450913
DATE PAID:
FEE PAID:
RECEIPT #'
DOCUMENT #: PR1284638
[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
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 0[ ]DOSES PER 24 HRS #Pumps
D [ 500 ] SQUARE FEET Drainfield new SYSTEM
R I ] SQUARE FEET N/A SYSTEM
A TYPE SYSTEM: [ ] STANDARD [ ] FILLED pc] MOUND [ ]
I CONFIGURATION: [XI TRENCH [ ] BED [ ]
N
F LOCATION OF BENCHMARK: site BM IR N of system
I ELEVATION OF PROPOSED SYSTEM SITE [ 4.00 ] [I INCHES FT ][ABOVE /tppLOW_p BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 3.00 ][FINCHES FT ][ ABOVE BELOW] BENCHMARK/REFERENCE POINT
L
D I
0
T
H
E
R
ILL REQUIRED: I'Gb.UU] INCHES EXCAVATION HEQUIHEU: L aa.w i iav� Q
The system is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total estimated flow of
400 gpd.
SPECIFICATIONS
BY: Arian J Ingr
TITLE: Environmental.Specialist
II
APPROVED BY:
TIE: Environmental Specialist II
St. Lucie CHD
Brian J Ingr
DATE ISSUED:
12/12/2019
EXPIRATION DATE:
06/12/2021
DH 4016, 08/09
(Obsoletes all previous
editions which may not be used)
Incorporated:
64E-6.003, PAC
Page 1 of 3
V 1.1.4
AP1450913 SE1233477
11, 1 1NOTICE 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.
r
'Im��rcTa
HEALTH
PAYING ON:
RECEIVED FROM
PAYMENT FORM:
St. Lucie County Health Department
5150 NW Milner Dr Port Saint Lucie, FL 34983
#:56-SF-2012780 91LLDOC#•56-BID-4479759 CONSTRUCTION APPLICATION #: AP1450913
Benjamin Drew"s Plumbing & Drain Ser AMOUNT PAID: $ 545.00
CREDIT CARD 153712 PAYMENT DATE: 10/31/2019
MAIL TO: Daryl & Marie Clark
FACILITY NAME:
PROPERTY LOCATION:
TBD Pulitzer Rd
Fort Pierce, FL 34945
Lot: Block:
Property ID: 2318-131-0001-000-2
EXPLANATION or DESCRIPTION: QUANTITY FEE
128 - OSTDS Construction System Inspection Research Fee
1
$
5.00
-1 - Surcharge (All)
1
$
45.00
-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-4222280
SNE 8Z
Q. STATE OF FLORIDA
J ' DEPARTMENT OF HEALTH
Q ONSITE SEWAGE TREATMENT AND DISPOSAL
„ SYSTEM
APPLICATION FOR CONSTRUCTION PERMIT
U1611— No . CSq 300l5 G
PERMIT NO. •,^�� DO
DATE PAID: 1 3
FEE PAID:
RECEIPT #: 16311a.-
APPLICATION FOR:
[ x] New System [ ] Existing System [ ] Holding Tank
[ ] Repair [ ] Abandonment [ ] Temporary
[ ] Innovative
APPLICANTT:: _1..i�LY1 G10,rk COA MQ6e, L° urk
AGENT: ty�. w j�'(1Cw.e7S ��UYYLd'�fG\h ..7Vy(445. TELEPHONE: -7-);1 GA
MAILING ADDRESS:
re
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:
PROPERTY ID #:7_318-131-DOO1-DDO-2 ZONING: JA6-S I/M OR EQUIVALENT: I Y /(N
�^
PROPERTY SIZE: ! ACRES WATER SUPPLY: [,(] PRIVATE PUBLIC [ <=2 GPD [ ]>2000GPD
IS SEWER AVAILABLE A,Spp PER 381.0065, FSS? I Y / iv0 ] DISTANCE TO SEWER: . /NO FT
PROPERTY ADDRESS: -r60 QU U+2---e-r- ed �F+, Y\�.YC�
DIRECTIONS TO PROPERTY: S� .McQ QyAi l �4--VC o%-y2_C J1
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
2 3,
ZH(3 / FP
3
4
[ ] Floor/Equipment Dr [ ] Other (Specify) (�
SIGNATURE: _ DATE: -1
DH 4015, 08/09 (Obsoletes previous editions which may not be used)
Incorporated 64E-6.001, FAC Page 1 of 4
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATION
APPLICATION # AP1450913
PERMIT # 56-SF-2012780
DOCUMENT # SE1233477
APPLICANT: Daryl & Marie Clark
CONTRACTOR / AGENT: Benjamin Drew"s Plumbing & Drain Services _
LOT: BLOCK:
SUBDIVISION: 113#:2318-131-0001-000-2
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: 35.80 ACRES
TOTAL ESTIMATED SEWAGE FLOW: 400 GALLONS PER DAY [ RESIDENCES -TABLET / OTHER -TABLE 2 ]
AUTHORIZED SEWAGE FLOW: 53700.00 GALLONS PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE ]
UNOBSTRUCTED AREA AVAILABLE: 5000.00 SQFT UNOBSTRUCTED AREA REQUIRED: 1000.00 SQFT
BENCHMARK/REFERENCE POINT LOCATION: site BM IR N of system
ELEVATION OF PROPOSED SYSTEM SITE 4.00 [[INCHES / FT ] [ ABOVE / HELOW ] 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: 100 FT NON -POTABLE: FT
BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: 100 FT POTABLE WATER LINES: 75 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
ROTT. PROFIT.R INFORMATION RTTP. T. SOIL PROFILE INFORMATION SITE 2
USDA SOIL SERIES:
Munsell #/Color
Texture
Depth
10YR 4/2
Sand
0 To 16
1 OYR 5/2
Sand
16 To 24
5YR 5/8
CMN/PRM RF
17 To 24
10YR 4/2
Sand
24 To 27
10YR 512
Sandy Clay Loam
27 To 51
10YR 5/2
Loamy Sand
51 To 72
USDA SOIL SERIES:
Munsell #/Color
Texture
Depth
1 OYR 412
Sand
0 To 15
1 OYR 512
Sand
15 To 25
7.5YR 518
CMN/PRM RF
18 To 25
10YR 4/2
Sand
25 To 28
1 OYR 512
Sandy Clay Loam
28 To 55
1 OYR 5/2
Loamy Sand
55 To 72
OBSERVED WATER TABLE: 72.00 INCHES [ ABOVE / BEE] EXISTING GRADE TYPE: [ PERCHED / APPARENT ]
ESTIMATED WET SEASON WATER TABLE ELEVATION: 17 INCHES [ ABOVE / BELOW ] EXISTING GRADE
HIGH WATER TABLE VEGETATION: [ ]YES EX ]NO MOTTLING: [X]YES [ ]NO DEPTH: 17.00 INCHES
SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: Sand/0.80 DEPTH OF EXCAVATION:
DRAINFIELD CONFIGURATION: I ] TRENCH [ ] BED [ ] OTHER (SPECIFY)
7 REMARKS/ADDITIONAL CRITERIA
/T determined using USDA WSS and soil borings.
5/8 CMN PROM RF mottling in IOYR5/2 matrix >2% starting
4" below BM. SB2 S' below BM /
SITE EVALUATED BY: A�,
Ingram, Brian (Title:
DH 4015, 00/09 (Obsoletes previous editions which
t17"in SB7.
7
55 INCHES
kl —^ DATE: 12/09/2019
rental Speclalist 11) (ENVIRONMENTAL HEALTH)
be used) Incorporated: 64E-6.001, FAC Page 3 of 4
AP1460913 EID2012780 v 1.0.2
Property Card
Page 1 of 2
56-5F• 7027g0
51/50o/5
Michelle Franklin,
CFA--Saint Lucie County Property Appraiser -- All rights reserved.
Property Identification
Site Address:PULITZER
Parcel ID: 2318-13 1 -000 1 - Account#:13916 Sec/Town/Range:
RD
000-2 18/35S/39E
Map ID: 23/I8N
Zoning: AG-5 Count Use Type: 6000 Jurisdiction: Saint
Lucie
County
Ownership
Legal Description
Daryl D Clark
18 35 39 E 14 FT OF N 1/2 OF SW 1/4 OF NE 1/4 AND SE 1/4
Tara M Clark
OF NE IMAND THAT PART OF S 1/2 OF SW 1/4 OF NE 1/4
619 Beach AVE
LYG ELY'LI A' AND NLY OF'LI B' Ll A MPDAF: FROM
Port St Lucie, FL 34952
SE COROF NW 1/4 OF SE 1/4 RUN W 4 FT FOR POB, TH
NLY TO PT 14 FT W OF SE COR OF N 1/2 OF SW 1/4 OF
NE 1/4 AND END OF SPEC DESC LI AND LI'B' MPDAF:
FROM SE COR OF SE 1/4 OF NE 1/4 RUN N ON SEC LI
'
105.5 FT FOR POB, TH W LY TO PT 89.5 FT N OF SW COR
OF SE 1/4 OF NE 1/4, TH CONT WLY ON SAME LI TO INT
WITH AFORESD LI'A' AND END OFSPEC DESC LI (35.80
AC) (OR 4102-1739, 1742)
Current Values Historical Values 3-year
Just(Market:
$181,800 Assessed:
$9,845 Year Just/Market Assessed
Exemptions Taxable
Exemptions:
$0 Taxable:
$9,845 2019 $181,800 $9,845
$0 $9,845
2018 $225,540 $9,845
$0 $9,845
2017 $225,540 $9,845
$0 $9,845
Sale History
Date
Book/Page
Sale Code Deed Grantor
Price
02-27-2018
4102 / 1742
0111 WD Clark Daryl D
$0
02-27-2018
4102 / 1739
0001 WD Noelke (TR) (EST) Margaret S
$232,700
04-24-2002
1519 / 1946
XXOI - DE Noelke (EST) Joseph H
$100
Primary Building Information
Finished Area of this building: 0 SF
Gross Sketched Area: 0 SF
View:
Year Built: N/A
Primary Wall:
Bedrooms: 0
Full Baths: 0
Half Baths: 0
Type
Roof Cover:
Frame:
Story Height:
A/C %: 0%
Heated %: N/A%
Sprinkled %: 0%
;Or .:
Exterior Data
Roof Structure:
Grade:
No. Units: 0
Interior Data
Electric:
Heat Type:
Heat Fuel:
Building Type:
Effective Year: N/A
Secondary Wall:
Primary Int Wall:
Avg Hgt/Floor: 0
Primary Floors:
Total Areas
Finished/Under Air
(SF):
Gross Sketched Area
(SF):
Land Size (acres):
Land Size (SF):
Total Building Count:
Special Features and Yard Items
Qty Units Year Blt
0
0
35.8
1,559,448
1
https://www.paslc.org/RECard/
10/31/2019
Custom Soil Resource Report
Soil Map
Z ZG WN
rvf>F�>r�
( 4e0
a
m
N
N
A
Nap Sole: 1:2,900 dpmlted mA pfte (85° z 11') dree<
0 40 80 160 240
Feet
0 100 200 400 600
map projeNm: Web Mentor Cm ooc dnates: WGS84 Edged¢: UrM Zone 17N WGS84
6
�Iu
2 XWN
2 SWN
Custom Soil Resource Report
St. Lucie County, Florida
32—Pineda sand, 0 to 2 percent slopes
Map Unit Setting
National map unit symbol., 2x1 nb
Elevation: 0 to 100 feet
Mean annual precipitation: 47 to 58 inches
Mean annual air temperature: 70 to 77 degrees F
Frost -free period., 355 to 365 days
Farmland classification: Farmland of unique importance
Map Unit Composition
Pineda and similar soils: 85 percent
Minor components: 15 percent
Estimates are based on observations, descriptions, and transacts of the mapunit.
Description of Pineda
Setting
Landform: Drainageways on marine terraces, flats on marine terraces
Landform position (three-dimensional): Tread, dip, talf
Down -slope shape: Linear
Across -slope shape: Linear, concave
Parent material: Sandy and loamy marine deposits
Typical profile
A - 0 to 5 inches: sand
E - 5 to 19 inches., sand
Bw - 19 to 35 inches: sand
Btg/E - 35 to 38 inches: sandy loam
Btg - 38 to 60 inches: sandy loam
Cg - 60 to 80 inches: loamy sand
Properties and qualities
Slope: 0 to 2 percent
Depth to restrictive feature: More than 80 inches
Natural drainage class: Poorly drained
Runoff class: Very high
Capacity of the most limiting layer to transmit water (Ksat): Moderately low to
moderately high (0.06 to 0.20 in/hr)
Depth to water table: About 3 to 18 inches
Frequency of flooding: None
Frequency ofponding: None
Calcium carbonate, maximum in profile: 4 percent
Salinity, maximum in profile: Nonsaline to very slightly saline (0.0 to 2.0
mmhoslcm)
Sodium adsorption ratio, maximum in profile. 4.0
Available water storage in profile: Low (about 4.6 inches)
Interpretive groups
Land capability classification (irrigated): None specified
Land capability classification (noninigated): 3w
Hydrologic Soil Group: C/D
10
Custom Soil Resource Report
Forage suitability group: Sandy over loamy soils on flats of hydric or mesic
lowlands (G 1 55XB241 FL)
Other vegetative classification: Slough (R155XY011 FL)
Hydric soil rating: Yes
Minor Components
Malabar
Percent of map unit: 6 percent
Landform: — error in exists on —
Landform position (three-dimensional): Tread, dip, talf
Down -slope shape: Linear, concave
Across -slope shape: Linear, concave
Ecological site: Slough (R155XY011 FL)
Othervegetative classification: Slough (R155XY011FL)
Hydric soil rating: Yes
Wabasso
Percent of map unit: 5 percent
Landform: Flatwoods on marine terraces
Landform position (three-dimensional): Tread, talf
Down -slope shape: Linear
Across -slope shape: Linear
Other vegetative classification: South Florida Flatwoods (R155XY003FL)
Hydric soil rating: No
Hallandale
Percent of map unit., 2 percent
Landform: Flatwoods on marine terraces
Landform position (three-dimensional): Tread, talf
Down -slope shape: Linear
Across -slope shape: Linear
Other vegetative classification: South Florida Flatwoods (RI55XY003FL)
Hydric soil rating: Yes
Valkaria
Percent of map unit: 2 percent
Landform: Drainageways on flatwoods on marine terraces
Landform position (three-dimensional): Tread, dip; talf
Down -slope shape: Linear
Across -slope shape: Concave, linear
Other vegetative classification: Slough (R155XY011 FL)
Hydric soil rating: Yes
11
1545 Pulitzer Rd
A 7 A
:,�I� lip it `� ! r? � .�, ii►1i �� `; dill 1(l�ll li i�%��'� ��1�ua�� =.:
tI'.�
",?•+at:i+ ' ��'1 .� ��-0 � it f l 1 � i
r� f
t X
<f �l�-.+
tli 1 ( I _'� 1
1 ) \ r
I
17
1 i
If
�Ili�,t�llzl�j�al
TM�'rj-1;-
November 26, 2019
IA II F
LA'
I.
1:18,056
0 500 1,000 2,000 ft
i . + I�rJTII
0 225 450 900 m
Sources: Esri, HERE, Garton, USGS, Inlermap, INCREMENT R NRCan,
Esri Japan, METI, Esri China (Hong Kong), Esri Korea, Esri (Thailand),
SPATE OF.FLORIDA PERPAITAPPLICATION:TO CONSTRUCT,
REPAIR MODIN, Oil ABANDON A WELL
JSOUthwast PLEASE FILL OUT ALL APPLICABLE FIELDS
❑ No$hwest Manatee Required Relds Where Appil
OSt, Johns River
;a mt,ih Florida n1p1°Ofwrvdlr°nrteuvro,H,"eno'GferwwmyfeFng
raiclamrualrWvnrduin racyrrrrtiti¢�prittinm rn d;r
CTStlwennoe River oyyrasdoreddtgdrrAwrhMtyrilti+taynEraOk
DEP
Delegated Authority (If Applicable)
7.'TypeofWark: 4?5.zConst
S. 'Numbarof Proposed Wells
9. -Specify lntepded•Use(s),of
ownesdc
Battled Wafer Supply
Public Water Supply (Limit
PubBo Water Supply (Com
J Class I Injeatioo
,lass Vipjexon:.❑ Rechar4
iemediation:0 P.m
I-
No. ' 59-30015
Unique ID
SBpWallons ReQulred (Sea Attubed)
ne) .Lot Block' - Unit
Si Luoje Cheek if 62-524:0' Yes 0 No
e 'County " Subdivision --
11352 954,1318-4269 '. downthehole@att:net
'License Number '''Telephone Numtiar " 4EamMlAddress
Port St. Lucie FI 34988
City.' State ...ZIP' -
Repair. 0 Modification[] Abandonment
:cape Irrigation _
alien Area; Irrigation
Agricultural Im ation
Livestock
Site Investigations
gationa
U
iMonitoring
)OH)
Nursery Irrigation
. Test
r Non-CommuiftyIDEP)�
CommarclaUk4ustrial,
Earth-Couplad Geothermal
DEC 1 7 201
Golf Course Irrigation
HVAC Supply
r
hVAe Retum
Commsrdalnndustdai,Dis oral
p ❑ AquifarSto2ge
and Raeoveryl0 Drainage
DOH in St Lucia C
rge �'j Other tor�*sa,.
nnoiNtesevuittiL u
'Estimated Well Depliv lUU tt. 'Estimated Casing OeDth 90 fL Primary Casing. Men neler 2 in. Open Hole: From
Estimated. Screen Interval:From 90 To 100 tt,
'Primary Casing' Material: Black Steel (Galvanized Stainless Steel
Not Cased Other'
Secondary Casing: Telescope Casing liner SurfaeeCasing 'Diameken :- in: '
17. Secondery Casing Material:. Black Steel Galvanized PVC Stainless Steel Oth,er�
18•Methad of Construction, Repair.,or Abandonment Auger Cabla?col Jetted :7 Sonic
Combination (Two or More Methods) HandDriven (Well Point. Sand.Poin9 Hydraulic Point (Direct Push)
.. HorizonteLDdlling P luggedrsww
by Method Other to;
19. Prcpose6Grouting'lnterval for, the: Primary, Secondaryand Add�illgqR�CTC3'y g:
From 0. ,To BS Seal Matedal.0 Banlontte f(t_Nrr',t6mrt�nl Other_ J
Frortt - To _ SeafMatedal'( Bantonike Neat Cement Other 1
From To Seal Material ( Benlonite Neat'Cement Other 1
Front_ To Seai'Malerial( Be roriHe Neat Cement Other i
20. Indicate total number of existing.xrells on site _ Ust number of existing unused were on she
21:Isthis well or any existinrelfor watervpt a an'the owners contiguous propervy covered under a Consumptive/Water USe.Permit(CUPANUp)
or CUPANUP. Appgcaticn Yes Ryes, complete the followsrtg: CNAIUP No.. District Well ID No.
22. Latitude Le, gitude
23. Data Obtained' From: SPA Aar:
11352
'License Ne,
THIS PERIAYIS NOT VALID
Issue
THE
H11YAH
/qunoo
31
waaa�.wnrma0.snwa ltaro»tratl axsxe
munmmumwmu.arvuma
Btl3ddM9fLGa3FtlMTIH069ifOtld
OWDNIABANYSa O"IONHV
9
nld is ui HOa
y�
'L —65'
L t O30
g
I �
Z
h
tl
;b�1
J
i
aI8
�iE� pepv
I'
CD
2
s
Y
I
I
z_
9S
fS
I
a
i i
'-I
•; a
x
WSJ 3
Y� 8
Eappa�gbg
C`tl+�� 02,'i
�AA
9C
Sa2ag Yg 3� YI h i
6�
a�
el
��
z I %
qeg
f 11ho I a
8 pp FF�
ai�9 @a i�6
pp F q 5
Sao!
all ca
5 3a 6 9 1 9• y
z s@
m yob@ 9� �3@@ 3B @gne q@ Ag eSe
9@@6Y ?��IalH��$�@���su@:A5
yYey.4i'a1°s;S€.hull.a;®..an
;Bridge Web Viewer
Page 1 of (
Mission:
To protect promote B Improve the health
of all people in Florida through integrated
Veto, county 8 community efforts.
i.
HEALTH
Vision: To be the Healthiest State in the Nation
Ron Desantis
Gwemor
Scott A. Rivkcesr MD
State Surgeon General
SCANNED
BY
Florida Department of Health in St. Lucie County St. Lucie County
Conditions for Issuance of Water Well Permits
Effective July 24, 2017
• Contact the Florida Department.of Health in Saint Lucie, County (FDOH —St. Lucie)
prior to constructing or abandoning any well.
a. Call the FDOH — St. Lucie Well Line at 772-873-4936 or email
S L C D O H-W ELLS(cD FL H EALTH. G O V
b. Provide the following information:
i. Permit number
ii. Driller name
iii. Address
iv. Date and time to begin constructionlabandonment
• A minimum of 24 hours' notice is required before constructing any public water supply
wells. Please call our main office at 772-873-4931 and speak with Environmental
Health Staff or provide notification by email to SLCDOH-WELLS(cDFLHEALTH.GOV
Submit revisions to permit and/or site map and associated fee 'tjn8 hours of well
construction or abandonment.
ct,"JY), VE
Florida Department of Health
St. Lucio County
5150 Nby Mner Drive • Port Sl. Lucie, FL 34963
PHONE: 772/462.3603 • FAX: 77278715360
St Lu cle Co un ty H oalth.eom
Accredited Health Department
Public Health Accreditation Board
ittps://s 1.ebridge.com/ebridge/1.0/webviewerNiewer.aspx?ref=jgGE`/`2bHKLLJOIViW7mUAKL 1 Wqd... 12/4/2015
;Bridge Web Viewer
Page 2 of (
a/Txasrat STATE OF FLORIDA PERMIT APPLICATION TO CONSTRUCT.
REPAIR, IV
PeanlNo. 59-30015
~ . P •.•SDuthwast FILFlaida UK
ee JNorthwest PLE15Etes Require
ire Fie' DLEFIELa3 qu010
d {•OenaNS RogUirerl F{Clds Wnera AppAaNB)Pelmit SlSulaGons RaquirtM (See AtLnzrysa)
> USL Johns River
•fi. " �:Soulh Florida fir• r+wtrcnwnerhreymu^lrlarremptt:na
CDopaaaV�- •JS uVlannee River mYLuncMlua�cdnD rhrMmraPPFenGauoWr e2-5240uad No.__Oalfi:eadon No._
DEP^T•+ropimr2dyeeNo,Wa?ywM1amipr;h6le
❑ Delegated Authority (if Applicable) CUPFAUPAp; keton No.
25 Sunrise Blvd Ft Pierce. Ff
'Well Location-Address,.Road Name or Number, CRy
3.2318.111-0002-000-7
'Parcel ID No. (PIM or Allernale Key (Circle One) Lot Block
S• 78 35 39 St Lucie • anti
'Scallion cr Land Grant •T., hlp •Range 'Caunly SuMilrta!an Check if62.524:❑ Yes ❑✓ No
S, James Paul Tyson 11352 954.81842S9 downthehole0att,net
WmttWe881496 'Llumse NDmber 'Tate hone Number
6. PO 60X 881496 P E•mad Address
Water Well ConlmUor's Address Port St. Lucie FI 34988
7. 'Typoorwark: ❑✓ Conslmcilon ❑ Repair ❑ Modificadon❑ Abandonment City Slate ZIP
6. 'Nlmherof Proposed Walls 1 •Rmsntrvaepav Noaf d
9. 'SPOofy Intended Uses) of Well(s): f'a
8 Domestic (��t} Landscape Irrigation ® IL}7
Seeded Watcr Supply uReaeation Arda lmgagon ugdio`�Kalimgagon ® Site Investigations
Public Water Supply (Limited Use/DOH) Nurse I Test monitoring
( It irrigation u ❑ Teat V _
Class^Water Supply(Community or NorrCammu' 90• CammerelalAndwlrfDl EDnh-Coupled Geothermal OCT 14 201
Classlln,'anlon Golf Course Irrigation HVAC Supply
Class V Injection: Rechz e ❑ P HVAC REIM
❑ r8 ge [3 91het sviaf015 osel ❑Aquifer Sloraga eed Recoveryryrynh Drainage Rarnothersn:❑ RDcoVery ❑ Air Sparga ❑Other Nervieer t>f i l71 St LUC(G Q UOty
❑ other to x o) `LTH
t0; 01stance from Sapitc System if <200 R.' 1 7- 11. Fao]iry Description es once
13.'Eslimated Well Depth 100 fL •Estlmnletl Cashg Depth 90 (L Primary Casing DlamelBr 2 12 Estimated Star( pate _•_
14,E5Umaled SC.rean InlBNal:Frpm 90 To 100 R. --Jn• Open Hole: From To—R.
15.'Primary Casing MBlerlal' Blau Steal Galvanized �� VC 618119e55 Steel
Nat Cased Other
to, Secondary Casing: Telescope Casing Liner Sudecd Casing Diameter —In.
17. Secondary Casing Material: Black Steel Galvanized PVC Stainless Steel
16.•Memod o(Corslrudlpn, Repair or AbantlonmBnL' Auger Cable Tool Jetted ,r, fret
Combination (Ave or Mwe McNods) Hand Driven Some
(Well Point. Sand Point) HydrOUL0Point(Oltect Push)
Horizontal Otllling Plugged by Approved Method Omar to.,.
IS. Prppoead Groullurg lnlorval forme Primary, Secondary, and Ad tonelEa ing:
From 0 _ To a_ s Seri Material ( Samanite dgt Ca n✓ Other 1 Fmm—To sea] Matedel( Senumi.0 Neat Cement Other 1 FromTo — Seal material ( Bam"Jus Neat Cement Other_
From To Scal ME!Cdal ( Bemoage Neal Cement Other s
20. Indicate total number of ekisfing wells on site 0 List number of ezisdng Unusedvralls on site 0
21: Is ihls vrell or any exislvtgg WagorlvatervriIhdrmTaf nthe owner's congguousppaped99covared under a ConswmpUverWater Use Permit(CUPNVUp)
cr CUPAMJPAppllcadon7 Yes JNo Fyas,complalelherelowna:cu XvuPNO'
22. Latitude OisUld Well ID Na.
Long Jude
23. Data Oblalned From: GPS
lamvY.u,n..•y..,n.:.er<..e.ri:Map
urma:mcUvu.nna...v, Datum: �HAD 27 _NAD 63 WGS gq
11352
'Lken I. N.No.
APFr.a.l Gr.nted By wu.o.b ElyAmban Vito yy ZO
HTdoloplel Approval
Foe Recelv.d S
Raodpt Na. chart No, a—�•'+
THIS PERMIT IS NOT VALID UNTIL PROPERLY SIGNED BYAN AUTHORIZED OFFICER OR REPRESENTATIVE OF THE WMD OR DELEGATED AUTHORITY, TKE
PERMIT SRALL BE AVAILABLE ATTHEWELL SITE DURING AL MMRTRI 11T111
ittps://sl.ebridge.com/ebridge/3.0/webviewerNiewer.aspx?ref—jgGE%2bHKLLJOIWMV7mUAKL1 Wqd... 12/4/201S
;Bridge Web Viewer
, I
MS - 11) -n;),CW-7
SITE PLAN
LOCATED IN
SECTION 18, TOWNSHIP 35 SOUTH, RANGE 39 EAST
STREET AOURGSS
11111 6a14 ftV Q0 "A% r(YYI I'S" U, IL JCaO
I
I f
\Ifl('r;M
':r.: °Y.
—:x^,^�"�r,.ra,..,>..:.F,r..,,,��.4µ,,,,.�..,>,,,,.,,.•M[,.I.•.,
i, ill _n
4 al L'
I`di
I'I t
+I I
!jj-
,i.`.," i`
•
I i�'(
I f (11' ��j11 Y..�^.n•^�..r/.'"
..FL1 I,I� I
I
•
wr r
'LSv �Y
\`•i
(''Y
/..• I �i
IM.l"Naar
ri
�n�- ���\a •d)in[x
b °. Y. F [i �Y�. y tta,•w• ]i •W MiwY fY Intl "'�•.".• •_. ',
,.
� � �� iw.
:,.r,�r tI'
IIMWIPVYr 1
w�
OCT 14 2019 1
.a,{�,
It'iCq'
F��oigl��L
ENVRONMENTALHEALTH
Page 3 of f
ittps://s l .ebridge.com/ebridge/3.0/webviewer/Viewer.aspx?ref—�jgGE%2bI-IKLLJOIVVW7mUAKL1 Wqd... 12/4/201 S
;Bridge Web Viewer
Page 4 of (
" € cV•. Tie •diASt1•YY8QRE4{`Gas a¢°dRzSRig"i;'
e�dIdeF
CC
35 ��e 1� � � gi
I
R IIt-5 a� � S 3 Af
.ij��� �� !� � �'.,ij ides ! �„. �.,,o...,.e..w....w....w•..,.I Y i3 wZ� `��L� r
° o
pop
ti
„1ly�°
k Owl
It
�jlj/ ij gl i F� �. i ¢ m
jt(j t INzt cn
S q 2
I �
e x�.
' m
�_�_ _may -ci��3 �•_• �...�=i-Fz' �•�y.`n"�£'iFi'.!C,'....la +??.�Li_ .. 'fw..
_ � ._ _ —,yam , �_:__ _' �?1�-__ �•' _^.^�' �.�".-o n>w•.ey�,r�ii� .Q�,'—• """— a
dd $ fP•
Fj; I ;t: " •
r = I
'L � 6a R(' d' 1;7.i" ¢S' a" �• 6' a" aS j°, a . ^ X XR I
R R¢�" ! n° e„4 yy io F ggRA .R ! SR •Ai app ¢pt gg,e R ga,'p d¢bXd
asyC
s A 46 6d c� zgag7 IF =;Q ;9$ 5Ag �A ' R. aC; �y.g;QEadS £."Z:$9°�
aipR a @ Ey E a� d„� 5 Yg Ra F$fi
11ga g°� FAE .14IM�R
R A�¢• kQ� 5R S ;u$ 4d s @ d'¢ 'A ;° ,a AT HS FJ3 1aai$ao,4aQ x 1 e°.[e dj I1
Q gA '2 a� °� aX0 a aq 95�a A r
y1 1 g• P gy
d L SA6 g L..�p Qg B¢u"¢ p(: 4 aSo`F�i•�'� g
9rp{xS •AFy � e p�: se p•dy 6 4a a �•d+ �dA
1! !' iAQ R A� �g aRSd ' s 17R 9 n 2g ia3': "v sigijsAyS A 9d »
;d U d a s d a I y d +� ai R u-ji'NiiS p p 010
� � a ggp i =• �°. 6e 4 X aiE !✓
i @ Q @ � �S sl E Q eY y'a � 65:SA�36R • SgiA¢yY�¢ xpA r+W
RX:Rx:
a
ARNOLD SURVEYING, INC.
gg reuowr�xuunua.o�.ar m
1 _ 1 �� '� �F d ' am4erv:°ueeuicuttnu:uruwrxewaa. rnarnagrulnuamouunevacs
1 ° fitTf WIGWLfi4AGN20.Ca fa'�YxW.HO
— I � ;j 4 x _ " nn n wo.¢ rtfiuunl avavttwwwx.v<eu
ittps://s 1.ebridge.com/ebridge/3.0/webviewer/Viewer.aspx?ref—�jgGE%2bHKLLJOI)YW7mUAKLI Wqd... 12/4/2015
;Bridge Web Viewer
Property Card
Page 5 of(
Pagel of 1
Michelle Franklin, CFA -- Saint Lucie County Property Appraiser -- All rights reserved.
Property Identification
Site Address: PULITZER Parcel ID: 2318-III-0002- Account#: 13909 Secfrosvn/Range:
RD 000-7 18/35SI39E
Map ID: 2311 SN Zoning: AG-5 Count Use Type: 6000 Jurisdiction: Saint Lucie
County
ownership
Jose LMiranda
Maria I Miranda
1125 Sunrise BLVD
Fort fierce, FL 34950-5049
Current Values
JusUMarker $294,774 Assessed: $117,663
Exemptions: so Taxable: 5117.663
Date
OS-25-2016
03-01-1983
12-01-1986
View:
Year Built: 2018
Primary Will: Corr Metal
Bedrooms:0
Full Baths: 0
Half Baths: 0
Legal Description
18 35 39 NE 1/4 OF NE 1/4-LESS E46 PT- (38.41 AC) (OR
3905.2487)
Historical Values 3-year
Year Just/Market
Assessed Exemptions
Taxable
2019 $294,774
S117,663 $0
$117,663
2018 $241,983
SIO,563 SO
$10,563
2017 $241,983
510,563 $0
$10,563
Sale History
Book/Pagc
Sale Code Deed Grantor
3905 / 2487
0001 WD Geronimo Groves Inc
0553 / 0193
XX01 CV
0526/0442
XX01 CV
Primary Building Information
Finished Area of this building: 6.660 SF
Gross Sketched Area: 6,660 SF
Roof Cover: Metal
Frame:
Story Height: 1 Story
A/C %: 100%
Heated %: 100%
Sprinkled %: 0%
Exterior Data
Roof Structure: Steel Truss
Grade: Y D+
No. Units: I
Interior Data
Electric: MAXIMUM
Heal Type: FrcdHotAir
Heat Fuel: ELEC
Price
5268,900
S100
SO
Building Type: INDW
Effective Year: 2019
Secondary Wail:
Primary Int Wall:
Avg Hgt/Floor: 0
Primary Floors: CONC GRD
Total Areas
Finished/Under Air
6,660
(SF):
Gross Sketched Area
7,986
(SF):
Land Size (acres):
38.41
Land Size (SF):
1,673,139.6
Total Building Count:
3
Special Features and Yard Items
Type Qty Units Year Bit
All infommlion is believed to be correct at this time, but is subject to change and is provided without any warranty.
0 Copyright 2019 Saint Lucie County Property Appraiser. All rights reserved.
littps://pasle-dev.org/RECard/ 10/11/2019
ittps://s 1.ebridge.com/ebridge/3.0/webviewerNiewer.aspx?ref=jgGEa/o2bHKLLJOIVVW7mUAKL1 Wqd... 12/4/2015
;Bridge Web Viewer Page 6 of f
St. Lucie County Health Department
Flo 5150 NW Milner Dr Port Saint Lucie, FL 34983
HEALTH
PAYING ON: s BILooca:56-BID-4458181
RECEIVED FROM: Down The Hole AMOUNT PAID: S 345.00
PAYMENT FORM: CREDIT CARD 071579 PAYMENT DATE: 10/11/2019
MAIL TO: Down The Hole
PO Box 881496
Pon Saint Lucie FL 34988
FACILITY NAME : Down The Hole
PROPERTY LOCATION:
PO Box 881496
Poe Satnt Lucie FL 34988
Lot:
Property ID: _
-1 - Well Construction
EXPLANATION or DESCRIPTION:
RECEIVED BY: MontanezNM
Note: 59-30014 through 59-30016
f�
QUANTITY FEE
3 S 345.00
AUDIT CONTROL NO. 56-PID-4196792
ittps:Hs l .ebridge.com/ebridge/3.0/webviewer/Viewer.aspx?ref—�jgGE%2bHKLLJOIWW7mUAKL 1 Wqd... 12/4/201 S