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HomeMy WebLinkAboutD.O.H. PAPPERWORKF 1� �O ^ PERMIT #:56-SF-2009283 STATE OF FLORIDA ,�'& y APPLICATION #:AP1448796 DEPARTMENT OF HEALTH `n D DATE PAID: ONSITE SEWAGE TREATMENT AND DISPOSAL 6%p1 p 0 FEE PAID: SYSTEM 66;> �jY �fJ '?'iS RECEIPT #: T%DocDNeNT #: PR1284752 SCANNED CONSTRUCTION PERMIT FOR: OSTDS New B�/ Y APPLICANT: (Adams Homes of Northwest Florida Inc) . St. Lucie County PROPERTY ADDRESS: 5613 Palm Dr Fort Pierce, FL 34982 LOT: 22 BLOCK: 61 SUBDIVISION: Indian River Estates PROPERTY ID #: 3402-609-0340-000-7 [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 [ 900 ] 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 HRS #Pumps [ ] D [ 375 ] SQUARE FEET Drainfield new SYSTEM R [ ] SQUARE FEET N/A SYSTEM A TYPE SYSTEM: [ ] STANDARD [ ] FILLED [X] MOUND [ ] I CONFIGURATION: ]X] TRENCH [ ] BED [ ] N F LOCATION OF BENCHMARK: Orange spot, NW corner of catch basin, E of property I ELEVATION OF PROPOSED SYSTEM SITE [ 23.001[ INCHES FT ][ ABOVE BELOW] BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 25.0011 INCHES FT I EFABOVEq BELOW] BENCHMARK/REFERENCE POINT L D 0 T H E R system is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total estimated flow of gpd• C 0 p y SPECIFICATIONS BY: Brian J Ingr m7 TITLE: Environmental Specialist II APPROVED BY: ALE: Environmental Specialist II St. Lucie CID) 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, FAC Page 1 of 3 v 1.1.4 AP1448796 SE1233594 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. 9 i7`fMa HEALTH PAYING ON: RECEIVED FROM PAYMENT FORM: St. Lucie County Health Department 5150 NW Milner Dr Port Saint Lucie, FL 34983 #:56-SF-2009283 BILL Ooc#:56-BID-4462045 CONSTRUCTION APPLICATION #: AP1448796 Benjamin Drew"s Plumbing & Drain Ser AMOUNT PAID: $ 545.00 CHECK 181784 PAYMENT DATE: 10/17/2019 MAIL TO: (Adams Homes of Northwest Florida, Inc) FACILITY NAME: aZ101:10 iWill[iZNtil[*IE 5613 Palm or Fort Pierce, FL 34982 22 61 Lot: Block: Property ID: 3402-609-0340-000-7 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-4201964 per STATE OF FLORIDA DEPARTMENT OF HEALTH 8 ONSITE SEWAGE TREATMENT AND DISPOSAL ,K SYSTEM APPLICATION FOR CONSTRUCTION PERMIT PERMIT NO.%—SF-AMIASs3 DATE PAID: •1 FEE PAID: �j RECEIPT #: APPLICATION FOR: [�] New System [ ] Existing System [ ] Holding Tank [ ] Innovative [ ] Repair [ ] Abandonment [ ] Temporary [ ] APPLICANT:MS^(����L-l_7 AGENT: MAILING ADDRESS: TELEPHONE: -I-► Z- 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: 22 BLOCK: �QI SUBDIVISION: PLATTED: Rao VLJA� + 8 PROPERTY ID #:3�OZ-�G1•n3�0 "Df�l�'7 ZONING:'LS" '{ I/M OR EQUIVALENT: [ Y / N0 PROPERTY SIZE: r-13 ACRES WATER SUPPLY: [ ] PRIVATE PUBLIC [,(]<=2000GPD [ 1>2000GPD IS SEWER AVAILABLE AS 'PEER 381.0065, FS? [ Y / N0 )- DISTANCE TO SEWER: N FT PROPERTY ADDRESS: s w e) Paim�� ' brive, �+ • P(-.� ce- �^ DIRECTIONS TO PROPERTY: -P lil�chcd map BUILDING INFORMATION [)(] RESIDENTIAL [ ] COMMERCIAL Unit Type of No. of No Esstaab�blishment1 Bedrooms 1 V�1 ��i►lUl.1� ,� 2 (J 3 4 Building Commercial/Institutional System Design Area Sqft Table 1, Chapter 64E-6, FAC [ ] Floor/Equipment Drains [ ] Other (Specify) SIGNATURE: 1l a DH 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated 64E-6.001, FAC DATE: Iolinfig Page 1 of 4 7 STATE OF FLORIL; . APPLICATION # AP1448796 DEPARTMENT OF HEALTH PERMIT # 56-SF-2009283 ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM DOCUMENT # SE1233594 SITE EVALUATION AND SYSTEM SPECIFICATION APPLICANT: Adams Homes of Northwest Florida, Inc CONTRACTOR / AGENT: Benjamin Drew"s Plumbing & Drain Services LOT: 22 BLOCK: 61 SUBDIVISION: Indian River Estates ID#: 3402-609-0340-000-7 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 CONFORME TO SITE PLAN: IX]YES I ]NO NET USABLE AREA AVAILABLE: 0.23 ACRES TOTAL ESTIMATED SEWAGE,FLOW: 300 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: 750.00 SQFT UNOBSTRUCTED AREA REQUIRED: 563.00 SQFT BENCHMARK/REFERENCE POINT LOCATION: Orange Spot NW Comer Of Catch basin, E of property ELEVATION OF PROPOSED SYSTEM SITE 23.00 [ INCHES / FT 1 [ 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: 15 FT NORMALLY WET: I ]YES IKINO WELLS: PUBLIC: FT LIMITED USE: FT PRIVATE: FT NON -POTABLE: FT BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: 5. FT POTABLE WATER LINES: 30 FT SITE SUBJECT TO FREQUENT FLOODING? I ]YES EX ]NO 10 YEAR FLOODING? I ]YES [R]NO] 10 YEAR FLOOD ELEVATION FOR SITE: FT [ MSL / NGVD 1 SITE ELEVATION: FT [ MSL / NGVD SOTL PROFILE INFORMATION STTE 1 SOIL PROFILE INFORMATION SITE 2 USDA SOIL SERIES: Munsell #/Color Texture Depth 10YR 52 Sand 0 To 33 1 OYR 6/1 Sand 22 To 37 1 OYR 42 Sand 37 To 42 10YR 2/1 Spodic Material 42 To 72 USDA SOIL SERIES: Munsell #/Color Texture Depth 10YR 511 Sand 0 To'17 10YR 52 Sand 17 To 29 10YR 62 Sand 23 To 33 1 OYR 42 Sand 33 To 41 10YR 2/1 Spodic Material 41 To 72 t OBSERVED WATER TABLE: 59.00 INCHES L ABOVE / FBELOW13 EXISTING GRADE TYPE: [ PERCHED / APPARENT ] ESTIMATED WET SEASON WATER TABLE ELEVATION: 22 INCHES L ABOVE / BELOW ] EXISTING GRADE HIGH WATER TABLE VEGETATION: E ]YES [X]NO MOTTLING: IX]YES L ]NO DEPTH: 22.00 INCHES SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: Sand/0.80 DEPTH OF EXCAVATION: INCHES DRAINFIELD CONFIGURATION: IX ] TRENCH [ ] BED L ] OTHER (SPECIFY) REMARKS/ADDITIONAL CRITERIA WSWT determined using USDA WSS and sail borings. 10YR6/1 stripping in 10YR5/2 matrix >10% with diffuse boundaries starting at 22" in SB1. S131 and SB2 23" above BM. SITE EVALUATED BY: DATE: 12/092019 Ingram, Brian (Title- vironmental Specialist 11) (ENVIRONMENTAL HEALTH) Orr4015, 08/09 (Obsoletes previous editions whi may not be used) Incorporated: 64E-6.001, FAC Page 3 of 4 AP1448796 EID2009283 v 1.0.2 Property Car¢ Michelle Franklin, CFA -- Saint Lucie County Property Appraiser -- All rights reserved. Property Identification Site Address: 5613 PALM Parcel ID: 3402-609-0340- Account k: 37872 Seefrown/Range: DR 000-7 11/36S/40E Map ID: 34/11N Zoning: RS-4 Count Use Type: 0000 Jurisdiction:. Saint Lucie County Ownership Legal Description Adams Homes of Northwest Florida Inc INDIAN RIVER ESTATES -UNIT 08- BLK 61 LOT 22 (MAP 3000 Gulf Breeze PKWY 34/1IN) Gulf Breeze, FL 32563-0000 Current Values Historical Values 3-year Just/Market: $11,700 Assessed: $11,,700 Year Just/Market Assessed Exemptions Taxable Exemptions: $0 Taxable: $11,700 2019 $11,700 $11,700 $0 $11,700 2018 $10,000 $7,245 $0 $7,245 2017 $9,400 $6,587 $0 $6,587 Sale History Date Book/Page Sale Code Deed Grantor Price 04-02-2019 4252 / 0888 0001 WD Entre Homes LLC $17,000 06-21-2018 4149/0686 0001 WD Blenner Franklin H $12,000 05-27-2004 1984 / 1510 XX00 WD Farquhar Scott $35,500 Primary Building Information Finished Area of this building: 0 SF Gross Sketched Area: 0 SF Exterior Data View: Roof Cover: Roof Structure: Building Type: Year Built: N/A Frame: Grade: Effective Year: N/A Primary Wall: Story Height: No. Units: 0 Secondary Wall: Interior Data Bedrooms: 0 A/C %: 0% Electric: Primary Int Wall: Full Baths: 0 Heated %: N/A% Heat Type: Avg Hgt/Floor: 0 Half Baths: 0 Sprinkled %:,0% Heat Fuel: Primary Floors: e . Total Areas •. 71. 4�. " !I .. Finished/UnderAir 0 Gross Sketched Area 0 (SF): 0 Land Size (acres): 0.23 `WN.LA' Land Size (SF): 10,000 Total Building Count: I Type 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. © Copyright 2019 Saint Lucie County Property Appraiser. All rights reserved. Page 1 of 1 https://paslc-dev.org/RECard/ 10/17/2019 9/9/2019 Goggle Maps 5613 Palm Dr V Sun Slw;ans Pl' ..-..,... _ 'rlmdow Tin my c Su at lip,Fat Nissan of O ry •'"°� Fort Pierce '"'"""'6` yCunkm ------ fl5ng� _'"•` _�—Dur9er Jay I. lie Craan�® 9WN:dy„ Ktgdo, JehOv311W 16^`� WinmDixm ® Walyleens(p SL Lame Copy Fite • District - Stalmn 6 Oily Fetma® "l de C:fi RJ btlwuY :yvrav Rd' AataZOOe Auto Pass Tri-County Feed E Heldwate +L'Collins Park IDe0Treasure Case, Lexas� y 5 Go(m�muna an 'r� Y iIisIJonea ®Ch � ..• •..• •. nan Acatlmnv i_Vi v ,:.,m,ry KidLi in Presenool� GaNeADick.. 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