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HomeMy WebLinkAboutD.O.H. PAPPERWORKPERMIT #:56-SF-2012264 APPLICATION #•AP1 0 STATE OF FLORIDA 45 603 DEPARTMENT OF HEALTH D ,1 FCI�_ ONSITE SEWAGE TREATMENT AND DISPOSAL100 �CI Fp SYSTEM 5��4i�9 j10/ 14,C/s 00,11 0, ,17 CD4'x. el CONSTRUCTION PERMIT FOR: OSTDS New 'APPLICANT: (Adams Homes of Northwest Florida, Inc) PROPERTY ADDRESS: 5001 Sunset Blvd Fort Pierce, FL 34982 DATE PAID: FEE PAID: RECEIPT #: DOCUMENT #: PR1284309 LOT: 24 BLOCK: 46 SUBDIVISION: Indian River Estates PROPERTY ID #: 3402-608-0219-000-7 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] [OR TAR 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 CH'�++ANGE IN MATERIAL FACTS, WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THySCANW&T TO MODIFY THE PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEIIBY MADE NULL AND VOID. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM CW1[IC+➢IJAV OTHER FEDERAL, STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY. VVUU����l17 SYSTEM DESIGN AND SPECIFICATIONS SCANNED BY T [ 1,050 ] GALLONS /.GPD SeDtiCNew CAPACITY St Lucie County 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 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: Site BM'X' painted In C/R I ELEVATION OF PROPOSED SYSTEM SITE [ 1.00 1 [1 INCHES FT ][ABOVE A BELOW BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 4.00 ][ INCHES FT I [FABOVa BELOW] BENCHMARK/REFERENCE POINT L D O T H E -R REQUIRED: [23.001 INCHES EXCAVATION REQUIRED: [ system is sized for 4 bedrooms with a maximum occupanc Of, perso7s(2 per gpd- Liza flow of SPECIFICATIONS BY: S May TITLE: Environmental Supervisor I APPROVED BY: ^Dianna 16"-, TITLE: Environmental Supervisor I St. Lucie CHD Dianna S May DATE ISSUED: 12/10/2019 .. EXPIRATION DATE: 06/10/2021 DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E-6.003, FAC Page 1 of 3 / ap /C - ooSi St. Lucie County Health Department 5150 NW Milner Dr Port Saint Lucie, FL 34983 HEALTH PAYING ON: n:56-SF-2012264 BILL Doca:56-BID-4468652 CONSTRUCTION APPLICATION 0: AP1450603 RECEIVED FROM: Benjamin Drew"s Plumbing & Drain Ser AMOUNT PAID: $ 545.00 PAYMENT FORM: CHECK 185053 PAYMENT DATE: 10/29/2019 MAIL TO: (Adams Homes of Northwest Florida, Inc) FACILITY NAME : PROPERTY LOCATION: 5001 Sunset Blvd Fort Pierce, FL 34982 Lot: 24 Block: 46 Property ID: 3402-608-0219-000-7 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 .11 RECEIVED BY: MontanezNM AUDIT CONTROL NO. 56-PID-4210941 "Z" d SxE 4 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM APPLICATION FOR CONSTRUCTION PERMIT APPLICATION FOR: New System [ ] Repair APPLICANT: [ ] Existing System [ ] Abandonment PERMIT NO. DATE PAID: FEE PAID: RECEIPT #: [ ] Holding Tank [ ] Innovative [ ] Temporary [ 1 AGENT: LM\ TELEPHONE: 17, -$1n - 29oz MAILING ADDRESS: L4 M. rd\J Civi- . Fi-• 1-e,1(CQ. Fz.- Bg9E-1 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: `y' BLOCK: �(� SIIBDIVISION: jam tjyeY yam,, �' G} jz$1ccs PLATTED: `StO I. Ait-, PROPERTY ID #:3102• LQ(i'- M-H • ZONING: e.S'LI I/M OR EQUIVALENT: [ Y / ND arras PROPERTY SIZE: -C ACRES WATER SUPPLY: [ ] PRIVATE PUBLIC [(,]<=2000GPD [ ]>2000GPD IS SEWER AVAILABLE AS PER 381.0065, FS? [ Y /©/]� DISTANCE TO SEWER: }a FT PROPERTY ADDRESS: szn I �'[ \lj�j1- ,' xyfc(, DIRECTIONS TO PROPERTY: See aA+�here M ( � BUILDING INFORMATION Unit Type of No Establishment 3 4 [ ] Floor/Equipment SIGNATURE: [)( RESIDENTIAL [ ] COMMERCIAL No. of Building Commercial/Institutional System Design Bedrooms Area Sqft Table 1, Chapter 64E-6, FAC [ ] Other (Specify) DH 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated 64E-6.001, FAC Page 1 of 4 -A-MI-0orl STATE 'OF FLORIDA APPLICATION # DEPARTMENT OF HEALTH PERMIT # 56-SF-2012264 ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATION DOCUMENT # SE1233143 APPLICANT: Adams Homes of Northwest Florida, Inc CONTRACTOR / AGENT: Benjamin Drew°s Plumbing & Drain Services LOT: 24 BLOCK: 46 SUBDIVISION: Indian River Estates ID#: 3402-608-0219-000-7 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 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: 800.00 SQFT UNOBSTRUCTED AREA REQUIRED: - 750.00 SQFT BENCHMARK/REFERENCE POINT LOCATION: Site BM °X° painted in C/R ELEVATION OF PROPOSED SYSTEM SITE 1.00 [ INCHES / FP 1 [ ABOVE / 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:. 80 FT BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: 11 FT POTABLE WATER LINES: 60 FT SITE SUBJECT TO FREQUENT FLOODING? [ ]YES [X]NO 10 YEAR FLOODING? [ ]YES [X]N OI 10 YEAR FLOOD ELEVATION FOR SITE: FT [ MSL / NGVD 1 SITE ELEVATION: FT [ MSL / NGVD SOIL PROFILE INFORMATION SITE 1 SOIL PROFILE INFORMATION SITE 2 USDA SOIL SERIES:Waveland Munsell #/Color fine sand Texture Depth 10YR 311 Sand 0 To 8 1 OYR 4/1 Sand 8 To 13 10YR 5/1 Sand 13 To 25 1 OYR 6/1 Sand 19 To 29 1 OYR 4/1 Sand 29 To 38 10YR 311 Spodic Material 38 To 46 1OYR 4/1 Loamy Sand 46 To 60 REFUSAL Refusal 60 To 72 USDA SOIL SERIES:Waveland Munsell #/Color Pine sand Texture Depth 10YR 3/1 Sand 0 To 8 10YR 411 Sand 8 To 13 1 OYR 5/1 Sand 13 To 25 1 OYR 6/1 Sand 22 To 29 10YR 4/1 Sand 29 To 40 1 OYR 3/1 Spodic Material 40 To 46 1 OYR 4/1 Loamy Sand 46 To 58 REFUSAL Refusal 58 To 72 OBSERVED WATER TABLE: 29.00 INCHES [ ABOVE / BELOW ] EXISTING GRADE TYPE: [ PERCHED / APPARENT ) ESTIMATED WET SEASON WATER TABLE ELEVATION: 19 INCHES [ ABOVE / BELOW ) EXISTING GRADE HIGH WATER TABLE VEGETATION: [ ]YES [X]NO MOTTLING: [X]YES [ ]NO DEPTH: 19.00 INCHES S03: TEXTURE/LOADING RATE FOR SYSTEM SIZING: Sand/0.80 DEPTH OF EXCAVATION: INCHES DRAINFIELD CONFIGURATION: [X] TRENCH [ ] BED [ ] OTHER (SPECIFY) jiEMARKS/ADDITIONAL CRITERIA WSWT determined using USDA WSS and soil borings. 10YR6/1 stripping In a 10YR5/1 matrix >10 % with diffused boundaries starting at 19" In S61. SB7 and S62 V below SM. Refusal due to saturation in both profiles. SITE EVALUATED BY: � DATE: 12/06/2019 May, Dianna (Title: EnvirKnmental Supervisor 1) (Florida Department of Health in St Lu 0H 4015, 0e/09 (Obsoletes Previous editions which may not be used) Incozporated: 64E-6. 001, FAO Page 3 of 4