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Home My WebLink AboutD.O.H. PAPPERWORKSTATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSALC�O SYSTEM CONSTRUCTION PERMIT FOR: OSTDS 04 Ctl 10% Oepavtoet pe<Rd��9 �e Coorj 5t. APPLICANT: (Adams Homes of Northwest Florida, Inc) PROPERTY ADDRESS: 5810 Tangelo Dr Fort Pierce, FL 34982 LOT: 17 BLOCK: 77 soBnlvlsION: Indian River Estates PERMIT #:56-SF-2012257 APPLICATION #:AP1450597 DATE PAID: FEE PAID: RECEIPT #: DocD,M� AA��.1281696 7711�� BY St. Lucie County [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] PROPERTY ID #: 3402-610-0202-000-2 [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 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 SeDtio New CAPACITY A [ ] GALLONS / GPD N/A CAPACITY N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:I250 GALLONS] K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ] D [ 500 1 SQUARE FEET Drainfield.New SYSTEM R [ ] SQUARE FEET N/A SYSTEM A TYPE SYSTEM: [ ] STANDARD [ ] FILLED D[] MOUND [ ] I CONFIGURATION: [X] TRENCH [ ] BED L ] N F LOCATION OF BENCHMARK: Site BM "X" Painted on C/R Center of Property - I ELEVATION OF PROPOSED SYSTEM SITE [ 7.00 ][INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 0.00 ][ INCHES FT ][ ABOVE BELOW] BENCHMARK/REFERENCE POINT L D 0 T H E R REQUIRED: [25.001 INCHES EXCAVATION RNQULa W' r 1 +• system is sized for 4 bedrooms with a maximum occupancy of B persons (2 per bedroom), for a total estimated flow of 9pd- " SPECIFICATIONS BY: Dianna S May TITLE: Environmental Supervisor I APPROVED BY: �� _ TITLE: Environmental Supervisor I St. Lucie CHD Dianna S Nay 11/20/2019 EXPIRATION DATE: 05/20/2021 DATE ISSUED: DH 4016, 08/09 (Obsoletes all previous editions which may not be used) 3 Page 1 0£ Incorporated: 64E-6.003, FAC 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 governedby 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. 0 3� ` St. Lucie County Health Department D Yfda 5150 NW Milner Dr Port Saint Lucie, FL 34983 HEALTH PAYING ON: #.56-SF-2012257 13ILLDOC#,56-BID-4468643 CONSTRUCTION APPLICATION #:AP1450597 RECEIVED FROM: Beniamin Drew"s Plumbing & Drain Ser AMOUNT PAID: $ 545.00 PAYMENT FORM: CHECK 185054 PAYMENT DATE: 10/29/2019 MAIL TO: (Adams Homes of Northwest Florida, Inc) FACILITY NAME: PROPERTY LOCATION: 5810 Tangelo Dr Fort Pierce, FL 34982 Lot: 17 Block: 77 Properly ID:. 3402-610-0202-000-2 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-4210930 �L STATE OF FLORIDA ` f DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM APPLICATION FOR CONSTRUCTION PERMIT PERMIT NO. DATE PAID: FEE PAID: RECEIPT #: ic APPLICATION FOR: [�] New System [ ] Existing System [ ] Holding Tank [ ] Innovative I I Repair [ ] Abandonment [ ] Temporary [ ] APPLICANT: p(jWn�,- jA,on-)es J Fork-�[Qes&j EL. AGENT: Y� CYiU� �r'e� S r ��XY�KJ I r M TELEPHONE: MZ.--p / O9)rl- Z9ll?Z MAILING ADDRESS: .COW 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: 1 BLOCK: SUBDIVISION:�T�f `( 11�Q�� IC-�YQi —.>°S PLATTED: 020 PROPERTY ID N:�+[LOZ• l9 LO ' ��Z • IA.I/"Z ZONING:S� I/M OR EQUIVALENT: [ Y PROPERTY SIZE: D•13 ACRES WATER SUPPLY: [ ] PRIVATE PUBLIC ['x]<=2000GPD [ 1>2000GPD IS SEWER AVAILABLE AS PER 381.0065, FS? [ Y /QN ] DISTANCE TO SEWER: ! JW FT PROPERTY ADDRESS: DIRECTIONS TO PROP BUILDING INFORMATION [� RESIDENTIAL [ ] COMMERCIAL Unit Type of No. of Building Commercial/Institutional System Design No Establishment Bedrooms Area Sq£t Table 1 Chapter 64E-6, FAC 1 PLdevlc�p [-� 2115-- 2 3 4 [ ] Floor/Equipment Drains � I Other (Specify) SIGNATURE: DATE, /oI 21 lei DH 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated 64E-6.001, PAC Page 1 of 4 STATE OF FLORIDA - _ APPLICATION # DEPARTMENT OF HEALTH PERMIT # 56-SF-2012257 ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM DOCUMENT # SE1230583 SITE EVALUATION AND SYSTEM SPECIFICATION APPLICANT: Adams Homes of Northwest Florida, Inc CONTRACTOR / AGENT: .Benjamin Drew"s Plumbing & Drain Services LOT: 17 BLOCK: 77 SUBDIVISION: Indian River Estates ID#: 3402-610-0202-000-2 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: EX ]YES [ ]NO NET USABLE AREA AVAILABLE: 0.23 ACRES TOTAL ESTIMATED SEWAGE FLOW: 400 GALLONS PER DAY [ RESIDENCES -TABLET / OTHER -TABLE 2 ] AUTHORIZED SEWAGE FLOW: 576.01 GALLONS PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE ] UNOBSTRUCTED AREA AVAILABLE: 1000.00 SQFT UNOBSTRUCTED AREA REQUIRED: 750.00 SQFT BENCHMARK/REFERENCE POINT LOCATION: ELEVATION OF PROPOSED SYSTEM SITE Site BM "X" Painted on C/R Center of P 7.00 [ INCHES / FT ] [ 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: PT NON -POTABLE: FT BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: 5 FT POTABLE WATER LINES: 20 FT SITE SUBJECT TO FREQUENT FLOODING? 10 YEAR FLOOD ELEVATION FOR SITE: n+r_ nnnart.c •WFnarra MTMW crmF 1 [ ]YES IX]NO 10 YEAR FLOODING? [ ]YES [X]N01 FT [ MSL / NGVD ] SITE ELEVATION: FT [ MSL / NGVD USDA SOIL SERIES:Waveland Munsell #/Color fine sand Texture Depth 10YR 211 Sand 0To6 10YR 4/1 Sand 6 To 22 10YR 511 Sand 17 To 22 10YR 6/2 Sand 22 To 36 REFUSAL Refusal 36 To 72 Mn FrrF TuWV%rMAMTnV Cr TE 9 USDA SOIL SERIES:Waveland Munsell #/Color fine sand Texture Depth 1 OYR 2/1 Sand 0 TO 10 1 OYR 4/2 Sand 10 To 24 10YR 612 Sand 24 To 37 REFUSAL Refusal 37 To 72 OBSERVED WATER TABLE: 10.00 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 [X]NO MOTTLING: [X]YES [ ]NO DEPTH: 17.00 INCHES •SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: Sand/0.80 DEPTH OF EXCAVATION: DRAINFIELD CONFIGURATION: [XI TRENCH [ ] BED [ ] OTHER (SPECIFY) .r REMARKS/ADDITIONAL CRITERIA WSWT determined using USDA WSS and soil borings. 10YR511 stripping >10%with diffused boundaries In a 10YR411 matrix starting @ 17" in SB1. Refusal due to saturation in both profiles. Recent rain activity responsible for 10" observed water table. SBI 7" below SM. S132 5" below BM. SITE EVALUATED BY: a 20 DATE: May, Dianna (Title: Environmerital Supervisor 1) (Florida Department of Health in St Lu Da 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated: 64E-6.001, FAC INCHES 11/06/2019 Page 3 of 4