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Home My WebLink AboutDOH PAPPERWORKRECEIVED PERMIT #.56-SF-2012241 STATE OF FLORIDA DEC 12 2019 PLCCATION #:AP1450582 DEPARTMENT OF HEALTH DATE PAID: ONSITE SEWAGE TREATMENT AND D §?Q County, Permitting FEE PAID: SYSTEM RECEIPT #: SCANNED DOCUMENT #: PR1284507 St. Luce Count CONSTRUCTION PERMIT FOR: OSTDS New y APPLICANT: (5039 Land Trust(Carr Investment Properties, Inc) PROPERTY ADDRESS: 5039 Amv Ln Fort Pierce. FL 34946 LOT: 6 BLOCK: 1 SUBDIVISION: Green Acres PROPERTY ID #: 1430-701-0006-000-8 [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 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 [ 900 ] GALLONS / GPD Seotlo 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 I ] FILLED pc] MOUND I CONFIGURATION: IX] TRENCH [ ] BED [ ] N F LOCATION OF BENCHMARK: Site BM at El 21.71 NiD in rd I ELEVATION OF PROPOSED SYSTEM SITE [ 5.00 ][ INCHES FT ] E BOTTOM OF DRAINFIELD TO BE [ 9.00 ][FINCHES FT ] L D F 0 T H E R BELOW] BENCHMARK/REFERENCE POINT BELOW]BENCHMARK/REFERENCE POINT HsyulmU: LLL.UU] INCHES EXCAVA'1'lUN ENVUIHEU: L ] 1Nl.DL'D system is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total estimated flow of 9pd. ) SPECIFICATIONS BY: ^Dianna S May TITLE: Environmental Supervisor I APPROVED BY: J TITLE: Environmental Supervisor I St. Lucie CHD Dianna S MYQ; DATE ISSUED: 12/11/2019 EXPIRATION DATE: 06/11/2021 ` DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E-6.003, FAC Page 1 of 3 File Copy' 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. St. Lucie County Health Department tOYI ' 5150 NW Milner Dr Port Saint Lucie, FL 34983 HEALTH PAYING ON: s:56-SF-2012241 13ILLDOCa:56-BID-4468614 CONSTRUCTION APPLICATION #:AP1450582 RECEIVED FROM: Kamer Surveying, Inc AMOUNT PAID: $ 545.00 PAYMENT FORM: CREDIT CARD 034340 PAYMENT DATE: 10/29/2019 MAIL TO: (5039 Land Trust/ Carr Investment Properties, Inc) FACILITY NAME: PROPERTY LOCATION: 5039 Amy Ln Fort Pierce, FL 34946 6 1 Lot: Block: Property ID: 1430-701-0006-000-8 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-4210887 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM APPLICATION FOR CONSTRUCTION PERMIT APPLICATION FOR: [X ] New System [ ] Existing System [ ] Holding Tank [ ] Repair [ X ] Abandonment [ ] Temporary APPLICANT: 5039 Land Trust / Carr Investment Properties Inc. PERMIT NO. DATE PAID: FEE PAID: RECEIPT #: [ ] Innovative AGENT: Karner Surveying, Inc. TELEPHONE:(772) 288 7206 MAILING ADDRESS: 2740 SW MARTIN DOWNS BLVD #333, PALM CITY, FL. 34990 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 LOT: 6 BLOCK: 1 SUBDIVISION: Green Acres Unit 2 S/D PLATTED: Oct. 1971 PROPERTY ID #: 1430-701-0006-000-8 ZONING: RHM-5 I/M OR EQUIVALENT: [ NO ] PROPERTY SIZE: 0.17 ACRES WATER SUPPLY: [ ] PRIVATE PUBLIC [x]<=2000GPD [ ]>2000GPD IS SEWER AVAILABLE AS PER 381.0065, FS? [ No] DISTANCE TO SEWER: FT PROPERTY ADDRESS: 5039 Amy Lane, Fort Pierce DIRECTIONS TO PROPERTY: US 1 towards St. Lucie Blvd. Head west for 2 miles to Hammond Road. Turn right onto Hammond Road. Proceed .15 miles to Amy Lane. Turn left onto Amy Lane. 5039 is on the right (see attached). BUILDING INFORMATION [ X ] RESIDENTIAL [ ] COMMERCIAL Unit Type of No. of Building Commercial/Institutional System Design No Establishment Bedrooms Area Sqft Table 1, Chapter 64E-6, FA- 1 (159 Per Floor clan RESIDENCE 3 I1R3'r 2 3 4 [ ] Floor/Eq SIGNATURE: [ ] Other (Specify) DATE: 10-24-19 DH 4015, 10/97 (P:kevrious Editions May Be Used) ONLINE VERSION Page 1 of 4 STATE OF FLORIDA APPLICATION # DEPARTMENT OF HEALTH PERMIT # 56-SF-2012241 ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM DOCUMENT #SE1233365 SITE EVALUATION AND SYSTEM SPECIFICATION APPLICANT: 5039 Land Trust/ Carr Investment Properties, Inc CONTRACTOR / AGENT: Kamer Survevinq. Inc LOT: 6 BLOCK: 1 SUBDIVISION: Green Acres ID#: 1430-701-0006-000-8 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: 0.17 ACRES TOTAL ESTIMATED SEWAGE FLOW: 300 - GALLONS PER DAY [ RESIDENCES -TABLET / OTHER -TABLE 2 ] AUTHORIZED SEWAGE FLOW: 424.99 GALLONS PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE ] UNOBSTRUCTED AREA AVAILABLE: 865.00 SQFT UNOBSTRUCTED AREA REQUIRED: 750.00 SQFT BENCHMARK/REFERENCE POINT LOCATxON: Site BM at El 21.71 NiD in rd ELEVATION OF PROPOSED SYSTEM SITE 5.00 [ INCHES / FT I [ / BELOW I 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: 65 FT BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: 10 FT POTABLE WATER LINES: 10 FT SITE SUBJECT TO FREQUENT FLOODING? [ ]YES [X]NO 10 YEAR FLOODING? I ]YES [X]NO) 10 YEAR FLOOD ELEVATION FOR SITE: FT[ MSL / NGVD I SITE ELEVATION: FT [ MSL / NGVD SOIL. PROFILE INFORMATION SITE 1 USDA SOIL SERIES:Nettles Munsell#/Color send Texture Depth 10YR 3/1 Fine Sand 0 To 6 10YR 4/1 Fine Sand 6 To 14 10YR 5/1 Fine Sand 14 To 36 10YR 6/1 Fine Sand 20 To 36 1 OYR 413 Loamy Sand 36 To 42 10YR 3/2 Loamy Sand 42 To 51 10YR 5/1 Loamy Sand 51 To 65 10YR 512 Loamy Sand 65 To 72 c ruLNnMLmrnu QTm. 9 USDA SOIL SERIES:Nettles sand Munsell #/Color Texture Depth 1 OYR 4/1 Fine Sand 0 To 14 10YR 5/1 Fine Sand 14 To 24 10YR 611 Fine Sand . 23 To 39 10YR 7/1 Fine Sand 30 To 39 10YR 4/3 Loamy Sand 39 To 61 10YR 512 Loamy Sand 61 To 72 OBSERVED WATER TABLE: 65.00 INCHES [ ABOVE / EELOW ] EXISTING GRADE TYPE: [ PERCHED / APPARENT ] ESTIMATED WET SEASON WATER TABLE ELEVATION: 20 INCHES [ ABOVE / BELOW ] EXISTING GRADE HIGH WATER TABLE VEGETATION: [ ]YES [X]NO MOTTLING: [X]YES [ ]NO DEPTH: 20.00 INCHES SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: Sand/0.80 DEPTH OF EXCAVATION: DRAINFIELD CONFIGURATION: IX ] TRENCH I ] BED [ ] OTHER (SPECIFY) r- REMARKS/ADDITIONAL CRITERIA WSWT determined using USDA WSS and soil borings. 10YR611 stripping In a 10YR511 matrix >10 % with diffused boundaries starting at 20" In S61. Sal 6" above BM. SB2 7" above BM. INCHES SITE EVALUATED BY: � � DATE: 12/05/2019 May, Dianna (Title: Envi manta) Supervisor 1) (Florida Deparhnent of Health In St Lu DH 40ISt 08/09 (Obsoletes previous editions which may not be used) Incorporated: 64E-6.001t SAC Page 3 of 4 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS PERMIT #. APPLICANT: 5039 Land Trust/Carr Investment Properties Inc AGENT: KARNER SURVEYING INC. LOT: 6 BLOCK:1 SUBDIVISION: Green Acres Unit 2 S/D PROPERTY ID #:1430-701-0006-000-8 [Section/Township/Parcel No. or Tax ID Number] TO BE COMPLETED BY ENGINEER, HEALTH DEPARTEMENT EMPLOYEE,OR OTHER QUALIFIED PERSON. ENGINNEERS 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:0.17 ACRES TOTAL ESTIMATED SEWAGE FLOW: 300 GALLONS PER DAY [RESIDENCES -TABLE 1/OTHER-TABLE21 AUTHORIZED SEWAGE FLOW: 300 GALLONS PER DAY [1500 GPD/ACRE OR 2500 GPD/ACRE] UNOBSTRUCTED AREA AVAILABLE: 865 SQFT UNOBSTRUCTED AREA REQUIRED: 750 SQFT BENCHMARK/REFERENCE POINT LOCATION: Set Mag Nail/Disk at south edge of Pavement at EL 21.71 NAVD. ELEVATION OF PROPOSED SYSTEM SITE IS 0.72 [inehes/M] [.SOV /SEE6W] NC.. -/REFERENGS POINT THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES SURFACE WATER: 75 FT DITCHES/SWALES: 15' FT NORMALLY WET? [ ] YES [x] 0 WELLS: PUBLIC:N/A FT LIMITED USE: FT PRIVATE: n/a FT NON -POTABLE: 50 FT BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: 10 FT POTABLE WATER LINES: 10 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/NAVD SOIL PROFILE SITE 1 MUNSELL #/COLOR TEXTURE i" T USDA SOIL SERIES: bull. Yxur'"O• 1NA!11l DWx LU1V b1•L•r: L MUNSEL.L #/COLOR TEXTURE USDA SOIL SERIES: DEPTH TO TO TO TO TO TO TO TO mn OBSERVED WATER TABLE: INCHES [ABOVE / BELOW] EXISTING GRADE. TYPE:[PERCHED / APPARENT] ESTIMATED WET SEASON WATER TABLE ELEVATION: INCHES [ABOVE / BELOW] EXISTING GRADE HIGH WATER TABLE VEGETATION: [ ] YES [ ] NO MOTTLING: [ ] YES [ ] NO DEPTH: INCHES SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: DEPTH OF EXCAVATION: INCHES DRAINFIELD CONFIGURATION: [ ] TRENCH [ ] BED [ ] OTHER (SPECIFY) REMIUIKS/ADDITIONAL CRITERIA: SITE EVALUATED BY DH 4015, 10/96 (Replaces 4-4. 4015 [page 33 which may be used) DATE:10/24/2019 Page 3 of 4 INSTRUCTIONS: 10/2412019 Google Maps 5039 Amy Ln court �� 5039 Amy Ln - Google Maps IIOF-0mnCILC® M:hYi..ln M.iau Ln h S pp VW39AmyWe µvyue(Ounln Nyryvt4 Am�ln AbGfl(1 TuOnnvml P European ylighl Ttm m g P Awn3lo1Co11Lg0 Y � "r XoulnvvA SI LWW IINU WL'nlY X06Iu Im" WL.0 .1. (:OIO'y HQ CUtl U,d., >I LIKR.11. 1--nIy HV OVtl(LOS11 SI LLCIC Vllf L' umy wo b11M ([➢51f 11 11 v Ea1I r.W1l Tlil'a.'i® All Covnly AlAWlonFa ® AulWsh USA Cm Wash Sum Slpoo(TNSeei Ltd Love LUlld Fnmvq Google Map data ©2019 200 ft L https://www.google.comlmapslplacel5039+Amy+Ln,+Fort+pierce,+FL+349461@27.4859295,-80.3767998,17zldata=!4m5!3m4! lsOx88def3fac9fa86ab:Ox8945998i5ef84bOdl8m213d27A85939!4d-80.375... 112 Kamer Surveying, Inc. 2740 SW Martin Downs Blvd. #333 Palm City, FL 34990 Bill To Andrews Capitol Corp Jayson Oneschuck Invoice Date Invoice # 10/24/2019 8553 I LEGAL DESCRIP... I CLIENT NUMBER I JOB NUMBER I Gm Acrs U2 Bl L6 1 1 1908-14 Description Amount Preparation of Boundary Survey / Topography 570.00 Preparation of Onsite Sewage Disposal System Application / 4 copies 275.00 Preparation of site plan for submission to Health Department 175.00 Courtesy Discount-300.00 All invoices are payable upon receipt. After 14 calendar days, any unpaid balances will be subject to a $20.00 penalty charge and interest charges compounded daily based on a 1.5% Total $720.00 monthly interest rate. Payments/Credits $0.00 Phone# I Balance Due $720.00 1 772-288-7206 1 i EXCITEMENT 3 Beds • 2 Baths • 1159 sq. ft. • 44' width • 28' depth Home Plan 36TRU28443RH https://www.claytonhomes.com/homes/36TRU28443RH Environmental Health Site Plan Approved for Construction Supersedes All Previous Site Plans for OSTDS # & Well # 1* A :aDate: 9 • -., - ._r"/'. lJi .5.r ?`y/ /r `>fi'r4/. /�3'% ". ,r. Features Reviewer: _ ,d Ape Split Bedrooms Utility Room Open Floor Plan The home series and floor plans shown all have starting prices within the price range indicated Your local Home Center can quote you specific prices and terms of purchase for specific homes. Clayton invests in continuous product and process improvement. All home series. floor plans, specifications, dimensionsfeatures. materialsavailability and starting prices shown are artist's renderings or estimates and are subject to change without notice or obligation. Dimensions are nominal and length and width i measurements are from exterior wall to extenor wall. Starting prices include the home only, plus typical delivery and installation Starting prices do not include other costs such as taxes title fees, insurance premiums, fling or recording fees, land or improvements to the land, optional home features, optional delivery or installation services, wheels and axles, community or homeowner association fees. or any other items not shown on your Retailer Closing Agreement and related documents (your RCA). Your RCA will show the details of your purchase 2019 Clayton Homes All rights reserved. Published 2019 www.claytonhomes.com