21-025-Golfview Heights of Westgate Water Main Replacement -Appendix A Permits and Appendix B Geotechnical results.pdf

Mission:

To protect, promote & improve the health of all people in Florida through integrated state, county & community effor1s.

Ron Desantis Governor

Jo&eph A. Ladapo, M.D., Ph.D.

State Surgeon General

Vision: To be the Healthiasl Slate in the Nation

Notification of Acceptance of Use of a General Permit

Permitee:

Krysten Berntsen, P.E.

Deputy Director Palm Beach Water Utilities Department 8100 Forest Hill Boulevard West Palm Beach, FL kBerntsen@pbcwater.co m

Dear Ms. Berntsen:

Permit Number: 138307-748-DSGP Issue Date: 09/28/2023 Expiration Date: 09/27/2028 County: Palm Beach Project: (WUD 21-025) Golfview Heights of Westgate Water Main Replacement Water Supplier: PBCWUD

PWS ID: 4504393

On September 13 ,2023 the Florida Department of Health-Palm Beach County, as an approved local program of the Florida Department of Environmental Protection, received a "NoUce of Intent to Use Construthe General Permit for Construction of Water Main Extensions for PWSs" [DEP Form No. 62- 555.900(7}], under the provisions of Rule 62-4.530 and Chapter 62-555, Florida Administrative Code (F.A.C.). The proposed project includes:

Construction of approximately 4,163 LF of 6" PVC, 270 LF of 6" DIP Poly-wrapped, 14,119 LF of 8" PVC, 2,503 LF of 8" DIP Poly-wrapped water main for replacement of existing undersized watermain. 12 additional fire hydrants and grouting in place of 9,321 LF 4,, and 6" and 4,558 LF of 8" water main for 410 PBCWUD customers in the Golfview Heights community of Westgate in West Palm Beach, Florida.

Based upon the submitted Notice and accompanying documentation, this correspondence is being sent to advise that the Departm~nt does not object to the use of such general permit at this time.

Please be advised that the permittee is required to abide by Rule 62-555.405. F.A.C., all applicable rules in Chapters 62-4, 62-550, 62-555, F.A.C., and the General Conditions for All General Drinking Water Permits (found in 62-4.540. F.A.C.).

When any existing asbestos cement (AC) pipes are replaced under this permit, the permittee shall do so in accordance with the applicable rules of the Federal Asbestos Regu lation and Florida DEP requirements. For specific requirements applicable to AC pipes, the permittee should contact the Air and Waste Management section managers prior to commencing any such activities at (561) 837- 5900 #3. Please be aware that a notification is required to be submitted to the Department for a regulated project.

Florida Department of Health, Palm Beach County Office of the Director P.O. Box 29, 600 Clematis Street, West Palm Beach, FL 33402

PHONE: 561-837-5900 •FAX: 561-837·5294

FloridaHealth.gov / pal mbeach.floridahealth.gov

I P 1-1 A B Accredited Health Department Public Health Accreditation Board

APPENDIX “A” – APPROVED PERMITS

PALM BEACH COUNTY HEALTH DEPARTMENT PERMIT – 138307 - 748 - DSGP

PBC WUD No. 21-025 Appendix “A” – Approved Permits PAGE Appx. “A” - 1

PERMITTEE: Palm Beach County Water Utilities Department Krysten Berntsen, P.E., Deputy Director

Permit/Certification No.: 138307-7 48-DSG P

The permittee shall comply with all sampling requirements specific to this project. These requirements are attached for review and implementation. Pursuant to Rule 62-555.345, F.A.C ., the permittee shall submit a certification of construction completion [DEP Form No. 62-555.900(9 )) to the Department and obtain approval, or clearance, from the Department before placing any water main extension constructed under this general permit into operation for any purpose other than disinfection or testing for leaks.

Within 30 days after the sale or legal transfer of ownership of the permitted project that has not been cleared for service in total by the Department, both the permittee and the proposed permittee shall sign and submit an application for transfer of the permit using Form 62-555.900(8), F.A.C. , with the appropriate fee. The permitted construction is not authorized past the 30-day period unless the permit has been transferred.

This permit will expire five years from the date of issuance. If the project has been started and not completed by that time, a new permit must be obtained before the expiration date in order to continue work on the project, per Rule 62-4.030, F.A.C.

Sincerely, For he Division

J

LM/JH/JP

c: Project Engineer: Amir Keshavarz, P.E.

Utility: Same

PAGE Appx. “A” - 2

PERMITIEE: Palm Beach County Water Utilities Department Krysten Berntsen, P.E., Deputy Director

Permit/Certification No.: 138307. 7 48-DSGP

Civil Penalty May Be Incurred if this project is placed into operation before obtaining a clearance from this office.

Requirements for clearance upon completion of projects are as follows:

1) Clearance Form Submission of a fully completed Department of Environmental Protection (DEP) Form 62-555.900(9) Certification of Construction Completion and Request for Clearance to Place Permitted PWS Components into Operation.

2) Record Drawings Submission of the portion of record drawings showing deviations from the DEP construction permit, including preliminary design report or drawings an specifications, if there are any deviations from said permit (Note that it is necessary to submit a copy of only the portion of record drawings showing deviations and not a complete set of record drawings.).

3) Bacteriological Results Copies of satisfactory bacteriological analysis (a.k.a. Main Clearance), taken within sixty (60) days of completion of construction, from locations within the distribution system or water main extension to be cleared, in accordance with Rules 62-555.315(6), 62-555.340, and 62-555.330, F.A.C. and American Water Works Association (AWNA) Standard C 651-92, as follows:

• Connection to an existing system

• The end point of the proposed addition

• Any water lines branching off a main extension

• Every 1,200 feet on straight runs of pipe

Each location shall be sampled on two consecutive days, with sample points and chlorine residual readings clearly indicated on the report. A sketch or description of all bacteriological sampling locations must also be provided . All samples shall be collected by an employee of a state certified laboratory or a certified operator and be reported on DEP Reporting Format 62-

550. 730.

For further clarification contact:

Jay Hardman, P.E.

Florida Department of Health Palm Beach Plan Review & Permit Section 800 Clematis Street, 4 th Floor West Palm Beach, FL 33401

561-837-5900 #5

PAGE Appx. “A” - 3

NOTICE OF INTENT TO USE THE GENERAL PERMIT FOR CONSTRUCTION OF

WATER MAIN EXTENSIONS FOR PWSs

INSTRUCTIONS: This notice shall be completed and submitted by persons proposing to construct projects permitted under the "General Pennit for Constmction of Water Main Extensions for Public Water Systems" in Rule 62-555.405, F.A.C. AT LEAST 30 DAYS BEFORE BEGINNING CONSTRUCTION OF A WATER MAIN EXTENSION PROJECT, complete and submit one copy of this notice to the appropriate Depat1ment of Environmental Protection (DEP) District Office or Approved County Health Department (ACHD) along with payment of the proper permit processing fee. (When completed, Part II of this notice serves as the preliminary design report for a water main extension project, and thus, it is unnecessary to submit a separate preliminary design report or drawings, specifications, and design data with this notice.) AU infonnation provided in this notice shall be typed or printed in ink. The DEP permit processing fee for projects requiring the services of a professional engineer during design is $650, and the DEP permit processing fee for projects not requiring the services of a professional engineer during design is $500. * Some ACHDs charge a county permit processing fee in addition to the DEP permit processing fee. Checks for permit processing fees shall be made payable to the Department of Environmental Protection or the appropriate ACHD. NOTE THAT A SEP ARA TE NOTIFICATION AND A SEP ARA TE PERMIT PROCESSING FEE ARE REQUIRED FOR EACH NON-CONTIGUOUS PROJECT. t

* Except as noted in paragraphs 62-555.520(3)(a) and (b), F.A.C.. projects shall be designed under the responsible charge of one or more professional engineers licensed in Florida.

t Non-contiguous projects are projects that are neither interconnected nor located nearby one another (i.e., on the same site. on adjacent streets, or in the same neighborhood).

I. General Prnject Information

A. Name of Project: (WUD 21-025} Golfview Heights of Westgate Water Main Replacement B. Description of Project and Its Purpose:

Replace 21,560 LF of existing undersized water mains, existing front-lot water services for 410 WUD customers & affected fire hydrants by installing 12 additional fire hydrants for coverage, 4,163 LF of 611 PVC water main, 270 LF of 6 11 DIP Poly-wrapped water main, 14,119 LF of 8" PVC water main, 2,503 LF of 8" DIP Poly-wrapped water main and grouting in-place 9,321 LF of existing 4" & 6" water main as well as 4,558LF of existing 8" water main.

C. Location of Project CEJVED

1. County Where Project Located: _P_a_rm_ Be_a_c_h_C_o_u_n...;.ty ___ _____ ____ _ ..,.B...,. ... E ...... ~:-=~-----

2. Description of Project Location:

Golfview Heights Community of Westgate in West Palm Beach, FL SEP 11 2023 Florida Department ~[Health .. PBC

D. Estimate of Cost to Construct Project:_$_6_,2_4_0_,5_6_1 _.5_8 _ ____ _____ ____ ___ _.P_.lan..=.R==-evi_ ew ___ _ E. Estimate of Dates for Starting and Completing Construction of Project:

Start date: June 2024 Finish date: December 2025 F. Permittee

PWS/Comoanv Name: PALM BEACH COUNTY WATER UTllllY DEPARTMENT I PWS Identification No.:*4504393

PWS Tvne:* [-1 Communitv Ll Non-Transient Non-Communitv I l Transient Non-Communitv 1. ii Consecutive

Contact Person: Krystin Berntsen. P.E .• PMP I Contact Person's Title: Deputy Director

Contact Person's Mailing Address: e100 FOREST HILL BLVD

Citv: WEST PALM BEACH I State: FL I Zio Code:33413

Contact Person's Telephone Number: ss,-493-tiooo I Contact Person's Fax Number: NIA

Contact Person's E-Mail Address: KBERNTSEN@PBCWATER.COM

* This information is required only if the permittee is a public water system (PWS).

G. Public Water Svstem (PWS) Supplying Water to Proiect

PWS Name: PALM BEACH COUNTY WATER UTILITY DEPARTMENT SYSTEM

PWS Tvne: I• I Conununitv I .I Non-Transient Non-Communitv PWS Owner: PALM BEACH COUNlY WATER l!TllllY DEPARTMENT

Contact Person: Krystin Berntsen, P.E., PMP

Contact Person's Mailing Address: 8100 FOREST HILL SLVD

Citv: WEST PALM BEACH

Contact Person's Teleohone Nwnber: 551-493.5000

Contact Person's E-Mail Address: KBERNTSEN@PBCWATER.COM

OEP Form 62-SSS.900(7)Altemate Effective August 213, 2003 (Updated September 8, 2015>

Pagel

I PWS Identification No.: 4504393

I J Transient Non-Communitv I I Consecutive l Contact Person's Title: Deputy Director l State: FL I Zio Code:33413 I Contact Person's Fax Number: NIA

PAGE Appx. “A” - 4

NOTICE OF INTENT TO USE THE GENERAL PERMIT FOR CONSTRUCTION OF WATER MAIN

EXTENSIONS FOR PWSs

I project Name: (WUD 21-025) Gol(vlew Heights ol Westgate Waler Main Replacement I Permittee: PALM BEACH COUNTY WATER UTILITY DEPARTMICNT

H.

I.

Public Water System (PWS) that Will Own Proiect After Tt rs Placed into Permanent Operation PWS Name: PALM BEACH COUNTY WATER UTILITY DEPARTMENT I PWS ldenti fication No.:* 4S04393

PWS Type:* I • .. I Conununitv I ,I Non-Transient Non-Communitv I I Transient Non-CotnmW1itv I I Consecutive PWS Owner: PALM BEACH COUNTY WATER UTILITY DEPARTMENT Contact Person: K,ystin Berntsen, P.E .. PMP I Contact Person's Title: Deputy Director

Contact Person's Mailing Address: 8100 FOREST Hill BLVD

City: WEST PALM BEACH I State: FL I Zio Code: 3341 3

Contact Person's Tele Phone Number: ss1-<193-6000 I Contact Person's Fax Number: NIA Contact Person's E-Mail Address: KBERNTSEN@PBCWATER.COM

* This information is required only if the owner/operator is an existing PWS.

Professional Enmn.eer(s) or Other Person(s) in Responsible Charge of Designing Proiect"' Company Name: Keshavsrz & Associat&s. Inc.

Designer(s): , Amir J. Keshavarz, P. E. I Title(s) ofDesigner(s): M . D" t anaging irec or

Ytlalifications of Designer(s):

Professional Engineer(s) Licensed in Florida-License Number(s): 85259

D Public Officer(s) Employed by State, County, Municipal, or Other Governmental Unit ofStatet D Plumbing Contractor(s) Licensed in Flo1ida - License Number(s):/\ Mailin~ Address ofDesiener(s ):111 DIXIE HWY. SUITE 201

Cit\•: WEST PALM BEACH I State:FL I Zip Code: 33401

Telephone Number ofDesiener(s ):(561)689-8600 I Fax Number ofDesil11ler(s): NIA

E-Mail Address(es) ofDesigner(s): amir@keshavarz.com

* F.xcept as noted in paragraphs 62-555. 520(3)(a) and (h), F.A. C., projects shall be designed under the responsible charge of one or more professional engineers licensed in Florida.

t Attach a detailed construction cost estimate shawing that the cost to construct this project is $ I 0, 000 or less.

I\ A tlach documentation showing that this project will be installed by the plumbing contractor(s) designing this project, documentation showing that this project involves a public water system serving a single property and fewer than 250 fixture units, and a detailed construction cost estimate showing that the cost to construct this project is $50,000 or less.

11. Preliminary Dr~ign Report for l'rojed'

A. Service Area, Water Use, and Service Pressure Information

1. Design Type and Number of Service Connections, and Average Daily Water Demands and Maximum-Day Water Demands, in the Entire Area to Be Served by the Water Mains Being Constructed Under this Proiect:

SinlZle-Familv Home Mobile Home

C = Av~tage Daily· Water Dcm!llld Pee Service (;onneciil)ll, imd

·o ;= Total Ai'Crage Daily Water Demand<, gpq (Columns .BxC for

Residential service Co~ections)

A:nutment o Commercial, Institutional or Industrial FacilitV"

E = Total Maximum Day Water Demaruib, lllld

T,.,,.1 o ... •, ·. o o

a. Description of Commercial, Institutional, or Industrial Facilities and Explanation ofMethod(s) Used to Estimate Average Daily Water Demand for These Facilities:

NIA

b. Explanation of Peaking Factor(s) or Method(s) Used to Estimate Maximum-Day Water Demand:

NIA

OEP Fam62-555.900(7)Altemate Effective August 28. 2003 (Updated ~pl11mb~r 8, 2015)

PAGE Appx. “A” - 5 j Project Name: (\'IUD 21-025) GolMew Heights of W~taate Weter Main Replacement I Permittee: PALM BEACH COUNlYWATER urn.rrv ocPAATMENT

2. Explanation of Peaking Factor{s) or Method(s) Used to Estimate Design Peak-Hour Water Demand and, for Small Water Systems that Use Hydropneumatic Tanks or that Are Not Designed to Provide Fire Protection, Peak Instantaneous Water Demand:

N/A

3. Design Fire-Flow Rat.e and Duration:

1000GPM

4. Design Service Pressure Range:

30-50 PSI

B. Project Site Infonnation

l. ATTACH A SITE PLAN OR SKETCH SHOWING THE SIZE AND APPROXIMATE WCATION OF NEW OR ALTERED

WATER MAINS, SHOWING THEAPPROXCMATELOCATIONOF HYDRANTS, VALVES, METERS, AND BLOW

OFFS TN SAID MAINS, AND SHOWING HOW SAID MAINS CONNECT TO THE PUBUC WATER SYSTEM

SUPPLYING WA1ER FOR THE PROJECT.

2. Description of Any Areas Where New or Altered Water Mains Will Cross Above or Under Surface Water or Be Located in Soil that Is Known to Be Aggressive:

There are no surface water crossings for this project.

There are no known aggressive soils that require anti-corrosion measures be implemented within the project area.

C. information About Compliance with Design and Construction Requirements

1. If this project is being designed to comply with the following requirements, initial in ink before the requirements. If any of the following requirements do !!Qt apply to this project or ifthls project includes exceptions to any of the following requirements as allowed by rule, mark "X" before the requirements and complete Part il. C.2 below. RSWW = Recommended Standards for Wf.!!:JVorks as incorporated into Rtile 62-SSS.330, F.A.C.

~ a. This pr?j~c~ is ?eing de~igned to keep ex_isting ~ter mains ~d service lines in operation during construction

X or to mmuruze mterrupt1on of water service dunng construction. (RSWW 1.3.a; citceptions allowed under FAC 62- S55.3301

b. All pipe, pipe fittings, pipe joint packing and jointing materials, valves, fire hydrants, and meters installed under this project will confonn to applicable American Water Works Association (A WWA) standards. (FAC 62-555.320(2 lXb), RSWW 8.0, and AWWA st.mdards as incorporated into FAC 62-555.330; exceptio~ allowed under FAC 62- 555.320(21)(c)]

c. All public water system components, excluding fire hydrants, that will be installed Wider this project and that will come into contact with drinking water will conform to NSF International Standard 61 as adopted in Rule 62-555.335, F.A.C., or other applicable standards, regulations, or requirements referenced in paragraph 62- 555.320(3)(b), F.A.C. [FAC 62-555.320(3)(1,); exceptions allowed under FAC 62-555.320(3)(d)]

d. All pipe and pipe fittings installed under this project will contain no more than 8.0% lead, and any solder or flux used in this project will contain no more than 0.2% lead. [FAC 62-555.322]

e. All pipe and pipe fittings installed under this project will be color coded or marked in accordance with subparagraph 62-555.320(2I)(b)3, F.A.C., using blue as a predominant color. (Underground plastic pipe will be solid-wall blue pipe, will have a co-extruded blue external skin, or will be white or black pipe with blue stripes incorporated into, or applied to, the pipe wall; and underground metal or concrete pipe will have blue stripes applied to the pipe wall. Pipe striped during manufacturing of the pipe will have continuous stripes that run parallel to the axis of the pipe, that are located at no greater than 90~degree intervals around the pipe, and that will remain intact during and after installation of the pipe. If tape or paint is used to stripe pipe during installation of the pipe, the tape or paint will be applied in a continuous line that runs parallel to the axis of the pipe and that is located along the top of the pipe; for pipe with an internal diameter of24 inches or greater, tape or paint will be applied in continuous lines along each side of the pipe as well as along the top of tbe pipe.

Aboveground pipe will be painted blue or will be color coded or marked like underground pipe.) (FAC 62- 555.320(2l)(b)3) f All new or altered water mains included in this project are sized after a hydraulic analysis based on flow demands and pressure requirements. A TIA CH A HYDRAULIC ANALYSIS JUSTIFYING THE SIZE OF

ANY NEW OR ALTERED WATER MAINS WITH AN INSIDE DIAMETER OF LESS THAN THREE

INCHES. [FAC 62-555.320(21)(b) an<l .l?SWW8. IJ

OEP Form 62-56S.II00(7JAflemate Ell'ectlve August 28. 2003 (Updaled Saptember 8, 2015)

PAGE Appx. “A” - 6

X

X

X g.

h.

i.

j.

k.

I.

m.

Pennittee: PALM BEACH COUNTY WATER lJTlUTY DEPARTMENT

The inside diameter of new or altered water mains that are included in this project and that are being designed to provide fire protection and serve fire hydrants will be at least six inches. [FAC 62-555.320(2l}(b) and RSWW 8.1.2] New or altered water mains that are included in this project and that are not being designed to carry fire flows do !!Qt have fire hydrants connected to them. [FAC 62-555.320(21J(b) and RSWW 8.L5] This project is being designed to minimize dead-end water mains by making appropriate tie-ins where practical. [FAC 62-555.320(21 )(b) and RSWW 8.1.6.a] New or altered dead-end water mains included in this project will be provided with a fire or flushing hydrant or blow-off for flushing purposes. [FAC 62·555.320(2 l)(b} and RSWW8.1.6.b] Sufficient valves will be provided on new or altered water mains included in this project so that inconvenience and sanitary hazards will be minimized during repairs. [FAC 62-555.320(2 1)(b) and RSWW8.2] New or altered fire hydrant leads included in this project will have an inside diameter of at least six inches and will include an auxiliary valve. [FAC 62-555.320(21Xb} and RSWW 8.3.3] All fire hydrants that will be installed under this project and that will have unplugged, underground drains will be located at least three feet from any existing or proposed storm sewer, stormwater force main, pipeline conveying reclaimed water regulated under Part III of Chapter 62-610, F .A. C., or vacuum-type sanitary sewer;

at least six feet from any existing or proposed gravity- or pressure-type sanitary sewer, wastewater force main.

or pipeline conveying reclaimed water not regulated under Part Ill of Chapter 62-10, F.A.C.; and at least ten feet from any existing or proposed "on-site sewage treatment and disposal system." [FAC 62-555.31 4(4)]

n. At high points where air can accumulate in new or altered water mains included in this project, provisions will be made to remove the air by means of air relief valves, and automatic air relief valves will not be used in situations where flooding of the valve manhole or chamber may occur. (FAC 62-555.320(21)(b) and RSWW8.4.1J

o. The open end of the air relief pipe from all automatic air relief valves installed under this project will be extended to at least oue foot above grade and will be provided with a screened, downward-facing elbow. (FAC 62-555.320(2l)(b) and RSWW 8.4.2)

p. New or altered chambers, pits, or manholes that contain valves, blow-offs, meters, or other such water dislribution system appurtenances and that are included in this project will not be connected directly to any sanitary or stonn sewer, and blow-offs or air relief valves installed under this project wilJ not be connected directly to any sanitary or stonn sewer. {FAC 62-555.320(21)(b) and RSWWS.4.3)

q. New or altered water mains included in this project will be installed in accordance with applicable AWW A standards or in accordance with manufacturers' recommended procedures. [FAC 62-S55.320(21Xb), RSWWS.5. 1, and AWWA standards as inco,poruted into PAC 62-555.330]

r. A continuous and unifonn bedding will be provided in trenches for undergro1U1d pipe installed under this project; backfill material will be tamped in layers around underground pipe installed under this project and to a sufficient height above the pipe to adequately support and protect the pipe; and unsuitably sized stones (as described in applicable A WW A standards or manufacturers' recommended installation procedures) found in trenches will be removed for a depth of at least six inches below the bottom of underground pipe installed under this project [FAC 62-555.320(2\Xb), RSWW 8.5.2]

s. All water main tees, bends, plugs, and hydrants installed under this project will be provided with thrust blocks or restrained joints to prevent movement. (FAC 62-555.320(2 l)(b) and RSWW 8.5.4)

t. New or altered water mains that are included in this project and that will be constructed of asbestos-cement or polyvinyl chloride pipe will be pressure and leakage t.ested in accordance with A WWA Standard C603 or C605, respectively, as incorporated into Rule 62-555.330, F.A.C., and all other new or altered water mains included in this project will be pressure and leakage tested in accordance with A WW A Standard C600 as incorporated into Rule 62-555 .330. (FAC 62-555.320(2 l)(b)I and AWW A standards as incorporated into FAC 62-555.330)

u. New or altered water mains, including fire hydrant leads and including service lines that will be tmder the control of a public water system and that have an inside diameter of three inches or greater, will be disinfected and bacteriologically evaluated in accordance with Rule 62-555.340, F.A.C. [FAC 62-555.320(21Xb)2 andFAC 62- 555.340)

v. New or altered water mains that are included ill this project and that will be installed in areas where there are known aggressive soil conditions will be protected tlu·ough use of corrosion-resistant water main materials, through encasement of the water mains in polyethylene, or through provision of cathodic protection. [FAC 62- 5SS.320(2l)(b} and RSWW 8.S.?.d)

OEP Form 82-656.900(7)Altema:.

Effective August 28, 2003 (Updated September 8, 201 S)

PAGE Appx. “A” - 7

X

X

X

: (WUD 21 -025) GclMaw Heights of we,~te Waler Main RopleC<lfllen! Pennittee: PALM BEACH COUNTY WATER UTILl'!Y DEPARTMENT

w. New or relocated, underground water mains included in this project will be laid to provide a horizontal distance of at least three feet between the outside of the water main and the outside of any existing or proposed vacuum type sanitary sewer, stonn sewer, stormwater force main, or pipeline conveying reclaimed water regulated under Part III of Chapter 62-610, F.A.C.; a horizontal distance of at least six feet between the outside of the water main and the outside of any existing or proposed gravity-type sanitary sewer ( or a horiz.ontal distance of at least three feet between the outside of the water main and the outside of any existing or proposed gravity type sanitary sewer if the bottom of the water main will be laid at least six inches above the top of the sewer); a horizontal distance of at least six feet between the outside of the water main and the outside of any existing or proposed pressure-type sanitary sewer, wastewater force main, or pipeline conveying reclaimed water not regulated under Part ill of Chapter 62-610, F.A.C.; and a horizontal distance of at least ten feet between the outside of the water main and all parts of any existing or proposed "on-site sewage treatment and disposal system.n [FAC 62-555.3 14(1); exceptions allowed wider FAC 62-555.314(5)]

x. New or relocated, underground water mains that are included in this project and that will cross any existing or proposed gravity- or vacuum-type sanitary sewer or stonn sewer will be laid so the outside of the water main is at least six inches above the other pipeline or at least 12 inches below the other pipeline; and new or relocated, underground water mains that are included in this project and that will cross any existing or proposed pressure type sanitary sewer, wastewater or stonnwater force main, or pipeline conveying reclaimed ·water will be laid so the outside of the water main is at least J 2 inches above or below the other pipeline. [FAC 62-555.314(2);

exceptions allowed under FAC 62-555.314(5))

y. At the utility crossings described in Part ll.C. I . w above, one full length of water main pipe will be centered above or below the other pipeline so the water main joints will be as far as possible from the other pipeline .Q!

the pipes will be arranged so that all water main joints are at least three feet from all joints in vacuum-type sanitary sewers, storm sewers, stormwater force mains, or pipelines conveying reclaimed water regulated under Part Ill of Chapter 62-610, F.A.C., and at least six feet from all joints in gravity- or pressure-type sanitary sewers, wastewater force mains, or pipelines conveying reclaimed water llill regulated under Part ID of Chapter 62-61 0, F.A.C. [FAC 62-555.314{2); exceptions allowed under FAC 62-555.314(5)]

z. New or altered water mains that are included in this project and that will cross above surface water 1,vill be adequately supported and anchored, protected from damage and freezing, and accessible for repair or replacement. [FAC 62-555.320(2I)(b} and RSWW8.7.1J

aa. New or altered water mains that are included in this project and that will cross under surface water will have a minimum cover of two feet. (FAC 62-555.320(2 !)(b) aod RSWW8.7.21

bb. New or altered water mains that are included in this project and that will cross under surface water courses greater than I 5 feet in width will have flexible or restrained, watertight pipe joints and will include valves at both ends of the water crossing so the underwater main can be isolated for testing and repair; the aforementioned isolation valves will be easily accessible and will llQt be subject to flooding; tl:te isolation valve closest to the water supply source will be in a manhole; and permanent taps will be provided on each side of the isolation valve within the manhole to allow for insertion of a small meter to determine leakage from the underwater main and to allow for sampling of water from the underwater main. (FAC 62-555.320(2 l)(b) and RSWW 8.7.2]

cc. This project is being designed to include proper backflow protection at those new or altered service connections where backflow protection is required or recommended under Rule 62-555.360, F.AC., or in Recommended Practice for Backjlow Prevention and Cross-Connection Control, A WW A Manual Ml 4, as incorporated into Rule 62-555.330, F.A.C.; m: the public water system that will own this project after it is placed into operation has a cross-connection control program requiring water customers to install proper backflow protection at those seivice connections where bacldlow protection is required or recommended under Rule 62-555.360, F.A.C., or in AWWA Manual Ml 4. [FAC 62-555.360 and AWWA Manual Ml4 as incorporated into

FAC 62-5S5.330]

dd. Neither steam condensate, cooling water from engine jackets, nor water used in conjunction with heat exchangers will be returned to the new or altered water mains included in this project. [FAC 62-555.320{2 l )(b) and

RSWW882]

OEP Fomi 62-5S5.900{7JA1temate Effec~ve August 28, 2003 (Llpdaled SeplemberS, 2015)

Pages

PAGE Appx. “A” - 8

I Project Name: {WUO 2 1-025) Gollview Heights of WDslgate Water Main Replacement I Permittee: PALM BEACH COUNTY WATER UTILITY DEPARTMENT

2. Explanation for Requirement3 Marked "X" in Part II.C. l Above, Including Justification; Documentation, Assurances, and/or Alternatives as Required by Rule for Exceptions to Requirements in Part H.C. l:

F. PBCWUD performed any Hydraulic Modeling and confirmed proposed water main pipe diameters as acceptable.

M. There are no proposed fire hydrants with underground drains

N. No ARV's are proposed in this project.

0. No ARV's are proposed in this project.

V. There are no known aggressive soils that require anti-corrosion measures within the project area.

Z. No aerial water main crossings are proposed for the project.

AA. No subaqueous water main crossings are proposed in the project.

BB. No subaqueous water main crossings are proposed in the project.

I completed Part II of this notice, and the information provided in Part II and on the attaclunent(s) to Part 11 is true and accurate to the best of m know led e and belief.

Signature, Seal, and Date of Professional Engineer (PE) or Signature and Date of Other Person in Responsible Charge of Designing Project:$

Printed/I' ed Name: Amir J. Keshavarz. P .E.

License Number of PE or License Number or Title of Other Person in Responsible Charge ofDesigning Project:* 85259

Portion of Preliminary Design Report for Which Responsible:

ALL

Signature, Seal, and Date of Professional Engineer (PE) or Signature and Date of Other Person in Responsible Charge of Designing Project:*

Printed/Typed Name:

License Number of PE Q!: License Number or Title of Other Person in Responsible Charge ofDesigning Project:*

Portion of Preliminary Design Report for Which Responsible:

* Except as noted in paragraphs 62-555.520(J)(a) and (b), FA.C.. projects shall be designed under the responsible charge of one or more PEs licensed in Florida. If this project is being designed under the responsible charge of one or more PEs licensed in Florida, Part II of this notice shall be completed, signed, sealed, and dated by the PE(s) in responsible charge. If this project is not being designed under the responsible charge of one or more PEs licensed in Florida, Part II shall be completed. signed, and dated by the person(s) in responsible chal'ge of designing this project.

DEP f arm 62-55S.900(7)Allemate El'leclive Auguil 23, 2003 (Updated September a. 2015)

Page6

PAGE Appx. “A” - 9 i Project Name: (WUD 21-025) GOIM.W Holgors otWM,gote WtMr Main Re:>lacemont I Pennlttee; PAl.l',I se..cH couNTY wAreR ur,uw 01:PAATMENr

111. l 't•rlilic:lli"n~ A. Certification by PermiUee

I am duly authorized to sign this notice on behalf of the permittee identified in Part I.F of this notice. I certify that., to the best of my knowledge and belief, this project complies with Chapter 62-555, F.A.C. I also ce1tify 1hat coostructio11 of this project has 1!Q1 l)esun yet and that, to the best of my. knowledge and belief, this project does !!Qi include any of the following construction work:

• construction of water mains conveying raw or partially tTCated drinking water;

• construction of drinking water treatment, pumping, or storage facilities or conflict manholes;

• construction of w11ter mains in areas contaminated by low-molecular-weight petroleum products or organic solvents;

• construction of an interconnection between previously separate public water systems or construction of water mains that create a "new system" as described under subsection 62-S55.525(1), F.A.C.; or

• construttion of water mains that will remain dry following completion of construction.

(A specific construction pe1tnit is required for each project involving any of the above listed constrnction work.)

I understand that, if this p'roject is designed under the responsible charge of one or more professional engineers (PEs) licensed in Florida, the pemuttee must retain a Florida-licensed PE to take responsible charge of inspecting construction of this project for 1he purpose of determining in general if the construction proceeds in compliance with the Department of Envirorunentai Protection construction permit, including the approved preliminary design report, for this project. I understand that the permittee must have complete record drawings prepared for this project. I also understand that the permittee must submit a certification of construction completion to the Department and obtain written approval. or clearance, from the Department before the penn.ittee places this pject into o ; ration for any purpose other than disinfection or testing for leaks.

-1~ q _ -7JJ Krystin Berntsen, P.E., PMP Deputy Director ...:...-.=.Mft<Z4,<. ....... .J-,_..:.>o<.......::'---...:..---1""-....:...;;._::,,.-

~ Signatur and Date Printed or Typed Name Title

B. Certification by PWS Supplying Water to Project

I am duly authorized to sign this notice on behalf of the PWS identified in Part LG oft1Iis notice. I certify that said PWS will supply the water necessary to meet the design water demands fur this project. As indicated below, the water treatment plant(s) to which 1his project will be connected has(have} the capacity necessary to meet the design water demands for this project, and I certify that all other PWS components affected by this project also have the capacity necessary to meet t1Ie design water demands for this project. r certify that said PWS is in compliance with applicable planning requirements in Rule 62-555.348, F.A.C.;

applicable cross-connection control requirements in Rule 62-S55.360, F.A.C.; and to the best ofmy knowledge and belief, all other applicable rules in Chapters 62-550, 62-555, and 62~699, F.A.C.; furthennore, I certify that, to the best ofmy knowledge ancl belief, said PWS's connection to this project will not cause said PWS to be in noncompliance with Chapter 62-550 or 62-55S, F.A.C. I also certify that said PWS has reviewed the preliminary design report for this project and that said FWS considers the connection(s) between this project and said PWS acceptable as designed.

• Name(s) of Water Treatment Plant(s) to Which this Project Will Be Connected:

EASTERN SYSTEM (WTP 8)

• Total Permitted Maximum Day Operating Capacity of Plant(s), gpd: _1_03_.2_8_M_G_D _____ _ _ ___ ____ _

• Tota.I Maximum Day Flow at Plant(s) as Recorded on Monthly Operating Reports During Past 12 Months, gpd:

75.33MGD

-1-2JJ23 Krystin Berntsen, P.E. , PMP Deputy Director --'-'-...... fo+.....&.,._....__,c;..,;;;;....1--_ _ ..._...!.....==:..::=-

~ Signatur . Printed or Typed Name Title

C. Certification by PWS that Will Own Project After Jt ls Placed into Permanent Operation

I am duly authorized to sign this notice on behalf of the PWS identified in Part I.Hof this notice. I certify that said PWS will own this project after it is placed into pennanent operation. I also certify that said PWS has reviewed the preliminary design report for this project and that said PWS considora this project acceptable as designed

~U:1\ ,~ q -7-2023> Krystin Berntsen, P.E., PMP Deputy Director Signatu~d Date Printed or Typed Name Title

OEP F<m62-6$5.9JOfl)AHatnale Efltcti"" Ai.,gu, t 28, 2003 {Updated SOl)lembed!, 2015)

Page7

PAGE Appx. “A” - 10 l Project Name:(WUD21-025) GolMcwHelghtsofWestgaleW&Cer MaioRcplacement I Permittee: PAu.1aEAcH couNlYWATERur,uTY DEPARTMENT

D. Certification by Professional Engineer(s) in Responsible Charge of Designing Project*

I, the undersigned professional engineer licensed in Florida, am in responsible charge of designing this project. 1 certify th.at, to the best ofmy knowledge and belief, the design of this project complies with Chapter 62·555, F.A.C. I also certify that, to the best of my knowledge and belief, this project is not being designed to include any of the following construction work:

• construction of water mains conveying raw or partially treated drinking water;

• construction of drinking water treatment, pumping, or storage facilities or conflict manholes;

• construction of water mains in areas contaminated by low•molecular·weight petroleum products or organic solvents;

• construction of an interconnection between previously separate public water systems or construction of water mains that create a "new system" as described under subsection 62·555.525(1), F.A.C.; or

• construction of water mains that will remain dry following completion of construction.

A s ific construction ennit is re uired for each ro · ect involving anv of the above listed construction work.)

Signature, Seal, ai1d Date: Signature, Seal, and Date:

\\ \\11111111,, ,,,,,, 0.N K£s ,,,,,,, ,, ,0 .. . . . . . . 1-/,;1 ,,,,, ' .:J •• •• ~11,,, ., ~' ~ ..- ,cEN.s;.· .. -1,<\~ ..

:: ~ _. V ...._, ·. r -;.

::~: ·.N,:. = : No. 85259 ~* = . . .

P1inted/T ed Name: Amir J. Keshavarz Printed/Tvaed Name:

License Number: 85259 License Number:

Portion of Preliminary Design Report for Which Responsible: Portion of Preliminary Design Report for Which Responsible:

ALL

"' Except as noted in paragraphs 62-555.520(3)(a) and (b), F.A.C. , projecJs shall be designed under the responsible charge of one or more professional engineers (PEs) licensed in Florida. if this project is being designed under the responsible charge of one or more PEs licensed in Florida, PCU't ll!D of this notice shall be completed by the PE(s) in responsible charge. If this project is not being designed under the responsible charge of one or more PEs licensed in Florida, Part l!ID does not have to be completed.

O!:P Forni 62-555.900(7)Atternate Effective August 28. 2003 (Updated ~ ptembe,' 8, 2015)

PAGE Appx. “A” - 11

PALM BEACH COUNTY FIRE RESCUE APPROVAL – PBC2023 - 6500

PAGE Appx. “A” - 12

PERMIT NUMBER:

PROJECT NAME:

RIGHT-OF-WAY CONSTRUCTION - UTILITY PERMIT

PERMITEE NAME:

EXPIRATION DATE: 12/07/2024

Golfview Heights of Westgate WM Replacement

UT66449-1223

Palm Beach County Water Utilities Department

PALM BEACH COUNTY LAND DEVELOPMENT DIVISION

1 . Improvements approved with this permit may be subject to removal due to Roadway Production's pending projects in the 5 year Road program.

2 . AFTER THE PERMIT CONDITIONS HAVE BEEN ACCEPTED BY THE PERMITTEE, HE/SHE SHALL CONTACT GRACIELA MCAUSLAND FOR PROJECTS NORTH OF STATE ROAD 80 AND SEAN REILLY FOR PROJECTS SOUTH OF STATE ROAD 80 AT THE PBC TRAFFIC DIVISION (561) 684-4030. THEY WILL DETERMINE IF MAINTENANCE OF TRAFFIC PLAN (FOR VEHICLES AND/OR PEDESTRIANS) IS REQUIRED. IF REQUIRED, THE PLAN SHALL BE SUBMITTED VIA EPERMITTING UNDER THE MAINTENANCE OF TRAFFIC APPLICATION. A MINIMUM OF 2 WEEKS PRIOR TO START OF CONSTRUCTION. THE PERMITTEE/DULY AUTHORIZED AGENT

SHALL BE RESPONSIBLE TO HAVE THE PLAN APPROVED PRIOR TO CONSTRUCTION.

WHEN THE PLAN HAS BEEN APPROVED, OR DETERMINED NOT TO BE REQUIRED, THE PERMIT CONTACT, EITHER THE PERMITTEE OR THE ENGINEER OF RECORD, SHALL CONTACT THE CONSTRUCTION

COORDINATION DIVISION AT (561) 684-4180, 48 HOURS BEFORE COMMENCEMENT OF WORK FOR A START

DATE. (SEE CONDITION NUMBER 1 ON THE BACK OF THIS PERMIT)

3 . This condition applies to Advanced Wireless Infrastructure Pole installation permits that exclude the associated underground electric, fiber optics, cables and other types of service conduits required to operate the pole mounted communication system (s). These supporting service lines are required to be permitted by a separate permit (if not included in this approval). "Pole installation only permits" shall not be connected without the supporting underground infrastructure being permitted. Operation without the proper permits will result in the removal of illegally installed components by the permittee and suspension of the Antenna use until properly permitted.

4 . All construction within Palm Beach County jurisdiction shall be in accordance with the rules and regulations promulgated by Palm Beach County (this includes the Land Development Design Standards Manual and details ).

5 . The Permittee is required to coordinate with the property's applicable Drainage District for all work proposed or drainage discharge into that District's rights of way or easements.

6 . All construction shall be in accordance with the requirements of the FDOT Utility Accommodation Manual 2017 Edition. This includes depth below grade based on bore diameter.

7 . The contractor shall coordinate and provide a Grouting Plan (with the location of the grout ports) to the Palm Beach County Construction Coordination Division Inspector prior to beginning work.

8 . This permit does not include approval of Maintenance of Traffic (MOT). Contact Graciela MCausland for projects north of Southern Blvd. or Sean Reilly for projects south of Southern Blvd., Construction Coordinators- Palm Beach County Traffic Division at 561-684-4030.

9 . Coordinate with the local utility providers and provide the clearances to existing utilities established by those agencies.

At a minimum, maintain 4 feet of horizontal clearance between proposed underground facilities and existing utilities (wall to wall) and a minimum of 12 inches of vertical clearance.

10. Two satisfactory reviews from the PBC Construction Coordination Division shall be obtained by Palm Beach County Water Utilities Department in order to close the permit; one for the initial final field review, the second six months after the initial final field review. If repair is needed prior to the second satisfactory review the permittee shall comply within 30 days of written notification from the Engineering Department. If the permittee fails to do the repair, the Engineering Department will do so and be reimbursed by the permittee.

11. A current set of approved permit documents shall be on site at all times while preparing to work or performing work within a County maintained right of way. Failure to comply with this condition will result in a cease and desist order requiring the Contractor, crew and equipment to immediately vacate the right of way. Prior to leaving the site the contractor shall restore the area to a safe condition.

12. If necessary as part of the permitted work pothole and groundwater discharge ( dewatering ) locations shall be coordinated with the PBC Construction Coordination Division. Milling and resurfacing of the road pavement may be required due to the number of pothole locations. Avoid disturbing travel lane wheel paths if possible.

PALM BEACH COUNTY UTILITY PERMIT CONDITIONS - UT66449 - 1223

PAGE Appx. “A” - 13

13. The Permittee shall provide evidence of insurance to the Construction Coordination Division prior to receiving a construction start date, as required by Ordinance No. 2019-030, and as may be amended.

The Certificate Holder shall be:

Palm Beach County Land Development C/O Construction Coordination Division 2300 N. Jog Road West Palm Beach, FL 33411

Under: DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Acord 101, additional Remarks Schedule):

The following must be added as Additional Insured for General Liability insurance:

Palm Beach County Board of County Commissioners, Its Employees, Agents and Contractors.

The limits of coverage of insurance required shall be not less than the following:

(a) Worker's Compensation and Employer's Liability Insurance Worker's Compensation-Florida Statutory Requirements Employer's Liability - $100,000 each accident

- $500,000 disease--policy limit

- $100,000 disease--each employee

(b) Comprehensive General Liability Bodily injury and property damage- $1,000,000 each occurrence $3,000,000 general aggregate

(c) Automobile Liability Bodily injury and property damage- $1 ,000,000 combined single limit each accident

14. Please note that future roadway construction may require relocation of these facilities at no expense to Palm Beach County.

15. All inspections are scheduled through Construction Coordination (561) 684-4180 either by the permittee, the engineer of record or his/her representative, who must be present at the inspections. Prior to scheduling a final field review with Construction Coordination, the Permittee shall submit to the Land Development Division a signed and sealed certification of completion from the Engineer-of-Record for the above work, referencing the permit number and indicating the work was completed in substantial accordance with the approved plans.

If the Permittee is exempt from requirement to contract with a Professional Engineer for design, then the Permittee shall provide a certification of completion letter. The letter is not required to be signed and sealed by a Professional Engineer except in the case where a Professional Engineer is on staff and EOR for the usually exempt project.

16. WORK SHALL NOT COMMENCE UNTIL THE PERMITTEE HAS REQUESTED AND RECEIVED APPROVAL FOR A

START DATE FROM THE CONSTRUCTION COORDINATION DIVISION AT 561-684-4180.

FAILURE TO BEGIN CONSTRUCTION ON THE START DATE WITHOUT 24 HOUR NOTIFICATION WILL RESULT IN A

CANCELED PERMIT.

IF WORK COMMENCES WITHOUT AN APPROVED START DATE OR ON AN ALTERNATIVE DATE WITHOUT

PROPER NOTICE, THIS PERMIT SHALL BE CANCELED.

17. All utility structures installed below grade, of any type, in the Palm Beach County right- of- way are required to have traffic bearing tops. This includes all valve boxes, meter boxes, hand holes, splice boxes, storm grates, manhole tops, traffic boxes etc. This requirement applies to structures within the sidewalks, grassed areas and/or pavement.

All pull boxes, hand holes, etc., in Palm Beach County Right-of-Way are to be a minimum of Tier 15, (15K design load/ 22.5K Test load) traffic bearing in locations that are subject to occasional traffic.. Pull boxes, hand holes, etc., in the roadway (deliberate vehicular traffic applications) are to be a minimum of AASHTO H 20.

18. It is the contractor¿s responsibility to maintain vehicular and pedestrian detection at traffic signals during construction.

Vehicle detection must be repaired within 30 days of notice by Palm Beach County and pedestrian detection must be repaired within 3 days of notice by Palm Beach County. The cost for maintaining detection, repairing detection, or adding temporary detection during construction shall be at the expense of the permittee.

19. Permittee shall coordinate the proposed installation with the existing utilities in the permitted work area.

PAGE Appx. “A” - 14

CONDITIONS FOR RIGHT-OF-WAY CONSTRUCTION (UTILITIES)

1. The Construction Coordination Division shall be contacted 48 hours before commencement of work to establish the start date and establish a timeline when field review(s) of the work are required. Construction shall be done Monday through Friday. Weekend work shall be approved by Construction Coordination 48 hours before Saturday. Plans bearing the approval stamp of the County Engineer and the approved permit shall be at the work site.

Work may proceed beyond the permit expiration date if a start date was established and work started prior to the permit expiration date. When work is complete and the engineer’s certification of completion has been submitted to the Land Development Division, the permittee/representative/engineer (as applicable) shall schedule a final review with Construction Coordination Division. If a permitted project has been completed but does not require an engineer’s certification, the permittee/representative (as applicable) shall submit a letter to the Land Development Division indicating the work is complete and ready for final field review. Land Development will notify the permittee/representative to schedule final field reviews with Construction Coordination.

2. The permittee understands and agrees that the rights and privileges herein set out are granted only to the extent of the County's right, title and interest in the land to be entered upon and used by the permittee. THE PERMITTEE SHALL, AT ITS SOLE COST AND EXPENSE, PROTECT, DEFEND, REIMBURSE, INDEMNIFY, AND HOLD THE COUNTY, ITS ELECTED OFFICERS, AGENTS, AND EMPLOYEES, HARMLESS FROM AND AGAINST ALL CLAIMS, LIABILITY, EXPENSE, LOSS, DAMAGES CAUSES OF ACTION OF EVERY KIND OR CHARACTER, INCLUDING ATTORNEY’S FEES AND COSTS, WHETHER AT TRIAL OR APPELLATE LEVELS OR OTHERWISE, ARISING, DURING, AND AS A RESULT OF PERMITTEE’S PERFORMANCE UNDER THE ORDINANCE, HOWEVER, A PROVIDER’S DUTY UNDER THIS SECTION DOES NOT EXTEND TO LIABILITIES NOT CAUSED BY THE PROVIDER, INCLUDING LIABILITIES ARISING FROM THE COUNTY’S NEGLIGENCE, OR WILLFUL CONDUCT, NOTHING CONTAINED IN THIS SECTION SHALL BE CONSTRUED OR INTERPRETED: (A) AS DENYING TO EITHER PARTY ANY REMEDY OR DEFENSE AVAILABLE TO SUCH PARTY UNDER THE LAWS OF THE STATE OF FLORIDA; (B) AS A WAIVER OF SOVEREIGN IMMUNITY, OR (C) AS CONSENT BY THE COUNTY TO BE SUED. THE INDEMNIFICATION REQUIREMENTS SHALL SURVIVE AND BE IN EFFECT AFTER THE

SUSPENSION, REVOCATION, TERMINATION OR EXPIRATION OF A PERMIT.

3. Permittee assumes full responsibility to maintain all areas under construction safe for the public and to properly route and direct traffic through the construction area.