HomeMy WebLinkAboutHealth Department Septic Approval APPLICATION #:AP1322528
Q" STATE OF FLORIDA PERMIT #:56-SF-1813808
DEPARTMENT OF HEALTH DOCUMENT #:FI1151705
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
,y CONSTRUCTION INSPECTION AND FINAL APPROVAL DATE PAID:01/09/2018
�wig �"-� I 'a FEE PAID:65.00
RECEIPT #:56-PID-3463161
APPLICANT: Bluegoose Construction
AGENT: Bruce Mc Cullers(Reliable Treasure Coast Services)
PROPERTY ADDRESS: 2808 Avenue R Fort Pierce, FL 34946
LOT: BLOCK:
SUBDIVISION: Garden City Farms ID#: 2404.608-0082-000-0
CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED.
TANK INSTALLATION SETBACKS
[ ] [01] TANK SIZE [1] [21 [ ] [27] SURFACE WATER FT
[ ] [02] TANK MATERIAL [ ] [28] DITCHES FT
[ ] [03] OUTLET DEVICE [ ] [29] PRIVATE WELLS FT
[ ] [04] MULTI-CHAMBERED [ Y / N ] [ ] [30] PUBLIC WELLS FT
[ ] [05] OUTLET FILTER [ ] [31] IRRIGATION WELLS FT
[ ] [06] LEGEND 1. 2. [ ] [32] POTABLE WATER FT
[ ] [07] WATERTIGHT [ ] [33] BUILDING FOUNDATIONS FT
[ ] [08] LEVEL [ ] [34] PROPERTY LINES FT
[ j [09] DEPTH TO LID [ ] [35] OTHER FT
DRAINFIELD INSTALLATION FILLED / MOUND SYSTEM
[ ] [10] AREA [1] [2] SQFT [ ] [36] DRAINFIELD COVER
[ ] [11] DISTRIBUTION BOX HEADER [ ] [37] SHOULDERS
[ ] [12] NUMBER OF DRAINLINES 1. 2. [ ] [38] SLOPES
[ ] [13] DRAINLINE SEPARATION [ ] [39] STABILIZATION
[ ] [14] DRAINLINE SLOPE
[ ] [15] DEPTH OF COVER ADDITIONAL INFORMATION
[ ] [16] ELEVATION [ ABOVE / BELOW ]BM [ ] [40] UNOBSTRUCTED AREA
[ 1 [17] SYSTEM LOCATION [ ] [41] STORMWATER RUNOFF
[ ] [18] DOSING PUMPS [ ] [42] ALARMS
[ ] [19] AGGREGATE SIZE [ ] [43] MAINTENANCE AGREEMENT
[ ] [20] AGGREGATE EXCESSIVE FINES [ ] [44] BUILDING AREA
[ ] [21] AGGREGATE DEPTH [ ] [45] LOCATION CONFORMS WITH SITE PLAN
FILL / EXCAVATION MATERIAL [ ] [46] FINAL SITE GRADING
[ ] [22] FILL AMOUNT [ ] [47] CONTRACTOR
[ ] [23] FILL TEXTURE [ ] [48] OTHER
[ ] [24] EXCAVATION DEPTH ABANDONMENT
[ ] [25] AREA REPLACED [ ] [49] TANK PUMPED 01/09/2018
[ ] [26] REPLACEMENT MATERIAL [ ] [50] TANK CRUSHED S FILLED 01/0912018
Comments: Comments are on page 2.
CONSTRUCTION St. Lucie CHD DATE: 01/17/2018
DISAPPROVED ] ' Environmental Specfalist I Tanna S May(Florida Department of Health
FINAL SYSTEM [ APpROVED / DISAPPROVED ] : 7 - zeki- St. Lucie CHD DATE: 01/17/2018
Environmental Specialist Janna 5 May(Florida Department of Health
(Explanation of violations on following page)
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC Page 2 of 3
EH Database v 1.0.1 AP1322528 EID1013808
d� APPLICATION #:AP1322528
STATE OF FLORIDA PERMIT #:56-SF-1813808
r DEPARTMENT OF HEALTH DOCUMENT #:F11151705
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
,y CONSTRUCTION INSPECTION AND FINAL APPROVAL DATE PAID:01/09/2018
s FEE PAID:65.00
RECEIPT #:56-PID-3463161
Violation Number Comment
Comments
No violations observed at time of inspection.
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC Page 2 of 3
EH Database v 1.0.1 AP1322528 EID1813008
SEPTIC TANK
ABANDONMENT CERTIFICATION
Permit: # r-S(-s-F -
Address: R el
IeKce F (_ - 3�-1CIQAly
DATE THE TANK WAS PUMPED:
DATE TANK WAS ABANDONED:
METHOD OF ABANDONMENT:
TANK WAS REMOVED TANK-PUNCT l-�ND FILLED IN PLACE
Company Name
Signature of Licensed Contractor
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Date