HomeMy WebLinkAboutHealth Department Septic Approval APPLICATION #:AP1319205
ti STATE OF FLORIDA PERMIT #:56-SF-1808665
DEPARTMENT OF HEALTH DOCUMENT #:FI 1151697
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
c CONSTRUCTION INSPECTION AND FINAL APPROVAL DATE PAID:1211312017
FEE PAID:65.00
-7)� , 6L4�B RECEIPT #:56-PID-3451478
APPLICANT: Blue Goose Construction
AGENT: Bruce Mc Cullers(Reliable Treasure Coast Services)
PROPERTY ADDRESS: 619 Rio Vista Fort Pierce, FL 34982
LOT: 13 BLOCK:
SUBDIVISION: Rio Vista ID#: 2426-501-0015-000-0
CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED.
TANK INSTALLATION SETBACKS
[ ] [01] TANK SIZE [1] [2] [ ] [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
[ ] (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
L ] (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
( ] [17] SYSTEM LOCATION [ ] [41] STORMWATER RUNOFF
[ ] (18] DOSING PUMPS L ] [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 L ] [47] CONTRACTOR
[ ] (23] FILL TEXTURE ( ] [48] OTHER
[ ] [24] EXCAVATION DEPTH ABANDONMENT
[ ] [25] AREA REPLACED [ ] [49] TANK 7Pj$_'M /2018] (26] REPLACEMENT MATERIAL [ ] [50] TANK 01/09/2018
Comments: Comments are on page 2.
/ -- ,�y� trr • cpm (9bE: 01
CONSTRUCTION L APPROVED DISAPPROVED ] Q
Environmental Specialist I Dianna S May(Plori �tL
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FINAL SYSTEM L APPROVED / �! Oe��pp{TE: 01/17/20
DISAPPROVED ] : � �- /✓
Environmental Specialist I canna S May(Florida Department o allb0
(Explanation of Violations on following page) 41/�
08/09 (Obsoletes all previous editions which may not be used) Z.
DH 4016, `
Incorporated: 64E-6.003, FAC e 2 of 3
EH Databaso v 1.0.1 AP1319205 EID1000665
�r APPLICATION #:AP1319205
STATE OF FLORIDAPERMIT #:56-SF-1808665
r~ DEPARTMENT OF HEALTH
't* ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM DOCUMENT # F11151697
:
,y CONSTRUCTION INSPECTION AND FINAL APPROVAL DATE PAID:12/13/2017
qac wa
FEE PAID:65.00
RECEIPT #:56-PID-3451478
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 Databiise v 1.0.1 AP1319205 EID1800665
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SEPTIC TANK
ABANDONMENT CERTIFICATION
Permit: # aL-ST - 1 00 b- (05
Address: �i �� F r Oyfr,'. �P
DATE THE TANK WAS PUMPED:
DATE TANK WAS ABANDONED:
METHOD OF ABANDONMENT:
TANK WAS REMOVED TANKPt717L-MEDAND FILLED IN PLACE
Company Name -k-j'k a_ J (-e- S--c- - ''h
Signature of Licensed Contractor
Date J '! U 1 1 i