HomeMy WebLinkAboutHealth Department , OSTOS Abandonment L°l
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PERMIT #:56-SF-1954547
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� per-nitting p� APPLICATION #:AP1417452
STATE OF FLORIDA Sr, DATE PAID:
DEPARTMENT OF HEALTH �t-v
ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID:
SYST RECEIPT #:
DOCUMENT #.- PR1239857
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CONSTRUnIJ IT FOR: OSTDS Abandonment
APPLICANT: (Glassman Holdings,LLC)
PROPERTY ADDRESS: 5100 Russakis Rd Fort Pierce, FL 34951
LOT: BLOCK: SUBDIVISION:
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PROPERTY ID #: 1315-121-0001-000-9 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
[OR TAX 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 IFACTS,
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 ANDI 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 SPECIFICATIONS
T [ j GALLONS / GPD CAPACITY
A [ ] GALLONS / GPD CAPACITY
N [ j GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @I ]DOSES PER 24 HRS #Pumps )[ ]
D [ ] SQUARE FEET SYSTEM
R [ ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [ ] STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [ ] TRENCH [ ] BED [ ]
N
F LOCATION OF BENCHMARK:
I ELEVATION OF PROPOSED SYSTEM SITE [ ] [ / ] [ ABOVE/BELOW]BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ ] [ / ] [ABOVE/BELOW]BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: [ ] INCHES
Have the tank abandoned in accordance with the following procedures:(a)The tank shall be pumped out.(b)The bottom of
0 the tank shall be opened or ruptured,or the entire tank collapsed so as to prevent the tank from retaining water,and(c)The
T tank shall be filled with clean sand or other suitable material,and completely covered with soil.Have the system inspected
H by the health department after it has been pumped and ruptured but before it is filled with sand and covered.
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SPECIFICATIONS BY: Jamie) DiFrancesco TITLE:
APPROVED BY: A TITLE: Environmental Specialist I St.Lucie ' CHD
Hunter A Collier
DATE ISSUED: 06/10/2019 EXPIRATION DATE: 09/08/2019
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC Page 1;of 3
V 1.1.4 AP1417452 SE-1
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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 j
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.
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St. Lucie County Health Department
For a 5150 NW Milner Dr Port Saint Lucie, FL 34983
HEALTH
PAYING ON: #:56-SF-1954547 BILL ooc#:56-BID-4207937 CONSTRUCTION APPLICATION#:AP1417452
RECEIVED FROM: All Contractor Services AMOUNT PAID: $65.00
PAYMENT FORM: CREDIT CARD 034150 PAYMENT DATE: 06/04/2019
MAIL TO: (Glassman Holdings, LLC)
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FACILITY NAME :
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PROPERTY LOCATION:
5100 Russakis Rd
Fort Pierce,FL 34951
Lot: Block:
Property ID: 1315-121-0001-000-9
EXPLANATION or DESCRIPTION: QUANTITY FEE
-1 - Surcharge (All) 1 $ 15.00
1
134-OSTDS Construction Abandonment Permit and Inspecti 1 $ 50.00
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RECEIVED BY: MontanezNM AUDIT CONTROL NO. 66-PID-3963950
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