HomeMy WebLinkAboutHealth Department Septic Permit PERMIT .56 SF::ZOtt89. .
09tilCA2}ION :AP 1-448900.
STATE: OF ivolA
DEPARTMENTOF HEALTH DATE PAID.:
OXS.TTL SEWAGE' ''TREATMENT ,ANL-)' WISPO.SAL FEE PAID>;
RECEIVED "
RECEIPT �
,
wcumENT # R1.26792
OCT 25 2019
.CONSTRUCTION PERMIT EOR: 'OST0SAbari00nme0 ST. Lucie County, Permitting
APPLICANT: Mitchell Siseman
PROPERTY ADDRESS•; 1215 lvv Joy Ln Fort-Pierce,'FL 34945
LOT" 2; BLOCK: B _ SUBDIVISION,,'-! AVON Manor
[SECTION,,, TOWNSHIP', .RANGE`, PARCEL 'WMBW
PROEERTk- ID 230161.Q.0030000,13. - _-__ -.------ [OR. TAX ID 'NrnMBERI!
SYSTEM MUST B$ CONSTRUCTED IN' ACCORDANCE WITH: SPECIFICATIONS• AND STANDARDS OF SECTION
3B1,0065., F S;. AND CHAPTER, 6,9E-6'. E Ac.C. DEPARTMENT APPROVAL: :OF SYSTEM Wtgt NOT: GQARANTEI
SATISFACTORY PERFORMANCE EOR ANY SPECTnO PERSOD Q? TIME:.f: ANY CHANGE: IN. MATERIAL FACTS.;
WHICH SERVED AS A BASIS FOR- ISSUANCE OF THIS, P> RMTT;, REQUTRE: THE APPLICANT TO MODIFY _THE
PERMIT APPLICATION-. SUCH MODIFICATIONS MAY ;RESt'I,T. IN -THI3 .1?ERMIT BEING- MADE NULL AND- -V,OTD.
ISSUANCE
OF THIS; PERMIT 'DOES` ;IJOT EXEMPT THE; APL?L=CA11T' FROM COMPLIANCE 'WITH OTHER FEDERAL,
TATE,,, OR LOCAL PERMIT-TING REQUIRED FOR.'nEVEI:OPMENT OF THIS -PROPERTY-.
- ,STEM DESI-GN AND SPECIFICATIONS `
l,[' ] GALLONS^j GPD CAPACITY;
[ ] GALLONS' _/ GPD
[; ] GALLONS"GREASE INTERCEPTOR; CAPACITy. [MAXIMUM.CAPACIT.Y SINGLE TANK 1250 GALLONS]
GALL,ONS DOSING TANK 'CAPACITY` C y GALI;ONS .0-x ]DOSES'PER 24 F3RS #Puinps:
D [ ] :SQUARE :FEEM SYSTEM
[' ] .SQUARE .E!EET ,SYSTEM.
TYPE SYSTEM.[ ] STANDART) [ I FTPLED [;] MOUND
CONFIGORATTONS [ ] TRENCH'. [ ] SED
x
LLF' LOCATION OE`- BENgMPj K•a
I :ELEVATION OF 'PROPOSErj SYSTEM ;SITE; ;[ [ f ].['ABOVE/.BELOW],BENCHMARK/REFERENCE. POINT
E BOTTOM 6V DRAINFIELD TO BEi
G ] E, ].C. EI BELOW'j:BENCHMARK/REFERENCE PAINT
E.
D FII;I, EQUIRED:. [ 0.00j INCHES- EXCAVATION REQUIRED::_Have the tank abiorn ned m;accoCdahcd Vith the:following pracedules(aj The tank shall be pumped out.(b)'The bottom of
the;tank shall be opened:or ruptured;arthe entire"tank collapsed so as>U prevent the tank;frorn retaining wafer„:and(cy..T•he
_ T tank shall be filled with clean isand-or other-suitable material,and completely covered with;soil Have the:systern,ihspeGted
H 0the health;department atter Whas peen'purriperf and criptured but before it Is filled-with sand and covered..
E
SPECIFICATIONS. BY''! TITI13'
APPROVED BY:` TITLE Environmental Specidlist I, St Lucie CHD
Hunter A @ollier _
DATE XPUP.- 10/29/201.9 E}tPII ATION'DATE:a __ 01121/2020
DH. 4016, '04/:09 (DbsoZetes all- previous edit ons which- may not he- used)
Incosporateds 6419-6-003, FAC: Page I of: 3
w L.A.A. APl44QQ'OP 58=1
-Aparty-whose subtfAhf16Hmfer.,8�st It'affbeted,by"this order may petition for on
admnistrativeIhearingpursuant.tosecfav120.,569 ln0 12 ..51.",:Plorldd' statuteg. Such
proc6edinigs are goveined by Rule;287.1"06,.,,, Floddh Administr6five Zbdei A petition for
aftinistrative hearing must.be in be
yeWNPO l y the Agency.Cler[.for the
Departments wiffifin'twerAy-one, k6mi-the.,receipt of
Ihisorder; Theaddress Ofthe
-0
ql'.Vioriddl�S .0. Agency
Ag, Clerk is 4052 Bal Cypress.* A-Q2-,i Talligho SIS-0
01e*%Jh6sIm&number It 850413 8M
Modftaf[ionjs,not qvp[lable,as an iIt6tnAt'tv'e' lrdtn-6dy.
' 'er.
Your failure t to submit a-poftitiont for h6arinig:w2jOay frQMmqP
Ithin receipt this Ord .*111'
C,gn,sfi,IOWA waiver of you
Should'thls-,order bewme,a f1hifarder,a:party Who is'ad'v-0r,.stly'affected.by
' itfs,pntfod
to,ludicial reuiew pursuant to Seetfon 120 68,Florida Statutes,. e lew-proceedings.ahj
vi ' . -
governed bytho.Florida kiul6g of Appellbfte.Procedure, Such proceedings may'be:comrn..enced
on _R
by filing one copy of a Notice of Appeal with:the CWk of'the•Department;t of i 6611th ancLa,
_y
second copy accorrupa, ed bythelling foos.required by law,Mthz, 0ou ,o.fIA
;Appeal ire
thb
appropriate D(strct'Ob The' muttb6IIfedwithin St days-6f rendition of-1hefinal order.
St., Lucie-;County Health"DOpartmenf
5150 NW-Milner Dr Port Salr t Lucie, FL':349:$
HF�LTH •
PAYING Ow., # 56--SP 20-09289 arcs oocit.56-BID-446205? CONS FRIJCTfQN ARPLICATIQN#.APti+€4$QQC
RECE.IveD'PROM:. Benjamin Drew"s Plumbing:&_Drain-S:er_ , AMOUNT'PAID:
PAYMENTFO.RM ' :CHE-O , 1816 PAYMENT DATE: 10117F2013
MAfL TO: Mifcltelf :Eisemans
FACILITY NAME.:
PRO
_R_
LOCATION
1215*Joy° Lrf
Fort Plercg,FL 045,45
Lot
Property lQ: ..2303 G1;0-0Q3Q OQO-8.___--- __... -•.
EXPLANATION or'DESCRIPTION: QUANTITY 'FEE:
-1. -$urcharge',(AIL)• 1 $ 4540.
-34-QSTQS.construction Abandonment Permit and.Inspecti 1 $ 50.00:
RECEII/ED BY; MontanezNM __ __ _ AUDITCONTRQL Ra 56'-PID_-4201974.
STATE, :OF FLORIDA PERMIT No.
DEPARTMENT OF, HEALTH: BATE LAID
ONSITE; SEWAGE. TREATMENT ;AND -DISPOSAL FEE PAID:
SYSTEM RECEIPT #
AP.PI+ICATION` FOR CONSTRUCTION. PERMIT
APPT�I;CATION' FOEY
[ 1
New System [ ] Exista ng SYste�t � ] Ho]d�ng Tank
Innovative`
Be air VjiAbandonment velvomryC ]
APPLICANT �1
Adm: rn Y1 Emory �S1.t%. V' TET,EP .�:/f ,
n G�j
MAILING ADDRESS: 1�,-
TO BE COMPLETED -BY APPLICANT QR_APPLICANT';S; AUTHORIZED. AGENT.. SYSTEMS MUST BE WX$TRUCTEa
BY A PERSON LICENSED PURSUANT TO 4�89.1Q5-010i) OR; 489 552, FIARIDA STATUTES, fT IS --'z
APPLICANTS RESPONSIBILITY TO PROVIDE DOdMClffATrON OP :THE DATE THE LOT WPiS CREATED,' OF2'.
PLATTED. (MM/DD/YY): IE` REQIIESTIIYG C0NSIDERATl0U 07,STATUT.ORY GRANDFATHER PROVISIOM.
PROPERTYINFORK.ATION
'LOT._ BLOCK SUBDIVISIONt. V`. S f� t til^r=� 'PLATTED::
PROPERTY 2D: : 3+UP C(J" f,. Q ZdNING;•( I•IM. OR EQUIVALENT,; [; Y /f N
;PROPERTY" •SIZE;.: ACRES' WATER SUPPLY: [' ] PATVATE PUBLIC-1 +<=2000GPD 'r ]?2000GPD'.
S$: SEWER AVAT7AB7sE, AS: PER 36j:,6065, FS'? { Y /` DISTANCE TO SEWER: " FT
-PROPERTY' ADDRESS: 12- ..........- R 148
5 RECT3ONS TO PROPERTY::
BUI_LDIIIG INFORMATION ] RESIDENTIAL [ ] CQMMERC-TM.
Unit Type of: No. of: Building Comaiercia_I.flnstituta 6JU4 system _Degvj.n-
-No "Establishment Bedrooms; :Area Sgft Table '1r Chapter 6 ,4E-6,
3:
] Floor/Equipment. Dsans { ] Other (Specify) ,
SIGNATURE_: DATEc JI -
l'i—Li—
DH' _ _ .
40 09 15;1 08/ (Obsoletes previous editions which magnot be used)
Incorporated 64k-6.001, FAC Page: l -of 9�