HomeMy WebLinkAboutHealth Department Septic Approval • f�
PERMIT #:56-SF-910710
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APPLICATION #:AP1452502
Q.c STATE OF FLORIDA
�-• , DATE PAID:
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID:
SYSTEM RECEIPT #:
DOCUMENT #: PR1280537
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CONSTRUCTION PERMIT FOR: OSTDS Abandonment
APPLICANT: (D&B Inc)
PROPERTY ADDRESS: 1936 Bluefield Rd Okeechobee, FL 34972
LOT: BLOCK: SUBDIVISION:
PROPERTY ID. #: 4104-243-0040-;000-0 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
[OR TAX ID NUMBER]
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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 FACTS,
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 AND 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 [ ] GALLONS / GPD CAPACITY
A [ ] GALLONS / GPD CAPACITY
N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ]
D [ ] SQUARE FEET SYSTEM
R [ ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [ ] STANDARD [ J FILLED [ ] MOUND [ ]
I CONFIGURATION: [ ] TRENCH [ ] BED [ ]
N
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LOCATION OF BENCHMARK:
Ii ELEVATION OF PROPOSED SYSTEM SITE [ ] [ / ] [ ABOVE/BELOW]BENCHMARK/REFERENCE POINT
BOTTOM OF DRAINFIELD TO BE [ ] [ / ] [ ABOVE/BELOW]BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: [ 0.001 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
the tank shall be opened or ruptured,or the entire tank collapsed so as to prevent the tank from retaining water,and(c)The
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.
it
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SPECIFICATIONS BY: TITLE:
APPROVED BY: TITLE: Environmental Specialist II St. Lucie CHD
Brian J TTWaxn
TE ISSUED: 11/13/2019 EXPIRATION DATE: 02/11/2020
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 AP1452502 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
j 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
governed by the Florida Rules of Appellate Procedure. Such proceedings may be commenced
by filing one copy of a Notide 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
5150 NW Milner Dr Port Saint Lucie, FL 34983
HEALTH
PAYING ON: #:56-SF-910710 BILL DOC#:56-BID-4487431 CONSTRUCTION APPLICATION#:AP1452502
RECEIVED FROM: Superior Water Works AMOUNT PAID: $ 95.00
PAYMENT FORM: CREDIT CARD 013640 PAYMENT DATE: 11/12/2019
MAIL TO: (D & B Inc)
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FACILITY NAME :
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PROPERTY LOCATION:
1936 Bluefield Rd
Okeechobee, FL 34972
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Lot: Block:
i Property ID: 4104-243-o040-000-0
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EXPLANATION or DESCRIPTION: QUANTITY FEE
11 -Surcharge (All) 1 $ 45.00
134- OSTDS Construction Abandonment Permit and Inspecti 1 $ 50.00
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RECEIVED BY: VanceMH AUDIT CONTROL NO. 56-PID-4229099
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STATE OF FLORIDA PERMIT NO. - t -jjV
DEPARTMENT OF HEALTH DATE PAID: ( °,
ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID:
SYSTEM RECEIPT #:
APPLICATION FOR CONSTRUCTION PERMIT
; APPLICATION FOR:
C ] New System ( ] Existing System [ I Holding Tank I I Innovative
[ ] Repair [ fI Abandonment I ] Temporary [ ]
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APPLICANT;: D&B INC (DIEGO RODRIGUEZ))
AGENT: SUPERIOR WATER WORKS 863-634-7625 TELEPHONE: 863-763-2636
MAILING ADDRESS: 4072 HWY 441 NORTH OKEECHOBEE FL 34972
TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. SYSTEMS MUST BE CONSTRUCTED
� BY A PERSON LICENSED PURSUANT TO 489.105(3) (m) OR 489.552, FLORIDA STATUTES. IT IS THE
; APPLICANT'S RESPONSIBILITY TO PROVIDE DOCUMENTATION OF THE DATE THE LOT WAS CREATED OR
! PLATTED (MM/DD/YY) IF REQUESTING CONSIDERATION OF STATUTORY GRANDFATHER PROVISIONS.
PROPERTY INFORMATION
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LOT: BLOCK: SUBDIVISION: BLUEFIELD ROAD PLATTED: 1950
PROPERTY ID #: 4104-243-0040-000-0 ZONING: AG-5 I/M OR EQUIVALENT: [ No ]
PROPERTY SIZE: 186.3 ACRES WATER SUPPLY: [ d] PRIVATE PUBLIC C ]<=2000GPD [ 1>2000GPD
IS SEWER AVAILABLE AS PER 381.0065, FS? [ No ] DISTANCE TO SEWER: FT
PROPERTY ADDRESS: 1936 BLUEFIELD ROAD
DIRECTIONS TO PROPERTY: SEE PERMIT 56-SF-910710
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,BUILDING INFORMATION [✓ ] RESIDENTIAL [ ] COMMERCIAL
(Unit Type of No. of Building Commercial/Institutional System Design
,No Establishment Bedrooms Area Sq£t Table 1, Chapter 64E-6, PAC
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2
3
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[ ] Floor/Ecief 'Dr �Yfs -E'+ 7 _ 0`t'h$Y (Specify)
6�JeSIGNATURE; mil; f_ 0 DATE: �O cln f
iDH 4015, 08/09-14bb sole tss�-Previous edition which may no be used)
Incorporated 64E-6.001, PAC Page 1 of 4
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