HomeMy WebLinkAboutHealth department paperworkSTATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION INSPECTION AND FINAL APPROVAL
APPLICANT: Amanda Allih
AGENT: RJM Custom Homes, Inc
PROPERTY ADDRESS: 4705 Elm Ave Fort Pierce, FL 34982
LOT: 17 BLOCK:
APPLICATION # : AP 1404163
PERMIT #:56 -SF -1933956
DOCUMENT # : FI 1435162
DATE PAID:01/06/2020
FEE PAID: 140.00
RECEIPT #:56 -PID -4258943
SUBDIVISION: White City ID#: 3404-501-0632-000-6
CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED.
TANK INSTALLATION
[ ] [01]
TANK SIZE [1] 1050.00 [2] 525.00
[ ] [02]
TANK MATERIAL Concrete
[ ] [03]
OUTLET DEVICE
[ ] [04]
MULTI-CHAMBERED [ LIJ N ]
[ ] [05]
OUTLET FILTER Polylok PL -122
[ ] [06]
LEGEND 1. 01-011-09DC3 2. 01-011-97SC4
[ ] [07]
WATERTIGHT
[ ] [08]
LEVEL
( ] [09]
DEPTH TO LID
DRAINFIELD INSTALLATION
[ ] [10]
AREA [1] 528 [2] SQFT
[ ] [11]
DISTRIBUTION BOX HEADER X
[ ] [12]
NUMBER OF DRAINLINES 1. 4.00 2.
[ ] [13]
DRAINLINE SEPARATION
[ ] [14]
DRAINLINE SLOPE
[ ] [15]
DEPTH OF COVER
[ ] [16]
ELEVATION [ ABOVE / BELOW ]BM 12.00
[ ] [17]
SYSTEM LOCATION
[ ] [18]
DOSING PUMPS 1.00
[ ] [19]
AGGREGATE SIZE
[ ] [20]
AGGREGATE EXCESSIVE FINES
[ ] [21]
AGGREGATE DEPTH
FILL / EXCAVATION MATERIAL
[ ] [22] FILL AMOUNT
[ ] [23] FILL TEXTURE
[ ] [24] EXCAVATION DEPTH
[ ] [25] AREA REPLACED
[ ] [26] REPLACEMENT MATERIAL
Comments: Comments are on page 2.
SETBACKS
[27] SURFACE WATER
[28] DITCHES
[29] PRIVATE WELLS
[30] PUBLIC WELLS
[31] IRRIGATION WELLS
[32] POTABLE WATER
[33] BUILDING FOUNDATIONS
[34] PROPERTY LINES
[35] OTHER
FILLED / MOUND SYSTEM
[36] DRAINFIELD COVER
[37] SHOULDERS
[38] SLOPES
[39] STABILIZATION 06/22/2020
FT
FT
FT
FT
62 FT
50 FT
14 FT
27 FT
FT
ADDITIONAL INFORMATION
[40] UNOBSTRUCTED AREA
[41] STORMWATER RUNOFF
[42] ALARMS
[43] MAINTENANCE AGREEMENT
[44] BUILDING AREA
[45] LOCATION CONFORMS WITH SITE PLAN
[46] FINAL SITE GRADING
[47] CONTRACTOR DAVID WHITESIDE (ACCUR
(48] OTHER INFILTRATOR Quick4 EQ36 (single c
ABANDONMENT
[ ] [ 4 9 ] TANK PUMPED 07/31/2019
[ ] [50] TANK CRUSHED 6 FILLED 07/31/2019
CONSTRUCTIONI APPROVED / DISAPPROVED ] All Fog St. Lucie CHD
Environmental Specialist 111306 J Ingram (ENVIRONMENTAL HEALTH)
FINAL SYSTEM [ APPROVED / DISAPPROVED St. Lucie CHD
Environmental Supervisor I Diann May (Florida Department of Heal
(Explanation of Violations on following page)
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC
EH Database v 1.0.1 AP1404'163 EID1933956
DATE: 05/05/2020
DATE: 06/22/2020
Page 2 of 3
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION INSPECTION AND FINAL APPROVAL
Violation Number Comment
Comments
APPLICATION
PERMIT #:56 -SF -1933956
DOCUMENT # :FI 1435162
DATE PAID . 01/06/2020
FEE PAID: 140.00
RECEIPT #:56 -PID -4258943
The system is sized for 4 bedrooms with a maximum occupancy of 8 persons (2 per bedroom), for a total estimated flow of 400
gpd.
ABANDONMENT INSPECION ONLY
ST pumped and abandoned properly. Tank removed completely. Contractor notified that hole ok to cover.
New ST, filter, DT, barnes 1/3 hp pump, and 4x11 long TRENCH DF installed. No violations, system ok to cover. Contractor
notified by phone. Needs final inspection for riser installation verification, irrigation well inspection/setback verification, mound
system, final site grading.
Final system approved, no violations observed. Inspection performed by Brian Ingram,final inspection entered by Dianna May.
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC Page 2 of 3
EFI Database v'1.0.1 AP'1404163 EID1933956