HomeMy WebLinkAboutSeptic• FLORIDA DEPA� OF<. J
Charlie Crist HJaLT' Ana M. Viamonte Ros, M.D.; M.P.H.
Governor - Secretary of Health
May 29, 2007
Sandra Brown
21220 Glades Cut -Off Rd.
Port St. Lucie, FL. 34987
RE: Permit # 56-SF-09268
Dear Ms. Brown:
An inspection made on the above property on May 25, 2007 found the existing septic system
appearing to be operating in a satisfactory manner. No sanitary nuisance or sign of septic
system failure or stress was noted.
This office has no objection to the replacement of the existing mobile home with a new 3-
bedroom mobile home due to hurricane damage. The building area of the mobile home will be
F 1398 sq. ft. Plans, which are stamped, dated and initialed by the St. Lucie County Health
Department, must accompany -this approval.
This approval does not guarantee the future performance of the septic system and is
valid for a period not to exceed 180 days from the date of this letter.
If you have any questions, please contact this office at (772) 873-4931.
SingKiely,
Jo ' Polissky
Environmental Specialist II
xc: file
R!JUL 19 2007
11
ST. LUCIE COUNTY HEALTH DEPARTMENT
Environmental Health Division
5150 NW Milner Drive - Port St. Lucie FL 34983
(772) 873-4931 - Fax (772) 873-4893
www.stluciecouniyhealth.com
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PROPERTY ID #: [SECTION/TOWNSHIP/RANGE/PARCEL NUMBER]
[OR TAX ID NUMBER]
CHECKED [XJ ITEMS ARE NOT IN COMPLIANCE WITH CHAPTER 10D-6, FLORIDA ADMINISTRATIVE CODE.
---------------
TANK INSTALLATION vY SETBACKS
[ ] [01] TANK SIZE [1] [27] SURFACE WATER
[ ] [02] TANK MATERIAL [ J (28] DITCHES
[ ] [03] OUTLET DEVICE [ ] [29] PRIVATE WELLS
[ ] [-04] MULTI —CHAMBERS [ ] [30] PUBLIC WELLS
[ ) [ 05 ] LEGENDy) J! lv l � [ ] [ 31 ] IRRIGATION WELLS
[ j (06] WATERTIGHT ( ] [32] POTABLE WATER LINES
[ ] [07] LEVEL [ J [33] BUILDING FOUNDATION
[ ] [08] DEPTH OF LID [ ] [341 PROPERTY LINES
] [ 3 5 ] OTHER
DRAINFIELD INSTALLATION
] [09] AREA (1] [2) VV SQF
] [10] DISTRIBUTION BOX/HEADER
z] (11] NUMBER OF DRAINLINES
g) [12] DRAINLINE SEPARATION
] (13] DRAINLINE SLOPE
] [14] DEPTH OF COVER a�
] [15] SYSTEM ELEVATION �
J [16) SYSTEM LOCATION
] [17] DOSING PUMPS
] [18] AGGREGATE SIZE
J [19] AGGREGATE SOURCE
] [20] AGGREGATE WASHED
] [21] AGGREGATE DEPTH
FILL/EXCAVATION MATERIAL
[ ] [22] FILL AMOUNT
[ J [23] FILL TEXTURE
[ ] [24] EXCAVATION DEPTH
[ ] (25] EXCAVATION AREA
[ ] [26] REPLACEMENT MATERIAL
I
FILLED/MOUND SYSTEM
[ ] [36]'DRAINFIELD COVER
[ ] [37] SHOULDERS
[ ] [38] SLOPES
[ J [39) STABILIZATION MATERIAL
ADDITIONAL INFORMATION
[40] UNOBSTRUCTED AREA
[41] STORMWATER RUNOFF
[42] ALARMS
[43] MAINTENANCE AGREEMENT
[44] BUILDING AREA
[45] PLUMBING FIXTURES
[46] FINAL SITE GRADING
[47] CONTRACTOR
[48] OTHER
ABANDONMENT
[ ] [49] TANK PUMPED
[ ] [50] TANK CRUSHED AND FILLED
l J
CONSTRUCTION4[A;PPRO
ROVE 'DISAPPROVED]- DATE:
FINAL SYSTEM D/DISAPPROVED]. ! DATE:"? v
F
DH 4016. 9/96 (Replaces HRS-H Form 4016 [page 2] which may, a used) Page 2 Of 2
(Stock td'umber: 5744-002-4016=4)
APPLICANT
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
APPLICATION FOR CONSTRUCTION PERMIT
�r
PERMIT N0. r f��
DATE PAID:
FEE PAID:
RECEIPT #:
APPLICATION FOR:
t j New System [X ] Existing System [ ] Holding Tank [ ] Innovative
[ ] Repair [ ] Abandonment [ ] Temporary I l
APPLICANT:
AGENT: 0 )�9,)-CP-J .8Ll i chLk TELEPHONE:
MAILING ADDRESS:
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/DDIYY) IF
REQUESTING CONSIDERATION OF STATUTORY GRANDFATHER PROVISIONS. `f
PROPERTY INFORMATION 0 C' Drl IU � AX,0L
PROPERTY ID #: ASA—O03O -•QW ZONING: D' S I/M OR EQUIVALENT.: [ Y / N ]
PROPERTY SIZE: le) --ACRES WATER SUPPLY] PRIVATE PUBLIC [ ]<=2000GPD [ 1>2000GPD
IS SEWER AVAILABLE AS PER 381.0065, FS? [ Y / N ] DISTANCE TO SEWER: FT
PROPERTY ADDRESS: `
fR. c-G+ A kept
DIRECTIONS TO PROPERTY:
l: ry) 1 l cz key.
BUILDING INFORMATION
Unit Type of
No Establishment
1 Single Family Home
2
3
4
(Type of Addition/Modification)
Drains
jX ] RESIDENTIAL
VIli.tjtcXSj;!s'
ncz an
h
[ ] COMMERCIAL
No. of
Building
Bedrooms
Area S ft
-
699
SIGNATURE: TX/w[C('-M
DH 4015, 10/97 (Previous Editions May Be Used)
s
Other (Specify)
Commercial/Institutional System Design.
Table 1 Chapter 64E-6 FAC
DATE:
Page 1 or 4
STATE OF FLORIDA PERMIT #
DEPARTMENT OF HEALTH
ONSITE`SEWAGE TREATMENT AND DISPOSAL SYSTEM
EXISTING SYSTEM AND SYSTEM REPAIR EVALUATION
.APPLICANT:
CONTRACTOR / AGENT: IN L4!�!, 0c 6
LOT:
BLOCK:
SUBDIV:
ID#:
rraars=asarrrrarzsssazzazsrrmarszssaxasassaaaazrzsaarrrrazcoaarsscssssrzcr:rxsrsrraasraascarraas
TO BE COMPLETED BY FLORIDA REGISTERED ENGINEER, DEPARTMENT EMPLOYEE, SEPTIC TANK CONTRACTOR OR
OTHER CERTIFIED PERSON. SIGN AND SEAL ALL SUBMITTED DOCUMENTS. COMPLETE ALL APPLICABLE ITEMS.
COMPLETE TANK CERTIFICATION BELOW OR ATTACH LETTER FROM A PERMITTED SEPTAGE DISPOSAL SERVICE.
sssaazaas¢ssmsersamrrrsasamsasa.smass¢ez¢saasrarssscoarssaczssasaracssrcxaassr¢srrssarsc rrssmars
EXISTING TANK INFORMATION
I1D.V] GALLONS SEPTIC TANK/GPD ATU LEGEND: MATERIAL: /J BAFFLED:[Y / N]
[ ] GALLONS SEPTIC TANK/GPD ATU LEGEND: MATERIAL: BAFFLED:IY / N]
[ ] GALLONS GREASE INTERCEPTOR LEGEND: MATERIAL:
[ ] GALLONS DOSING TANK LEGEND: MATERIAL: # PUMPS:[ ]
m rrsasrarsaaasssszsrrmzrrmrrsarscssrarrszraasasszsasssrrssacar:zsssasrzsrsrsersssaarszrrs¢rrsssa
I CERTIFY THAT THE ABOVE NOTED TANKS WERE PUMPED ON 1/240.V, HAVE THE VOLUMES SPECIFIED, ARE
ST TTARA LY SOUND, HAVE A [ SOLIDECTZO`N VEVICE / OUTLET FILTER DEVICE ] INSTALLED.
• - �—
SI ATURE O LICENSED CONTRACTOR BUSINESS NAME DATE
rraarsscsassssrzsrr=acsrsaasczrsassssssarmarsxassassassazcsssasssxarressrscmmas�sascrrrz¢sas¢s
EXISTING DRAINFIELD INFORMATION
I Sd ] SQUARE.FEET PRIMARY DRAINFIELD SYSTEM NO. OF TRENCHES I ] DIMENSIONS: lO X 'o
[ ] SQUARE FEET SYSTEM NO. OF TRENCHES I ] DIMENSIONS: X
,PYPE OF SYSTEM: [ ] STANDARD ?--q FILLED ( ] MOUND ( ]
CONFIGURATION: [ ] TRENCH 1-4 BED I ]
DESIGN: [ ].HEADER Ate' D-BOX >< GRAVITY SYSTEM [tt ] DOSED SYSTEM
ELEVATION OF BOTTOM OF DRAINFIELD IN RELATION TO EXISTING GRIME .f HES [ ABOVE / ELOW
SYSTEM FAILURE AM REPAIR INFORMATION
J l l SYSTEM
INSTALLATION DATE DOMESTIC .COMMERCIAL
I 1 � / TYPE OF WASTE � I ]
( LfUU ] GPD ESTIMATED SEWAGE FLOW BASED.ON [ ] METERED WATER .P"�CTABLE 1, 64E-6, FAC,
SITE [ ] DRAINAGE STRUCTURES [ ] POOL [ ] PATIO / DECK [ ] PARKING
CONDITIONS: ( ] SLOPING PROPERTY [ ]
NATURE OF [ ] HYDRAULIC OVERLOAD [ ] SOILS [ ] MAINTENANCE [ ] SYSTEM DAMAGE
FAILURE: [ ] DRAINAGE / RUN OFF [ ] ROOTS I ] WATER TABLE I ]
FAILURE I ] SEWAGE ON GROUND [ ] TANK [ ] D BOX/HEADER [ ] DRAINFIELD
SYMPTOM: [ ] PLUMBING BACKUP
REMARKS/ADDITIONAL CRITERIA ��'�'��'�7T/dl s.. Y4fn 71 e V417r
SUBMITTED BY: TITLE/LICENSE f/ ^o;-vr DATE:,/6 -e 7
DH 4015, 10/9 (Previous Editions may be used) Page 4 of 4