HomeMy WebLinkAboutHealth Department Septic Approval PERMIT #:56-SF-2034768
ok APPLICATION #:AP1464908
STATE OF FLORIDA ` (� _. DATE PAID
DEPARTMENT OF HEALTH
1 - * ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID:
SYSTEM
• RECEIPT #:
�WE DOCUMENT #:PR1301071
CONSTRUCTION PERMIT.FOR: OSTDS Abandonment
APPLICANT: (TD Enterprises FP/Tracey Pallas)
PROPERTY ADDRESS: 2210 S 40th St Fort Pierce, FL 34947
LOT: 16 ft of 13& 14 BLOCK: 2 SUBDIVISION:
[SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
PROPERTY ID #: 2417-704-0025-000-8 [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 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 j ] GALLONS / GPD CAPACITY
A [ ] GALLONS / GPD CAPACITY
N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACI.TY 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 [ ] 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: [ 0.001 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
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.
E
R
SPECIFICATIONS B Marvin D"Kell TITLE: Septic Contractor
APPROVED BY: TITLE: Environmental Specialist I St.Lucie CHD
%Ktw ircollier
DATE ISSUED: 01/31/2020 EXPIRATION DATE: 04/30/2020
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC Page"'l of 3
v 1.1.4 APi1464908 SE-1
i
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
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.
1
St. Lucie County Health Department
5150 NW Milner Dr Port Saint Lucie, FL 34983
HEALTH
PAYING ON: #:56-SF-2034768 BILL DOC#:56-BID-4544310 CONSTRUCTION APPLICATION#:AP1464908
RECEIVED FROM: TD Enterprises FP/Tracey Pallas AMOUNT PAID: $ 95.00
PAYMENT FORM: CREDIT CARD 01010D PAYMENT DATE: 01130/2020
MAIL TO: (TD Enterprises FP/Tracey Pallas)
FACILITY NAME :
PROPERTY LOCATION:
2210 S 40th St
Fort Pierce, FL 34947
16ftof13& 14 2
Lot: Block:
Property ID: 2417-704-0025-000-8
EXPLANATION or DESCRIPTION: QUANTITY FEE
-1 -Surcharge (All) 1 $ 45.00
134- OSTDS Construction Abandonment Permit and Inspecti 1 $ 50.00
RECEIVED BY: MontanezNM AUDIT CONTROL NO. 56-PID-4284653
of e
STATE OF FLORIDA PERMIT NO.5b-sF
►- 'j; '�, DEPARTMENT OF HEALTH DATE PAID: d
ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID:
SYSTEM RECEIPT #:
•~�Op° ' APPLICATION FOR CONSTRUCTION PERMIT
APPLICATION FOR:
[ ) New System [ ] Existing System [ ] Holding Tank [ ] Innovative
[ ] Repair [ `/] Abandonment [ ] Temporary I l
APPLICANT-
AGENT: - +-� (� -
TELEPHONE: Il� b lQ
MAILING ADDRESS: 71�d��� ) GE'C CR k C_Q1 K Cr
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
LOT: BLOCK: V, SUBDIVISION: -0-tr' ' S�E, ) PLATTED:
PROPERTY ID #: Co."A - C)00 - ZONING: C,0%AA\ I/M OR EQUIVALENT: [ Y/ ) ]
PROPERTY SIZE: ACRES WATER SUPPLY: [It] PRIVATE PUBLIC [ ]<=2000GPD [ 1>2000GPD
IS SEWER AVAILABLE AS PER 381.0065, FSP [ Y/O ] DISTANCE TO SEWER: , FT
PROPERTY ADDRESS: ��l S '� \(,Q, F� *�Aci
DIRECTIONS TO PROPERTY:. �,Vl
BUILDING INFORMATION [ ] RESIDENTIAL [ ] COMMERCIAL
Unit Type of No, of Building Commercial/Institutional System Design
No Establishme�lnt1 1 Bedrooms Area Sgft" Table 1, Chapter 64E-6, FAC
2
3
4
[. ] LFiqU3-pment Drains ] Other (Specify)
eSIGNATC L'j� DATE: ` � � )Q
DH 4015, 08/09 (Obsoletes previous editions which may not be used)
Incorporated 64E-6.001, FAC Page 1 of 4