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't1S! APPLICATION #:AP12629Z2
4+` STATE OF FLORIDA PERMIT #.56-SF-1719598
DEPARTMENT OF HEALTH DOCUMENT #:F11164545
ONSITE SEWAGE' TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION INSPECTION AND FINAL APPROVAL DATE PAID,:11109/2016
FEE PAID:51.5.00
D111 RECEIPT 4:56-PID-3139448.
APPLICANT: Peter&Jody Hays
AGENT: Charles Paschal(Cole Construction)
PROPERTY ADDRESS: TBD S Brocksmith Rd Fort Pierce, FL 34945
LOT: 2 BLOCK:
SUBDIVISION: ID#: 23W-500-0003-000-5
CHECKED [X] ITEMS .ARE NOT IN COMPLIANCE WITH STATUTE. OR RULE, ANU MUST BE CORRECTED.
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TANK INSTALLATION SETBACKS
[ ] [01] TANK SIZE [1] 1090.00 121 483.00 [ ] [271 SURFACE' WATER 100 FT
[ ] (021 TANK MATERIAL Polyethylene [ ] .[28] DITCHES, FT
[ ] [03] OUTLET DEVICE [ ] [29] PRIVATE WELLS 100 FT
[ ] [0.4] MULTI-CHAMBERED [ Y N 1 [ ] 130.1 PUBLIC WELLS FT
[ ] [051 OUTLET FILTER Polylok PL-68 [ ] [311 IRRIGATION WELLS FT
[ ] [06.] LEGEND 1, 70=143-11DC3 2. 70-143-54SC4 [ ] 1.321 POTABLE WATER 100 FT
[ ] [071 WATERTIGHT [ ] [33] BUILDING FOUNDATIONS 6 FT
[ 1 [08] LEVEL [ ] [34:] PROPERTY LINES 100. FT
[ ] [091 DEPTH TO :LID [ ] [35] OTHER FT
DRAINFIELD INSTALLATION "FILLED / MOUND SYSTEM
[ ] [101' AREA (11 509.4 [2-1 SQFT [ 1 [36.] DRAINFIELD COVER'
[ ] [111 DISTRIBUTION BOX HEADER X [ ] [37] SHOULDERS
[ 1 (12]. NUMBER OF DRAINLINES 1. 5.00 2. [ 1 [36] SLOPES
[ ] [131 DRAINLINE SEPARATION [ ] [391 STABILIZATION 03/19/2018
[ 1 [14] DRAINLINE SLOPE
[ ] 1151 DEPTH OF. COVER ADDITIONAL INFORMATION
[ ] 116] ELEVATION [ ABOVE / BELOW ]BM 20.00 [ ] [40] UNOBSTRUCTED AREA
[ ] [17] SYSTEM LOCATION [ ] [4l] STORMWATER RUNOFF
[ ] 118] DOSING PUMPS 1.00 [ ] 142) ALARMS
[ } 1191 AGGREGATE SIZE j ] [43] MAINTENANCE ;AGREEMENT y
} [26] AGGREGATE EXCESSIVE FINES [ ] [49] BUILDING AREA
[ ] [21.] AGGREGATE DEPTh [ } 145] LOCATION CONFORMS WITH SITE PLAN
FILL / EXCAVATION.MATERIAL [ ) [46] HINAL SITE GRADING;
[ ] [221 FILL AMOUNT [ ] [471 CONTRACTOR MICHAEL W STUHR-(ASHTO }
[, '] [2,3] FILL TEXTURE [ ] 148I OTHER INFILTRATOR Quick4 Plus EQ36 LP
[ ] [24] EXCAVATION DEPTH ABANDONMENT
[ ] [251 AREA REPLACED [ ] [•491 TANK PUMPED
[ ] [26] REPLACEMENT MATERIAL [ ] [50] TANK CRUSHED & FILLED
Comments: Corrmehts are on page 2.
[ APPROVED / — St.Luce CHD DATE: 12/01/2017
CONSTRUCTION
DISAPPROVED 1 ' E viroo ental Speclaiisf ri J Ingram(ENVIRONMENTAL HEALTH)
FINAL SYSTEM [ APPROVED / DISAPPROVED ]: r ��- St. Lucie CHD DATE: 03/19/2018
Environmontal Spec allst 11 an J Ingram(ENVIRONMENTAL HEALTH)
(Explanation of Violations on following page)
DH 4016, 08/Q9 (Obsoletes all previous editions which may not be used)
Incorporated: 64E=.6.003, PAC l` Page 2 of 3i
EH Database v.1
1L0.1 AP1262922 EID1719596
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APPLICATION #-:.AP1262922
STATE OF FLORIDA PERMIT # 56-S'F=1719598
DEPARTMENT OF HEALTH
ON SITE SEWAGE TREATMENT AND DISPOSAL SYSTEM DOCUMENT #.F1:1164545
CONSTRUCTION INSPECTION' AND FINAL APPROVAL DATE PArD:11/09/2016
FEE PAID':515:00
RECEIPT #-:56-PIQ-31-394.48
Violation Number Comment.
Comments
The system is sized for 3:bedrooms with a maximum occupancy of 6 persons(2 per bedroom),fora total estimated flow of,300
gpd. New ST and DT installed.Liberty 113 hp.pump.5x9.long DF.
No violations,system ok,to cover.Contractor Notified.onsite.Needs final.inspection for-mound system,alarm check,and site
grading.
Final system approved.Contractor and building department emailed final approval.
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DH 4016, 08/b9 (Obs:oletes ail previous editions which may not be used)
Incorporated: 64E-6.003, ,FAC Page 2 of 3
EH Database v 1 0,1 AP1262922 EID1719590