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Home My WebLink AboutSewageSTATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT FOR: OSTDS Abandonment APPLICANT: Matthew Schauer PROPERTY ADDRESS: 663 Rio Vista Dr Fort Pierce, FL 34982 LOT: 15 BLOCK: SUBDIVISION: Rio Vista PROPERTY ID #: 2426-501-0017-000-4 PERMIT #:66-SF-2211986 APPLICATION #: AP1606258 DATE PAID: FEE PAID: RECEIPT #: DOCUMENT # : PR1492850 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] [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 [ ] 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 [ ] 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 F7 O T H E R PILL REQUIRED: L U-UU] INCHES EXCAVATION REQUIRED: F J LvunGs 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 by the health department after it has been pumped and ruptured but before it is filled with sand and covered. SPECIFICATIONS BY: " 19 TITLE: APPROVED BY: /1� TITLE: Environmental Specialist II St. Lucie CHD Brian J Ingr n DATE ISSUED: 12/09/2020 EXPIRATION DATE: 03/09/2021 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 AP1606258 SE-1 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. St. Lucie County Health Department. 5150 NW Milner Dr Port Saint Lucie, FL 34983 HEALTH PAYING ON: #: 56-SF-2211985 BILL ooc #:56-BID-5123597 CONSTRUCTION APPLICATION #: AP1606258 RECEIVED FROM: Reliable Treasure Coast Services Septi AMOUNT PAID: $ 95.00 PAYMENT FORM: CREDIT CARD 396866' PAYMENT DATE: 12/09/2020 MAIL TO: Matthew Schauer FACILITY NAME: PROPERTY LOCATION: 663 Rio Vista br Fort Pierce, FL 34982 Lot: 15 Block: . Property ID: 2426-501-0017-000-4 EXPLANATION or DESCRIPTION: QUANTITY FEE -1 - Surcharge (All) 1 $ 45.00 134 - OSTDS Construction%W dQ f ffientiRermit and Inspecti 1 $ 50.00 RECEIVED BY: EvansJS AUDIT CONTROL NO. 56-PID-4826122 4DSTATE OF FLORIDA DEPARTMENT OF HEALTH ` '�* ONSITE SEWAGE TREATMENT AND DISPOSAL ' ;� SYSTEM APPLICATION FOR CONSTRUCTION PERMIT APPLICATION FOR:- ' PERMIT NO. ZZII'9 DATE PAID: 12 9°ZP• FEE PAID: RECEIPT: [ ] New System xisting System [ ] Holding Tank [ ] Innovative [ ] Repair fV] Abandonment [ ] Temporary [ ] APPLICANT: Matthew S auer AGENT: Reliable Tredsure Coast Services Indian River Septic TELEPHONE: 772-562-4242 MAILING ADDRESS: P.O. Box 1116, Vero Beach FL 32961 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: 15 BLOCK: SUBDIVISION: Rio Vista PLATTED: PROPERTY ID # : 2426-501-0017-0004 ZONING. Residentia I/M OR EQUIVALENT: [ Y / N ] PROPERTY SIZE: 0.84 ACRES WATER SUPPLY: [ ] PRIVATE PUBLIC [ ]<-2000GPD [ ]>2000GPD IS SEWER AVAILABLE AS PER 381.0065, FS? [ YIN ] DISTANCE TO SEWER: FT PROPERTY ADDRESS: 663 Rio Vista.Dr, Fort Perice, F134982 DIRECTIONS TO PROPERTY: BUILDING INFORMATION [✓] RESIDENTIAL [ ] COMMERCIAL Unit Type of No. of Building Commercial/Institutional System Design NO Establishment Bedrooms Area Sqft Table 1, Chapter 64E-6, PAC 1 Single Family 2/1 896 2 3 4 [ ] Floor/Equiprpent-Drains [ ] Other (Specify) SIGNATURE: DATE: 12/8/20 DR 4015, 08/09 (013soletes previous editions which may not be used) Incorporated 64E-6.001, FAC Page 1 of 4 STATE OF FLORID. l� 'RMIT # DEPARTMENT OF HEALTH a ONSITE SEWAGE TREATMENT AND'DISPOSAL SYSTEM EXISTING SYSTEM AND SYSTEM REPAIR EVALUATION •�°oo sue`" APPLICANT: Matthew Schauer AGENT l: Reliable Treasure Coast Services Indian River Septic LOT: 15 BLOCK: SUBDIV: Rio Vista ID#: 2426-501-0017-0( 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 NOTE IN REMARKS WHY THE TANKS CANNOT BE CERTIFIED. EXISTING ANK INFORMATION [ j GALLO SEPTIC TANK �� MATERIAL: BAF D : [ N] [ ] GALLONS TIC TANK LEGEND: MATERIAL: _,BAFFLED: [ Y / N ] [ ] GALLONS IN EPTOR LEGEND: MATERIAL: GALLONS DOSING LEGEND: r _ MATERIAL: # PUMPS:[ ] I CERTIFY THAT THE LISTED TANKS PUMPED- iI�tSIONS / / BY i e Senitc and Services HAVE THE VOLUMES �PECIFIED AS DETERMINED ], ARE FREE OF OBSERVABLE DEFECTS gW-LEAKS, AND HAVE A [SOLIDS FL DEVICE CE ] INSTALLED. j Reliable Treas oast ervices Indian Rive eDtic 12/8/20 SI TURE OF LICENSED CONTRACTOR BUSINESS NAME DATE EXISTING DRAINFIELD [ ] SQUARE FEET PRIMARY DRAINFIELD SYSTEM NO. OF TRENCHES [ [ j SQUARE FEET SYSTEM No. OF TRENCHES [ TYPE OF SYSTEM: [ ] STANDARD [ ] FILLED [ ] MOUND [ ] CONFIGURATION: [ ] TRENCH [ ] BED [ ] DESIGN: [ ] HEADER [ ] D-BOX [ ] GRAVITY SYSTEM ELEVATION OF BOTTOM OF DRAINFIELD IN RELATION TO EXISTING GRADE SYSTEM FAILURE AND REPAIR INFORMATION ] DIMENSIONS: X ] DIMENSIONS: X [ ] DOSED SYSTEM INCHES [BELOW El] [ 1954 ] SYSTEM INSTALLATION DATE TYPE OF WASTE [ ] DOMESTIC [ ] COMMERCIAL [ j GPD ESTIMATED SEWAGE FLOW BASED ON [ ] METERED WATER [ ] TABLE 1, 64E-6, FAC SITE [ ] DRAINAGE STRUCTURES [ ] POOL CONDITIONS: [ ] SLOPING PROPERTY [ ] [ ] PATIO / DECK [ ] PARKING NATURE OF [ ] HYDRAULIC OVERLOAD [ ] SOILS [ ] MAINTENANCE FAILURE: [ ] DRAINAGE / RUN OFF [ ] ROOTS [ ] WATER TABLE FAILURE [ ] SEWAGE ON GROUND SYMPTOM: [ ] PLUMBING REMARKS/ADDITIONAL CRITER [ ] SYSTEM DAMAGE I I [ ] TANK [ ] D BOX/HEADER [ ] DRAINFIELD SUBMITTED BY: TITLE/LICENSEPTBSident DATE:12/8/20 DH 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated 64E-6.001, FAC Page 4 of 4