HomeMy WebLinkAboutHealth Dept Approval Jig APPLICATION #:AP1448796
> STATE OF FLORIDA PERMIT #:56-SF-2009283
DEPARTMENT OF HEALTH
DOCUMENT #: 900
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
y CONSTRUCTION INSPECTION AND FINAL APPROVAL DATE PAID:10/17/0/17/2019
WE. FEE PAID:545.00
RECEIPT #:56-PID-4201954
APPLICANT: Adams Homes of Northwest Florida, Inc
AGENT: Benjamin Drew"s Plumbing& Drain Services
PROPERTY ADDRESS: 5613 Palm Dr Fort Pierce, FL 34982
LOT: 22 BLOCK: 61
SUBDIVISION: Indian River Estates ID#: 3402-609-0340-000-7
CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED.
TANK INSTALLATION SETBACKS
[ ] [01] TANK SIZE [1] 1090.00 [21 [ ] [27] SURFACE WATER FT
[ ] [021 TANK MATERIAL Polypropylene [ ] [281 DITCHES 19 FT
[ ] (031 OUTLET DEVICE [ ] [291 PRIVATE WELLS FT
[ ] [041 MULTI-CHAMBERED [LZJ N ] [ ] [301 PUBLIC WELLS FT
[ ] [051 OUTLET FILTER Polylok PL-68 [ ] [311 IRRIGATION WELLS FT
[ ] [061 LEGEND 1, 70-143-11DC4 2. [ ] [321 POTABLE WATER 26 FT
[ ] [071 WATERTIGHT [ ] [331 BUILDING FOUNDATIONS 6.5 FT
[ ] [081 LEVEL [ ] [34] PROPERTY LINES 11 FT
( ] [091 DEPTH TO LID [ ] [351 OTHER FT
DRAINFIELD INSTALLATION FILLED / MOUND SYSTEM
[ ] [101 AREA [1] 382.5 [2] SQFT [ ] [361 DRAINFIELD COVER
[ ] [111 DISTRIBUTION BOX HEADER X [ ] [37] SHOULDERS
[ ] [121 NUMBER OF DRAINLINES 1. 5.00 2. [ ] [381 SLOPES
[ ] (131 DRAINLINE SEPARATION [ ] [391 STABILIZATION
[ ] [141 DRAINLINE SLOPE
[ ] [151 DEPTH OF COVER ADDITIONAL INFORMATION
[ ] [161 ELEVATION [ ABOVE / BELOW ]BM 25.00 [ ] [401 UNOBSTRUCTED AREA
[ ] [171 SYSTEM LOCATION [ ] (411 STORMWATER RUNOFF
[ ] [181 DOSING PUMPS [ ] [42] ALARMS
[ ] [191 AGGREGATE SIZE [ ] [431 MAINTENANCE AGREEMENT
[ 1 [201 AGGREGATE EXCESSIVE FINES [ ] [441 BUILDING AREA
[ ] [211 AGGREGATE DEPTH [ ] [45] LOCATION CONFORMS WITH SITE PLAN
FILL / EXCAVATION MATERIAL [ ] [461 FINAL SITE GRADING
[ ] [221 FILL AMOUNT [ ] (471 CONTRACTOR Bruce T Mc Cullers(Reliable T
[ ] [231 FILL TEXTURE I. ] [48] OTHER ADS MPS-9(9 pipes-2 tier)
[ ] [241 EXCAVATION DEPTH ABANDONMENT
[ ] [251 AREA REPLACED [ ] [491 TANK PUMPED
[ ] [261 REPLACEMENT MATERIAL [ ] [501 TANK CRUSHED & FILLED
Comments: Comments are on page 2.
CONSTRUCTION [ APPROVED / St. Lucie CHD DATE: 11/02/2020
DISAPPROVED Envir mental Specialist m V Frett(Florida Department of Health
FINAL SYSTEM [ AppROVED / DISAPPROVED ] : St. Lucie CHD DATE: 02/17/2021
Environmental Specialis I Brian J Ingram(ENVIRONMENTAL HEALTH)
(Explanation of Violations on following page)
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC Page 2 of 3
EH Database v 1.0.1 AP1448796 EID2009283
�rt APPLICATION #:AP1448796
r STATE OF FLORIDA PERMIT #:56-SF-2009283
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM DOCUMENT #:F11581900
.y ,s CONSTRUCTION INSPECTION AND FINAL APPROVAL DATE PAID:10/17/2019
FEE PAID:545.00
RECEIPT #:56-PID-4201954
Violation Number Comment
Comments
The system is sized for 3 bedrooms with a maximum occupancy of 6 persons(2 per bedroom), for a total estimated flow of 300
gpd.
Verified soils, setbacks, and elevations. Unable to verify setback to waterline. Hold final for setback to waterline, building
walkthrough, final grade, and mound requirements.
New ST,filter, and 2x30.5'+1x25.5'+2x20.5'TRENCH DF installed. No violations.
Final system approved. Contractor and building department emailed final approval.
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC Page 2 of 3
EH Database v 1.0.1 AP1448796 EID2009283