HomeMy WebLinkAboutHealth Dept' E APPLICATION #;AP14•26805
r STATE OF FLORIDA PERMIT #:56-SF-1978105
f. DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM DOCUMENT #:F11630116
CONSTRUCTION INSPECTION AND FINAL APPROVAL DATE PAID:
12/10/2019
FEE PAID:25.00
RECEIPT #:56-PID-4246921
APPLICANT: Adams Homes of Northwest Florida, Inc
AGENT: Benjamin Drew"s Plumbing & Drain Services
PROPERTY ADDRESS: 5811 Balsam Dr Fort Pierce, FL 34982
LOT: 18
SUBDIVISION:
BLOCK: 81
Indian River Estates ID#: 3402-610-0344-000-9
CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITH
STATUTE OR RULE AND MUST BE CORRECTED.
TANK INSTALLATION
SETBACKS
[ ] [01]
TANK SIZE [1] 1090.00 [2] 300.00
[ ] [27]
SURFACE WATER
FT
[ ] [021
TANK MATERIAL Polypropylene
[ ] [281
DITCHES 20
FT
[ ] [03]
OUTLET DEVICE
[ ] [291
PRIVATE WELLS
FT
[ ] [04]
MULTI -CHAMBERED [ Y N ]
[ ] [301
PUBLIC WELLS
FT
[ ] [051
OUTLET FILTER Polylok PL-68
[ ] (31]
IRRIGATION WELLS
FT
[ ] [061
LEGEND 1. 70-143-11DC4 2. 70-156-03SC3
[ ] [32]
POTABLE WATER 26
FT
[ ] (071
WATERTIGHT
[ ] [33]
BUILDING FOUNDATIONS 6
FT
[ ] 1081
LEVEL
[ ] [34]
PROPERTY LINES 8
FT
[ ] [091
DEPTH TO LID
[ ] [35]
OTHER
FT
DRAINFIELD INSTALLATION
FILLED / MOUND SYSTEM
[ ] [10]
AREA [1] 540 [2] SQFT
[ ] [361
DRAINFIELD COVER
[ ] [111
DISTRIBUTION BOX HEADER X
L ] [371
SHOULDERS
[ ] [121
NUMBER OF DRAINLINES 1. 6.00 2.
[ ] [38]
SLOPES
[ ] [13]
DRAINLINE SEPARATION
[ ] [391
STABILIZATION 05/25/2021
[ ] [14]
DRAINLINE SLOPE
[ ] [15]
DEPTH OF COVER
ADDITIONAL INFORMATION
[ ] [16]
ELEVATION [ ABOVE / BELOW ]BM 11.00
[ ] [40]
UNOBSTRUCTED AREA
[ ] [171
SYSTEM LOCATION
[ ] [41]
STORMWATER RUNOFF
[ ] [181
DOSING PUMPS 1.00
[ ] [42]
ALARMS
[ ] [191
AGGREGATE SIZE
[ ] [43]
MAINTENANCE AGREEMENT
[ ] [20]
AGGREGATE EXCESSIVE FINES
[ ] [441
BUILDING AREA
[ ] [21]
AGGREGATE DEPTH
[ ] [45]
LOCATION CONFORMS WITH SITE PLAN
FILL
/ EXCAVATION MATERIAL
[ ] [46]
FINAL SITE GRADING
[ ] [47]
CONTRACTOR Bruce T Mc Cullers (Reliable T
[ ] [221
FILL AMOUNT
[ ] [48]
OTHER ADS MPS-9 (9 pipes - 2 tier)
[ ] [231
FILL TEXTURE
[ ] [241
EXCAVATION DEPTH
ABANDONMENT
( ] [251
AREA REPLACED
[ ] [491
TANK PUMPED
[ ] [26]
REPLACEMENT MATERIAL
[ ] (501
TANK CRUSHED & FILLED
Comments: Comments
are on page 2.
/
�
St. Lucie CHD
DATE: 01/05/2021
CONSTRUCTION
[ APPROVED
DISAPPROV
cia stIll B !pIng(ENVI
MENTAL HEALTH)
nnvironmental
FINAL SYSTEM
[ APPROVED / DISAPPROV
St. Lucie CHD
DATE: 05/26/2021
Environmental Sp ialist Niez ( I
ida Department of He
(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
AP1425805 EID'1978105
STATE OF FLORIDA
►.� DEPARTMENT OF HEALTH
'1r ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
�y CONSTRUCTION INSPECTION AND FINAL APPROVAL
Violation Number Comment
Comments
APPLICATION #:AP1425805
PERMIT #:56-SF-1978105
DOCUMENT # : FI 1630116
DATE PAID:12/10/2019
FEE PAID:25.00
RECEIPT #:56-PID-4246921
The system is sized for 4 bedrooms with a maximum occupancy of 8 persons (2 per bedroom), for a total estimated flow of 400
)Pd.
Vew ST, filter, DT, and 6x30' long TRENCH DF installed. No violations, system ok to cover. Contractor notified by phone. Needs
9nal approval for dosing pump, mound system, gutters(on garage only), alarm check, and final site grading.
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 AP1425805 EID1978105