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APPLICATION #:AP1510943
STATE OF FLORIDA
PERMIT #:56-SF-2092719
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
DOCUMENT #:F11647327
c b
,y CONSTRUCTION INSPECTION AND FINAL APPROVAL
DATE PAID:06/19/2020
FEE PAID:660.00
RECEIPT #:56-PID-4459581
APPLICANT: 434 21st Street LLC
AGENT: 434 21st Street LLC
PROPERTY ADDRESS: 5412 Deleon Ave Fort Pierce, FL 34951
LOT: 13 BLOCK: 160
SUBDIVISION: Lakewood Park ID#: 1301-614-0103-000-4
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] 483.00 [
] [27]
SURFACE WATER FT
[ ] (02] TANK MATERIAL Polypropylene [
] (28]
DITCHES FT
[ ] [031 OUTLET DEVICE [
] [291
PRIVATE WELLS 76 FT
[ ] [041 MULTI -CHAMBERED [ Y N ] [
] [301
PUBLIC WELLS FT
[ ] 1051 OUTLET FILTER Polylok PL-68 [
] [311
IRRIGATION WELLS FT
[ ] (061 LEGEND 1. 70-143-11 DC4 2. 70-143-54SC4 [
] [321
POTABLE WATER 55 FT
[ ] [07) WATERTIGHT [
] [331
BUILDING FOUNDATIONS 5 FT
( ] [081 LEVEL [
] [341
PROPERTY LINES 10 FT
[ ] [091 DEPTH TO LID [
] [351
OTHER FT
DRAINFIELD INSTALLATION
FILLED / MOUND SYSTEM
[ ] [101 AREA [11 407.52 [21 SQFT [
] [361
DRAINFIELD COVER
[ ] [111 DISTRIBUTION BOX HEADER X [
] [371
SHOULDERS
[ ] [121 NUMBER OF DRAINLINES 1. 4.00 2. [
] [381
SLOPES
[ ] [131 DRAINLINE SEPARATION [
] (391
STABILIZATION 06/15/2021
[ ] (141 DRAINLINE SLOPE
[ ] [151 DEPTH OF COVER
ADDITIONAL INFORMATION
[ ] [161 ELEVATION [ ABOVE / BELOW ]BM 2.00 (
] [40]
UNOBSTRUCTED AREA
[ ] [171 SYSTEM LOCATION [
] [411
STORMWATER RUNOFF
[ ] [18] DOSING PUMPS 1.00 [
] [421
ALARMS
[ ] [191 AGGREGATE SIZE [
] [43]
MAINTENANCE AGREEMENT
[ ] [201 AGGREGATE EXCESSIVE FINES [
] [441
BUILDING AREA
[ ] [211 AGGREGATE DEPTH [
] [45]
LOCATION CONFORMS WITH SITE PLAN
[
] [461
FINAL SITE GRADING
FILL / EXCAVATION MATERIAL
[
] [471
CONTRACTOR Oscar Alonso Perez (Oscar P
[ ] [221 FILL AMOUNT
[
1 [481
OTHER INFILTRATOR Quick4 Plus EQ36 LP
[ ] [231 FILL TEXTURE
[ ] [24] EXCAVATION DEPTH
ABANDONMENT
[ ] [251 AREA REPLACED [
] [491
TANK PUMPED
[ ] [261 REPLACEMENT MATERIAL [
] [501
TANK CRUSHED & FILLED
Comments: Comments are on page 2.
St. Lucie CHD DATE: 04/23/2021
CONSTRUCTION ( APPROVED
DISAPPROVED 1: En rtiental
n J Ingram (ENVIRONMENTAL HEALTH)
FINAL SYSTEM [ APPROVED DISAPPROVED ] :
St. Lucie CHD DATE: 06/15/2021
Environmental Sp ialist II
rian 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 AP1510943
EID2092719
" `t
r STATE OF FLORIDA
t DEPARTMENT OF HEALTH
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�Y CONSTRUCTION INSPECTION AND FINAL APPROVAL
Violation Number Comment
Comments
APPLICATION #:AP1510943
PERMIT #:56-SF-2092719
DOCUMENT # : FI 1647327
DATE 2AID:06/19/2020
FEE PAID :660.00
RECEIPT #:56-PID-4459581
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.
New ST, DT, liberty 1/3 hp pump, and 49 long TRENCH DF installed. No violations, system ok to cover. Contractor notified
onsite. Needs final inspection for outlet filter installation, alarm check, mound system, and final site grading. Work performed by
Oscar Perez Drain Services LLC.
Final system approved. Contractor 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 AP1510943 EID2092719