HomeMy WebLinkAboutHealth Dept final4" STATE OF FLORIDA
DEPARTMENT OF HEALTH
t NSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION INSPECTION AND FINAL APPROVAL
Ica; we S�
APPLICANT: 434 21st Street LLC
AGENT: Pedro Quijac
PROPERTY ADDRESS:
LOT: 13
5504 Deleon Ave Fort Pierce, FL 34951
BLOCK: 160
APPLICATION #: AP1525822
PERMIT #:56-SF-2109584
DOCUMENT # : FI 1647320
DATE PAID:07/15/2020
FEE PAID:660.00
RECEIPT #:56-PID-4502539
SUBDIVISION: Lakewood Park ID#: 130161401030004
CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED.
TANK INSTALLATION
[ ] [01]
TANK SIZE [1] 1090.00 [21
[ ] [02]
TANK MATERIAL Polypropylene
[ ] (031
OUTLET DEVICE
[ ] [041
MULTI -CHAMBERED [ Y N ]
[ ] [05]
OUTLET FILTER Polylok PL-68
[ ] [061
LEGEND 1. 70-143-11 DC4 2.
[ ] [071
WATERTIGHT
[ ] [081
LEVEL
[ ] [091
DEPTH TO LID
DRAINFIELD INSTALLATION
[ ] [101
AREA (1) 407.52 [21
SQFT
[ ] [111
DISTRIBUTION BOX HEADER
X
[ ] (12]
NUMBER OF DRAINLINES 1. 4.00 2.
[ ] (131
DRAINLINE SEPARATION
[ ] [141
DRAINLINE SLOPE
[ ] [15]
DEPTH OF COVER
[ ] [161
ELEVATION [ ABOVE / BELOW ]BM
0.00
[ ] [17]
SYSTEM LOCATION
[ ] [181
DOSING PUMPS 1.00
[ ] [19]
AGGREGATE SIZE
[ ] [201
AGGREGATE EXCESSIVE FINES
[ ] [211
AGGREGATE DEPTH
FILL
/ EXCAVATION MATERIAL
[ ] [221
FILL AMOUNT
[ ] [231
FILL TEXTURE
[ ] [241
EXCAVATION DEPTH
[ ] [251
AREA REPLACED
[ ] [261
REPLACEMENT MATERIAL
Comments: Comments are on Daae 2.
CONSTRUCTION [ APPROVED DISAPPROVED ]
Enviro ental Sped
FINAL SYSTEM [ AppROVED DISAPPROVED ]:
nOronmental Spec
(Explanation of Violations on following page)
DH 4016, 08/09 (Obsoletes all previous editions which n
Incorporated: 64E-6.003, FAC
EH Database v 1.0.1 AP1525822
SETBACKS
[ ] [27]
SURFACE WATER
FT
[ ] [28]
DITCHES
FT
[ ] (291
PRIVATE WELLS 75
FT
[ ] [301
PUBLIC WELLS
FT
[ ] [311
IRRIGATION WELLS
FT
[ ] [32]
POTABLE WATER 50
FT
[ ] (33]
BUILDING FOUNDATIONS 10
FT
[ ] [341
PROPERTY LINES 10
FT
[ ] [351
OTHER
FT
FILLED / MOUND SYSTEM
[ ] [361
DRAINFIELD COVER
[ ] [37]
SHOULDERS
[ ] [38]
SLOPES
[ ] [391
STABILIZATION 06/15/2021
ADDITIONAL INFORMATION
[ ] (40]
UNOBSTRUCTED AREA
[ ] [41]
STORMWATER RUNOFF
[ ] [421
ALARMS
[ ] (43]
MAINTENANCE AGREEMENT
[ ] (44]
BUILDING AREA
[ ] [45]
LOCATION CONFORMS WITH SITE PLAN
[ ] [461
FINAL SITE GRADING
[ ] [47]
CONTRACTOR Oscar Alonso Perez (Oscar P
[ ] [481
OTHER INFILTRATOR Quick4 Plus EQ36 LP
ABANDONMENT
[ ] [ 4 91
TANK PUMPED
[ ] [501
TANK CRUSHED & FILLED
St. Lucie CHD DATE: 05/07/2021
J Ingram (ENVIRONMENTAL HEALTH)
ih%b_ _ St. Lucie CHD DATE: 06/15/2021
III Brian J Ingram (ENVIRONMENTAL HEALTH)
not be used)
EID2109584
Page 2 of 3
STATE OF FLORIDA
DEPARTMENT OF HEALTH
c" ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
;y CONSTRUCTION INSPECTION AND FINAL APPROVAL
W
Violation Number Comment
Comments
APPLICATION #:AP1525822
PERMIT #:56-SF-2109584
DOCUMENT # : FI 1647320
DATE PAID:07/15/2020
FEE PAID:660.00
RECEIPT #:56-PID-4502539
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, libertyl/3 hp pump, and 4x9 long Trench DF installed. no violations, system ok to cover, contractor notified onsite.
Needs final inspection for outlet filter, mound system, alarm check, and final site grading.
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 AP1525822 EID2109584