HomeMy WebLinkAboutSewageL� 10 �Lo I �)-
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION PERMIT FOR: OSTDS Abandonment
APPLICANT: Alexander Hensley
PROPERTY ADDRESS: 1901 S 33rd St Fort Pierce, FL 34947
LOT: 22,23,24 BLOCK: 3
PROPERTY ID #: 2417'-702-0048-000-9
SUBDIVISION: Westwood Manor
PERMIT #:56-SF-2220899
APPLICATION # : AP 1612764
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT # : PR1498371
[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 [
A [
N [
K [
] GALLONS / GPD
] GALLONS / GPD
] GALLONS GREASE INTERCEPTOR CAPACITY
] GALLONS DOSING TANK CAPACITY [
D [ ] SQUARE FEET
R [ ] SQUARE FEET
A TYPE SYSTEM: [ ] STANDARD
I CONFIGURATION: [ ] TRENCH
N
F LOCATION OF BENCHMARK:
CAPACITY
CAPACITY
[MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
]GALLONS 0[ ]DOSES PER 24 HRS #Pumps [
SYSTEM
SYSTEM
[ ] FILLED [ ] MOUND
[ ] BED [ ]
I ELEVATION OF PROPOSED SYSTEM SITE [ ][ /
E BOTTOM OF DRAINFIELD TO BE
L
D I
0
T
H
E
R
][ABOVE / BELOW] BENCHMARK/REFERENCE POINT
][ABOVE/BELOW] BENCHMARK/REFERENCE POINT
'ILL REQUIRED: [ U.UU] INCHES EXCAVATION REQUIRED: I I LvurlZb
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: - TITLE:
APPROVED BY: TITLE: Environmental Specialist II
Brian J gram
DATE ISSUED: 01/13/20 EXPIRATION DATE:
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC
1 v 1.1.4 AP1612764 SE-1 '
St. Lucie CHD
04/13/2021
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