HomeMy WebLinkAboutHealth Department Septic Approval APPLICATION #:AP1282940
STATE OF FLORIDA PERMIT #:56-SF-1750472
'¢ DEPARTMENT OF HEALTH
IONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM DOCUMENT #:F11138139
'�Vl CONSTRUCTION INSPECTION AND FINAL APPROVAL DATE PAID:03/27/2017
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RECEIPT #:56-PID-3204204
APPLICANT: Clifford&Ann Peterson l
AGENT: Stewart Cooper i 1
PROPERTY ADDRESS: 4915 Seagrape Dr Fort Pierce, FL 34982 dI
LOT: 44 BLOCK: 27
SUBDIVISION: Indian River Estates ID#: 3402-608-0039-000-1
CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED.
TANK INSTALLATION SETBACKS
[ ] [01] TANK SIZE [11 1090.00 [2] [ ] [271 SURFACE WATER FT
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( ] [021 TANK MATERIAL Polyethylene [ ] [281 DITCHES 18 FT
[ ] [031 OUTLET DEVICE [ ] [29] PRIVATE WELLSi FT
[ ] [041 MULTI-CHAMBERED [ Y N ] [ ] [301 PUBLIC WELLS FT
[ ] [05] OUTLET FILTER Polylok PL-68 [ ] [311 IRRIGATION WELLS FT
[ ] [06] LEGEND 1, 70-143-11DC4 2. [ ] [32] POTABLE WATER 35 FT
[ ] [071 WATERTIGHT [ ] [331 BUILDING FOUNDATIONS 7 FT
[ ] [081 LEVEL [ ] [341 PROPERTY LINES 5 FT
[ ] [091 DEPTH TO LID [ , ] [351 OTHER FT
DRAINFIELD INSTALLATION FILLEDIi/ MOUND SYSTEM
[ ] [101 AREA [l] 504 [2] SQFT [ ] [36] DRAINFIELD COVER
[ ] [111 DISTRIBUTION BOX HEADER X [ ] 1371 SHOULDERS
[ ] [121 NUMBER OF DRAINLINES 1. 6.00 2. [ ] (381 SLOPES
( ] [131 DRAINLINE SEPARATION [ ] [391 STABILIZATION
[ ] [141 DRAINLINE SLOPE 11
[ ] [151 DEPTH OF COVER ADDITIONAL INFORMATION
[ ] [161 ELEVATION [ ABOVE / HELOW ]BM 14.00 [ ] (40] UNOBSTRUCTED AREA
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[ ] [171 SYSTEM LOCATION [ ] [411 STORMWATER RUNOFF
[ ] [181 DOSING PUMPS [ ] [421 (ALARMS
[ ] [191 AGGREGATE SIZE '[ ] [43] (MAINTENANCE AGREEMENT
[ ] [201 AGGREGATE EXCESSIVE FINES [ ] [441 BUILDING AREA
[ j [211 AGGREGATE DEPTH [ ] [45] LOCATION CONFORMS WITH SITE PLAN
FILL / EXCAVATION MATERIAL [ ] [46] FINAL SITE GIRADING
[ ] [22] FILL AMOUNT [ ] [47] CONTRACTOR i Telisa Gomez(SEPTIC ENV[
[ ] [481 OTHER INFIL{ RATOR Quick4 EQ36(single c
[ ] [231 FILL TEXTURE I,
[ ] [24] EXCAVATION DEPTH ABANDONMENT
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[ ] [251 AREA REPLACED [ ] [49] TANK PUMPED
[ ] 1261 REPLACEMENT MATERIAL [ ] [50] TANK CRUSHED & FILLED
Comments: Comments are on page 2.
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CONSTRUCTION I APPROVED / St. Lucie CHI) DATE: 10/20/2017
DISAPPROVED ` Environmental Specialist II qffn J Ingram(ENVIRONMENTAL HEALTH)
FINAL SYSTEM [ APPROVED / DISAPPROVED ]: II St.Lucie � CHD DATE: 10/20/2017
Environmental Specialist 118. n 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, PAC Page 2 of 3
EH Database v 1.0.1 AP1282940 E0,750472 RECEIVED OCT 25 2017
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i - APPLICATION #:AP1282940
STATE OF FLORIDA PERMIT #:56-SF-1750472
�- DEPARTMENT OF HEALTH
V ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM �; DOCUMENT #:F 11138139
CONSTRUCTION INSPECTION AND FINAL APPROVAL DATE PAID:03/27/2017
•� �'�• ] 515.00
FEE PAID:
RECEIPT #:56-PID-3204204
Violation Number Comment
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Comments
The system is sized for 2 bedrooms with a maximum occupancy of 4 persons(2 per bedroom),for a total estimated flow of 300
gpd.New ST and 6x7 DF Installed. I �I
No violations,system ok to cover.Contractor notified onsite. No final inspection required.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
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EH Database v1.0.1 AP1282940 EID1750472
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