HomeMy WebLinkAboutAPPROVED Health dept approvalSTATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION PERMIT FOR: OSTDS New
APPLICANT: Sally Donovan
PROPERTY ADDRESS: 11770 Palomino Dr Fort Pierce, FL 34945
PERMIT #:56-SF-2277144
APPLICATION #: AP1659796
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR1594798
LOT: 33 BLOCK: A SUBDIVISION: Pony Pines
[SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
PROPERTY ID #: 3309-605-0036-000-5
[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 [ 1,050 ] GALLONS / GPD seotlC new CAPACITY
A [ ] GALLONS / GPD N/A CAPACITY
N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [
D [ 667 ] SQUARE
FEET
Drainfield new
SYSTEM
R [ ] SQUARE
FEET
N/A
SYSTEM
A TYPE SYSTEM:
[ ]
STANDARD [X] FILLED
I MOUND
I CONFIGURATION:
[ ]
TRENCH [x] BED
[ ]
N
F LOCATION OF BENCHMARK:
Site BM, NiD CL of Rd, center of property
I ELEVATION OF PROPOSED SYSTEM SITE [ 20.00 1 [1 INCHES V FT ] (I ABOVE BELOW]BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 16.0011 INCHES FT ][ ABOVE BELOW] BENCHMARK/REFERENCE POINT
L
D
O
T
H
E
R
REQUIRED: [14.001 INCHES EXCAVATION REQUIRED: [ Zb.UU1 lvcrb
system is sized for 4 bedrooms with a maximum occupancy of 8 persons (2 per bedroom), for a total estimated flow of
gpd.
ALL UNSUITABLE FILL MATERIAL PRIOR TO INSTALLATION
SPECIFICATIONS
BY: Brian J In
TITLE. Environmental Specialist
III
APPROVED BY:
r"k"--TITLE:
Environmental Specialist III
St. Lucie CHD
Brian J 1.
DATE ISSUED:
07/06/2021 /
EXPIRATION DATE:
01/06/2023
DH 4016, 08/09
(Obsoletes all previous
editions which may not be used)
Page 1 of 3
Incorporated:
64E-6.003, PAC
v 1.1.4
AB1659796 SE1551583
NOTICE OF RIGHTS
A party whose substantial interest is affected by this order may petition for an
administrative hearing pursuant to sections 120.569 and 120.57, Florida Statutes. Such
proceedings are governed by Rule 28-106, Florida Administrative Code. A petition for
administrative hearing must be in writing and must be received by the Agency Clerk for the
Department, within twenty-one (21) days from the receipt of this order. The address of the
Agency Clerk is 4052 Bald Cypress Way, BIN A-02, Tallahassee, Florida 32399. The Agency
Clerk's facsimile number is 850-413-8743.
Mediation is not available as an alternative remedy.
Your failure to submit a petition for hearing within 21 days from receipt of this order will
constitute a waiver of your right to an administrative hearing, and this order shall become a 'final
order'.
Should this order become a final order, a party who is adversely affected by it is entitled
to judicial review pursuant to Section 120.68, Florida Statutes. Review proceedings are
governed by the Florida Rules of Appellate Procedure. Such proceedings may be commenced
by filing one copy of a Notice of Appeal with the Agency Clerk of the Department of Health and a
second copy, accompanied by the filing fees required by law, with the Court of Appeal in the
appropriate District Court. The notice must be filed within 30 days of rendition of the final order.
St. Lucie County Health Department
marraa 5150 NW Milner Dr Port Saint Lucie, FL 34983
HEALTH
PAYING ON: #:56-SF-2277144 BILL ooc#:56-BID-5270438 CONSTRUCTION APPLICATION#: AP1659796
RECEIVED FROM: Pace 2000, Inc AMOUNT PAID: $ 545.00
PAYMENT FORM: CHECK 8077 PAYMENT DATE: 04/29/2021
MAIL TO: Sally Donovan
FACILITY NAME:
PROPERTY LOCATION:
11770 Palomino Dr
Fort Pierce, FL 34945
Lot: 33 Block: A
Property ID: 3309-605-0036-000-5
EXPLANATION or DESCRIPTION: QUANTITY FEE
128 - OSTDS Construction System Inspection Research Fee
1
$
5.00
-1 - Surcharge (All)
1
$
45.00
-1 - OSTDS New Permit Surcharge
1
$
100.00
-1 - OSTDS Construction Application and Plan Review,New
1
$
100.00
123 - OSTDS Construction Site Evaluation
1
$
115.00
126 - OSTDS Construction Permit (New or Mod, Amendment)
1
$
55.00
127 - OSTDS Construction System Inspection
1
$
75.00
133 - OSTDS Construction Reinspection
1
$
50.00
RECEIVED BY: VVhighamJL
AUDIT CONTROL NO,
56-PID-4958554
Note: Well app from Down the Hole to be sent
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