HomeMy WebLinkAboutabandonmentSTATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION INSPECTION AND FINAL APPROVAL
APPLICANT: Dionne Morris
AGENT: Reliable Septic & Service
PROPERTY ADDRESS: 3005 Cortez Blvd Fort Pierce, FL 34981
LOT: BLOCK:
APPLICATION # : AP 1 f 564-01
PERMIT #:56-SF-2356071
DOCUMENT #: F11733205
DATE PAID :10/12/2021
FEE PAID :95.00
RECEIPT #:56-PID-5314863
SUBDIVISION: ID# : 2420-421-0003-000-0
CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED.
TANK
INSTALLATION
SETBACKS
[ ] [01]
TANK SIZE [1] [21 [ ]
(271
SURFACE WATER
FT
[ ] [021
TANK MATERIAL [ ]
[281
DITCHES
FT
[ ] [031
OUTLET DEVICE [ ]
[29]
PRIVATE WELLS
FT
[ ] [04]
MULTI -CHAMBERED [ Y / N ] [ ]
[301
PUBLIC WELLS
FT
[ ] [051
OUTLET FILTER [ ]
[311
IRRIGATION WELLS
FT
[ ] [061
LEGEND 1. 2. [ ]
[321
POTABLE WATER
FT
[ ] [07]
WATERTIGHT [ ]
[331
BUILDING FOUNDATIONS
FT
[ ] [081
LEVEL [ ]
[34]
PROPERTY LINES
FT
[ ] [091
DEPTH TO LID [ ]
[35]
OTHER
FT
DRAINFIELD INSTALLATION
FILLED / MOUND SYSTEM
[ ] [101
AREA [1] [2] SQFT [ ]
[361
DRAINFIELD COVER
[ ] [111
DISTRIBUTION BOX HEADER [ ]
[37]
SHOULDERS
[ ] [12]
NUMBER OF DRAINLINES 1. 2. [ ]
[381
SLOPES
[ ] [131
DRAINLINE SEPARATION [ ]
[391
STABILIZATION
[ ] [14]
DRAINLINE SLOPE
[ ] [151
DEPTH OF COVER
ADDITIONAL INFORMATION
[ ] [161
ELEVATION [ ABOVE / BELOW ]BM [ ]
[40]
UNOBSTRUCTED AREA
[ ] [17]
SYSTEM LOCATION [ ]
[411
STORMWATER RUNOFF
[ ] [18]
DOSING PUMPS [ ]
[421
ALARMS
[ ] [191
AGGREGATE SIZE [ ]
[43]
MAINTENANCE AGREEMENT
[ ] [201
AGGREGATE EXCESSIVE FINES [ ]
[441
BUILDING AREA
[ ] [211
AGGREGATE DEPTH [ ]
[451
LOCATION CONFORMS WITH SITE PLAN
[ ]
[46]
FINAL SITE GRADING
FILL
/ EXCAVATION MATERIAL
[ ] [22]
FILL AMOUNT
[ ] [47]
CONTRACTOR
[ ] [23]
FILL TEXTURE
[ ] [48]
OTHER
[ ] [241
EXCAVATION DEPTH
ABANDONMENT
[ ] [25]
AREA REPLACED
[ ] [491
TANK PUMPED 11/11/2021
[ ] [261
REPLACEMENT MATERIAL
[ ] [501
TANK CRUSHED & FILLED 11/11/2021
Comments: Comments are on page 2.
CONSTRUCTION [ /
APPROVED DISAPPROVED ]�
FINAL SYSTEM [ APPROVED / DISAPPROVED Ln
i onmental Spe ialist I Nicc le Mont
(Explanation of Violations on following page)
DH 4016, 08/09 (Obsoletes all previous editions which may not be us
Incorporated: 64E-6.003, FAC
EH Database v 1.0.1 AP1756401
EID2356071
CHD DATE:
Lucie CHD DATE: 11/12/2021
martment of He
Page 2 of 3
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION INSPECTION AND FINAL APPROVAL
Violation Number Comment
Comments
Verified tank abandoned according to permit conditions. Emailed final approval to contractor.
APPLICATION # : AP 1 564-0 i
PERMIT # : 56-S F-2356071
DOCUMENT #: F11733205
DATE PAID- 10/12/2021
FEE PAID :95.00
RECEIPT #:56-PID-5314863
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 AP1756401 EID2356071