HomeMy WebLinkAboutOSTDS ABANDOMENTSTATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION PERMIT FOR: OSTDS Abandonment
APPLICANT: }carol Cosgrove
PROPERTY ADDRESS: 797 Woodlands Dr Fort Pierce, FL 34982
LOT: 12 BLOCK:
PROPERTY ID #: 3415-701-0012-000-2
SUBDIVISION: The Woodlands
PERMIT #:56-SF-992695
APPLICATION #: AP1760519
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR1676907
(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 [
x[
] 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 @[ ]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
L REQUIRED: [ U,UU] INCHES EXCAVATION REQUIRED: L J 1NUt .7
ve the tank abandoned in accordance with the following procedures:(a) The tank shall be pumped out.(b) The bottom of
tank shall be opened or ruptured, or the entire tank collapsed so as to prevent the tank from retaining water, and(c) The
ik shall be filled with clean sand or other suitable material, and completely covered with soil.Have the system inspected
the health department after it has been pumped and ruptured but before it is filled with sand and covered.
SPECIFICATIONS BY: .Bruce T Mc callers TITLE:
APPROVED BY: TITLE: Environmental Specialist III
Brian J I ram
DATE ISSUED: 10/29/202
DE 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6,003, FAC
EXPIRATION DATE:
]
St. Lucie CHD
01 /27/2022
Page 1 of 3
V 1.1.4 AP1760519 Sr-1
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.