HomeMy WebLinkAboutConstruction Permit New SepticSTATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION PERMIT
APPLICATION #:
DATE PAID:
FEE PAID:
RECEIPT #:
CONSTRUCTION PERMIT FOR:
APPLICANT:
PROPERTY ADDRESS:
LOT:
PROPERTY ID #:[SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
BLOCK:SUBDIVISION:
[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 [
D [
R [
A TYPE SYSTEM:
I CONFIGURATION:
N
F LOCATION OF BENCHMARK:
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE
L
D FILL REQUIRED:
O
T
H
E
R
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED:
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC Page 1 of 3
TITLE:
TITLE:CHD
EXPIRATION DATE:
1,050
250
01/12/2022 07/12/2023
27.00
10.00
1.00
St. Lucie
]
]
] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
] GALLONS DOSING TANK CAPACITY ]GALLONS ]DOSES PER 24 HRS ]
GALLONS
GALLONS
/
/
GPD
GPD
CAPACITY
CAPACITY
] SQUARE FEET
] SQUARE FEET SYSTEM
x
] STANDARD ] FILLED x] MOUND ]
] TRENCH ] BED ]
][
][
INCHES ][]BENCHMARK/REFERENCE POINT
][]BENCHMARK/REFERENCE POINT
] INCHES ] INCHES
Nicole Montanez
[
[
[
[
[
[@[#Pumps [
[
[
[ EXCAVATION REQUIRED: [
[
[BELOW
BELOW
Site BM #1 at elevation: 12.48
/
/FT
INCHES FT
/
/ABOVE
ABOVE
AP1784412
Ian P Moore CEHP 19-2072
Environmental Specialist II
Scott & Mary Jakab
TBD Edwin Ave Fort Pierce, FL 34982
3 & 4 02
1428-703-0013-000-9
OSTDS New
SE1635153
DOCUMENT #:PR1720250
Septic New
N/A
N/A
SYSTEMDrainfield New
PERMIT #:56-SF-2444746
The system is sized for 2 bedrooms with a maximum occupancy of 4 persons (2 per bedroom), for a total estimated flow of
200 gpd.
v 1.1.4 AP1784412
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 3900 Commonwealth Boulevard, Mail Station 35, Tallahassee, Florida 32399-
3000. The Agency Clerkâs email is agency_clerk@FloridaDEP.gov.
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
Environmental Protection 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.
NOTICE OF RIGHTS