HomeMy WebLinkAbout13179 ird aba approval.pdfSTATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION INSPECTION AND FINAL APPROVAL
APPLICANT: Sawczak Toni
AGENT: COOkes Septic
PROPERTY ADDRESS: 13179 Indian River Dr Jensen Beach, FL 34957
LOT: BLOCK:
APPLICATION #:AP1802693
PERMIT #:56-SF-09174
DOCUMENT #:F11788088
DATE PAID:02/10/2022
FEE PAID:9 5.0 0
RECEIPT #:56-PID-5453175
SUBDIVISION:
ID # : 4509-120-0009-000-6
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
[ ] (041
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 [
] [351
OTHER FT
DRAINFIELD INSTALLATION
FILLED / MOUND SYSTEM
[ ] [10]
AREA [1] [21 SQFT [
] [361
DRAINFIELD COVER
[ ] [111
DISTRIBUTION BOX HEADER [
] [371
SHOULDERS
[ ] [121
NUMBER OF DRAINLINES 1. 2. [
] [381
SLOPES
[ ] [131
DRAINLINE SEPARATION [
] [391
STABILIZATION
[ ] [141
DRAINLINE SLOPE
[ ] [15]
DEPTH OF COVER
ADDITIONAL INFORMATION
[ ] [161
ELEVATION [ ABOVE / BELOW ]BM [
] [401
UNOBSTRUCTED AREA
[ ] (171
SYSTEM LOCATION [
] [411
STORMWATER RUNOFF
[ ] [181
DOSING PUMPS [
] [421
ALARMS
[ ] [191
AGGREGATE SIZE [
] [431
MAINTENANCE AGREEMENT
[ ] [201
AGGREGATE EXCESSIVE FINES [
] [441
BUILDING AREA
[ ] [211
AGGREGATE DEPTH [
] [45]
LOCATION CONFORMS WITH SITE PLAN
FILL / EXCAVATION MATERIAL [
1 [461
FINAL SITE GRADING
[ ] [221
FILL AMOUNT [
] [471
CONTRACTOR MICHAEL W STUHR (ASHTO
[ ] [231
FILL TEXTURE [
] [48]
OTHER
[ ] [241
EXCAVATION DEPTH
ABANDONMENT
[ ] [251
AREA REPLACED [
] [491
TANK PUMPED 02/22/2022
[ ] [261
REPLACEMENT MATERIAL [
] [50]
TANK CRUSHED & FILLED 02/22/2022
Comments: Comments are on page 2.
CONSTRUCTION
I APPROVED /
St. Lucie CHD DATE: 02/22/2022
DISAPPROVED Enviro ental Specialist II
n J Ingram (ENVIRONMENTAL HEALTH)
FINAL SYSTEM
[ AppROVED / DISAPPROVED ]: _
St. Lucie CHD DATE: 02/22/2022
Environmental Specialist IP1
rian 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, FAC
Page 2 of 3
EH Database v 1.0.1 AP1802693
EID351159
APPLICATION #:AP1802693
STATE OF FLORIDA PERMIT #:56-SF-09174
DEPARTMENT OF HEALTH DOCUMENT # : FI 1788088
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION INSPECTION AND FINAL APPROVAL DATE PAID:02/10/2022
FEE PAID:95.00
RECEIPT #:56-PID-5453175
Violation Number Comment
Comments
Tank pumped by Ashton Septic. Tank abandoned properly. No violations.
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
EH Database v 1.0.1 AP1802693 EID351159