HomeMy WebLinkAboutD O H ONSITE SEWAGE TREATMENT DISPOSAL SYSTEMTATE OF FLORIDA
EPARTMENT OF HEALTH
NSITE SEWAGE TREATMENT AND DISPOSAL
YSTEM
I
CONSTRUCTION PERMIT FOR:
APPLICANT Jerry & Sylvia
i
PROPERTY ADDRESS: 5144
OSTDS New F I
�L� PY
Lawson
Palm Wav Fort Pierce, FL 34981
LOT: 3 BLOCK: SUBDIVISION: River Branch Estates
PROPERTY ID #: 3404-809-0007-000-1
PERMIT # : 56-S>i-__
APPLICATION # : AP 1357964--
DATE PAID: /
FEE PAID:
RECEIPT #:
DOCUMENT # : PR1140497
[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 IOF 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 [
1,0501 ]
GALLONS / GPD
Septic New
CAPACITY
A [
]
GALLONS / GPD
N/A
CAPACITY
N [
]
GALLONS GREASE
INTERCEPTOR CAPACITY
[MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [
]
I
GALLONS DOSING
TANK CAPACITY [
]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ]
D [ 667I ] SQUARE FEET Drainfield New SYSTEM
R [ ] SQUARE FEET N/A SYSTEM
A TYPE SYSTEM: [ ] STANDARD [ ] FILLED [X] MOUND [ ]
I CONFIGURATION: [ ] TRENCH [x] BED [ ]
N
F LOCATION IOF BENCHMARK: Orange paint "X" CL of Rd on N side of sul-de-sac
I ELEVATION�OF PROPOSED SYSTEM SITE [ 19.001r INCHES FT ][ABOVE BELOW]BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 22.001C INCHES FT ][ABOVE BELOW]BENCHMARK/REFERENCE POINT
L I
D F
O
T
H
E
R
tED: [21.001 INCHES EXCAVATION REQUIRED: [ ] INCHES
is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total estimated flow of
10 gpd.
ie licensed contractor installing the system is responsible for installing the minimum category of tank in accordance with
64E-6.013(3)(0, FAC.
I
SPECIFICATIONS BY: Brian J Ingram TITLE: Environmental Specialist II
APPROVED BYI 1W913P TITLE: Environmental Specialist I St. Lucie CHD
Dianna S MayOr
-DATE ISSUED:' 08/21/2018 EXPIRATION DATE
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC
v 1.1.4 AP1357964 SE1090165
02/21/2020
ye 1 of 3
i
' NOTICE OF RIGHTS
- A party whose substantial interest is affected by this order may petition for an
admi I istrative hearing pursuant to sections 120.569 and 120.57, Florida Statutes. Such
proceedings are governed by Rule 28-106, Florida Administrative Code. LA 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 jud�'cial 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.
�I" '
- HEALTH
St. Lucie County Health Department
5150 NW Milner Dr Port Saint Lucie, FL 34983
PAYING ON: PERMIT#: 56-SF-1867383 BILL DOC #:56-BID-3858350 CONSTRUCTION APPLICATION #: AP1357964
RECEIVED FROM: KARNERINC AMOUNT PAID: $ 515.00
PAYMENT'IFORM: CHECK 2003 PAYMENT DATE: 08/0k/2018
MAIL TO: Jerry & Sylvia Lawson
FACILITY NAME:
PROPERTY LOCATION:
5144 Cherry Palm Way
Fort Pierce, FL 34981
Lot: ; 3 Block:
Property ID: 3404-809-0007-000-1
EXPLANATION or DESCRIPTION:
QUANTITY
FEE
128 - OSTDS Construction System Inspection Research Fee
1
$
5.00
-1 - Surcharge (All)
1
$
15.00
I
-1 - CISDS 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
RECEIVEiD BY: VanceMH
AUDIT CONTROL NO. 56-PID-3633847