HomeMy WebLinkAboutD O H PAPERWORKRECEI�/cr
STATE OF FLORIDA
I V 0 2018 PE IT #: 56-SF-1878112
DEPARTMENT OF HEALTH ST, Lucle County, p PLICA ION # : AP 1364794
itt
ONSITE SEWAGE TREATMENT AND DISPOS PAID:
SYSTEM
FEE PAID•
CONSTRUCTION PERMIT
RECEIPT #'
I
CONSTRUCTION PERMIT FOR:
APPLICANT: I Carlos Robaina
PROPERTY ADDRESS: 167 Iml
LOT: 6 BLOCK:
OSTDS Existing Modification
Fort Pierce, FL 34951
4 SUBDIVISION: Bel -Aire Estates
PROPERTY In, #: 1312-701-0064-000-9
DOCUMENT # : PR1154160
S
[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 SE VED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE
PERMIT 7LICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL. AND VOID.
ISSUANCE jIOF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL,
STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY.
i
SYSTEM DESIGN AND SPECIFICATIONS
T [ 900 ] GALLONS / GPD _ Seotic New CAPACITY
A [ ] GALLONS / GPD N/A CAPACITY
N [ j GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ].4 A
D [ 500 ] SQUARE FEET Drainfield New SYSTEM
R [ ] SQUARE FEET N/A SYSTEM
A TYPE SYSTEM: [X] STANDARD. [ ] FILLED [] MOUND
I CONFIGURATION: [ ] TRENCH [x] BED [ ]
N
F LOCATION OF BENCHMARK: Orange paint mark on crown of road
I ELEVATION OF PROPOSED SYSTEM SITE [ 4.00 ][ INCHES FT ][ ABOVE BELOW BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 13.001 INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT
i
L
D FILL REQUIRED: [ 5.001 INCHES EXCAVATION REQUIRED: [ ] INCHES
I
O The system is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total estimated flow of
T 300 gpd.
H
E
R
BY: Jason Harris TITLE: Septic Tank Contractor
APPROVED BY: �i4 cf- 0°"Q"` TITLE: Environmental Supervisor I St. Lucie CHD
� Manna S May
0
DATE ISSUED: 09/20/2018 EXPIRATION DATE: 03/20/2020
1
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC Page 1 of 3
FILE COrRov% _
\. 1
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION INSPECTION AND FINAL APPROVAL
Comment
I I
APPLICATION #:
PERMIT #:56-SF-1878112
DOCUMENT # : F 11224123
DATE PAID:10/24/2018
FEE PAID:25.00
RECEIPT #:56-PID-3778444
:omments
The system is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total estimated flow of 300
]pd. Existing ST pumped and abandoned properly. New ST, filter and 4x6+2x5 TRENCH DF installed. No violations, system ok to
:over. Contractor notified onsite . No final inspection required. Final system approved. Contractor emailed final approval.
DH 4016, 08/i09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC
c-i 0))W'x'.su V
Page 2 of 3
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION INSPECTION AND FINAL APPROVAL
APPLICANT: ICarlos Robaina
APPLICATION #'=
PERMIT #:56-SF-1878112
DOCUMENT #: F11224123
DATE PAID:10/24/2018
FEE PAID:25.00
RECEIPT #:56-PID-3778444
AGENT: Jason Harris (All About Septic Services, Inc)
PROPERTY ADDRESS: 167 Imperial Way Fort Pierce, FL 34951
LOT: 6
BLOCK: 4
SUBDIVISION Bel -Aire. Estates ID#: 1312-701-0064-000-9
jCHECKED [XI ITEMS ARE NOT IN COMPLIANCE WITH
STATUTE OR RULE AND MUST BE CORRECTED.
TANK
INSTALLATION
SETBACKS
[ ] [01]
TANK SIZE [11 1090.00 [21
[ ]
[27]
SURFACE WATER
FT
[ ] [0211
TANK MATERIAL Polyethylene
[ ]
[28]
DITCHES
FT
[ ] [031,
OUTLET DEVICE
[ ]
[29]
PRIVATE WELLS 76
FT
[ ] [0411
MULTI -CHAMBERED [ Y N ]
[ ]
[301
PUBLIC WELLS
FT
[ ] [05]
OUTLET FILTER Polylok PL-68
[ ]
[311
IRRIGATION WELLS
FT
[ ] 10611
LEGEND 1. 70-143-11DC4 2.
[ ]
[321
POTABLE WATER 33
FT
[ ] [07]i
WATERTIGHT
[ ]
[33.]
BUILDING FOUNDATIONS
27 FT
[ ] [081
LEVEL
[ ]
[34]
PROPERTY LINES 5
FT
[ ] [091
DEPTH TO LID
[ ]
[351
OTHER
FT
DRAINFIELD INSTALLATION
FILLED / MOUND SYSTEM
[ ] [10]
AREA [11 384.88 [21 SOFT
[ ]
[361
DRAINFIELD COVER
[ ] [111
DISTRIBUTION BOX HEADER X
[ ]
[37]
SHOULDERS
[ ] [12]1
NUMBER OF DRAINLINES 1. 6.00 2.
[ ]
[381
SLOPES
[ ] [131
DRAINLINE SEPARATION
[ ]
[39]
STABILIZATION
[ ] 1141
DRAINLINE SLOPE
[ ] [15]1
DEPTH OF COVER
ADDITIONAL INFORMATION
[ ] [16]I
ELEVATION [ ABOVE / BELOW ]BM 13.00
[ ]
[40]
UNOBSTRUCTED AREA
[ ] [17]
SYSTEM LOCATION
[ ]
[41]
STORMWATER RUNOFF
I ] [181
DOSING PUMPS
I ]
[42]
ALARMS
[ ] 11911
AGGREGATE SIZE
[ ]
[431
MAINTENANCE AGREEMENT
[ ] [20]1
AGGREGATE EXCESSIVE FINES
[ ]
[44]
BUILDING AREA
[ ] [21]j
AGGREGATE DEPTH
[ ]
[451
LOCATION CONFORMS WITH SITE
PLAN
FILL'
/ EXCAVATION MATERIAL
[ ]
[46]
FINAL SITE GRADING
[ ] [22]
FILL AMOUNT
[ ]
[47]
CONTRACTOR Jason Harris (All
About Septi
[ ] [23]
FILL TEXTURE
[ ]
[481
OTHER INFILTRATOR Quick4 Plus EQ36 LP
[ ] [24]1
EXCAVATION DEPTH
ABANDONMENT
[ ] [251
AREA REPLACED
[ ]
[49]
TANK PUMPED
[ ] [26]
REPLACEMENT MATERIAL
[ ]
[501
TANK CRUSHED & FILLED
Comments: Comments are on page 2.
CONSTRUCTION [ APPROVED /
St. Lucie • CHD DATE:
10/08/2018
DISAPPROVED ] Environmental Specialist II Bria
ngram (ENVIRONMENTAL HEALTH)
FINAL SYSTEM
[ AppgOVED / DISAPPROVED ]:
Lucie CHD DATE:
10/08/2018
nvironmental Specialist 11 Br
J Ingram (ENVIRONMENTAL HEALTH)
(Explanation of Violations on following page)
DH 4016, 08109
(Obsoletes all previous editions which may
not
be used)
Incorporated: 64E-6.003, FAC
Page 2 of 3
APB794
i
I
STATE OF FLORIDA. PERMIT NO.
DEPARTMENT OF• HEALTH DATE PAID:
ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID:
�* SYSTEM RECEIPT #:
APPLICATION FOR CONSTRUCTION PERMIT
APPLICATION FOR:
I7RIePWI
System JI Existing System I Holdin
i g Tank I j Innovative
. J I Abandonment I ! Temporary
/j
APPLICANT:f _�ii ,t„ b - � �/%(,J if
AGENT: A / l? �.ac/ �+�'� ' �� O'�'+LC•. <. ` t% t13! 1,-(- P.) inc a i TELE PHONE :
ADDRESS:�Y(�1�t� F�iY►v��L"�.n �C1�i , _ !-iTC�'9"- Yi,f
TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. SYSTEMS MUST BE CONSTRUCTED
BY A PERSON LICENSED PURSUANT TO 489.105(3)(m) OR 489.552, FLORIDA STATUTES. IT IS THE
APPLICANT'S RESPONSIBILITY TO PROVIDE DOCUMENTATION OF THE DATE THE LOT WAS CREATED OR
PLATTED (MM/DD/YY) IF REQUESTING CONSIDERATION OF STATUTORY GRANDFATHER PROVISIONS.
INFORMATION
LOT: BLOCK: (" SUBDIVISION: (� !- •1 J �e1+ i,.�✓+� PLATTED: ) f_
PROPERTY ID # : f j p[ •• `?�7 j • �,�����, 12(9 _ f ZONING: " !1 % I /M OR EQUIVALENT: Y N ]
PROPERTY SIZE: ,i+a�} � CM WATER SUPPLY: j, PRIVATE PUBLIC 1<=2000GPD ! 1>2000GPD
IS SEWER AVAILABLE AS PER 381.0665, FS? Y N _ DISTANCE TO SEWER: NJA FT
PROPERTYI ADDRESS: 1 �% �• �� T�"T
TO PROPERTY:
BUILDINGIINFORMATION
Unit Type of
No Establishment
I
1
sf r �o CI44fla. 1 L,
2.
3
4
No. of Building Commercial/Institutional System Design
Bedrooms Area Sqft Table 1, Chapter 64E-6, FAC
J
ci ✓ .
It
[ I F1oo /Equ-p ent Drains ( j Other (Specify)
SIGNATURE,I •
DR 4015, 08/09 (Obsoletes previous editions which may not be used)
Incorporated 64E-6.001, FAC
DATE: 5? I tC i ?
Page 1 of 4
f
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR: OSTDS Existing Modification
APPLICANT:I C:arinc Rnhninn '
PROPERTY ADDRESS: 167 Imperial Way Fort Pierce, FL 34951
LOT: 6 BLOCK: 4 SUBDIVISION: Bel -Aire Estates
PERMIT #: 56-SF-1878112
APPLICATION- #: AP1364794
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR1154160
PROPERTY ID #: 1312-701-0064-000-9 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
[OR TAX ID NUMBER]
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION
381.0065, i 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 [
900 ] GALLONS / GPD
Septic New
CAPACITY
A [
] GALLONS / GPD
N/A'-
CAPACITY
N [
] GALLONS GREASE
INTERCEPTOR CAPACITY
[MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [
] GALLONS DOSING
TANK CAPACITY [
]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ]
D [ 5001 ] SQUARE FEET Drainfield New SYSTEM
R [ ] SQUARE FEET N/A SYSTEM
A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [ ] TRENCH [x] BED [ ]
N
F LOCATION I OF BENCHMARK: Orange paint mark on crown of road
I ELEVATION OF PROPOSED SYSTEM SITE [ 4.00 ][ INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 13.001 INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: [ 5.001 INCHES EXCAVATION REQUIRED: [ ] INCHES
O
T
H
E
R
SPEC
The system is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total estimated flow of
BY: Jason Harris
TITLE: Septic Tank Contractor
APPROVED BY:
�i�--�-�- -"
TITLE: Environmental Supervisor I
St. Lucie CHD
I
Dianna s May
DATE ISSUED:
09/20/2018
EXPIRATION DATE:
03/20/2020
DH 4016, 08/09
(Obsoletes all previous
editions which may not be used)
Incorporated:
64E-6.003, FAC
Page 1 of 3
v 1.1.4
AP1364794 SE13 5
FILE UuFl