HomeMy WebLinkAboutD O H PAPERWORKSTATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE DISPOSAL SYSTEM
CONSTRUCTION INSPECTION AND FINAL APPROVAL
Authority: chapter 381, FS 6 Chapter 1OD-6, FAC
APPLICANT:
PERMIT $
RECEIPT #
FEE PAID
DATE PAID
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AGENT:
PROPERTY STREET ADDRESS:
LOT:_ �t BLOCK: d['f SUBDIVISION:
PROPERTY ID #:
[SECTION/TOWNSHIP/RANGE/PARCEL NUMBER]
[OR TAX ID NUMBER]
CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITH
CHAPTER IOD-6, FLORIDA ADMINISTRATIVE CODE.
- TANK INSTALLATION
_
SETBACKS=====_____________=________
[ ] [01] TANK SIZE [1] [2]
( ] [02] TANK MATERIAL !=t-,_n3��.
( ] [27] SURFACE WATER
[ ] [03] OUTLET DEVICE Kej+ K
[ ) [28) DITCHES
[ J [04] MULTI-CHAMBERS/y//,l
[ ) [29] PRIVATE WELLS
( j [05] LEGEND IN/A-
[ J [301 PUBLIC WELLS
[ ] [06) WATERTIGHT
[ J [31] IRRIGATION WELLS
[ ] (07] LEVEL
( ] [32] POTABLE WATER LINES
[ ] (08] DEPTH OF LID
[, ] [33] BUILDING FOUNDATION
[ ] (34] PROPERTY LINES
DRAINFIELD INSTALLATION
[35) OTHER
[ J
[ ] [09] AREA (1) 10K 3 (2] 210 SQFT
[ ] [10] ISTRIBUTION
FILLED/MOUND SYSTEM
BO/HEADER
[ ] [I1] NUMBER OF DRAINLINES
[ ) [361 DRAINFIELD COVER
[ ] [12] DRAINLINE SEPARATION
[ J [37) SHOULDERS
(
[ j [131 DRAINLINE SLOPE
) [38] SLOPES
[
[ ] [141 DEPTH OF COVER
J [39] STABILIZATION MATERIAL
( j (151 SYSTEM ELEVATION �y
- %T r/�i'
ADDITIONAL
_
[ ] [16] SYSTEM LOCATION
INFORMATION
[ ] [17] DOSING PUMPS A'
N A
[ ] [40] UNOBSTRUCTED AREA
_
[ ] [18) AGGREGATE SIZE
[ ] [411 STOR14WATER RUNOFF
( ] [19] AGGREGATE SOURCE
( ] [42] ALARMS
( ] [20] AGGREGATE WASHED
[ ) (43) MAINTENANCE AGREEMENT
( ) [21) AGGREGATE DEPTH
[ J [44) BUILDING AREA
( ] (45] PLUMBING FIXTURES
• FILL/EXCAVATION MATERIAL
( J 1461 FINAL SITE GRADING
( J [22] FILL AMOUNT
[ J [47] CONTRACTOR
. j [23] FILL TEXTURE
s�j�gj4�L,C
( 48 J OTHER
] [24] EXCAVATION DEPTH
ABANDONMENT
J [25) EXCAVATION AREA
] REPLACEMENT
( ] [491 TANK PUMPED / L6j
�—/—
• .J261 MATERIAL
[ ) (50] TANK CRUSHED AND FILLED
:XPLANATION OF VIOLATIONS:
Oi/ 6'y-i`3 /^rc°�rCf
tLtr�] ]rl C� Ste.K i�-.�'rl 6[-inK�'roi' /� %4..�
J y�zl.c 4a � s 4wd Ycsv+.s 1.F¢yt < •vn �-.
sty ran
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)
'ONSTRUCTION PPROVE
/DISAPPROVED]:
'INAL SYSTEM
JJ
DATE:
[APPROV /DISAPPROVED] :J(LL{.{/ )Od4 ,�i [ ) r[
t DATE:
H 4016, 9/96 )RePlOces Fosm 4016 )pope 2) Which moy be used)
lock N.mber 5744-002.4016,41
Page 2 of 2
FILE
COPY
i
YWRIDA DFPARTTdEW OF
E LT
Jeb Bush
Governor
January 11, 2006
John Anderson
5211 Palm Dr
Fort Pierce, FL. 34982
RE: SF - 08682
5211 Palm Dr
Fort Pierce, FL. 34982
Lot: 36 Block: 49 Sections: Indian River Dr
Dear John Anderson:
M. Rony Fmngois, M.D., M.S.P.H., Ph.D.
Secretary, Department of Health
An inspection made on the above property on January 6, 2006, found the existing septic system
appeared to be operating in a satisfactory manner. No sanitary nuisance or sign of septic
system failure or stress was noted.
This office has no objection to the proposed addition of a living room 441 to the existing
structure. Plans that are stamped, dated and initialed by St. Lucie County Health Department
must accompany this approval.
Note: Do not pave over the existing septic tank or drain field area. It is strongly recommended
that you flag the septic tank and drain field area. It is also recommended that the new covered
patio be guttered to divert rain water away from the drain field area.
This approval does not guarantee the future performance of the septic system and is valid for a
period not to exceed ninety (90) days from the date of this letter. This approval expires on April
11, 2006.
If you have any questions, please contact this office.
Sincerely, 7
.r"u A-K5w t_--
John Hanson
Environmental Specialist 1
ST. LUCIE COUNTY HEALTH DEPARTMENT
Environmental Health Division
5150 NW Milner Drive a Port St. Lucie FL 34983
(772) 873-4931 a Fax (772) 873-4893
w .stluciecountyheaIth.com