HomeMy WebLinkAboutD O H PAPERWORKRa:• G--�anbs
Mission:
To protect, promote 2 z'i-
or all people in Florida rarated
state, county & commu era.;>.
Vision To be the Healthiest State in the Nation
January 17, 2019
Jason Harris (All About Septic Services, Inc/Jason & Elizabeth Harris)
5808 Pinetree Drive
Fort Pierce, FL 34982
RE: Contingency Letter
Application Document No: AP1373096
Centrax Permit Number: 56-SF-1891681
OSTDS Number:
4914 Margaret Ann Ln
Fort Pierce. FL 34946
Lot:1
Block:2
Subdivision: Green Acres
SCANNED
BY
St timipi'mintl,
Dear Applicant:
This will acknowledge receipt of an application dated 11/13/2018 for a permit to use an existing
onsite sewage treatment and disposal system located on the above referenced property.
From a review of your completed application, it has been determined your septic tank is adequate
but the drainfield does not have the required separation from the wet season water table. To have
your system approved for the proposed use, a modification permit is required to bring your
drainfield into full compliance with new system drainfield standards.
If you have any questions on this matter, please call our office at (772) 873-4931.
Sincerely,
Dianna May, Environmental Supervisor I
Enclosures
cc:
Florida Department of Health w .FloridasHealth.com
in ST. LUCIE COUNTY TWITTER: HealthyFLA
5150 NW Milner or, Port Saint Lucie, FL 34983 FACEBOOK:FLDepartmentofHealth
PHr1NF 17771 A73-AQA1 FAx (7771 A73dA93 I YOUTUBE: Bdoh
St. Lucie County Health Department
5150 NW Milner Dr Port Saint Lucie FL 34983
`:.ACTH
PAYING ON: PERMIT # 56-SF-1 891681 BILL COCd56-BID-4016295 C^1151`RUCTIONAPPLICATIONMAP1373096
RECEIVED FROM: All About Septic Services, Inc/Jason& E AMOUNT PAID: $ 235.00
PAYMENT FORM: CREDIT CARD PAYMENT DATE: 11/13/2018
MAIL TO: Jorge Perelli
FACILITY NAME:
PROPERTY LOCATION:
4914 Margaret Ann Ln
Fort Pierce, FL 34946
1
I nt
2
Block:
Property ID: 1430-700-0018-000-2
EXPLANATION or DESCRIPTION:
QUANTITY
FEE
-1 - Surcharge (All)
1
$
15.00
126 - OSTDS Construction Permit (New or Mod, Amendment)
1
$
55.00
127 - OSTDS Construction System Inspection
1
$
75.00
131 - OSTDS Construction Application & Existing System E
1
$
50.00
139 - OSTDS Application Approval Existing, No Insp
1
$
35.00
128 - OSTDS Construction System Inspection Research Fee
1
$
5.00
RECEIVED BY: MontanezNM AUDIT CONTROL NO. 56-PID3792201
T11E z//.il:r
STATE OF FLORIDA
DEPARTMENT OF HEALTH
(> ONSITE SEWAGE TREATMENT AND
SYSTEM
-= -� APPLICATION FOR CONSTRUCTION
APPLICATION FOR:
�[ ] New System
] Repair
�
APPLICANT: _ J00
AGENT:).L_�
MAILING ADDRESS
PERMIT NO.
DATE PAID: I la
DISPOSAL FEE PAID: D:35
.�"I.
RECEIPT #: `,�C-51—._
PERMIT
] Existing System [ ] Holding Tank [ ] Innovative
] Abandonment [ ] Temporary
TELEPHONE: p f-S9 j O
,TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. SYSTEMS MUST BE CONSTRUCTED
IBY 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 LOTSBAS CREATED OR
PLATTED (MM/DD/YY) IF REQUESTING CONSIDERATION OF STATUTORY GRANDFATHER PROVISIONS.
PROPERTY INFORMATION n n.O
SLOT: BLOCK: � SSUBBDDIVIISIION::74 I n X'(S ["S PLATTED:
(PROPERTY ID #:1�. o-'2OO-o0ff CiV-9 `ZOONING: }�.5 I/M OR EQUIVALENT:Q : N ]
:PROPERTY SIZE: -P! ACRES WATER SUPPLY: [ PRIVATE PUBLIC N <=2000GPD [ 1>2000GPD
'ZS SEVER AVAILABLE AS PER 381.0065, FS? [ Y PI DISTANCE TO SEWER: FT
ISUILDING INFORMATION
'Unit Type of
INo Establishment
il,
it 4
[�] RESIDENTIAL [ ] COMMERCIAL
No. of Building Commercial/Institutional System Design
Bedrooms Area S ft Table 1, Chapter 64E-6, FAC
z i u. Zoo
�I[ ] Floor/Eq�y�pma�ains [ 1 Other (Specify)
''SIGNATURE:
:DR 4015, 08/09 (obsoletes previous editions which may not be used)
:Incorporated 64E-6.001, FAC
DATE: 1 j2-,q3--) 9
Page 1 of 4
STATE OF FLORIDA PERMIT
r DEPARTMENT OF HEALTH
ONSSTE SEWAGE TREATMENT AND DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
APPLICANT: 73 any' �eg h + /' n -,,AGENT:: / u "'jiytA+ c�Ui'1C�
LOT: �_ BLOCK: lTl�nf ppSUBB/D,,.�I,VISI��OIN: C�Y>r'rn /7t' hePz
PROPERTY ID a:J430-%00 -001 -COa -6 i [Section/Townshi arcel -1PU r Tax ID Number]
TO'BE COMPLETED BY ENGINEER, HEALTH DEPARTMENT EMPLOYEE,OR OTHER QUALIFIED PERSON. ENGINEERS
MUST PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS.
PROPERTY SIZE CONFORMS TO SITE PLAN- %4 YES [ ] NO NET USAB E...AREA-AZ�ATLABEn.- .Q / ACRES
TOTAL ESTIMATED SEWAGE FLOW: %C% GALLONS PER DAY SIDENCES-TABT,R_�Sr-/�TNiR_TABLE21
AUTHORIZED SEWAGE FLOW: GALLONS PER DAY [1 /ACRE OR 25QQ GP11D/ACRE]
UNOBSTRUCTED AREA AVAILABLE: ' Or. SQFT UNOBSTRUCTED AREA REQUIRED: L11 SQFT
BENCHMARK/REFERENCE POINT LOCATION: �l'0w� L�� 2��Z G(%•"f-1t _))Ci
ELEVATION OF PROPOSED SYSTEM SITE IS 4g, [MULIMlFT] QkS_._ ELOW] BENCHMARK/REFERENCE POINT
THE MINIMUM ICH CAN E MAINTAINED
OM THE:
E FOLLOWING FEATURES
WE]LLLS: PUBLICETHA FT LIMITED USE: ItXACE WATER: FT ES FT PRIVATED SYSTEMTH FT
NON -POTABLE: 7 FT
BUILDING FOUNDATIONS: ✓ FT PROPERTY LINES:16FT POTABLE WATER LINES: IC)
SITE SUBJECT TO FREQUENT FLOODING: [ YES q NO 10 YEAR FLOODING? ( ] YES X NO
id i (YEAR FLOOD ELEVATION FOR SITE:_FT MSL/NGVD SITE ELEVATION: A)A- FT MSL/NGVD
ON
Nai9.+v ;vW Wij
SERIES:
io
on
0 SERVED WATER TABLE: CoZ- INCHES [ABOVE
��
EXISTING GRADE. TYP<�
/ APPARENT]
ETIMATED WET SEASON WATER TABLE ELEVATION:
2(n
INCHES [ABOVE /�HELj�1P)
EXISTING GRADE
HIGH WATER TABLE VEGETATION: [ ] YES 0<1 NO
MOTTLING: 0 YES [ ]'140 DEPTH: LS. INCHES
/I SID
SgIL
TEXTURE/LOADING RATE FOR SYSTEM SIZING:�S
DEPTH OF EXCAVATION:
INCHES
DRAINFIELD
CONFIGURATION: [ ] E.
BED [
] OTHER (SPECIFY)
Ia,EMA,]2ICS/ADDITIONAL
�T/�aRENCH
CRITERIA: ' V—VL -7/ 1
�1 (�� '�
i n �',. 1 Ol d
Ft
�(i
EVALUATED BY
DATE
DR! j{015, 08/09 (Obsclates pr"ious editions which may not be used) Incorporated: 64E.6.001, FAC Page 3 of 4
w
OF FLOR ITAPPLICATIO10WCO, _ - T; `^`=" e �,"27 "
"CCI, DON A WELL. �_. Perrnd --.. _--
E FILL OUT ALL FImda I"MMK
notes Required Wn reAp lic Perms Re'q e-3med)
farwallCOMM e' `
rm entl /orwertlr
Ilnee R ✓ f pdafe;lell;paled a 1
[` P
- CAI =g=,ted A "homy (10 o.
_.w
) a l7
N�meam`i, cr C_
'awner�LE `� porator,
'Weil Location -Address,, ondN a
-tJ)or Altercate. Ke, _ ... •�.:..:.>s w.,a* -Block; .:
Grant Rag �ou� / -- bolvision h6Cf 24 "es' No
=7 7Vr ��� * 7 7Z
`Water Well Contactor I Eicense Numbs 'Telechone Numb r -mail Address - x
6 % � Z J l( z4_ k46 c '�r ' /_tom C/ L-
-teP llCont-actor Address CI ^SlaCe _+ . "' ZI°
7 iypr of;K!lor'ic - Constructlon''±� Re,Pair Mcdificalion',4+'-aridonmenl
,+` 1 +ic. w -- e'cp 11 r?nnatr Mod' -
B Pissed Welfs
3 'Sp,_ ;�nteiided Use(s)of
STATE OF FLOAIDA
DEPARTMENT OF HEALTH -- --
y:
ONS ITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
C
EXISTING SYSTEM AND SYSTEM REPAIR EVALUATION
APPLICANT:
C ♦
TO �SE COMPLETED BY FLORIDA REGISTERED ENGINEER, DEPARTMENT EMPLOYEE, SEPTIC TANK CONTRACTOR OR
OTHER CERTIFIED PERSON. SIGN AND SEAL ALL SUBMITTED DOCUMENTS. COMPLETE ALL APPLICABLE ITEMS
COMPLETE TANK CERTIFICATION BELOW OR NOTE IN REMARKS -WRY THE TANK -CANNOT BE CERTIFIED----_---
je, L"c. CFyg',tcl
EXISTING TANK INFORMATION
! w•c+-- f BAFFLED: [Y
MATERIAL: nG.FL
[C�C^�'- ] GALLONS SEPTIC TANK/GPD ATU LEGEND: MATERIAL: BAFFLED:[Y / N]
[ ] GALLONS SEPTIC TANK/GPD AID LEGEND: MATERIAL:
[ I ] GALLONS GREASE INTERCEPTOR LEGEND: MATERIAL: # PUMPS:[ ]
[ I. ] GALLONS DOSING TANK LEGEND _-_
HAVE
I CERTIFY THAT THE LISTED TANKS WERE PUMPED ON (C) /`L3BY LEGEND I, ARE FREE OF OBSERVABLE
T01VOLUMES SPECIFIED AS DETERMINED BY [ DIMENSIONS /Ljj / ] INSTALLED.
DE S, AND RAVE A [ SOLIDS DE-� CTI,Aij DEVP,,/ Q {Y. �(f- ZJIV
[• NAME (A DATE
SIG ATURE OF LICENSED CONTRACTOR BUSINESS NAME -O
EXISTING DRAINFIELD INFORMATION
] SQUARE FEET PRIMARY DRAINFIELD SYSTEM NO. OF TRENCHES [ 1 DIMENSIONS: X
) SQUARE FEET
SYSTEM NO. OF TRENCHES [ ] DIMENSIONS: X
[ MOUND [ )
TYPE OF SYSTEM: [a`] STANDARD [ ] FILLED [ ]
CONFIGURATION: [ ]TRENCH BED [ ]
DESIGN: [ ] HEADER I 1 D-BOX CA] GRAVITY SYBTEM [ ] DOSED SYSTEM
ELp�ATION OF BOTTOM OF DRAGRADE INFIELD IN RELATION TO EXISTING
INCHES [ ABOVE BE' L07f]'-
SYSTEM FAILURE AND REPAIR INFORMATION
[ ��Ib Z•` ] SYSTEM INSTALLATION DATE TYPE OF WASTE P ?, D014E,4TIC [ ]
COMMERCIAL
GPD ESTIMATED SEWAGE FLOW BASED ON [ ] METERED WATER [•"[�] TABLE 1, 64E-6, FAC
SITE [ ] DRAINAGE STRUCTURES [ ] POOL [ ] PATIO / DECK PARKING
[ ]
CONQITIONS: [ ] SLOPING PROPERTY [ ]
NAIL OF [ 1 HYDRAULIC OVERLOAD [ 1 SOILS [�] MAINTENANCE C ] SYSTEM DAMAGE
FA ORE: [ ] DRAINAGE / RUN OFF [ ] ROOTS [ ] WATER TABLE [ ]
i D BOX/HrDER [�I DRAINFIELD
FAILURE [ ] SEWAGE ON GROUND I�] T [ ) ,
SYMPTOM: [ ) PLUMBING BACKUP [� ty �" M Ch 1.i r
(REMARKS/ADDITIONAL
SUBMITTED BYA
TITLE/LICENST♦e(���3 _DATE
DH'f015, 08/bsoletes Previous editions which may not be used) page 4 0£ 4
Incorporated 64E-6.001, FAC
04111 If,//
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION INSPECTION AND FINAL APPROVAL
Fa
APPLLCP.T-_:: w: �%(D1373096
e_Pr rr 4:56-SF-1891681
DOCUMF'iT a:F11277835
DATE PAID' 04/05/2019
FEE PAID:65.00
RECEIPT u:56-PID-3896034
APPLICANT: Jorge Perelli
AGENT: Jason Harris (All About Septic Services Inc/Jason & Elizabeth Harris) -
PROPERTY ADDRESS: 4914 Margaret Ann Ln Fort Pierce FL 34946
LOT: 1 BLOCK: 2
SUBDIVISION:
Green Acres
IDN: 1430-700-0018-000-2
CHECKED
[X1
ITEMS ARE NOT
IN COMPLIANCE WITH STATUTE OR RULE AND MOST BE
CORRECTED.
]
i
TANK INSTALLATION
[011 TANK SIZE [1) 1090.00 (21
(021 TANK MATERIAL Polypropylene
[031 OUTLET DEVICE
(041 MULTI -CHAMBERED [L_jj N ]
[05] OUTLET FILTER PolylokPL-68
[061 LEGEND 1. 70-143-11DC4 2.
(071 WATERTIGHT
[081 LEVEL
[091 DEPTH TO LID
DRAINFIELD INSTALLATION
[101 AREA [13 384.88 [2) S4FT
[111 DISTRIBUTION BOX HEADER X
[121 NUMBER OF DRAINLINES 1. 2.00 2.
[131 DRAINLINE SEPARATION
[141 DRAINLINE SLOPE
[151 DEPTH OF COVER
[161 ELEVATION [ ABOVE / BELOW ]BM 7,00
[171 SYSTEM LOCATION
[181 DOSING PUMPS
[191 AGGREGATE SIZE
[201 AGGREGATE EXCESSIVE FINES
(211 AGGREGATE DEPTH
FILL / EXCAVATION MATERIAL
[ 1 [221 FILL AMOUNT
[ 1 [231 FILL TEXTURE
[ 1 [241 EXCAVATION DEPTH
[ 1 (251 AREA REPLACED
[ ] 1261 REPLACEMENT MATERIAL
Comments: Comments are on page 2.
CONSTRUCTION I APPHOVBD DISAPPROVED 1'
E vl ental Sped
C
FINAL SYSTEM [ APPROVED / DISAPPROVED
EAvIronmental Spec
(Explanation of violations on following page)
DH 4016, 08/09 (Obsoletes all previous editions which r
Incorporated: 64E-6.003, FAC
EH Database v 1.0.1 AP1373096
SETBACKS
[ ]
[271
SURFACE WATER 100
FT
[ ]
[281
DITCHES
FT
[ ]
[291
PRIVATE WELLS 78
FT
( ]
(301
PUBLIC WELLS
FT
[ 1
[311
IRRIGATION WELLS
FT
[ 1
[321
POTABLE WATER
FT
[ 1
[333
BUILDING FOUNDATIONS
FT
[ 3
[341
PROPERTY LINES 5
FT
[ 1
[351
OTHER
FT
FILLED / MOUND SYSTEM
[ 3
[361
DRAINFIELD COVER
[ 1
[371
SHOULDERS
[ 1
[381
SLOPES
[ 1
[391
STABILIZATION
ADDITIONAL INFORMATION
[ 1
[401
UNOBSTRUCTED AREA
[ ]
[411
STORMNATER RUNOFF
L 1
[421
ALARMS
[ 3
[431
MAINTENANCE AGREEMENT
[ 1
[441
BUILDING AREA
[ ]
[451
LOCATION CONFORMS WITH SITE PLAN
[ 1
[461
FINAL SITE GRADING
[ 1
[471
CONTRACTOR Jason Harris (All About Sept!
[ 1
1481
OTHER INFILTRATOR Quick4 Plus EQ36
LP
ABANDONMENT
[ ]
[491
TANK PUMPED 04/03/2019
[ ]
[50]
TANK CRUSHED S FILLED 04/03/2019
St. Lucie CHID DATE: 04/05/2019
J Ingram (ENVIRONMENTAL HEALTH)
J
not be used)
E101891681
CHD DATE: 04/03/2019
LTH)
Page 2 of 3
Violation Number
��n�nnn4�
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION INSPECTION AND FINAL APPROVAL
Comment
APPLICATION a%'�'r' ! J73096
PERMIT o:56-SF-1891681
DOCUMENT n:F11277835
DATE PAI0:04/05/2019
FEE PAID:65.00
RECEIPT n:56-PID-3896034
The system is sized for 2 bedrooms with a maximum occupancy of 4 persons (2 per bedroom), for a total estimated flow of 300
ST, outlet filter, and lxl6+lxl8 DF installed. Outlet pipe pack pitched. Drainfines greater than one alternative drainfeld
9ct unit difference in length. Drainfield not level. Grass and palm trees less than 6" away from drainline. Contractor notified of
[ions and sent inspection report and violations letter.
,truction inspection violations corrected. No other violations, system ok to cover. Contractor notified onsite. Needs final
fiction for potable water line setback, building foundation setback, filled system, gutters, building area, conformity with site
and final site grading.
Ie well with abandonment permit outside of 75' setback.
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Page 2 of 3
Incorporated: 64E-6.003, FAC
EH Database v 1.0.1 AP1373096 EID1891681
St. Lucie County Health Department
5150 NW Milner Dr Port Saint Lucie, FL 34983
HEALtH
PAYING ON: #:56-SF-1891681 BILL oocn:56-BID-4129293 CONSTRUCTION APPLICATION#_AP1373096
RECEIVED FROM: All About Septic Services Inc/Jason & E AMOUNT PAID: $ 65.00
PAYMENT FORM: CREDIT CARD PAYMENT DATE: 04/05/2019
MAIL TO: Jorge Perelli
FACILITY NAME:
PROPERTY LOCATION:
4914 Margaret Ann Ln
Fort Pierce, FL 34946
Lot:
Block:
Property ID:
1430-700-0018-000-2
EXPLANATION or DESCRIPTION:
QUANTITY FEE
145 - OSTDS Construction Pert Based - Relnspection
1 $ 50.00
-1 - Surcharge (All)
1 $ 15.00
4/52019 1035 AM Sales Receipt #21553
Stare: 1
St Lucie County Health Department
5150 NW Milner Drive
Port St Lucie, FL 34983
Environmental Health Division
'T7
772-873-4931
1
Item # City Price Ext Price
- _
1 $00 $50.00 T
50. 14
__(Z�
.Existing Inspection
1 1 $15.00 $15.00 T
�Z
'OSTDS Counhj' ur
cA
_
Subtotal: $65.05
Local Sales Tax 0 % Tax * $0.00
RECEIPT TOTAL: $65.00
Credit Card: $65.00
Visa
4914Margaret Ann Reinspec6en
i
Thank You & Have a Good Day!
II�III I�'I II'!I �IIII IIIII I IIII
RECEIVED BY:
MontanezNM AUDIT
CONTROL NO. 56-PID-3896034
Mission
To pro*.,-: : a,e & improve the health
of all p,- rle i., rta through Integrated
state, county & community efforts
-
T 3 K
HEALTH
Vision To be the Healthiest State In the Nation
April 04, 2019
Jason Harris (All About Septic Services, Inc/Jason & Elizabeth Harris)
5808 Pinetree Drive
Fort Pierce, FL 34982
Application Document No: AP1373096
4914 Margaret Ann Ln
Fort Pierce, FL 34946
Lot:i Block:2
Dear Applicant:
Subdivision:Green Acres
Ron beSantis
-. vernor
Enclosed is a report on inspection of the above referenced onsite sewage treatment and disposal
system conducted by the department. The items noted on the report and below require correction or
completion before a final inspection may be done.
Item Comments
[11] Distribution Outlet pipe back pitched.
[12] Number of Drainlines More than one alternative product unit difference between
drainlines.
[14] Drainline Slope Drainfield not level.
[37] Shoulders
Trees and grass in shoulder.
Please contact this office when you have completed these items to schedule a final inspection. A
$65.00 re -inspection fee must be paid to:
St. Lucie County Health Department
5150 NW Milner Dr
Port Saint Lucie, FL 34983
Florida Department of Health w .Fioridasttealth.00m
in ST. LUCIE COUNTY TWITTER:Healthi
5150 NW Milner or, Port Saint Lucie, FL 34983 FACEBOOK:FLDepartmentofHealth
PHONE: (772) 873-4931 . FAX: (772) 873-4893 1 YOUTUBE: 8doh
Jasor Harris (All About Septic Services Inc/Jason & Elizabeth -Tarns)
Page two
4/4/2019
If you have any questions on this matter, please call our office at (772) 873-4905.
Sincerely,
Brian Ingram, Environm ntal Specialist II
APPLICATION q:
STATE OF FLORIDA CF_'1,591681
PERMIT q:56-..
C� DEPARTMENT OF HEALT9
c- Zr ; ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM DOCUMENT qF1216973
:
\ . CONSTRUCTION INSPECTION AND FINAL APPROVAL DATE PAID: 11/13/2018
CQO y211
FEE PAID:235.00
RECEIPT q:56-PID-3792201
APPLICANT: Jorge Perelli
AGENT: Jason Harris (All About Septic Services, Inc/Jason & Elizabeth Hams)
PROPERTY ADDRESS: 4914 Margaret Ann Ln Fort Pierce FL 34946
LOT: 1 BLOCK: 2
SUBDIVISION: Green Acres IDN: 1430400-0018-000-2
CHECKED [XI ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED.
TANK INSTALLATION
SETBACKS
[ 1
[01]
TANK SIZE [1] 1090.00 [2)
[ 1
(273
SURFACE WATER 100
FT
[ ]
1021
TANK MATERIAL Polypropylene
[ 1
[28]
DITCHES
FT
[ ]
(031
OUTLET DEVICE
( ]
[291
PRIVATE WELLS 78
FT
[ ]
[041
MULTI -CHAMBERED
IL-11
N 1
( 1
[301
PUBLIC WELLS
FT
[ ]
(051
OUTLET FILTER POlylok PL-68
[ 1
(311
IRRIGATION WELLS
FT
[ 1
(061
LEGEND 1. 70-143-11DC4 2.
[ 1
[321
POTABLE WATER
FT
[ 1
[071
WATERTIGHT
[ 1
[331
BUILDING FOUNDATIONS
FT
( 1
1081
LEVEL
[ 1
(341
PROPERTY LINES 5
FT
[ 3
[091
DEPTH TO LID
( 1
[351
OTHER
FT
DRAINFIELD INSTALLATION
FILLED / MOUND SYSTEM
[ 1
[101
AREA (11 384.88 [21
SQFT
[ 1
(361
DRAINFIELD COVER
[X1
[111
DISTRIBUTION BOX HEADER
X
[XI
(371
SHOULDERS
1X1
(121
NUMBER OF DRAINLINES 1. 2.00 2.
( 1
(381
SLOPES
[ 3
[131
DRAINLINE SEPARATION
[ ]
(391
STABILIZATION
[X]
[141
DRAINLINE SLOPE
[ 1
(153
DEPTH OF COVER
ADDITIONAL
INFORMATION
[ ]
(161
ELEVATION IF
ABOVE
/ BELOW ]BM
7.00
[ 1
[40]
UNOBSTRUCTED AREA
[ ]
(171
SYSTEM LOCATION
[ 1
(411
STORMWATER RUNOFF
[ 1
[18]
DOSING PUMPS
( 1
(421
ALARMS
[ 1
[191
AGGREGATE SIZE
[ ]
[431
MAINTENANCE AGREEMENT
[ ]
[201
AGGREGATE EXCESSIVE FINES
[ ]
[443
BUILDING AREA
[ 1
[211
AGGREGATE DEPTH
[ 1
[451
LOCATION CONFORMS WITH SITE PLAN
FILL
/ EXCAVATION MATERIAL
1 1
1461
FINAL SITE GRADING
[ 1
(221
FILL AMOUNT
[ 1
[471
CONTRACTOR Jason Harris (All About Septi
[ ]
[231
FILL TEXTURE
[ ]
[48]
OTHER INFILTRATOR Quick4 Plus E036 LP
[ 1
[241
EXCAVATION DEPTH
ABANDONMENT
[ ]
(25]
AREA REPLACED
[ 1
[491
TANK PUMPED 04/03/2019
[ ]
(26]
REPLACEMENT MATERIAL
[ 1
[501
TANK CRUSHED 6 FILLED 04/03/2019
Comments: Comments are on page 2.
CONSTRUCTION I / DISAPPROVED St. Lucie CHO DATE: 04/03/2019
1
APPROVED ' Envlron ml Specialist II Br ngram (ENVIRONMENTAL HEALTH(
FINAL SYSTEM [
APPROVED / DISAPPROVED :
Environmental Specialist 11 117J Ingram
(Explanation of Violations on follorinq page)
DH 4016, 08/09 (Obsoletes all previous editions which may not be used
Incorporated: 64E-6.003, FAC
EH Database v 1.0.1 AP1373096
St. Lucie CHO DATE: 04/03/2019
EID1891681
Page 2 of 3
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION INSPECTION AND FINAL APPROVAL
APPLICATION
PERMIT u:56-SF-1891681
oocumENT x:F11276973
DATE PAID:11/13/2018
FEE PAID:235.00
RECEIPT V
Violation Number
Comment
[12] Number of Drainlines
More than one alternative product unit difference between drainlines.
Violation Number
Comment
(11 ] Distribution
Outlet pipe back pitched.
Violation Number
Comment
[141 Drainline Slope
Drainfield not level.
Violation Number
Comment
[37] Shoulders
Trees and grass in shoulder.
Comments
The system is sized for 2 bedrooms with a maximum occupancy of 4 persons (2 per bedroom), for a total estimated flow of 300
gpd.
New ST, outlet filter, and 1x16+tx18 DF installed. Outlet pipe pack pitched. Drainlines greater than one alternative drainfield
product unit difference in length. Drainfield not level. Grass and palm trees less than 6" away from drainline. Contractor notified of
violations and sent inspection report.
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 AP1373096 EID1891681
PERMIT k.- 56-SF-1891681
APPLICATION #: AP 1 3; 3096
STATE CF FLORIDA
DEPARTMENT OF HEALTH DATE PAID,
ONSITE SEWAGE TREATtENT AND DISPOSAL FEE PAID:
SYSTEM
RECEIPT #:
DOCUMENT #: PR1198818
CONSTRUCTION PERMIT FOR: OSTDS Existing Modification
APPLICANT: JDrae Perelll
PROPERTY ADDRESS:
LOT: 1
PROPERTY ID #:
4914 Margaret Ann Ln Fort Pierce, FL 34946
BLOCK: 2
1430-700-0018-000-2
SUBDIVISION: Green Acres
[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 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
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 [ 500 ] SQUARE FEET Drainfield New SYSTEM
R [ ) SQUARE FEET N/A SYSTEM
A TYPE SYSTEM: [X1 STANDARD [ ] FILLED [ ] MOUND
I CONFIGURATION: [ ] TRENCH [X] BED [ ]
N
F LOCATION OF BENCHMARK: Crown of road orange paint mark
I ELEVATION OF PROPOSED SYSTEM SITE [ 8.00 i[ INCHES FT )
E BOTTOM OF DRAINFIELD TO BE [ 7.00 ] [) INCHES Y FT )
L
D
0
T
H
E
R
BELOW] BENCHMARK/REFERENCE POINT
BELOW] BENCHMARK/REFERENCE POINT
� REQUIRED: [ 4.UU] INCHES EXCAVATION REQUIREu: r +
sting system is being abandoned to accommodate new mobile home.
ve the tank abandoned in accordance with the following procedures:(a) The tank shall be pumped out.(b) The bottom of
tank shall be opened or ruptured, or the entire tank collapsed so as to prevent the tank from retaining water, and(c) The
k shall be filled with clean sand or other suitable material, and completely covered with soil.Have the system inspected
the health department after it has been pumped and ruptured but before it is filled with sand and covered.The system is
ad for 2 bedrooms with a maximum occupancy of 4 persons (2 per bedroom), for a total estimated flow of 300 gpd.
SPECIFICATIONS
BY: Jason Harris
TITLE: Septic Tank Contractor
APPROVED BY:
TITLE: Environmental Supervisor I
St. Lucie CHD
Diama S May
DATE ISSUED:
01/17/2019
EXPIRATION DATE:
07/17/2020
DH 4016, 08/09
(Obsoletes all previous
editions which may not be used)
Incorporated:
64E-6.003, FAC
Page 1 of 3
NOTICE OF RIGHTS
A pa ;; ,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 a-e 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 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 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 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.
FDOH in St. Lucie County
Environmental Health
Site Plan Approved for Construction
Supersedes All Previous Site Plans for
OSTDS # S3(a - %J JGS I & Well #51- Zjl%IL
Date: 141-1411
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