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'T11F APPLICATION #:AP1202748
STATE OF T OF HE �,.nM M.\ DOCERMIT UMENT #:FI 0248897774
DEPARTMENT OF HEALTH �-lp ] 11 `1 J
oNSITE SEWAGE TREATMENT AND DISPOSAL SYST
CONSTRUCTION INSPECTION AND FINAL APPROVAL DATE PAID:2015
�`°°"�``�`• FEE PAID:515.015.00
RECEIPT #:56-PID-2765769
APPLICANT: Margiric Asst, LLC
AGENT: Darryl Tripp
PROPERTY ADDRESS: 16001 Inddo Rd Fort Pierce, FL34945 SCANNIM
LOT: BLOCK: BY
SUBDIVISION: ID#: 1213421.0001400.0 St. Lucie County
CHECKED [XI ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED.
L ]
C ]
TANK INSTALLATION
[01] TANK SIZE [1.] 1537.00 [21
[021 TANK MATERIAL Polyethylene
[031 OUTLET DEVICE
[041 MULTI -CHAMBERED ELZJ N ]
1051 OUTLET FILTER Polylok PL-68
[061 LEGEND 1. 70-143-16DC4 2.
[071 WATERTIGHT
1081 LEVEL
[091 DEPTH TO LID
DRAINFIELD INSTALLATION
[101 AREA [1] 870 [21 SQFT
[111 DISTRIBUTION BOX HEADER X
[121 NUMBER OF DRAINLINES 1. 8.00 2.
[13.1 DRAINLINE SEPARATION
[141 DRAINLINE SLOPE
[153 DEPTH OF COVER
SETBACKS
[ ]
[271
SURFACE WATER 97
FT
[ ]
[281
DITCHES 97
FT
[ ]
[291
PRIVATE WELLS 190
FT
[ 1
[301
PUBLIC WELLS
FT
L ]
[311
IRRIGATION WELLS
FT
[ ]
[321
POTABLE WATER
FT
[ ]
[33]
BUILDING FOUNDATIONS 7
FT
[ ]
[341
PROPERTY LINES
£T
[ ]
[351
OTHER
FT
FILLED / MOUND SYSTEM.
[ ]
[361
DRAINFIELD COVER
[ )
[371
SHOULDERS
[ ]
[381
SLOPES
[ 1
[39.1
STABILIZATION 11/10/2015
ADDITIONAL INFORMATION
1161
ELEVATION I ABOVE. / BELOW 1BM 45.00
[
] [40]
UNOBSTRUCTED AREA
[17]
SYSTEM LOCATION
[
] (411
STORMWATER RUNOFF
[181
DOSING PUMPS
I
1 (421
ALARMS
[191
AGGREGATE SIZE
[
] [431
MAINTENANCE AGREEMENT
[201
AGGREGATE EXCESSIVE FINES
[
3 [441
BUILDING AREA
(211
AGGREGATE DEPTH
(
3 [451
LOCATION CONFORMS WITH SITE PLAN
L
] [461
FINAL SITE GRADING
FILL
/ EXCAVATION MATERIAL
[
1 1471
CONTRACTOR Raymond Kane(Shorl[ne Lin
[22]
FILL AMOUNT
[
]—L48-3
OTHER ATS-MRS-9-(9j 1posi 2 r)
-[231--FILL.
TEXTURE— --
[ ]
[24]
EXCAVATION DEPTH ABANDONMENT
[ ]
(253
AREA REPLACED I ] [493 TANK PUMPED
[ ]
[261
REPLACEMENT MATERIAL [ ] [501 TANK CRUSHED 6 FILLED
Comments:
Comments are on page 2. -
CONSTRUCTION I APPROVED /
DISAPPROVED 1:
St. Lucie CHD DATE: 11102/2016
FINAL SYSTEM I pppgpygp / DISAPPROVED ]: .St. Lucie CHU
nv� rf onmenm tafSpee a nan J 1nqmmjmNv1m0N1nmNML HULTH)
(Explanation of Violations on following page)
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, PAC
EH Database v1.0.1 AP1202748 EID1627774
DATE: 11/10/2015
Page 2 of 3
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Q° STATE OF FLORIDA
DEPARTMENT OF HEALTH
K` ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION INSPECTION AND FINAL APPROVAL
•~moo osg�•
Violation Number Comment
Comments
No violations, system ok to cover. Contractor notified onsite.
Contractor emailed construction approval.
FINAL NEEDED FOR STABILIZATION.
Final construction approved. Contractor and building department emailed final approval.
APPLICATION #:AP1202748
PEaMIT # 56-SF-1627774
DOCUMENT #: FI1024889
DATE PAID:08/31/2015
FEE PAID:515.00
RECEIPT #:56-PID-2765769
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC
EH Database v 1.0.1 AP1202748 EIDM27774
Page 2 of 3