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.IPPLICATION u:AP1402650
STATE OF FLORIDA
PERMIT x:56-SF-1775682
DEPARTMENT OF HEALTH
DOCUMENT w:F112783$0
p ONSITE SEWAGE TREATMENT AND
DISPOSAL SYSTEM
CONSTRUCTION INSPECTION AND
FINAL APPROVAL
DATE PAID:04/04/2019
�o a1t toff
SCANNED
FEE PAID:65M
BY
RECEIPT n:56-PID-3895578
APPLICANT: St Luice Really Group, LLC
St. I [ [rip f)Qugbi
AGENT: St Lucie Realty Group. LLC
PROPERTY ADDRESS: 887 NE Prima Vista Blvd Port Saint Lucie, FL 34952
LOT: BLOCK:
SUBDIVISION: River Park ID#:
3419.516A001A00.3
CHECKED (X] ITEM ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED.
TANK INSTALLATION
SETBACKS
[ ] (all TANK SIZE [1] 121
( ] [271
SURFACE WATER FT
( ] [02] TANK MATERIAL
[ ] [281
DITCHES FT
( ] 1031 OUTLET DEVICE
[ ] [291
PRIVATE WELLS FT
[ ] [041 MULTI -CHAMBERED [ Y / N )
[ ) (303
PUBLIC WELLS FT
[ ] (05] OUTLET FILTER
[ ] [311
IRRIGATION WELLS FT
[ ] 1061 LEGEND 1. 2.
( ) [321
POTABLE WATER FT
[ ] [071 WATERTIGHT
[ ) [331
BUILDING FOUNDATIONS FT
[ ] (061 LEVEL
( ) 1341
PROPERTY LINES FT
[ ] (091 DEPTH TO LID
( ] [351
OTHER FT
DRAINFIELD INSTALLATION
FILLED / MOUND SYSTEM
[ ] (101 AREA [1] (2)
SQFT [ ) [361
DRAINFIELD COVER
[ ] [111 DISTRIBUTION BOX _ HEADER
[ ) (37)
SHOULDERS
[ ] [121 NUMBER OF DRAINLINES 1. 2.
( ] [381
SLOPES
( ) [131 DRAINLINE SEPARATION
[ ) 1393
STABILIZATION
[ ] [141 DRAINLINE SLOPE
[ ] (151 DEPTH OF COVER
ADDITIONAL INFORMATION
( ] 1161 ELEVATION ( ABOVE / BELCW ]BM
[ ] [401
UNOBSTRUCTED AREA
( ] 1171 SYSTEM LOCATION
( ) (41)
STORMWATER RUNOFF
( ] 1181 DOSING PUMPS
( ] (42)
ALARMS
[ ] [191 AGGREGATE SIZE
( ] (431
MAINTENANCE AGREEMENT
[ ] [201 AGGREGATE EXCESSIVE. FINES
[ ] [441
BUILDING AREA
[ ] [211 AGGREGATE DEPTH
[ ) (45]
LOCATION CONFORMS WITH SITE PLAN
[ ] [46]
FINAL SITE GRADING
FILL / EXCAVATION MATERIAL
[ ) [221 FILL A14OUNT
[ ) (471
CONTRACTOR
[ ) (231 FILL TEXTURE
( ] (481
OTHER
[ ] (241 EXCAVATION DEPTH
ABANDONMENT
[ ] [253 AREA REPLACED
( ] 1491
TANK PUMPED 03/29/2019
[ ) [261 REPLACEMENT MATERIAL
[ ] 1501
TANK CRUSHED 6 FILLED 04/08/2019
Comments: Comments are on page 2.
/
St. Lucie C!{D DATE: 04/08/2019
CONSTRUCTION [ APPROVED
DISAPPROVED )
E ron
ntal Spoclalistll Br( I gr
(ENVIRONMENTAL HEALTH)
FINAL SYSTEM [ /
^^ Lucie CHD DATE: 04/0812019
APpAOVED DISAPPROVED ]:
�^�
Envlmnmental
Specialist 118riap; Ingram (ENVIRONMENTAL HEALTH)
(Explanation of violations on following page)
7
DH 4016, 08/09 (Obsoletes all previous editions
Which may not be used)
Incorporated: 64E-6.003, FAC
Page 2 of 3
Eli 0.01,.sc v1.0,1 AP1402650
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. t~ STATE OF FLORIDA
y DEPARTMENT OF HEALTH
b ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION INSPECTION AND FINAL APPROVAL
Violation Number Comment
torments
:APPLICATION a:AP1402650
PERMIT x:56-SF-1775682
DocoHENT s:F11278380
DATE PAID:04/04/2019
FEE PAID :65.00
REcEIPT x:56-PID-3895578
All septic tanks pumped and abandoned properly. No violations, system ok to cover. Contractor notified onsite. Final approval
sent to contractor.
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC Page 2 of 3
EH DaWbaso V1.0.1 AP1402660 EID1775682
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;Bridge Web Viewer
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION PERMIT FOR: OSTOS Abandonment
APPLICANT: (St Lucce Realty Group, LLC)
Page 3 of
PERMIT #: 56-SF-I 775682
APPLICATION #;AP1402650
DATE PAID:
FEE PAID:
RECEIPT If:
DOCUMENT #: PR1207230
PROPERTY ADDRESS: 887 NE Prima Vista Blvd Port Saint Lucie, FL 34952
LOT: BLOCK: SUBDIVISION: RiverPark
PROPERTY ID #: 3419-515-0001-000-3 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
[OR TAX In 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 SPECIFICATIONS
T [ I GALLONS J GPD CAPACITY
A [ ] GALLONS / GPD CAPACITY
N ( ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]'
K ( j GALLONS DOSING TANK CAPACITY ( ]GALLONS @I ]DOSES PER 24'HRS #Pumps [
D [ ] SQUARE FEET
R [ ] SQUARE FEET
A TYPE SYSTEM: [ ] STANDARD
I CONFIGURATION: [ ] TRENCH
N
F LOCATION OF BENCHMARK:
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRATN£IELD TO BE
L
D F
0
T
H
E
R
( ] FILLED
( ] BED
SYSTEM
SYSTEM
[ ] MOUND [ j
][ ABOVE /BELOW] BENCHMARK/REFERENCE POINT
[ ][ ! ][ABOVE/BELOW I BENCHMARK/REFERENCE POINT
u:S2UixED: I U.uu j INCHES EXCAVATION REQUIRED: [ ] INCHES
L OF 6 TANKS TO BE ABANDONED. IF ALL OF THE TANKS ARE NOT ABANDONED IN CONJUNCTION, A
3PECTION FEE WILL BE ASSESED FOR EACH INSPECTION AFTER THE INITIAL. Have thetankabandoned in
lance with the following procedures:(a) The tank shall be pumped out.(b) The bottom of the tank shall be opened or
ed, or the entire tank collapsed so as to prevent the tank from retaining water, and(c) The tank shall be filled with
sand or other suitable material, and completely covered with soll.Have the system inspected by the health
tment after it has been pumped and ruptured but before it is filled with sand. and covered.
SPECIFICATIONS BY::7� Dianna S Nay TITLE' Environmental Supervisor I
APPROVED BY: a Y(rY�-.�.-- �`r .�.Y-' TITLE: Environmental Supervisor I St Lucia CHD
Dianna 5 May
DATE ISSUED: 03/14/2019 EXPIRATION DATE: 06/12/2019
DH 4016, 08/09 (Obsolates all previous editions which may not be used)
Incorporated: 64E-6.003, FAC
Page 1 of 3
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