HomeMy WebLinkAboutHealth Department Septic Approval J,
PERMIT #: 56-SF-1605252
tt sT.� STATE OF FLORIDA
DEPARTMENT OF HEALTH APPLICATION #:AP1188137
` '`a •.:'.""' ONSITE SEWAGE TREATMENT AND DISPOSAL DATE PAID:
1
SYSTEM FEE PAID:
.i� CONSTRUCTION PERMIT
RECEIPT #:
y�Op cos DOCUMENT #: PR974037
CONSTRUCTION PERMIT FOR: OSTDS Abandonment
APPLICANT: Margaret Carlton
PROPERTY ADDRESS: 210 Lamont Rd Fort Pierce,FL 34947
LOT: BLOCK: SUBDIVISION'
PROPERTY ID #: 231213200020004 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
[OR TAR 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 SPECIFICATIONS
T [ ] GALLONS / GPD Existinq Septic CAPACITY
A [ ] GALLONS / GPD CAPACITY
N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ j GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps I 7
D [ ] SQUARE FEET SYSTEM
R [ ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [ ] STANDARD [ ] FILLED [ ] MOUND [ J
I CONFIGURATION: [ ] TRENCH [ .] BED [ J
N
F LOCATION'OF BENCHARK:
I ELEVATION•-OF PROPOSED SYSTEM SITE [ ] [ / J [ABOVE/BELOW IBENCHMARK/REFERENCE POINT
E BOTTOM OF�DRAINFIELD TO BE [ ] [ / ] [ABOVE/BELOW I BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: [ 0.001 INCHES EXCAVATION REQUIRED: [ ] INCHES
O Have the tank abandoned in accordance with the following procedures:(a)The tank shall be pumped out.(b)The bottom
of the tank shall be opened or ruptured,or the entire tank collapsed so as to prevent the tank from retaining water,
T and(c)The tank shall be filled with clean sand or other suitable material,and completely covered with soil.Have the
H system inspected by the health department after it has been pumped and ruptured but before it is filled with sand and
covered.
E
R
SPECIFICATIONS BY: MICHAELjW STUHR TITLE: Registered Septic Tank Contractor
APPROVED BY: IV TITLE: Env. Sup 11 St. Lucie CHD
Victor Facoati �
DATE ISSUED: 05/08/2015 EXPIRATION DATE: 08/06/2015
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
i Incorporated: 64E-6.003, FAC 1, Page 1 of 3
V 1.1.4 AP1188137 SE-1
NOTICE OF RIGHTS
A party 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 are 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#A02,Tallahassee, Florida 32399-1703. The
Agency Clerk's facsimile number is 850-410-1448.
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.