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Of�1E C APPLICATION #:AP1212814
9" STATE OF FLORIDA PERMIT #:56-SF-1642837
DEPARTMENT OF HEALTH DOCUMENT #:FI 1028018
�v ONSITE SEWAGE TREATMENT AND DISPOSAL, SYSTEM
(y CONSTRUCTION INSPECTION AND FINAL, APPROVAL DATE PAID:11/16/2015
Q — �� /, / FEE PAID:65.0 0
RECEIPT #:56-PID-2848276
APPLICAIT: Joseph Miller
AGENT: All Contractor Services
PROPERTY ADDRESS: 345 Jenkins Rd Fort Pierce, FL 34947
LOT: BLOCK:
SUBDIVISION: IDN; 2312-414.0004-0003
CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED.
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TANK INSTALLATION SETBACKS
[ 1 (01] TANK SIZE [1] (2) [ ] [271 SURFACE WATER FT
( 1 [021 TANK MATERIAL [ J [28) DITCHES FT
[ 1 [031 OUTLET DEVICE ( ] [29] PRIVATE WELLS FT
( ] [04] MULTI-CHAMBERED [ Y / N J [ ] [30] PUBLIC WELLS FT
[ 1 [05) OUTLET FILTER [ ] (31] IRRIGATION WELLS FT
[ J [ 6] LEGEND 1. 2. [ J [32] POTABLE WATER FT
[ ] ('07) WATERTIGHT [ 1 [331 BUILDING FOUNDATIONS FT
[ ] [08] LEVEL [ 1 [34) PROPERTY LINES FT
( ] [i09) DEPTH TO LID [ 1 (35) OTHER FT
DRAINFIELD INSTALLATION FILLED / MOUND SYSTEM
[ ] [10] AREA [1] [2) SQFT [ 1 [36] DRAINFIELD COVER
[ 1 [R1] DISTRIBUTION BOX HEADER [ 1 [371 SHOULDERS
[ ] [12] NUMBER OF DRAINLINES 1• 2• [ ] [38] SLOPES
[ ] [13] DRAINLINE SEPARATION [ 1 [391 STABILIZATION
[ ) [14) DRAINLINE SLOPE
[ ] [15] DEPTH OF COVER ADDITIONAL INFORMATION
[ ) [16J ELEVATION [ ABOVE / BELOW ]BM [ 1 [401 UNOBSTRUCTED AREA
[ ] [17] SYSTEM LOCATION [ ] [41] STORMWATER RUNOFF
[ ] (18J DOSING PUMPS [ 1 [42] ALARMS
( ] (19] AGGREGATE SIZE [ J [43] MAINTENANCE AGREEMENT
[ ] [20] AGGREGATE EXCESSIVE FINES [ 1 [44) BUILDING AREA
[ ] [21) AGGREGATE DEPTH [ 1 [45) LOCATION CONFORMS WITH SITE PLAN
FILL / EXCAVATION MATERIAL ( J [46] FINAL SITE GRADING
[ ] [22] FILL AMOUNT [ 1 (47) CONTRACTOR Jamie DiFrancesco(AIL Cont
[ ] [231 FILL TEXTURE [ ] [48] OTHER
[ ] (24] EXCAVATION DEPTH ABANDONMENT
( ] (25] AREA REPLACED [ 1 [49], TANK PUMPED 12/04!2015
[ ) [26) REPLACEMENT MATERIAL ( ] [50] TANK CRUSHED & FILLED 12/04/2015
Comments: Comments are on page 2.
CONSTRUCTION [ APPROVED / DISAPPROVED 1, St. Lucie CHD DATE: 12/04/2015
Environmental Spoclafrst I Brian J Ingram(ENVIRONMENTAL HEALTH)
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FINAL SYSTEM [ APPROVED / DISAPPROVED ]; /�'"`—^Q St.Lucie CHD DATE- 2/0//2015
nv ron"€�[mental Spy at all st I wrianj Ingram STH)
(Explanation of Violations on following page)
DH 4016, 08/ 09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC &age 2 of 3
EH Database v 1.0.1 AP1212014 11101642837
https://s l.ebridg,e.com/ebridge/3.0/webviewel-/Viewer.aspx?ref--dkk5Ki7Exi%2fNvpTQt3gTLoOX2OvW7C... 4/6/2016
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Oti APPLICATION #:AP1212814
STATE OF FLORIDA PERMIT #:56-SF-1642837
DEPARTMENT OF HEALTH
DOCUMENT #:F11028018
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION INSPECTION AND FINAL APPROVAL DATE P7ID:11/16/2015
FEE PAID:65.00
RECEIPT #:56-PID-2848276
Violation Number Comment
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Comments
No violations.Tank pumped and abandoned and covered properly.Contractor emailed final approval.
DH 4016s' 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 AP1212814 EID1642837
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https:Hs l.ebridge.6om/ebridge/3.0/webvie,wer/Viewer.aspx?ref=dkk5Ki7Exi%2fNvpTQt3 gTLoOX2OvW7C... 4/6/2016