HomeMy WebLinkAboutHealth Department Septic Permit UIA
R E C E i .' D DEC 0 16 PERMIT #:56-SF-04195
STATE OF FLORIDA APPLICATION #:AP1265276
DEPARTMENT OF HEALTH DATE PAID:
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID:
CONSTRUCTION PERMIT
RECEIPT #:
UME
DOCUMENT #.- PR1040617
FILE CCttti
—` osTDs #-02-0237-R
CONSTRUCTION PERMIT FOR: OSTDS Abandonment
APPLICANT: (AG and JM LLC)
PROPERTY ADDRESS: 393 E Midway Rd Fort Pierce, FL 34982
LOT, 1-4 BLOCK, 2 SUBDIVISION: White City
PROPERTY ID 0: 3403-804-0014-000-5 [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 SPECIFICATIONS
T 1,000 1 GALLONS GPD Septic EXISTING CAPACITY
A I GALLONS GPD CAPACITY
N f I GALLONS GREASE INTERCEPTOR CAPACITY (MAXIMUM CAPACITY SINGLE TANK:1250.GALLONS]
K I GALLONS DOSING TANK CAPACITY ]GALLONS @[ ]DOSES PER 24 HRS #Pumps E I
D I SQUARE FEET SYSTEM
R I SQUARE FEET SYSTEM
A TYPE SYSTEM: STANDARD FILLED MOUND
I CONFIGURATION: TRENCH BED
N
F LOCATION OF BENCHMARK:
I ELEVATION OF PROPOSED SYSTEM SITE ABOVE/BELOW]BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE I if I C ABOVE/BELOW)BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: 0.00] INCHES EXCAVATION REQUIRED: I INCHES
Have the tank abandoned in accordance with the following procedures:(a)The tank shall be pumped out.(b)The bottom
0 of the tank shall be opened or ruptured,or the entire tank collapsed so as to prevent the tank from retaining water,and(c)
T The tank shall be filled with clean sand or other suitable material,and completely covered with soil.Have the system
H 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: ,,- JAMIE L D!==�CESCO TITLE:
A:�7L'
APPROVED BY: TITLE: Env. Sup 11 St Lucie CHD
Victor raconti
DATE ISSUED: 12/02/2016 EXPIRATION DATE* 03/02/2017
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated; 64E-6.003, PAC Page 1 of 3
v 1.1.4 AP1265276 SE-1