Form DH3144 "Homeowner Acknowledgment of Installation of Innovative Ostds" - Florida

Form DH3144 or the "Homeowner Acknowledgment Of Installation Of Innovative Ostds" is a form issued by the Florida Department of Health.

The form was last revised in January 1, 1994 and is available for digital filing. Download an up-to-date Form DH3144 in PDF-format down below or look it up on the Florida Department of Health Forms website.

ADVERTISEMENT

Download Form DH3144 "Homeowner Acknowledgment of Installation of Innovative Ostds" - Florida

692 times
Rate
4.6(4.6 / 5) 48 votes
(date)
County Health Department
Attention: Environmental Health Director or
OSTDS Program Coordinator
I
, owner of the residence or business property
located at (give physical location or street address)
,
understand that the proposed Onsite Sewage Treatment and Disposal System to serve my
property is permitted as an innovative system by the Department of Health.
I agree to allow agents of the Florida Department of Health, the manufacturer and the
local County Health Department to enter my property at reasonable hours for the purpose of
monitoring this system.
I agree that I will not hold DOH or the
CHD
responsible if this innovative system malfunctions.
I agree that I will notify
CHD of any
problems or malfunctions with this innovative system.
I also understand that if the innovative system fails within the five year testing period,
the manufacturer will be responsible for providing a certified installer who will provide
contractor equipment, material and labor necessary to modify the system or repair the system
with an DOH approved system at no additional cost to me. For the purposes of this evaluation,
failure of a system shall be defined as any system that meets one or more of the following
criteria: 1) systems that have been increased in size after installation for reasons other than
erroneous application information; 2) systems that experience effluent surfacing and sewage
backing up into the house plumbing; and 3) systems described by homeowner as having a
sluggish performance during wet weather or observed to have soggy, waterlogged soils above
the drainfield attributed to sewage effluent. The failure definition shall include persistent
electrical or mechanical device malfunctions. It is also my understanding that I will be
responsible for landscape restoration.
Sincerely,
Property Owner
DH Form 3144, 01/94 Incorporated: 64E-6.004, FAC
(date)
County Health Department
Attention: Environmental Health Director or
OSTDS Program Coordinator
I
, owner of the residence or business property
located at (give physical location or street address)
,
understand that the proposed Onsite Sewage Treatment and Disposal System to serve my
property is permitted as an innovative system by the Department of Health.
I agree to allow agents of the Florida Department of Health, the manufacturer and the
local County Health Department to enter my property at reasonable hours for the purpose of
monitoring this system.
I agree that I will not hold DOH or the
CHD
responsible if this innovative system malfunctions.
I agree that I will notify
CHD of any
problems or malfunctions with this innovative system.
I also understand that if the innovative system fails within the five year testing period,
the manufacturer will be responsible for providing a certified installer who will provide
contractor equipment, material and labor necessary to modify the system or repair the system
with an DOH approved system at no additional cost to me. For the purposes of this evaluation,
failure of a system shall be defined as any system that meets one or more of the following
criteria: 1) systems that have been increased in size after installation for reasons other than
erroneous application information; 2) systems that experience effluent surfacing and sewage
backing up into the house plumbing; and 3) systems described by homeowner as having a
sluggish performance during wet weather or observed to have soggy, waterlogged soils above
the drainfield attributed to sewage effluent. The failure definition shall include persistent
electrical or mechanical device malfunctions. It is also my understanding that I will be
responsible for landscape restoration.
Sincerely,
Property Owner
DH Form 3144, 01/94 Incorporated: 64E-6.004, FAC
ADVERTISEMENT
Fill PDF online