Form DH4014 "Septic Tank Manufacture, Septic Tank Service and Temporary Privy Service Inspection Report" - Florida

Form DH4014 or the "Septic Tank Manufacture, Septic Tank Service And Temporary Privy Service Inspection Report" is a form issued by the Florida Department of Health.

Download a PDF version of the Form DH4014 down below or find it on the Florida Department of Health Forms website.

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Download Form DH4014 "Septic Tank Manufacture, Septic Tank Service and Temporary Privy Service Inspection Report" - Florida

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STATE OF FLORIDA
DEPARTMENT OF HEALTH
SEPTIC TANK MANUFACTURE,
SEPTIC TANK SERVICE AND TEMPORARY PRIVY SERVICE INSPECTION REPORT
Authority:
Chapter 381, 386, 387, FS.
Chapter 64E-6,FAC
Name of Establishment
Telephone Number
Location
Owner
Owner’s Address
Purpose of Inspection:
Permit
Routine
Re-check
Disposal
Temporary
Installation
Manufacture
Other
Toilet Service
Note: Items marked "X" are unsatisfactory and require correction within 72 hours unless specified otherwise under
Comments and Instructions.
OFFICE, VEHICLE / EQUIPMENT
TANK TRUCK(S)
STORAGE & CONSTRUCTION YARD
14. Dual Compartments
28. Backfill
1. Required Permit
15. Suction Adequate
29. Tank Size, Construction
2. Water Supply
16. Stand-by Service
30. Drainfield Size, Construction
3. Waste Disposal
17. Tank Cleaned, Disinfected
31. Drain Tile
4. Toilet Fixtures
18. Leakage, Nuisance Free
32. Filter Material
5. Handwashing Fixtures
33. Distance and/or Location
DISPOSAL METHOD & SITE
6. Clean & Nuisance Free
SEPTIC TANK MANUFACTURE
19. Incineration
TEMPORARY PRIVY
20. Sanitary Landfill, Burial
34. Shape, Size, Construction
7. Self Contained
21. Sewage Treatment Facility
35. Material Mixture & Composition
8. Insect Control
22. Vermin Control
36. Strengths
9. Waste Receptacle
23. Odor Control
37. Watertight
10. Cleanable Surface
24. Pollution Control
38. Thickness
11. Adequate Fixtures
39. Reinforcements
12. Supplies
SEPTIC TANK INSTALLATION
40. Manholes or Openings
PUMP OUT AND/OR REPAIR
13. Service to Privies Adequate
41. Inlets and Outlets
25. Workmanship
42. Resins and Sealants
26. Area Clean & Nuisance Free
43. Freeboard Space
27. Lid
44. Other
ITEM
COMMENTS AND INSTRUCTIONS
Copy of Inspection Report Received by
Date of Inspection
Time
Sanitarian
County Health Department
DH 4014, 6/98
STATE OF FLORIDA
DEPARTMENT OF HEALTH
SEPTIC TANK MANUFACTURE,
SEPTIC TANK SERVICE AND TEMPORARY PRIVY SERVICE INSPECTION REPORT
Authority:
Chapter 381, 386, 387, FS.
Chapter 64E-6,FAC
Name of Establishment
Telephone Number
Location
Owner
Owner’s Address
Purpose of Inspection:
Permit
Routine
Re-check
Disposal
Temporary
Installation
Manufacture
Other
Toilet Service
Note: Items marked "X" are unsatisfactory and require correction within 72 hours unless specified otherwise under
Comments and Instructions.
OFFICE, VEHICLE / EQUIPMENT
TANK TRUCK(S)
STORAGE & CONSTRUCTION YARD
14. Dual Compartments
28. Backfill
1. Required Permit
15. Suction Adequate
29. Tank Size, Construction
2. Water Supply
16. Stand-by Service
30. Drainfield Size, Construction
3. Waste Disposal
17. Tank Cleaned, Disinfected
31. Drain Tile
4. Toilet Fixtures
18. Leakage, Nuisance Free
32. Filter Material
5. Handwashing Fixtures
33. Distance and/or Location
DISPOSAL METHOD & SITE
6. Clean & Nuisance Free
SEPTIC TANK MANUFACTURE
19. Incineration
TEMPORARY PRIVY
20. Sanitary Landfill, Burial
34. Shape, Size, Construction
7. Self Contained
21. Sewage Treatment Facility
35. Material Mixture & Composition
8. Insect Control
22. Vermin Control
36. Strengths
9. Waste Receptacle
23. Odor Control
37. Watertight
10. Cleanable Surface
24. Pollution Control
38. Thickness
11. Adequate Fixtures
39. Reinforcements
12. Supplies
SEPTIC TANK INSTALLATION
40. Manholes or Openings
PUMP OUT AND/OR REPAIR
13. Service to Privies Adequate
41. Inlets and Outlets
25. Workmanship
42. Resins and Sealants
26. Area Clean & Nuisance Free
43. Freeboard Space
27. Lid
44. Other
ITEM
COMMENTS AND INSTRUCTIONS
Copy of Inspection Report Received by
Date of Inspection
Time
Sanitarian
County Health Department
DH 4014, 6/98
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