Natural Resources Management Department
SEPTIC MAINTENANCE NOTICE
Instructions: 1. Fill out front page of this Notice. 2. Attach maintenance agreement. 3. File with
Brevard Clerk of Court. 4. Return copy of recorded documents to the Building Department before final
inspection.
Parcel Tax ID#: _________________
Florida Department of Health (FDOH) permit/application number: _____________________
Site Address__________________________________________________________
This property is serviced by the following type of septic system or onsite sewage treatment and
disposal system (O.S.T.D.S.).
Select one of the following:
Aerobic treatment unit
Engineered performance-based treatment system
Alternative system including in-ground nitrogen-reducing media authorized by Rule 64E-
6.009, Florida Administrative Code
Other (e.g., innovative, experimental, or research systems) ______________________
This system may require one or more of the following:
• the use of electricity to function
• a biennial operating permit
• proof of semiannual maintenance
• periodic monitoring
• s
pecial repair or maintenance procedures
• Please contact FDOH at (321) 633-2100 for additional information.
Check to Acknowledge that you have read and understood the above information
_________________________________________________
P
rint Name
_________________________________________________
Property Owner Signature
STATE OF FLORIDA
COUNTY OF BREVARD
The forgoing instrument was acknowledged before me this ____day of _____________ 20___, by
___________________. He/she is personally known to me ____or has
produced___________________, as identification and did/did not take an oath.
My commission expires: __________
Commission Stamp (below)
________________________________________
Notary Public Signature– State of Florida
_______________________________________
Printed Name
