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Home My WebLink AboutMisc LettersSTATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION INSPECTION AND FINAL APPROVAL APPLICANT: Kimberly Ciufo AGENT: Kimberly Ciufo PROPERTY ADDRESS: 10240 Carlton Rd Port Saint Lucie, FL 34987 APPLICATION # :A P123 496 PERMIT #:56 -SF -1757729 DOCUMENT # : FI 1110566 DATE PAID., 04/25/2017 FEE PAID :65.00 RECEIPT #:56 -PID -3220953 LOT: SUBDIVISION: FILL / EXCAVATION MATERIAL BLOCK: ID# : 4210-223-0001-000-9 [ ] [47] CONTRACTOR CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED. TANK INSTALLATION [ ] [48] OTHER SETBACKS [23] FILL TEXTURE [ ] [01] TANK SIZE [1] [2] [ ] (27] SURFACE WATER FT [ ] [02] TANK MATERIAL [ ] [28] DITCHES FT [ ] [03] OUTLET DEVICE [ ] [29] PRIVATE WELLS FT [ ] [04] MULTI-CHAMBERED [ Y / N ] [ ] (30] PUBLIC WELLS FT [ ] [05] OUTLET FILTER [ ] [31] IRRIGATION WELLS FT [ ] [06] LEGEND 1, 2. [ ] [32] POTABLE WATER FT [ ] [07] WATERTIGHT [ ] [33] BUILDING FOUNDATIONS FT [ ] [08] LEVEL [ ] [34] PROPERTY LINES FT [ ] [09] DEPTH TO LID [ ] [35] OTHER FT DRAINFIELD INSTALLATION FILLED / MOUND SYSTEM [ ] [10] AREA [1] [2] SQFT [ ] (36] DRAINFIELD COVER [ ] [11] DISTRIBUTION BOX HEADER [ ] [37] SHOULDERS [ ] (12] NUMBER OF DRAINLINES 1. 2. [ ] (38] SLOPES [ ] [131 DRAINLINE SEPARATION [ ] [39] STABILIZATION ( ] [14] DRAINLINE SLOPE [ ] [15] DEPTH OF COVER ADDITIONAL INFORMATION [ ] [16] ELEVATION [ ABOVE / BELOW ]BM [ ] [40] UNOBSTRUCTED AREA [ ] [17] SYSTEM LOCATION [ ] [41] STORMWATER RUNOFF ( ] [18] DOSING PUMPS L ] (42] ALARMS I ] [19] AGGREGATE SIZE [ ] [43] MAINTENANCE AGREEMENT [ ] [20] AGGREGATE EXCESSIVE FINES [ ] [44] BUILDING AREA [ ] [21] AGGREGATE DEPTH [ ] [45] LOCATION CONFORMS WITH SITE PLAN [ ] [46] FINAL, SITE GRADING f i^ CONSTRUCTION I APPROVED St. Lucie CHI) DATE: 04/27/2017 DISAPPROVED ) ' Environmental Speeci^a�#'tt 11 Brian J Ingram (ENVIRONMENTAL HEALTH) FINAL SYSTEM I APPROVED DISAPPROVED ] : St. Lucie CHI) DATE: 04/27/2017 Environmental Special II Brian J Ingram (ENVIRONMENTAL HEALTH) (Explanation of Violations on following page) DH 4016, 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 AP1287496 ElD1757729 FILL / EXCAVATION MATERIAL [ ] [47] CONTRACTOR [ ] [22] FILL AMOUNT [ ] [48] OTHER [ ] [23] FILL TEXTURE [ ] [24] EXCAVATION DEPTH ABANDONMENT ( ] [25] AREA REPLACED [ ] [49] TANK PUMPED 04/27/2017 [ ] [26] REPLACEMENT MATERIAL [ ] [50] TANK CRUSHED & FILLED 04/27/2017 Comments: Comments are on page 2. f i^ CONSTRUCTION I APPROVED St. Lucie CHI) DATE: 04/27/2017 DISAPPROVED ) ' Environmental Speeci^a�#'tt 11 Brian J Ingram (ENVIRONMENTAL HEALTH) FINAL SYSTEM I APPROVED DISAPPROVED ] : St. Lucie CHI) DATE: 04/27/2017 Environmental Special II Brian J Ingram (ENVIRONMENTAL HEALTH) (Explanation of Violations on following page) DH 4016, 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 AP1287496 ElD1757729 Violation Number STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION INSPECTION AND FINAL APPROVAL comments Tank empty and above ground. Tank abandoned property. No violations. Abandonment approved. APPLICATION #:AP1287496 PERMIT #..56-5F-1757729 DOCUMENT #:F1 1110566 DATE PAID . 04/25/2017 FEE PAID:65.00 RECEIPT #.,56 -PID -3220953 DH 4016, 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 AP1287496 E101757729 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT FOR: OSTDS Abandonment APPLICANT: Kimberly Clufo PROPERTY ADDRESS: 10240 Carlton Rd Port Saint Lucie, FL 34987 LOT: BLOCK: PROPERTY ID #: 4210-223-0001-000-9 SUBDIVISION: PERMIT #:56 -SF -1757729 APPLICATION # : qP 1287496 DATE PAID: FEE PAID: RECEIPT #: DOCUMENT #: PR1059429 [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 [ ] GALLONS / GPD Tank abandonment CAPACITY A [ J GALLONS / GPD CAPACITY N [ ] GALLONS GREASE INTERCEPTOR CAPACITY (MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K ( ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ D [ ] SQUARE FEET SYSTEM R [ ] 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 [ ]( / ][ABOVE/ BELOW] BENCHMARK/REFERENCE POINT L D O T H E R 'ILL REQUIRED: [ U.UU ] INCHES EXCAVATION REQUIRED! L I lrvUh65 Have the tank abandoned in accordance with the following procedures:(a) The tank shall be pumped out.(b) The bottom of the tank shall be opened or ruptured, or the entire tank collapsed so as to prevent the tank from retaining water, and(c) The tank shall be filled with clean sand or other suitable material, and completely covered with soil. Have the system inspected by the health department after it has been pumped and ruptured but before it is filled with sand and covered. SPECIFICATIONS BY: Dianna S May TITLE: Environmental Specialist I APPROVED BY: �J?//� TITLE: Environmental Specialist I Dianna S May DATE ISSUED: 04/27/2017 DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E-6.003, FAC 1.1.4 AP1287. 4 9 6 E St. Lucie CHD EXPIRATION DATE: 07/26/2017 Page 1 ofZ3 i �t NOTICE OF RIGHTS A party whose substantial interest is affected by this order may petition for an administrative hearing pursuant to sections 120.569 and 120.57, Florida Statutes. Such proceedings are governed by Rule 28-106, Florida Administrative Code. A petition for administrative hearing must be in writing and must be received by the Agency Clerk for the Department, within twenty-one (21) days from the receipt of this order. The address of the Agency Clerk is 4052 Bald Cypress Way, BIN A-02, Tallahassee, Florida 32399. The Agency Clerk's facsimile number is 850-413-8743. Mediation is not available as an alternative remedy. Your failure to submit a petition for hearing within 21 days from receipt of this order will constitute a waiver of your right to an administrative hearing, and this order shall become a 'final order'. Should this order become a final order, a party who is adversely affected by it is entitled to judicial review pursuant to Section 120.68, Florida Statutes. Review proceedings are governed by the Florida Rules of Appellate Procedure. Such proceedings may be commenced by filing one copy of a Notice of Appeal with the Agency Clerk of the Department of Health and a second copy, accompanied by the filing fees required by law, with the Court of Appeal in the appropriate District Court. The notice must be filed within 30 days of rendition of the final order. St. Lucie County Health Department 5150 NW Milner Dr Port Saint Lucie, FL 34983 HEALTH PAYING ON: PERMIT #: 56 -SF -1757729 BILL ooc #:56 -BID -3396018 CONSTRUCTION APPLICATION #: AP1287496 RECEIVED FROM: Kimberly Ciufo AMOUNT PAID: $ 65.00 PAYMENT FORM: CHECK 2111 PAYMENT DATE: 04/25/2017 MAIL TO: Kimberly Ciufo FACILITY NAME : PROPERTY LOCATION: 10240 Carlton Rd Port Saint Lucie, FL 34987 Lot: Block: Property ID: 4210-223-0001-000-9 EXPLANATION or DESCRIPTION: QUANTITY FEE 134 - OSTDS Construction Abandonment Permit and Inspecti 1 $ 50.00 -1 - Surcharge (All) 1 $ 15.00 r RECEIVED BY: VanceMH AUDIT CONTROL NO. 56 -PID -3220953 STATE OF FLORIDA PERMIT NO.; DEPARTMENT OF HEALTH DATE PAID: ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID: SYSTEM RECEIPT APPLICATION FOR CONSTRUCTION PERMIT APPLICATION FOR: New System Existing System Holding Tank Innovative Repair Abandonment Temporary APPLICANT: AGENT: TELEPHONE: MAILING ADDRESS: LLY-t-e, FL. Y TO BE COMPLETED By APPLICANT OR APPLICANTS AUTHORIZED AGENT. SYSTEMS MUST BE CONSTRUCTED BY A PERSON LICENSED PURSUANT TO 489.105(3)(m) OR 489.552, FLORIDA STATUTES. IT IS THE APPLICANT'S, RESPONSIBILITY TO PROVIDE DOCUMENTATION OF THE DATE THE LOT WAS CREATED OR PLATTED (MM/DD/YY) IF REQUESTING CONSIDERATION OF STATUTORY GRANDFATHER PROVISIONS. PROPERTY INFORMATION LOT: BLOCK: SUBDIVISION: PLATTED". - PROPERTY ID 4: AJ2j0-.2.)-3 ZONING: 46-,5- 1 /M OR EQUIVALENT: [ Y/ N ] PROPERTY SIZE: q,q ACRES WATER SUPPLY: (,j'pjRjvATE PUBLIC [ ]<=2000GPD [ 1>2000GPD IS SEWER AVAILABLE AS PER 381.0065, FS? t Y1(0— ) DISTANCE TO SEWER: FT PROPERTY ADDRESS: 102-'40 DIRECTIONS TO PROPERTY; d: -c iD I-LIU-/-\ BUILDING INFORMATION RESIDENTIAL COMMERCIAL Unit Type of No. of Building commercial /institutional System Design No Establishment Bedrooms Area Sqft Table 1, Chapter 64E-6, FAC 2- Ci v 44�r,C- V 2 c)-ot-0 �-t7ebOLW, 3 4 E I Floor/Equipment Drains [ ] Other (Specify) 9 10,4 11:1 SIGNATURE. 71,d DATE: DH 4015, 08;09 Obsoletes Previous editions which may not be used) Page 1 of 4 Incorporated 64E -6.001t FAC STATE OF FLORIDA PERMIT NO. DEPARTMENT OF HEALTH DATE PAID: c ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID: SYSTEM RECEIPT 4: APPLICATION ,FOR CONSTRUCTION PERMIT APPLICATION FOR: [ ] New System [ ] Existing System [ J Holding Tank [ ] Innovative [ ] Repair [/] Abandonment [ ] Temporary [ J APPLICANT: t AGENT: TELEPHONE: MAILING ADDRESS: � ti !\moi )_� C �l'�lrl�i 1. Y _ %s1l i �i� ) f V 1-P r1 � 1 TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. SYSTEMS MUST BE CONSTRUCTED BY A PERSON LICENSED PURSUANT TO 489.105(3)(m) OR 489.552, FLORIDA STATUTES. IT IS THE APPLICANT'S RESPONSIBILITY TO PROVIDE DOCUMENTATION OF THE DATE THE LOT WAS CREATED OR PLATTED (MM/DD/YY) IF REQUESTING CONSIDERATION OF STATUTORY GRANDFATHER PROVISIONS. PROPERTY INFORMATION LOT: BLOCK: SUBDIVISION: PLATTED: PROPERTY ID 4- -0001-000-07 ZONING: 46-6- I /M OR EQUIVALENT: [ Y / N PROPERTY SIZE: �'� ACRES WATER SUPPLY: [.s'J'PRIVATE PUBLIC [ 3<=2000GPD [ ]>2000GPD IS SEWER AVAILABLE AS PER 361.0065, FS? [ Y/tO— ) DISTANCE TO SEWER: FT PROPERTY ADDRESS: 1<)2,40 co -w- I +-Z)n r (- — DIRECTIONS TO PROPERTY: e��5 ^ t�t GCC •) y Ceu- f ,-\ R8 . i a 7 yrm J 6uO�w-\ BUILDING INFORMATION Unit Type of No Establishment 1 In N F. 3 4 [ ] RESIDENTIAL [ ] COMMERCIAL No, of Building Commercial/Institutional System Design Bedrooms Area Sqft Table 1, Chapter 64E-6, FAC 2 [ ] Floor/Equipment Drains [ ] Other (Specify) �a SIGNATURE: DH 4015, 08/09 bsoletes 4vious editions which may not be used) Incorporated 64E-6.001, FAC DATE: s � Page 1 of 4