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40 STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION INSPECTION AND FINAL APPROVAL
APPLICATION # : AP 1611102
PERMIT t):56-SF-2218686
DOCUMENT # : FI 1578712
DATE PAID , 01 /06/2021
FEE PAID:380.00
RECEIPT #:56-PID-4851747
APPLICANT: Hector Hemandez
AGENT: Roselis Moctezuma (AIL Coast Septic Services Inc.)
PROPERTY ADDRESS: 210 E arbor Ave Port Saint Lucie, FL 34952
LOT: 8 BLOCK: 4
SUBDIVISION: River Park ID#. 3419501-0041-000-2
CHECKED [XI ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED.
TANK INSTALLATION
SETBACKS
[
1
1011
TANK SIZE (1] 900.00 121 483.00 [
1
[27]
SURFACE WATER
FT
(
1
[02]
TANK MATERIAL Concrete [
1
(28]
DITCHES
FT
I
1
[03]
OUTLET DEVICE [
1
(291
PRIVATE WELLS
FT
(
1
[041
MULTI -CHAMBERED I Y LNJ I
I
[30)
PUBLIC WELLS
FT
I
1
[051
OUTLET FILTER Polylok PL-68 [
1
[311
IRRIGATION WELLS
FT
[
1
[061
LEGEND 1, Unknown 2, 70-143-54SC4 [
)
132]
POTABLE WATER g
FT
[
1
[071
WATERTIGHT [
1
[331
BUILDING FOUNDATIONS 7
FT
I
1
coal
LEVEL (
1
(341
PROPERTY LINES $
FT
[
1
[091
DEPTH TO LID [
1
[351
OTHER
FT
DRAINFIELD INSTALLATION
FILLED / MOUND SYSTEM
[
l
[201
AREA [1J 540 [2) SQFT c
1
[361
DRAINFIELD COVER
[
1
[111
DISTRIBUTION BOX HEADER x [
1
[37]
SHOULDERS
j
1
[121
NUMBER OF DRAINLINES 1. 5.00 2. [
1
[381
SLOPES
[
1
(131
DRAINLINE SEPARATION [
1
[391
STABILIZATION
[
l
1141
DRAINLINE SLOPE
[
1
(151
DEPTH OF COSIER
ADDITIONAL INFORMATION
[
1
1161
ELEVATION [ ABOVE / BELOW IBM 12.00 [
1
[401
UMBSTRUCTED AREA
[
1
[171
SYSTEM LOCATION [
1
[411
9TOR101ATER RUNOFF
I
1
[is]
DOSING PUNS 1.00 [
1
[421
ALARMS
I
1
[191
AGGREGATE SIZE [
1
[431
MAINTENANCE AGREEMENT
[
1
[201
AGGREGATE ExcEssm FINES I
1
[441
BUILDING AREA
I
1
[211
AGGREGATE DEPTH [
1
[451
LOCATION CONFORMS WITH SITE PLAN
FILL / EXCAVATION MATERIAL
( 1 [461
FINAL SITE GRADING
I 1
(221 FILL AMOUNT
[ 1 [471
CONTRACTOR Roselis Moctezuma (AIL Coas
[ 1
[231 FILL TEXTURE
( 1 [481
OTHER INFILTRATOR Quick4 EQ36 (single c
[ 1
[241 EXCAVATION DEPTH
ABANDONMENT
[ 1
(251 AREA REPLACED
[ 1 (491
TANK PUMPED
( 1
[261 REPT•nCM-ENT MATMAL
[ 1 1501
TANK CRUSHED 6 FILLED
Comments: Comments are on page 2.
OONSTRUC3IQ181 [ APPROVED /
•+� St. Lucie CHD DATE: 02/02/2021
DISAPPROVED ) ' Environmental Sped Ill Brien J Ingram (ENVIRONMENTAL HEALTH)
FINAL SYSTHM [ APPROVED / DISAPPROVED J..SL Lucie CHD DATE: 02/02/2021
(83Wiaaation of Violations on following page) Environmental Special III Brian J Ingram (ENVIRONMENTAL HEALTH)
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 1.0A APi611102 E102218686
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Page 2 of 17
W.
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AMID DISPOSAL SYSTEM
CONSTRUCTION INSPECTION AMID FINAL APPROVAL
Iva
Violation Number commen
mPLxc=xoN b : AP1611102
PERMIT A:56-SF-2218686
Documn #:FI1578712
DATE PAID:01/06/2021
FM 8Alb_380.00
RECEIPT 4:56-PID-4851707
Comments I
Existing tank lArmalion per DH4015 page 4.
Existing ST used. New filter, DT, liberty 113 hp pump, and 54 long TRENCH OF installed. No violations, system, oll to cover.
Contractor notified onsite. No final inspection required. Final system approved. Contractor emalled final approval. ,
DH 4016, 08/09 (obsoletes all previous editions whiab may not be used)
Incorporated: 64E-6.003, FAC
EH Database v 1.0.1 AP1611102 EID2218M
Page 2 of 3
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Page 3 of I'
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION PERMIT FOR:
APPLICANT:
PROPERTY ADDRESS: 210 E arbor Ave Port Saint Lucie, FL 34962
PERMIT #:56-SF-2218686
APPLICATION #: AP1611102
DATE PAID:
FEE PAID:
RECEIPT # *
DOCUMENT # : PRI600894
LOT: 8 BLOCK: 4 SUBDIVISION: River Park
PROPERTY ID #: 3419-501-0041-000-2 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
[OR TAX ID NUMBER]
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION
3a1.0065, 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 HASIS 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 I 1,050 J GALLONS / GPD SeMic exis§na CAPACITY
A [ ] GALLONS / GPD N/A CAPACITY
N [ ] GALLONS GREASE INTERCEPTOR CAPACITY (t9182MUM CAPACITY SINGLE TANK:1250 GALLONS)
K I 300 ] GALLONS DOSING TANK CAPACITY [67.00 ]GALLONS @[ $ ]DOSES PER 24 ERS #Pumps { 1 ]
D I 500 I SQUARE FEET Drainfield new SYSTEM
R ( ] SQUARE FEET N/A SYSTEM
A TYPE SYSTEM: (XJ STANDARD ( ] FILLED [ J MOUND
I CONFIGURATION: {XJ TRENCH E I BED I ]
N
F LOCATION OF BENCHMARK- oranne Spot SW Comer Df Datio Dad
I ELEVATION OF PROPOSED SYSTEM SITE [ 2.00 ]
E BOTTOM OF DRAINFIELD TO HE 112.00]
L
D
0
T
a
E
R
W
FT ] [ ABOVE
POINT
FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT
The system Is sized far 4 bedrooms with a maximum occupancy of 8 persons (2 per bedroom), for a total estimated flow of
400 gpd.
Performing Lift Dosing. Pumps must be certified as suitable for distributing sewage effluent.
Lift dosing not required if gravity flow can be achieved.
SPECIFICATIONS BY: Brian a IDVam TITLE: Environmental Specialist II
APPROVED BY: TITLE: Environmental Specialist II St. Lucie CED
Brian Joolrugram
DATE ISSUED: 01/27/20 1 EXPIRATION DATE: 07/27/2022
DE 4016, 08/09 (Obsoletea all previous editions which may not be used)
Incorporated: 64E-6.003, FAC Page 1 of 3
v 1.1.4 A91611102 SE1454371K
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NOTICE OF RIGHTS
Page 4 of 17
A party whose substantial interest is affected by this order may petition for an
administrative hearing pursuant to sections 120.669 and 120.57, Florida Statutes. Such
proceedings are governed by Rule 28-108, 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 altemative 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 e i ed
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 Healti� 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.
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Mission:
To protect, promote & improve the health
of all people in Florida through integrated
state, county & community efforts.
Vlslon : To be the Healthiest State in the Nation
Roselis Moctezuma (All Coast Septic Services Inc.)
Roselis Moctezuma
3106 Mura Drive
Fort Pierce, FL 34982
RE: Contingency Letter
Application Document No: AP1611102
Centrax Permit Number: 56-SF-2218686
OSTDS Number:
210 E arbor Ave
Port Saint Lucie, FL 34952
Lot:8
Block:4
January 27, 2021
Subdivision: River Park
Page 5 of 1
Ron Dosantts
Govemor
Scott A. Rivkoes, MD
State Surgeon General
Dear Applicant:
This will acknowledge receipt of an application dated 01/06/2021 for a permit to use an existing
onsite. sewage treatment and disposal system located on the above referenced property.
From a review of your completed application, it has been determined your septic tank is adequate
but the drainfield does not have the required separation from the wet season water table. To have
your system approved for the proposed use, a modification permit is required to bring your
drainfield into full compliance with new system drainfield standards.
If you have any questions on this matter, please call our office at (772) 873-4905.
Enclosures
cc:
Florida Department of Health
in ST. LUCIE COUNTY
5150 NW Milner Dr, Port Saint Lucie, FL 34983
PHONE: (772) 873-4931 FAX (772) 873-4893
Sincerely,
Brian Ingram, Environmental Specialist li
www.Flaridefenith.gov
'f WITTER:HealthyFLA
FAC EBOOK: FLDepartmentofHealth
YOUTUBE: fldoh
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Page 6 of 17
HEALTH
PAYING ON:
RECEIVED FROM:
PAYMENT FORM:
St. Lucie County Health Department
5150 NW Milner Dr Port Saint Lucie, FL 34983
* 5$-SF-2218686 BILL Doc rr.56-BID-5148218 CONSTRUCTION APPLICATION M AP1611102
All Coast Septic Services Inc. AMOUNT PAID: $ 380.00
CREDIT CARD 002338 PAYMENT DATE: 01/06/2021
MAIL TO: Hector Hernandez
FACILITY NAME:
PROPERTY LOCATION:
210 E arbor Ave
Port Saint Lucie, FL 34952
Lot: 8 Block: 4
Property ID: 3419-501-0041-000-2
EXPLANATION or DESCRIPTION:
QUANTITY
FEE
128 - OSTDS Construction System Inspection Research Fee
1
$
5.00
-1- Surcharge (All)
1
$
45,00
124 - OSTDS Construction Repair or Mod Site Evaluation
1
$
115.00
126 - OSTDS Construction Permit (New or Mod, Amendment)
1
$
55.00
127 - OSTDS Construction System Inspection
1
$
75.00
131 - OSTDS Construction Application & Existing System E
1
$
50.00
139 - OSTDS Application Approval Existing, No Insp
1
$
35.00
Ai
6oCPl�`�Zo�
RECEIVED BY: WhighamJL AUDIT CONTROL NO. 56-PID-4861707
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Page 7 of 1'
r .
STATE OF FI,ORZDA
immm 111, 1' OF JMRLTH
CUSIn SEVAM TREATMENT AND' DISPOSAL
SYSTEM
APPLICATION FOR CONSTRUCTION PERMIT
APPLICATION FOR:
Pz;=T NO _
DATE PAID: l FAal
Elm PAW:
RECEIPT #:
I ) New Syatem [AI Existing System [ l Holding Tank [ ] Innovative
[ ] Repair [ j] Abandonment [ ] Temporary [ ]
APPLICANT: �1 yn•a - � Oulty,
AID: W.-'�1.Ui—�i'�`�3�� 141�} T>�rBPxa : 71Z-
MOLING ADDR83s : �L' 13 iic1� Lli —JY ?
TO BE CaKF=TEII BY APPLICANT Cit APPLICANT'S !lDAWRIZED AST. SYSTEM musT B8 CQNSTRDC38D
AY 7l PBRSCW LICB D PDRSMM TO 489.105(3)(m) OR 489.552, FLORID& STATUTES. IT IS THE
APPLICANTS R8$PONSIBIyITY TO PROMO$ DOCUI ATION OF THE DWM THS LM WAS CREATED OR
PLATTED oeVvD/YY) IET DwaR Tm CONSIDER iou OF STAWWRY GRANDFATHER PROVISION$.
PROHMM IImraa1TION
LOT: 1" l WKIP� SDBDIYISIUN: � PL>LTraD:
P"ZRTY ID # : - c - - maw.: I/H OR BQMVAZ"T : [ Y / N j
PRiOVISM SIZE: c 14 AM= I+ATSR SUPPLY: [ ] PRIV= PUBLIC [ j<,=2000GPD I 1>2000=
IS SXMR, &VAILABI.A AS PER 381.0065, FS? [ Y Q) ] DISTANCE TO SEWER: ET
PROPERTY AbMkZSS: WIN
DnmCTIONB TO PROPERTY:
)&CT!XA J�cj C. S-A�
AA VA-) kA
LAO
30=1 NR XWOPOM A'i'ION [)d RESIDENTZAL [ ] COMMERCIAL
unit Type of No, of Buildingercial/Institutional 3yaie�t Design
No 8stabliabmeat � � Sqft Table 1 ter 648-6 FAC
2
3
4
I I Floor/Equipment Drains [ j other (specify)
slc�oo�: DA'JtS: - G
DR 4015, 08/09 (Obsoletes previous editions which may not be used)
Incorporated 648-6.001, FAC Page 1 of 4
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Page 8 of 17
vorcY
q�i
County
u4
Ell
J
0-
kI
Site Plan Approved for Construction
Supersedes All Previous Site Plans for
OSTD $ Well It
Date:
Reviewe NX.
2 kO 'C
W &MA � �Q
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Michelle Franklin, CFA — Saint Lucie County Property Appraiser — All
SiteAddress 210EARBORAVE
SW?0m lRangC 221363/408
Pma1 ID: 3419-501-0041-000.2
Jurisdiction: Saint Lade Casaty
Ownership
HectorHaraandet
Msrca Peat
210 EArborAVE
Poll St Lude, FL 34952-1306,
Legal Description
RIVERPARK LIMT 1 BLK4LOT8 ¢NAPNON)
Current Values
Just/Madmi Value:
$132,906
Assessed Value:
Si32,900
Exemptions:
so
Taxable Vahm
$132,900
Property Identification
Use Type. o100
Account#: 41658
Map ID:34rM
Zoning: RS-4 Carat
Property taxes are subject to change upon
change of ownership.
• Past bum are not s reruble projection of future taus,
• The safe arm property •rot prompt the removal of an
eumption6, anessmest caps, ad gmdd dassm ations.
TOM for this pmC& SLC Tax Collectors or= a
Download TRIM for this parcel: Download PDF 11
Date:
Book/Page:
Sale Code.
iked:
Pdce:
Date:
Sale Coder
Deed:
Grantor.
Ptiee:
Total Areas
Finished(UnderAir (SF): 11300
Cross SketchedAvea (SF): U36
Land Size (acres): 0.19
Land Size (SF): SX0
Building Design Wind
Speed
occupancy category I I R -i III & IV
Speed 140 160 j 170
Sale History
May22, 2019
4274 / 0731
0111
QC
Hemeadezveew
80
May22.2019
4274 / 0185
0111
QC
Hemaadez Hector
so
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Date~
Book/Pagc
Sate (code:
Deed:
Gmt=
Priem
Date:
Book/Page:
Sale Code:
Deed:
Pd=
Date:
Book/Page:
Sate Code:
Deed:
Grantor.
Price:
vMW.-
BuildingTypa: HC-
Glade: tr
Story Height: l Swy
Bedrooms: 3
Full Bathes I
AEBWW I
AIC %: most;
Jun 5, 2015
3755/2172
0c01
WD
Mil=Kameth
S93,oc0
Mar23, 2012
3375/0366
cool
WD
Goodwin M W R
$65,00D
May 1,1975
0239/1900
IMOO
Cv
Building Information {1 of 1)
FinirhedA=1,300 SF
Grm SbEchedArra: 2,436 SF
Exterior Data
RoofCover. Fibrr* shg
Year Built 1958
Effective yaw.im
No. Units: 1
InteeriorData
Electric: MAX MI]M
Heat Type: FrodHotAir
Heat Fuel• ELEC
Heated 96: l00°%
RoofStntchm Gab
FXZM
Primary Wall: Cone
Secondary WE
Primary int Wall:
Avg HgdFloor: 0
Primary Floors: cup'
Sprialded "/o:1WA36
Page 13 of 1
Special Features and Yard items
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"
Type
Qty Units YerBh
LTP=AVG
1 1112 19999
WOOD FEN 6
1 164 2017
Current Year Values
Cement Values Breakdown
Current Year Exemption VA m B
Bum
$90,300
Land:
$42.600
JastllMarket:
S13ZM
Ag Credit
S4
Sava Our Homes or
so
10% Cap:
Assessed:
5132,M
Exemptionft
so
Tsxnbla
$132.900
CurrentYear SpecialAssessmentBreakdown
Start year
AssessCode
Units Description
2009
2009
12 County3olid Waste
StartYear
ASSeMSCode'
Units Description
2010
9003
1 Riva Fade 1 Sheet Lights
This don not nepi a=ly topnrent tho total Special Ame mtents that could be ehuai8ed�aseinst dik
ehuged �i SpCC1818Cn19 to ID�IaCDed OII 1hC nlOSi CQttEat 41[ Statl�ldt 8Dd iinfoo is avalle
Collectors Office 13.
Historical Values
Year lustaladmt,
Assessed Exemptions
$134.7m
so
$10624
2
6�20019 S75,000
2018 $114.100
SIK636 S50,000
Permits
Number )site Date
Description Amount
C994060303 Jul 1.1999
Shed S2,129
C1202 M Feb 17, 2012
Alng $0
SO
C1411-0297 Nov 17, 2014
C15084M6 AU
Roof
Slab SO
CIS11-0133 Ploy 9.201S
Wood Fence So
C1602-0366 Mar 8, 2016
Shed So
Notice: Mdsdoes not neacmray reprmentall the peimmts for this Fe".
— — _ — Cliddbe Pollowing link to check for additio d permit data m Sdw Lucia County_ - — -- -
AA information is believed to be correct at
this times but is subject to change and is ptovided without
® Copyright 2021 Saint
Lucie County Property Appraistm All tights reserved.
Amount
$276.14
Ammmt
Taxable
$132.900
SSW66
Fee
=29
so
so
so
SO
Page 14 of 17
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' 3106 MURA DRIVE Office: 772-882.4432
FORT PIERCE, FL 34482 Cell: 772-353-6884
LICENSED S INSURED ALLCOASTSEPTICINC@GMAIL.COM
NAME .ti
ADDRESS
SYSTEM INSPECTION
STATE � ZIP
C( 0 ® Gallori Septic Tank
allom Grease Trap
Baffied Tank: Yes ❑ No Intact and Secure
Tank Stricture Condition:
Tank Lid/Manholes Condition:
Cracks:
Tank Construction:
Inlet and Outlet Devices in Place:
Outlet Filter Installed
Appra dmate Cost of Repair. $
Assessment
DATE 01- 0 2'~ ;Z /
PHONE, *:3os o-g0Se19
() None Found
) None Found
Yes No ❑
Good �B Sand Bottom ❑
Good a;Bad U it: Yes ❑ No Q
Yes Q No Leaks: Yes ❑ Nog--'
Concrete Fi rglass Q Plastic Q
Inlet: Yes No Q utlet: Yes [�-�1Qo Q
Yes Q No /A ❑
Drainfield Configuration: 9- X 1oLt.- Total Sq. Ft. None Found ❑
Field Type: Standard Q Mound Q Trench Or C-Block ❑ Plastic Chambers ❑
Drainfield Construction of : Mineral A to 9- ' Non Mineral Aggregate ❑ Plastic Chambers Q
Dramfield Failure: Yes ❑ No O N/A ❑��° t in use prior to inspection.
Recommend Replacing Drainfield: Yes ❑ No l�
Cause of Failure: Roots ❑ High H2O Table ❑ Hydraulic Overload Q System Damage
Assessment:
Gallon Dosing Tank
Pump *1: Yes Q No Q Float Operational:
Alarm Float Operational:
Alarm: Audio Q Visible ❑ Both ontm
Pump Elevated Off Chamber Botto • No Q
Can Surface water
Yes ❑ No ❑
Yes
Box Operational: Yes Q No
V Tank Pumped Yes ❑ No
I certify that the system (Septic Tank, Drain Field, Lift Station, Grease Trap Tank) above has been inspected by All Coast
Septic Services, Inc. All aspects from the tank to the system have been inspected and approved by the best of our knowledge.
Inspection does not offer a guarantee or warranty of the system being restricted from any defects, but a review of the condition
in which the system was found and inspected in. All Coast Septic Services, Inc. Shall not be liable or hold responsible for any
defects ma after the " 'on f the system (S tic Task, Drain Field, Lift Station, Grease Trap Tank).
Sigutature: AOZI)207 - Date
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