The URL can be used to link to this page

Home My WebLink AboutD O H PAPERWORKAPPLICATION #:AP13,66245 STATE dF' FLOA'IDA PERMIT #A.6 SF-1880424 DEPAFtTMEN'!' OF HEXLTB Docc Nm # 91290483 ONSI,TE, SEWAGE, TREATMENT AND DISPOSAL;, SYSTEM =STRU_,CTION INSPECTION AND FINAL AEPROVAL DATE 'PAID Q9I2-8I201$- E'EE RECEIPT #: Q-3740M. APPLICANT_I Kevin'.& Claire-O'bennor AGENT`; 9 4Cha in_ w _ - _ �. _-. _ . _ .. PROPEE?TY ,ADDRESS,; 610_ Willows AV& Port Saint Luae,., FL 34952 _ :._ ._ 1��' ...__ r n r LOT: 12 BLOCK19 -St Y Lucie Coljn T, Lucie County, Permitting SUBDIVISIbN:; River -Park CHECKED ii[$] ITEMS ARE NOT IN:CQMPLIANCE WITH STATUTE: OR RULE .AND 'MUST. BE CORRECTED„ TANK.;rX$TALtATI0Mt SETBACKS! . _. [1:]" 1090Polypropylene WATEFE 1QQ FT [ I: ['02] TANK :MATERIAL '[ ] [281 DITCHES FT ]' 143-1 'OUTLET DE UCE ___.._. [ ] [29j PRIVATE WELLS. E'r 'MULT'l-CHAMBERED ' [ .Y N :j [ ] [30] PUBLIC WELLS: FT ] P&]: .OUTLET :FILTER' PolylOk PL :68 C ;1 C311. IRRIGATION WELLS FT [ ] [06'] LEGEND 9. 70.143 11 DC3 2. C. 1 [321 POTABLE WATER• _ 2C ____ _ FT' [ 7 [0?:] WATERTIGHT. [ ] [331 BUILDING. FOUNDATIONS. 6 FT [ .l [08;1 LEVEL DEPTH 'TO- LID r 1 [:35] .OTHER DRi-1 FIELD INSTALLATION: F'IA; pr / 1NIOtJtm SYSTEM AREA [11 $09.4 [2] SQEV f l [3:6j DRAINFIELD',COVER DISTRIBOTION Aft HEADER: X' [. ] [37.1 ;SHOULDERS NOMHER OF DRA=';;,MS 1. [' 1 [38,] SLOPES [ ] [1�1 1 DRAINLINEi :SEPARATION' [ ] [391 STASZLIZATION 061042019 [ ] 1141 DRAINLINE SLOPE. [ ] [15.1 DEPTH OF COVER ADDITIONAL INFORMATLON [ 1 [16 1, ELEVATION I.459VE= f HELOW j$M 140 E lj 40.1 UNOBSTRUCTED AREA [ ]': [1�1 SY.4TEM LOCATION' [ ] ["411 STORMWifTER; RUNOFF` E. '] 11811 DOSING PUMPS' _.._.._ _ I ] [421 -ALARMS [191 AGGREGATE SIZE [ j (:49:1' MAINTENANCE AGREEMENT [ ] [20] AGGREGATE 'EXCEssIVE.FINEs, I 1 [441 BUILDING AREA j [2 I] AGGREGATE DEPTH [ ] ['451 LOCATION: 'CONFORMS WITH S,I.TE PLAN` C, a (4:61 FINAL SITE GRADING FITS. EBCAVATI09'.MATERIAL I: y, (47] CONTRACTOR Bruce T'M6 Cullers (Reliable T.. [ ]' jz2.Z. FILL 'AMOUNT ( ] C481 OTHER, INFILTRATOR Quick4 Plus EQ36 LP ]' C2;3 ]', FITIC L TETURE. [ ] [24.1' ERCAVATION EiEPTN 1(8�123DOL�MEIZT' [ ] C25.1 AREA REPLACED. [ ] 149.1 TANK PUMPED [ `1 [26 RREPI ACEMENT' MATERIAL E ] [$Q.] TANK CrRUSF ED &: Fli iED Comments:; Comments• are- on page_ 2,_-__ S( Lucie CHD DATE: 05/01L2019 Coug"DCTTON [ APPROVED DISAPPROVED ) Environmental Specialist II,Bri ' ~ t t (E"VIRONMEhITAL HEALTH) FINAL SYSTEM' [ ;APPROVED: DISAFPRO,`IED, '] _ . _.: :: Lucie __ .CHTY DATE'. 061041201:9 Ehviforim, Brian J , ram(EN.V.IRONMENTAL HEALTH); (Explanation. of violations one fol owing. page) DR 4016, 0'8/09 (Oh'sdjdtes AZl, pxeviaiis editions', Grh 6h may 'not be usodk I, 1hba#drated:: 6.4E-6..603,. FAC EH Database v 1.0.1 AP436.6215 EItN880424 API -62' TATE, QIF -8604 S #-;-56�SFA -'24— POPARTMENT OF HEALTH bod #,11-1200483: ONSITE 'SEWAGE, TREATMENT AM DISPOSAL SYSTEM CONSTAUCTION, INSPECTiobt am" FINAL, A-PP90VAL DATE p=a,09/201.20 .1$ 45 vtkl: .0 60 — :# -,56-P I D�3 74 057.6 vldlafwnhumbo-, bo;Mmeet: . . .. .......... ... ---- ---- ------- The syifemJssized for ,3bedrooms mdtfta maximum occupancy of 6,,persons: 2 per 4edropm), f6ra tolm.ostirnwod.flo—wof 3 -QR Neva $T, outlek'fi_Iter, and; 00+30-long FWOTAL, A$ A ,,ED Nq violations, system ok to qgvgr. Contractor notified onsiteK Needs,final irisp..ectidri fOr MOUOtl system. acid ftinal, site grAcIft. rural systernawroved. Con'tractor,art.d'buifdlnqdevartment�emailedinalapproval. 10 4A16 0*6/09 (O;bAO.I-AtQq: 41.1- PrMV ..IqUg 8CitA;A4, PAYrqtbe used). Yr agrpoxat4 al 64tr-6.r00,5, VAO Elf -DA(g4ako. v tq,ti EIDIjR80424- l 2A9�0i 2; 64 1 W14- �w- ®) STATE- dr 'MAttik DEPARTMENT' OF HEALTH; OXS1=; SEWAGE, TREATMENT AND AT.51?04AL SOTW CONSTRUCTION INS'PECTI.Ow''Am, YTINA;11- APPROVAL iipLxcATzoN'#.,:,AP'13.'662I'S'. PERMIT *,;F[1290483� J*Tk FEZ PAID -.515.00-- RECEIPT ; 971+ 4'q APPLacANT1. Kevin-& Claire- Qbonnor -- Ralph .Q-hap1n- PROPEVVIT •ADDRESP•." 610-VvIllowsAve, Port Saint Ludie,,EL 349.5.2 SCANNSp- LOT: 12 BLOCK' T StLwe Count f SUBDIV'is-11001 River Park - CHECREv] I MS ARE.NOT -IN'COMPLIANCE WITH STATUTE OR RULEAND MUST BE CORREtTEDt., -- .[X TANK ;INSTALLATION SETBACKS' 1' E4.1 TANx. SZgz rx, 109000;•1 11 [971 SURFACE WATER 10.0 FT 1: 19-2,1 TANK b- %-T.. W.- A L- PON py.opylene I I r-ZSJ DITCHES FT 7I [03] OutLvx 'pgvxcx [29,j PRIVATE WELLS. FT, 3 MULTI -CHAMBERED LIN [IPT] PUBLIC: WELLS! T FT 'l [btji OUTLET FILTER P01Yj9kk PL-66' E 1 [31]; IRRICaTIPIT WELLS FT E I M61 1. 70-J43A I QC3 -2. . . . .... ....... I. 7 [12 li :POTABLE laTAR, Z& V7 I I COT3 wetnttGHTI E I P41 BUILDING FOUNDATIONS FT I [,QSI LEVEL C 'I E3,4jL-XIMS [,09,1 DEPTH TO- LID 1 [351 OTHER Ing D41NFIELD I$$TALLATFIJ0K- OIL KOtMP SYSTEM ] [;,Q] AREA M 600A [2] SQrw [.3.61. DRAINFIELD:COVER DISTAXA01-oT B4OX HEADER: X. 1 EST] :SHOULDERS I' 1 1121 NUMBER or DgwUMS 1. 1M 2. C '1 p8,1 SLOPES I I r1ij bludnxft: s9pAkAttos, E. J [3RJ ;STABILIZATION 06/04/jOf 1.9 I 1 1143 DRAINLINE SLOPE ] DEPTH' OF COVER ADDITIONAL INFORMATION ,E 1 .[15 E163; ELEVATION ( A$09& BM 1.00: L 1: E 4 0I' UNOBSTRUCTED AREA T I E1�1- slmwEM Lowiolq! f 1; U42-j PTORMTERRUNOFF I J 1118I DOSING PUMPS` j I E-42j ALARMS AGGREGATE SIZE E j [43-1. kil3fidi Z AGREEMENT' AGGREGATE EXCESSIVE FINES; ('.44j; BUIteDItiO AREA -AGGREGATE DEPTH [.45,11 10CATION. CONFORMS WITH 0,1701OLM; -FILL / EXCAVATION':MATERrAL f4tI bk " -- xtiirtxtE GRADING d*T Bruce T'Mc '0u11erv-,ft1jbb1e7--, I I Ej'31 klit Tkkt� E481 R'� .OTHEA. INFILTRATO,Quic.k4,PIO.sEQ36LP I I t241' EXCAVATION OEM% ABANDONMENT' I ['251] AREA REPLACED 1. 1 E491 T PUMPED I MST REPLA MATERIAL 1, [Sol ;FILLED T �Ogv-snzv gxt�-^J Comments are.- on page,. 2; -- St -Lucie CHD DATRi 05/0112019i CONSTRUCT16N DISAPPROVED 3: (ENVIRONMENTAL HEALTH FINAL SYSTEM t :D1'$AL?PPQVE,--b, 'I Ludd c4D, DATE`: 0610412019 Env fonmental Spec -raftt 11 Biiiin!�J"ram '(ENVIRONMENTAL -HEALTH): ,(EfKpl.anationj of Violations on,:5ol2:owiqg( page) DR 4016, 08,/ , 69 (Ohskiletds a11. previous ectitions, %4h:Lcfi may not be used) 6.4E-61.003, PAC Page2 qf, 3 EM886414 EH Database,v 1.6.1 AN'366215 STATE; 9 R,;A �F;VwD DEPARTMENT OFHEALTH ONSITE SEWAGE, WREATMENTAND DISPOSAL SYSTEM CONSTRUCTION INSPECTION AND FINAL APPROVAL APPLfcAwrio2z,,#,::AP-'l-36.621'6 gzm.wt#,-56 SF- 88-0424-, Dodui-mw #-IFI-1290483, -- DATE PAM"le", vtk: :# i56-Pl DW405,76 --the system is sized for 3'bedrooms with a maximum occupancy' of. 6,,persons. (2 per bedroom),,fbta f01616Wmatod'flio, 01300' goo, no QF N9TAQL,4-0A0A.-05DNo- (gliqrs, $ysfqM:Pk to cover. Contractor notiffed onsite:, Needs final inspd,ebbb for mound system 6hdf(hai. site grading. Final ,system''approved. Contractorwdbfinaapproval.uilding department emailed I UN 40-16, 08/09 (Obsql�qtqs, all, pxeyiqus editsLqps, which. may not, bd lisedy tTXCQrPPXat4d-. 64S-6.0og., ^q' E604(a6as,e. V 110.1 EID,1880424, Page: Z: 6;t it • IP�cFj�'FO r 4op ,.00"'Y41, ?�1e o� STATE OF FLORIDA at, 4'79,D o� DEPARTMENT OF HEALTH 06yo "lent ONSITE SEWAGE TREATMENT AND DISPOSAk SYSTEM APPLICATION FOR CONSTRUCTION PERMIT APPLICATION FOR: PERMIT NO. DATE PAID: FEE PAID: SCANNED RECEIPT # : r%%ff I [v/] New System [ ] Existing System [ ] Holding Tank [ ] Innovative [ ] Repair [ l Abandonment [ ] Temporary [ ] APPLICANT: Kevin & Claire O'Connor AGENT: Alexander J. Piazza Inc. MAILINt9 ADDRESS : 619 SW Biltmore Street, Port St. Lucie, Florida 34983 TELEPHONE: 772-340-7770 (J 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. PROPER;Y INFORMATION LOT: 12 BLOCK: 19 SUBDIVISION: River Park Unit 2 PROPERTY ID #: 3419-510-0243-000-6 ZONING: R PROPERTY SIZE: 0.361 ACRES WATER SUPPLY: [ PRIVATE . IS SEW iFR AVAILABLE AS PER 381.0065, FS? [ No ] I PROPERTY ADDRESS: 610 Willows Avenue, Port St. Lucie FL 34952 I DIRECTIONS TO PROPERTY: SEE MAP I BUILDING INFORMATION Unit 'Type of No Establishment 1 'RESIDENCE 2 i I 3 4 [ ] Floor/Equipment Drains PLATTED: 1959 I/M OR EQUIVALENT: [ No ] PUBLIC [ ]<=2000GPD [ ]>2000GPD DISTANCE TO SEWER: FT [ ,/ ] RESIDENTIAL [ ] COMMERCIAL No. of Building Commercial/Institutional System Design Bedrooms Area Sqft Table 1, Chapter 64E-6, FAC 3 1,571 -Other (Specify) GARBAGE GRINDERS / DISPOSALS q Digitally signed by Alexander J Ph— - Alexander J Piazza j DN:�US,o=UreR"iilimA o-A01477[000001658 IEMC960MI981,=-Ala &oJ SIGNATURE: e Data±ols.o9.n 15!4043o4ao DATE 9-21-18 DH 40115, 08/09 (Obsoletes previous editions which may not be used) Incorporated 64E-6.001, FAC I Page 1 of 4 610 Willows Ave - Google Maps 6/15/2018 610 Willows Ave voymwfe�Iuu India Spice ss K St Lucie Oaks Apartments Bingo Madness Suntrust. Bank+'+ - - s En TraditionCD American FreightPi R N Furniture and Mattress ,� R 15 A fteat/#.!ft.d Day Florist r r F 1 ^ °,, �, r i3c311ar GeneralXk Al Treasure Co. ray y n v }< Bella Roma Bakeru'r - Beach Ave £each Ave Poppa Louie`s 610 Willows Avebue s Doga $aoga F9dt Sky N r ti �'I x�Google lk i a, k m -.> 1t.skS .. Map data ©2018 Google 200 ft 3 r � r , -an avnQirA17,/rintn=ldmril'Amdi1c0x88deeee7ea25ac11:Oxc44170d178944b77!8m2!3d27.332567!... 1/1 STATE OF FLORIDA PERMIT # . DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM SCANNED SITE EVALUATION AND SYSTEM SPECIFICATIONS St Lucie County win & Claire O'Connor AGENT: Alexander J. Piazza PSM, Inc. LOT: 12 � BLOCK: 19 SUBDIVISION: River Park Unit 2 PROPERTY (ID # : 3419-510-0243-000-6 [ Tax ID Number TO BE MUST PLE!ED BY ENGINEER, HEALTH DEPARTMENT EMPLOYEE,OR OTHER QUALIFIED PERSON. ENGINEERS IDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS. PROPERTY SIZE CONFORMS TO SITE PLAN: [✓] YES [ ] NO NET USABLE AREA AVAILABLE: 1.607 ACRES TOTAL ESTIMATED SEWAGE FLOW: 500 GALLONS PER DAY [ RESIDENCES -TABLE 1/OTHER-TABLE 2 ] AUTHORIZE D SEWAGE FLOW: GALLONS PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE ] UNOBSTRUCTED AREA AVAILABLE: 750 SQFT UNOBSTRUCTED AREA REQUIRED: 750 SQFT REFERENCE POINT LOCATION: OF PROPOSED SYSTEM SITE IS 34 [ INCHES / FT ] [ ABOVE / BELOW •] BENCHMARK/REFERENCE POINT THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES SURFACE WATER:100 FT DITCHES/SWALES:15 FT NORMALLY WET? [ I YES [✓] NO WELLS: PUBLIC:200 FT LIMITED USE:100 FT PRIVATE:75 FT NON—POTABLE:100 FT BUILDING FOUNDATIONS:5 FT PROPERTY LINES:10 FT POTABLE WATER LINES: FT SITE SUBJECT TO FREQUENT FLOODING: [ ] YES [✓] NO 10 YEAR FLOODING? [ ] YES [✓] NO 10 YEAR.FLOOD ELEVATION FOR SITE: FT MSL/NGVD SITE ELEVATION: FT MSL/NGVD SOIL PROFILE INFORMATION SITE 1 MUNSELLI#/COLOR TEXTURE DEPTH TO TO TO TO TO TO j TO TO TO USDA SOIL SERIES: ROTL PROFILE INFORMATION SITE 2 MUNSELL #/COLOR TEXTURE DEPTH TO TO TO TO TO TO TO TO TO USDA SOIL SERIES: OBSERVEDIWATER TABLE:40+ INCHES [BELOW EXISTING GRADE. TYPE:[ PERCHED/ APPARENT ] ESTIMATED WET SEASON WATER TABLE ELEVATION: INCHES ABOVE BELOW ] EXISTING GRADE HIGH WATER TABLE VEGETATION: [ ] YES [ ] NO MOTTLING: [ ] YES [ ] NO DEPTH: INCHES SOIL TEXT�JRE/LOADING RATE FOR SYSTEM SIZING:. DEPTH OF EXCAVATION: INCHES DRAINFIELD CONFIGURATION: [V/] TRENCH [.,] BED [ ] OTHER (SPECIFY) REMARKS/ADDITIONAL CRITERIA: SITE EVALUATED BY: f_ Dlpi-p, dby11ed AR Alexander J Piazza kplk"-°x� "°��_A j ,D,W.201&09.2115.4M.5 'W DATE: 9-21-18 Page 3 of 4 DH 4015, 12 111 (obsoletes previous editions which may not be used) Incorporated: 64E-6.001, FAC ■ + a APPLICANT'S NAibIE: Kevin & Claire O'Connor LEGAL DESCRIPTION: Lot 12, Block 19, River Park - Unit Two (PB 10, PG 72) Af I certify that there are no potable private wells within 75 feet of the available area for the sed septic system, that there are no non -potable wells within 50 feet of the available area prop1n for the proposed septic system,. that there are no wells within 25 feet of a pesticide -treated building foundation, that there are -no public wells that serve less than 25 people or less than 15: homes or businesses within 100-feet of the proposed septic system, that there are no public wells that serve more than 25 people or more than 15 homes or businesses within 200 feet of the proposed septic system, that the water line from the- water meter or well to the structure is at least 10 feet from the available area for the proposed septic system unless the plans show the line to, be double sleeved,. that there is not a gravity sewer line, low pressure sewer line or vacuum sewage line in a public easement or right-of-way that abuts the property, that there .are no lakes, streams, wetlands, or surface water within 75 feet of the available area for the proposed septic system unless the. property was created prior to 1972, that the septic system is proposedon the side of the lot farthest from surface water; that all private wells, septic systems and surface water on adjacent or contiguous land within 75 feet of the applicant's lot are shown on the. site plan, that all public wells within 200 feet of the applicant's lot are shown on the site plan, and that the location of building or residences, swimming pools, recorded easements; paved areas or driveways, sidewalks, the general slope of the property, filled areas, drainage features,, and surface waters such as lakes, ponds, streams, canals, or wetlands are shown on the applicants lot. The natural grade elevation in the area of the -proposed septic system and the benchmark must be s own on the site plan. Please locate the benchmark within 200. feet of the proposed septic system. Digitally signed by Alexander) Pia= /� ,.t • e' DN:r--.VS,-Unaffiliated, Alexander Piazza a A01427E0000016S81EEK9600001981, NOTE: MUST BE CERTIFIED BY A FLORIDA CERTIFIED BY: o w.2018.09.21P19:41:24-04M REGISTERED SURVEYOR OR ENGINEER. FLORIDA PROFESSIONAL; -NO.: 6330 DATE: 09/21 /18 J019 NO.: 18-3974 does/firms/septics/Septi cApppPage207 FILE COP Gc Or AnAAIA. STATE OF FLORIDA APPLICATION #:,AP1366215 'DEPARTMENT OF ' HEALTH DATE PAID ONSITE SEWAGE TREATMENT AND DISPOSAL rQ SYSTEM FCFl FEE PAID i CONSTRUCTION PERMIT FOR: N0�'49 RECEIPT #: 8 Jkv DOCUMENT # : PR1169349 C'414 0�� OSTDS New W bry�er�� APPLICANT: Kevin & Claire O'connor SCANNED PROPERTY ADDRESS: 610 Willows Ave Port Saint Lucie, FL 34952 LOT: 12 BLOCK: 19 SUBDIVISION: River Park PROPERTY 'ID #: [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] [OR TAX ID NUMBER] SYSTEM 381.0065, WHICH SE PERMIT. A ISSUANCE STATE, OR UST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF F•S•, AND- CHAPTER 64E-6, F.A.C. DEPARTMENT APPROVAL SECTION BASIS OF -SYSTEM DOES NOT GUARANTEE RY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. VED AS A ANY CHANGE IN MATERIAL FACTS, PLICATION. FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID. OF THIS PERMITDOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL, LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY. SYSTEM DESIGN AND SPECIFICATIONS T [ 900I ] GALLONS / GPD SeDtIC A [ ] GALLONS / GPD .c- new CAPACITY N [ CAPACITY ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ] D [ 375 ] SQUARE FEET Drainfield new SYSTEM R [ i] SQUARE FEET N/A SYSTEM A TYPE SYSTEM: [ ] STANDARD [X] FILLED I CONFIGURATION: N [ ] MOUND [ ] [X] TRENCH [ ] BED [ ] F LOCATION OF BENCHMARK: Site BM orange paint "X" CL of rd, center of Drooerty I ELEVATION �OF PROPOSED SYSTEM SITE E BOTTOM OF DRAINFIELD TO BE L I [ 5.00 ] [ INCHES k FT ] [ABOVE BELOW IBENCffiMRK/REFERENCE POINT [ 2.00 ][ INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT D FILL REQUIRED: [11.001 INCHES EXCAVATION REQUIRED: [ ] INCHES The system is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total estimated flow of 300 gpd. T license contractor installing the system is responsible for installing the minimum category of tank in accordance with groe . 64E-6.013(3)(% FAC. E R arzu.Lr'ICATIONI BY: Brian J Ingram TITLE Environmental Specialist II APPROVED BY: �' : TITLE: Environmental Specialist II Brian J In4 St. Lucie CHD DATE ISSUED: 10/31/2018 EXPIRATION DATE : 04/30/2020 OH 4016, 08/OP, (Obsoletes all previous editions which may not be used) Incorporated:64E-6.003, FAC Page 1 of 3 v'1,1.4 AP2366215 SE1119290 i NOTICE OF RIGHTS _ A party whose substantial interest is affected by this order may petition for an admlidrstrative 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 Cler�C'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'. iShould 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.