Petitioner: DEPARTMENT OF HEALTH
Respondent: MARTIN A. GUFFY
Judges: SUSAN BELYEU KIRKLAND
Agency: Department of Health
Locations: Port Charlotte, Florida
Filed: Jan. 06, 2010
Status: Closed
Settled and/or Dismissed prior to entry of RO/FO on Monday, February 15, 2010.
Latest Update: Dec. 25, 2024
i 7
RECEIVED
DEPARTHE ONT OF RE ALTH
STATE OF FLORIDA 2009 DEC 24 AMI: 47
DEPARTMENT OF HEALTH
: OFFICE GF THE
DEPARTMENT OF HEALTH, nN ANi, TD) FIRE CLERK
Petitioner, } } -COY | KB L
vs. DOH Case No.: 2009-
MARTIN A. GUFFY,
Respondent.
/
ADMINISTRATIVE COMPLAINT
WY 4 QyP 162
Nature of the Case
YOU ARE HEREBY NOTIFIED that this is an administrative actioft: This Giise arises
from Respondent’s unlawful acts and practices and failure to comply with Section” 481. 0065
Florida Statutes, Chapter 489 Part HI Florida Statutes and Chapter 64E-6 Florida Administrative
Code. This action is authorized pursuant to Sections 381.0061 and 489.556 Florida Statutes, and
Rule 64B-6.022 Florida Administrative Code that govern disciplinary actions against registered
septic contractors.
Factual Allegations and Law as to All Counts
1. The Petitioner, State of Florida, Department of Health, is the administrative
agency of the State of Florida charged with the duty to enforce the provisions of Chapter 381
Florida Statutes, Chapter 489 Part III Florida Statutes and the applicable rules contained in
Chapter 64E-6 Florida Administrative Code. :
2. The Respondent, Martin A. Guffey, is a registered. septic tank contractor,
Registration Number SR0971273. He is authorized to provide septic tank contracting services
through the corporation Martin Septic Service, Inc., Authorization Number SA0071446.
3. The Respondent advertises and holds himself out to the public as a septic tank
contractor and engages in the practice of septic tank contractor services in at least Sarasota and
Charlotte County. The Respondent is permitted to provide septage collection, hauling and
discharge services via an operating permit issued by the Sarasota County Health Department.
See Permit attached and incorporated herein as Attachment “A”. The Respondent’s permit
allows him to discharge waste at the Charlotte County Utilities Waste Receiving Facility.
4. Florida law prohibits the installation, repair, alteration, modification,
abandonment, or replacement of septic systems without first obtaining a permit from the
Department. See Florida Statute 381.0065(4) and Florida Administrative Rule 64E-6.003(1).
The Department requires permit applicants to have all septic tanks pumped by a licensed septic
tank contractor service to determine the volume and structural integrity of the tank before
obtaining a permit. This information must be certified to by the septic tank contractor on DH
Form 4015. . .
5. Charlotte County requires all septic tank contractors who are permitted to provide
septage collection, hauling and discharge services to fill out and submit a Transport Waste
Hauler Manifest prior to discharging each load of pumped waste into the county water treatment
facility. The completed manifest must include the address of the property from where the waste
originated. Therefore, there should be a corresponding manifest documenting the permit-
required initial septic tank pump-out for each septic permit application certification in Form DH
4015.
6. As part of an investigation into whether septic tank contractors were providing
true and accurate certifications of the permit-required initial septic tank pump-outs, a Charlotte
County Department of Health inspector pulled all septic system permit applications submitted to
the Department between June 1, 2009 and September 30, 2009. The inspector then pulled all
Charlotte County Transport Waste Hauler manifests for the relevant time periods to verify the
septic tank contractors had in fact conducted the permit-required initial pump-outs of the septic
systems as they had certified.
COUNT I
7. On July 23, 2009, the Department received an Application for a permit to repair
septic system, submitted by the property owner’s agent, Respondent Martin A Guffy, Martin
Septic Services, Inc.; for an existing residence located at 20282 Albury Drive, Port Charlotte,
Florida. See Application and Permit attached and incorporated herein as Attachment “B”. As
part of the Application, the Respondent completed Form DH 4015. The Respondent certified on
this form that he pumped and inspected the septic tank located at 20282 Albury Drive on June
24, 2009 and that it was structurally sound. See Certification attached and incorporated herein as
Attachment “B-1”. Additionally, the Respondent signed and dated the form entitled
“Attachment A - Instructions For Completing and Submitting Your Septic Permit Application”,
which again instructed him to pump the septic tank to determine volume and structural integrity.
See Attachment A - Instructions attached and incorporated herein as Attachment “B-2”. The
Department subsequently issued the repair permit.
8. A review of the pulled manifests submitted by septic tank contractors for the
relevant time period revealed the Respondent never filled out and submitted a Transport, Waste
Hauler Manifest for the initial, permit-required septic tank pump-out for the property located at
20282 Albury Drive, Port Charlotte, Florida. See Respondent’s Transport Waste Hauler
Manifests dated June 24, 2009 through July 4, 2009 attached and incorporated herein Composite
Attachment “C”. The lack of such a manifest evidences the Respondent falsified his
certification on DH Form 4015 that he pumped the septic tank and determined its volume and
structural integrity. Had the Respondent pumped the septic tank on June 24, 2009 as he certified,
there would be a corresponding Transport. Waste Hauler Manifest for the property located at
20282 Albury Drive showing the pumped waste had been discharged into the county water
treatment facility on or about June 24, 2009.
9. On or about July 30, 2009, a Charlotte County Department of Health inspector
spoke to one of the Respondent’s employees, who confirmed the Respondent did not conduct the
initial permit-required septic tank pump-out on June 24, 2009 as he had certified on DH Form
4015. The employee stated they certified the Albury Drive septic tank was structurally sound
without ever inspecting the tank because the homeowners told them the tank had been pumped
recently. The employee stated they never verified the information provided by the homeowners.
10. On or about August 10, 2009, the same inspector spoke with the Respondent in
the presence of other Charlotte County. Health Department employees and confronted him about
the false certification. The Respondent admitted he had been taking the homeowner’s word that
the septic tank had been pumiped and not conducting the initial permit-required septic tank pump-
out and inspection. .
11. The Respondent falsified and/or provided untrue statements on Health
Department Form 4015. The Respondent certified that he had pumped the septic tanks located at
20282 Albury Drive, Port Charlotte, Florida when in fact, the Respondent did not pump the tank.
The Respondent also certified the tank was structurally sound, when in fact, the Respondent had
not pumped the tank to properly inspect for structural soundness. The Respondent’s information
provided in the signed certification on Form 4015 contains false, misleading and untrue
representations and subjects the Respondent to the discipline mandated in Rule 64E-6.022(1)d,)
Florida Administrative Code, which is a letter of warning or a fine up to five hundred dollars
($500) for the first violation. The Department hereby imposes a fine of five hundred dollars
($500) for this violation against the Respondent. Alternatively, these acts and practices
amounted to gross negligence, incompetence, or misconduct in violation of Rule 64E-
6.022(1)(1)1, Florida Administrative Code. The Respondent’s actions subject the Respondent to
the discipline in Rule 64E-6.022(1)(), which is a letter of warning or fine up to five hundred
dollars ($500) for the first violation. The Department hereby imposes a fine of five hundred
dollars ($500) for this violation against the Respondent.
COUNT I
12. On September 8, 2009, the Department received an Application for a permit to
repair septic system, submitted by the property owner’s agent, Respondent Martin A Guffy,
Martin Septic Services, Inc., for an existing residence located at 9320 Anita Avenue, Englewood,
Florida. See Application and Permit attached and incorporated herein as Attachment “D”. As
part of the Application, the Respondent completed Form DH 4015. The Respondent certified on
this form that he pumped and inspected the septic tank located at. 9320 Anita Avenue on August
14, 2009 and that it was structurally sound. See Certification attached and incorporated herein as
“Attachment D-1”. Additionally, the Respondent signed and dated the form entitled
“Attachment A - Instructions For Completing and Submitting Your Septic Permit Application”,
which again instructed the Respondent to pump the septic tank to determine volume and
structural integrity. See Attachment A - Instructions attached and incorporated herein as
Attachment “D-2”. The Department subsequently issued the repair permit.
13. A review of the pulled Charlotte County Transport Waste Hauler Manifests
submitted by septic tank contractors for the relevant time period revealed the Respondent never
filled out and submitted a Transport Waste Hauler Manifest for the initial, permit-required septic
tank pump-out for the property located at 9320 Anita Avenue, Englewood, Florida. See
Respondent’s Transport Waste Hauler Manifests dated August 14, 2009 through August 24,
2009 attached and incorporated herein Composite Attachment “E”. The lack of such a manifest
evidences the Respondent falsified his certification on DH Form 4015 that he pumped the septic
tank and determined its volume and structural integrity. Had the Respondent pumped the septic
tank on August 14, 2009 as he certified, there would be a corresponding Transport Waste Hauler
Manifest for the property located at 9320 Anita Avenue showing the pumped waste had been
discharged into the county water treatment facility on or about August 14, 2009.
14. . The Respondent falsified and/or provided untrue statements on Health
Department Form 4015. The Respondent certified that he had pumped the septic tanks located at
9320 Anita Avenue, Englewood, Florida when in fact, the Respondent did not pump the tank.
The Respondent also certified the tank was structurally sound, when in fact, the Respondent had
not pumped the tank to properly inspect for structural soundness. The Respondent’s information
provided in the signed certification on Form 4015 contains false, misleading and untrue
representations and subjects the Respondent to the discipline mandated in Rule 64E-6.022(1)(k)
Florida Administrative Code, which is a letter of warning or a fine up to five hundred dollars
($500) for the first violation. The Department hereby imposes a fine of five hundred dollars ,
($500) for this violation against the Respondent. Alternatively, these acts and practices
amounted to gross negligence, incompetence, or misconduct in violation of Rule 64E-
6.022(1)(1)1, Florida Administrative Code. The Respondent's actions subject the Respondent to
the discipline in Rule 64E-6.022(1)()), which is a letter of warning or fine up to five hundred
dollars ($500) for the first violation. The Department hereby imposes a fine of five hundred
dollars ($500) for this violation against the Respondent.
REQUEST FOR RELIEF ;
Wherefore, the Department of Health hereby imposes an administrative fine in the total
amount of One Thousand Dollars ($1,000) against the Respondent, Martin A.Guffy, Registration
. Number SR0971273.
The Total Fine imposed herein, to date, being One Thousand Dollars ($1,000) is due and
payable within 21 days of receipt of this Complaint to the Charlotte County Health Department,
Attention Herman Velasco, Environmental Administrator, 18500 Murdock Circle, Port
Charlotte, Florida 33948.
Done this 10 %4ay of December, 2009, by the Department of Health, Charlotte
County Health Department.
STATE OF FLORIDA
~ DEPARTMENT OF HEALTH
DENISE DUQ
Florida Bar #00565921
Senior Attorney
2295 Victoria Avenue, Room 206
_ Fort Myers, Florida 33901
(239) 461-6130
(239) 461-6102 facsimile
CERTIFICATE OF SERVICE
I hereby certify that the true and original Administrative Complaint herein was furnished
via FedEx Tracking #1482 (O13 [750 to Martin A Guffy, Martin Septic
Services, Inc., 2308 Tropicaire Boulevard, North Port, Florida 34286; and a true and correct
copy herein was furnished via United States Mail to, Albert J. Tiseo, Jr. Esquire, 701 JC Center
| Of da cember, 2009.
Court, Suite 3, Port Charlotte, Florida 33954,
NOTICE OF RIGHTS TO APPEAL
A party whose substantial interest is affected by this order may petition for an
administrative hearing pursuant to sections 120.569 and 120.57, Fla. Stat. 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 # A02, Tallahassee FL 32399-1703. The Agency Clerk’s facsimile number is
850-410-1448. :
Mediation is not available as an alternative remedy. ;
Your failure to submit 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, Fla. Stat. 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.
Co. STATE OF FLORIDA C.. om Heay,
DEPARTMENT OF HEALTH @ RECEIVED %
® J od
APPLICATION FOR: a NOV 1 0: 2009 3
SEPTAGE DISPOSAL SERVICE PERMIT Z s
TEMPORARY SYSTEM SERVICE PERMIT & AD
SEPTAGE TREATMENT & DISPOSAL FACILITY % MIN Ny
SEPTIC TANK MANUFACTURING APPROVAL Ve . iP
: . Wironmne
Authority: Chapter 381,F.S. icat it Number,__ 200.057 PUMPER
Cha Non ase 6 NS ‘ Fr Application’Permt Appl cao 6 tor: i
Septage Disposal Service__X_Temporary System Service: Septage Treatment Facility: eptic Tank Manufacturing:
GENERAL INFORMATION
Business Name: Martin Septic Service Phone Number, (941 1429-6842
Gertinicate of Aufhafzation for Registration 43 Plum ing icense
Wri! 22, L Phone Number:__{941 =
SEPTAGE DISPOSAL SERVICES ‘ . ,
Vehicle Id. Number/_leense Plate Numbe ruck Gallonage Capacity Counties of O tion Inspected & ‘aved
INPALUOKAGN4T? Od NBIOTN | ook CaNgnage Capaciy asota Yes: Ror eroved
“BINPALUOXSYNEO 1470 —N219 — Yes: —X-No:
LAPALWE RUNS TCP Le (Taso rit i — No:
List equipment used in the operation of this B husingas necessary for the sanitary pumping, transport, and disposal of septage___
pproved: Yes_X No
Disposal Method: Wastewater Treatment Plant:___X___Locatian:_Cha A
Approved: Yes. OL
9 Utilities,
Land.Application Site: Lacation=—_. . aa Approved: Yes_No.
Satony Landfill: Location: Approved: Yes__No___
Owner/Operator of Disposal Site: Chad a Utilities
Are facilities availahia at the dis; r ihe proper ant and stabilization of septage and grease: @8. o_
(f No, location where the waste will be stabilized:
By what mathod: Facility wil be under the ragulation oF DER, ARS Both
Directions to Disposal Site: ~ :
Provide a letter of authorization from the operator of the disposal site allowing your business to dispose of septage at that location. If :
restrictions have been placed an your business by the operator of the pe at the resigns must be specified in the letter.
TEMPORARY SYSTEM SERVICES (INCLUDES PORTABLE TOILETS AND HOLDING TANKS)
Back up Service Available: Yes, No. tf Yes, Name of Back Up Service: :
Address: _ Phona Number,
Truck Gallonage Capacity
Vehicle ld, Numbar/License Plate Number Waste Water Counties of Operation = Inspected & Approved
Disposal Site: Approved: Yas:No:__
Provide a letter of authorization fram the operator of the disposal site allowing your businass to dispose of portabje ta
tank wastes at that location. If restichiang have been placed on your businaes by the operator af the disposal faclty, the restrictions
must be specified in the letter.
Page 1 of 2
toilet and/or holding —
my
ATTACHMENT aA
4
OPERATING PERMIT
For: OSTDS - Service and ATU Maintenance, Disposal Servicy, ' Billing ID: 58-B1D-1210964
Issued To: Martin Septic Service Permit Number: 58-Q3-00032
2308 Tropicaira Blvd County; 58 -Sarasota
North Port, FL 34286 : Issue Date; 01/01/2010
Permit Expires On: 12/31/2010
The facility shown above has been inspected by a duly authorized rapresentative of the Department of Health, and was found in
conformance with those rules promulgated by the department under the authority of Chapters 361, 386 and 489 Part Ili, Florida
Statutes, and eet forth in Rule 64E-6, Florida Administrative code.
This parmit grants authority to operate the abave referenced facility, service, or system in conformance with department rules and
the conditions of operation shown below. This permit is revovable, upon service of notice, when it is determined by the
department that the operational conditions and department standards are nat being maintained.
tssued by: Sarasata County Health Department
1301 Cattlemen Rd, Sarasota, FL 94232
DO NOT DETAGH HERE (Non-Transferable)
00 NOT SEPARATE FROM OPERATING PERMIT '
CONDITIONS OF OPERATION
For: OSTOS - Service And ATU Maintenance, Disposal Service, _ Billing ID; 58-BID-1210964
Permit Number: 58-Q3-00032
\ssued To; Martin Septic Service ; Permit Expires On: 12/31/2010
The operating permit for the facility shawn above has been issued with the following conditions of operation:
OH-1013 (03/97) DISPLAY OPERATING PERMIT AND CONDITIONS OF OPERATION IN A CONSPICUOUS PLACE (Non-Transferable)
DETACH HERE - RETAIN THIS PORTION FOR YOUR REGORDS
RECEIPT
2 . Billing ID: 58-BID-1210964
For: OSTDS - Service And ATU Maintenance, Disposal Service, Permit Number: §8-Q3-00032
Issued To: Martin Septic Service County: 58 - Sarasota
2308 Tropicaire Bivd Issue Date: 01/01/2010
North Port, FL 34286 . Amount Pald; 76.00
Date Paid: 11/10/2009
CheckNumber; 50944
Receipt Number: 58-PID-1206469
Mailed To: Martin Septic Service, inc. Operator 1D: DerasierOM
2308 Tropicaire Bivd Fee paid by: Martin Septic Service
North Port, FL 34286 issued By: Sarasota County Health Department
RETAIN FOR YOUR RECORDS
CONSTRUCTION PERMIT FOR:
a
ny ® OF 345A
permir #:08-SM-996650
appLication #: AP930420
e RIDA DATE PAID: oF
NT OF HEALTH ro
SEWAGE TREATMENT AND DISPOSAL FEE no: lla
RECEIPL #:
pocmen #:PR7B0516
OSTDS Repair
APPLICANT: Andrea Telman, Tr
PROPERTY ADDRESS: 20282 Albury Dr__ Port Charlotte, Fl 33952:
6 BLOCK: 464 SUBDIVISION: PC Sec 18
Lor:
PROPERTY ID #:
402216184001
(SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
[OR TAX ID NUMBER]
STANDARDS OF
SYSTEM MUST BE . CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND SECTION
381.0065, F.S., wo [errr 64E~6, FVA.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE
SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERTOD: OF TIME. ANY, CHANGE IN MATERIAL FACTS,
WHICH SERVED AS A |BASIS FOR ISSUANCE OF ‘HIS PERMIT,. REQUIRE JHE APPLICANT TO MODIFY THR
PERMIT APPLICATION.
ISSUANCE OF THTS
PERMIT DORS
‘STATE, OR LOCAL manson REQUIRED FOR DEVELOPMENT OF THIS PROPERTY.
SUCH MODIFICATIONS MAY -RESULT IN THIS - PERMIT BEING MADE NULL AND VOID.
NOT EXEMPT. THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL,
“ie
SYSTEM DESIGN AND SPECIFICATIONS
FILL REQUIRED: Cc 9
TL 750} Gartmons |/ cep Seotic CAPACITY
AL 01 cannons |/ cpp CAPACITY .
NI 0 ] GALLONS apense INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALEONS]
K[ _] GALLONS DOSING TANK CAPACITY i” IGALLONS. @[ ]DOSES PER 24 HRS #Pumps [ 1
Dt 360 } SQUARE raf 120 linear Ft PTI MPS-11_ sysT=m
RL. 0 } sQuarz, = : SYSTEM
A TYPE SYSTEM: i 1] STANDARD { ] FILLED [ ]- MOUND ti]
I CONFIGURATION: f |) TRENCH ‘{¢] BED aml
N
¥ LOCATION OF BENCHMARH: Orange. Dot C/L Lion Ter, Left Pl. 50:00 (ass'd) .
I ELEVATION oF PROPOSED) SYSTEM STTE t 6.00 i darsae} Fr 11 ABOVE git sma eerenme POINT
E ROTTOM OF DRAINFIELD [TO BE C d#o0 1 (rxcnes] lilixcres) rr 1¢ apoveAaerow]BENcMark/RErERENCE POINT
L
D 60] INCHES EXCAVATION REQUIRED: [ 60,08] INCHES
a
The licensed contractor in:
8, 64E+6,013(3)(f), FAC. R
Install a new sratera to
Remove existing drainfiel
a
H
SPECIFICATIONS BY;
YY,
DATE ISSUED:
DH 4016,
Pe
10/97 (Previous Editions May Be Used)
falling the system i is tesponsible for installing the. minimum category of tank in accordance with
quired drainfield area based on rule 64E-6, 015(8)(¢)2.
chieve Drainfield size requirement.
material and associated spoils to 60" below grade. Replace with appropriate drainfield material.
VITLE: Environmental Supervisor Charlotte CHD
EXPIRATION DATE: 10/25/2009
Page 1 of 3
vilii.a APYI0A20 SE793144
ATTACHMENTB
PERMIT NO. _———_——
pATS PAID. _—____—~
STATE OF BOE HE TH oe FEE PAID:
DEPARTMEN oF HEAL , ————
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM RECEIPT #2
CONSTRUCTION PERMIT ee
‘CONSTRUCTION PERMIT FOR: , vative
{ ] New System { J Existing System t 3 Holding Tank | i Inn
(Al Repair { Abandonment [ ] Temporary EEE
APPLICANT: ANORGA Tecan TRUSTEE
AMEERE
4FROPERTY ADDRESS: 20282 Aeguer dR, Por. LA Lor7e AL SSIS
Por S&C. 18
:
OT: 6 . Fb 4 ___susprvisioN:
OT: BLOCH: [TSECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
‘pROPERTY ID #: GORRIOIE G00 | | [OR TAX ID NUMBER]
15-40-22
a
R
SYSTEM MUST BE CONSTRUC) iD:
@.8., AND CHAPTER 6AE-4@, F.A.C. DEPARTMENT
‘PERFORMANCE FOR ANY SP. CIFIC PERIOD OF TIME.
BASIS FOR ISSUANCE or | THIS PERMIT, REQUIRE THE APPLICANT Oo MODLEY T
BUCH MODIFICATIONS MAY RESULT IN THIS PERMI iC
DOES NOT EXEMPT THE Al PLICANT FROM COMPLIANCE
REQUIRED FOR DEVELOPMENT OF THIS PROPERTY .
‘SYSTEM DESIGN AND SPEC{FICATIONS
wv [7SO | GALLONS / GPD_SEPTIC TANK |ULTI~CHAMBERED /IN-SERTES [A] .
aT ] GALLONS / GPD CAPACITY MOULTI~CHAMBERED/IN-SERIES [
woe ] GALLONS GREASE INTERCEPTOR CAPACITY {MAXIMUM CAPACISY SINGLE TANK: 1250 GALLONS”
gt } GALLONS. DOSING TANK CAPACITY [ |] GALLONS @ [ } DOSES PER 94 HRS # PUMPS [
[360] SQUARE FEET) REPLACEMENT DRAINFIELD system /ZO Zivene Kr, P22 mb$ 0} Ehuvat
io ] SQUARE FEET SYSTEM . :
TYPE SYSTEM: {| STANDARD { ] FILLED [> | MOUND f 4]
CONFIGURATION: [ | ]} TRENCH [A] BED ct]
ELEVATION OF PRO D S¥STEM SITE [ 6” ] [INCHES/FT) [ABOVE/BELOW] BENCHMARK, [REFERENCE POIN
LOCATION OF “crore OCRence 807 7 Z10N 7ERR eer? Ale (S06 a0’ Aeumee)
POS: :
BOTTOM OF DRAINFIELD TO BE t /%@" 1] LENCHES/FT! [ABOVE /BELOW] BENCHMARK/REFERENCE POIN
OM briny BZ be abt
FILL REQUIRED: [ W/A ] INCHES EXCAVATION REQUIRED: [60 ¥ 7 INCHES ©
Remove EGASPIVG ORAINAGCYO MAIER IAAL A A. a? Vd
: f 3 : NO APAOCS GO SAt/o$ 7o 40”
(hte ek) GGern Gks a F oy) ,
)_ 46 O6 . FRE Cet CG WTA] APP REPEIA 7E ORAINEAIECO ~
3 U.,
te
Ba
SPECIFICATIONS BY:
TITLE: ConvrRAe 7OR.
APPROVED BY:
TITLE: CharlotteCHD
SATE ISSUED: : ;
EXPIRATION DATE:
DH 40 i Lor
16, 10/97 (Previous Editions May Be Used)
Page 1 of 3
DEPAR'
|} ONSITE
SYSTEM
APPLICATION FOR:
STATE OF FLORIDA
APPLICATION FOR. CONSTRUCTION PERMIT
WAGE TREATMENT AND DISPOSAL
T OF HEALTH
permit No. O94 - -
DATE PAID: 9- 4- 3-07
FEE PAID: 255 Ao
RECEIPT #:
Lee
{ ] New System [/.] Bxisting System : { J Holding Tank [ ] Innovative
{X] Repair (| 1. Abandonment { 1]. Temporary
APPLICANT: Aner GCA Veécemanl - TRUSTEE Lok Zeora 1 ot. ie) ecensss)
AGENT: Sar tral| SEP we ve ERVICES TELEPHONE : 4297 $842.
MAILING appREss: 2 S08"
Teo Prenrec btvb, Waser
TO BE COMPLETED BY
BY A PERSON LICENSED coe
APPLICANT’ § RESPONSIBI
PLATTED (MM/DD/YY) IF
Sesaossse Sse Sse
PROPERTY INFORMATION
ot: G
PROPERTY ID #:
402
BLOCK: GE & -
16/8 2.001
LH
SUBDIVISION: Sée.
end eae ae cence eeeee seen
As
SYSTEMS MUST BE CONSTRUCTED
If IS THE
PLATTED:
PROPERTY StzE: 0°24
18 SEWER AVAILABLE AS
PROPERTY ADDRESS:
ACRES WATER SUPPLY:
PER 381.0065, Fs? [ ¥ /@1
t
DIRECTIONS TO PROPERTY:
SEée mAP ATTACHED
ZONING: ASE S
] PRIVATE PUBLIC [%]<=2000GPD [
-$_ I/M OR EQUIVALENT: [ ¥ (GL)
j>2000GPD
DISTANCE TO SEWER: (V/M__ Pr
2obee Acsuar dr, Foer CHpays77é, KL 33952
BUILDING INFORMATION
Unit
[%] RESIDENTIAL { ]
COMMERCIAL
Type of No. of Building Gommerdial/Institutional System Design
No Establishment [| Bedrooms Area Sqft Table ll, Chapter 64E-6, FAC
1 .
SAR a 1,36) V/A a
2
3 —_ _
4 ~ ~ _
tJ Floor/Equipment Drains { ] Other (Specify) oo| 0
SIGNATURE: DATE: We. 3 3/0 09 ae
f af, &
DH 4015, 10/97 (Previous Edi i1ohS May Be Used # Y Page 1 of 4
0999 bb ~ Wis-80
DEPARTMEN
ONSITE SE
SITE EVAL
apesreas: Avoren Terman - Teus7ee
_ STATE OF HLORIDA
OF HEALTH
AGE TREATMENT AND DISPOSAL ‘SYS
ATION AND: SYSTEM SPECIFICATION
PERMIT #.
i
AGENT: JURR ro Serre JSCRVICE.
& siock: $6
“LOT:
suspivtston: PCA SEC.
4
7&
PROPERTY ID #: 4OAR/E/E ZOO!
46-40
TO BE COMPLETED BY ENGINE)
MUST PROVIDE REGISTRATIO)
R, HEALTH DEPARTEMENT EMPLOYEE,OR O
NUMBER AND SIGN AND SEAL EACH PAGE
PROPERTY SIZE CONFORMS TO SITE PLAN: v3 YES { ] NO NET US:
TOTAL ESTIMATED SEWAGE FLOW:
AUTHORIZED SEWAGE FLOW:
UNOBSTRUCTED AREA AVAILABLE: /000
LOCATION: DRANGE G07 Ge, S10 VORR. LGET A/t. (§0'o0
BENCHMARK/REFERENCE POINT
#LEVATION OF PROPOSED SYS
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED
SURFACE WATER: W/, ET
WELLS: PUBLIC: AW/A ET
BUILD ENG FOUNDATIONS:
SITE SUBJECT TO FREQUENT
‘10 YEAR FLOOD ELEVATION HOR SITE: -
‘ SOIL PROFILE INFORMATION sire 1 S0O-So."
GALLONS PER DAY [
GALLONS PER DAY [
SQFT UNOBSTRUCT!
Z00 |
600
[Section/Township/Parcel No. or Tax ID Number]
HER QUALIFIED PERSON. ENGINNEERS
F SUBMITTAL. COMPLETE ALL ITEMS.
LE ARBA AVALLABLE: 0°22} aAcRES
SIDENCES-TABLE 1/OTHER-TABLE2]}
500. GPD/ACRE OR_2500 GPD/ACRE
1D AREA REQUIRED: 700 SQFT
ITEM SITE IS 4% LINCHES/FT] [ABOVE
DITCHES/SWALES: 58’ FT
LIMITED USE: W/# FT PRIVATE:
, FT PROPERTY Lines: 4z’
FLOODING: [ ] YES q
0/4
SITE ELEVATION:
,
BELOW] BENCHMARK/ REFERENCE 2)
SYSTEM TO THE FOLLOWING FEATURES.
NORMALLY WET? [.] YES Lory
a”, Fr NON=POTABLE : mie’ : MA
POTABLE WATER LINES: 2S 7 Fv
L] Yes {] wo
FT MSL/NGVD
© YEAR FLOODING?
oO,
SOIL PROFI
| INFORMATION srtE 2 SO: 407 .
| MUNSELL #/COLOR TEXTURE DEPTH [ MONSELL #/dOLOR TEXTURE DEPTH |
f ah ‘ OF TOO" Khe : #38 ov TOR”
d Ww Geayeuy FS 9 to 48" FS 0 Gravare. &" Tye
ve G/T Gre Fé is" 00 265 3 ge go
| ff te" TO Bar #S 2a” TO Jey
Ge Ye Lone eer 32” TO 36” RE (17a Ys Cmepsr 32" TO 34”
7 a4" TO 42" zs SE" 10 g2”
por Ws ta Sanoe bee. 42% TO SO” Pawsod ee Y TO Mer"
5; rao wank “og? 20
— ro TO
| USDA SOTL SERIES WOR PP EO BS ASS Deasmar Saevd USDA SOIL |SERLES: Arapred _¢~s # oF OL ai mie
; s - Sav!
QBSERVED WATER TABLE: INCHES [ABOVE / BELOW] EXISTING GRADE. TYPE: [PERCHED / APPARENT
ESTIMATED WET SEASON
HIGH WATER TABLE VEGETATI
SOIL TEXTURE/LOADING RATH
DRAINFIELD CONFIGURATION:
ae "
WATHR TABLE ELEVATION:
ON: [ ] YES {[X] NO
vor system sizinc: Ad /O'8S pv
[ ] TRENCH : [A] BED { ] OTHER
so w
pra of Excavariont 60
32" INCHES (ABOVE / BELOW] BRILSTING GRADE
; MOTTLING: ¥] YES [ J] NO DEPTH: &2” INCHES
INCHES
(SPECIFY)
vtties) Setan Ceade on FREE ORMMING SAM
REMBRKS/ ETT ONAL CRITERIA: *O/Gion? 70 £6°%
ASK) mugen ie| Keg7an &8 | 0636LV6O
@_ 32" BL" bGtrw/ GRAIG |
{
SITE EVALUATED BY: A darn Renolelem p K
BA (07k Ye etude Comms POUSIMET
bh 4015, 10/96 (Replaces HRS-H
[
Form 4015 [page at which may be used)
|
|
EAS, CEA vate: [23/09
Page 3 of 4
{ . |
STATE OF FLORIDA t | PERMIT #
DEPARTMENT |OF HEALTH :
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
EXISTING SYSTEM AND SYSTEM REPAIR BVALUATION
APRLICNNT: ANOREA (éemane Rus 7OG
CONTRACTOR / AGENT: VET 7rrv LEA a AC. J CRVICE
Lor: _&@ BLOCK: whe SUBDIV: Pen SEC. 8 ___ WH ORR/ELE 18300}
@O BE COMPLETED BY FLORIDA REGISTERED. ENGINEER, DEPARTMENT EMPLOYEE, SEPTIC TANK CONTRACTOR OR
OTHER CERTIFIED PERSON. SIGN AND SEAL ALL SUBMITTED DOCUMENTS. COMPLETE ALL APPLICABLE ITEMS .
MPLETE TANK CERTIFICATION BELOW OR ATTACH LETTER FROM A PERM TTED SEPTAGE DISPOSAL SERVICE.
TANK INFORMATION -
1780 ] GALLONS SEPTIC TANK/GPD ATU LEGEND: MATERTAL CONGRGE 7G BAFFLED: [x /GQD
“7 GALLONS SEPTIC TANK/GPD ATU LEGEND: MATERIAL: __ BAFFLED: [¥ / NJ
i ] GALLONS GREASE I[WTERCEPTOR
GALLONS DOSING F
OTED TANKS WERE PUMPED ON 06 /2&% /O% , HAVE THE VOLUMES SPECIFIED, ARE
RAVE, A KS DE! TON DEVICED 7 QULLET FILTER DEVICE 1 STALLED .
ase, ONC jACAVICE PRE /OF
CENSED CONPRACTOR s0Sniess NAME TE
EXISTING DRAINFIELD “ee i
'
£/60. ] SQUARE FEET PRIMARY DRAINFIELD SYSTEM NO. OF TRENCHES [ ]. DIMENSIONS: S ’ x 0”
i ] SQUARE FEET _ 7 |\_SYSTBM NO. OF TRENCHES [ ] DIMENSIONS: xX
TYPE OF SYSTEM: [ ] STANDARD [ FILLED [7%] MOUND [. ]
QONFIGURATION: [#4] TRENCH t ‘BED C ]
DESIGN: [ ] HEADER [794] D-BOxX [A] GRAVITY S¥s [ ] DOSED SYSTEM |
SLEVATION OF BOTTOM OF DRAINFIELD IW RELATION TO EXISTING GRADE 28 “INCHES [ ABOVE / BELOW]
SYSTEM FAILURE AND REPAIR TNFORMATION
£/970 | S¥STEM INSTALLATION DATE : . TYPE OF WASTE [ 41 pomesTrc f ] COMMERCIAL
‘ 260 °] GPD ESTIMATED SEWAGE FLOW BASED ow [%] METERED WATER [ ] TABLE 1, 64-6, FAC
SITE [ ] DRAINAGE] STRUCTURES tl ] POOL [ ] PATIO |/ DECK [ ] PARKING
ZONDITIONS: [%-] SLOPING PROPERTY ( ] :
: !
NATURE OF [ ] HYDRAULIC) OVERLOAD { ] SOILS [ ] MAINTENANCE [ ] SYSTEM DAMAGE
FAILURE: [ ] DRAINAGE / RUN OFF { 1] Roots [ ] WATER /fABLE (%1 AGE =
i . : .
SAILURE { ] SEWAGE OW| GROUND {| ] TANK [A] D BOX/HEADER [x] DRAINFIELD
SYMPTOM: {% ] PLUMBING BACKUP |
2a
SSMARKS /ADDITIONAL cRTTERfA
i
|
ne ee
|
L
i
f
SUBMITTED BY:
}
8 1 aR 7) A. G KB
i
. -——_--—
i
i
amas /uxcENse Lau coa/ Con RAC 70K DATE: zpos) 9
| ATTACHMENT
R41
‘STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION AND.INSTALLATION PERMIT
SHOW THE FOLLOWING: i
Existing system configuration and location, building location, property slope (if any)
“rights-of-way,” ob:
systems, surface w
ce PERMIT NUMBER _
PART Ih = SITE PLAN osecsefecsssecsssessssetseseersssoisnsstinstinnn
FOR REPAIRS & HOLDING TANKS ONLY
, property lines, easements,
tructions (buildings, driveways, sidewalks, etc.) private and public wells within 100° of
ter and stormwater retention systemp, and repair system: configuratign.
: — O44AU Pr :
932) H 307
* W- ame 4 GG RA
No LURFACE wh 7eR_ £o0y ies
es 7 ¥
POPARL Ge Maren 6A 20814 20nj OD
wv ; ‘
Ste Mt COCA PE beter pe ws?
OR PRepezz “2
la peorearee ANE) CACEPZ fj
ORAIVING 1107 72 SCALE
iefly describe the nature of the failure:
MEV G EK UA Cul 7D |SCOW) ORMINING
ERA EIGED
Site Plan submitted by: 7 ; Y Gh tn LAr] Weieyn REAS, CENIF
, : Title
Pian Approved __|
By County Health| Department
Signature
Not Approved Date
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
. ONSITE SE
STATE OF FLORIDA
DEPARTMENT OF HEALT
WAGE DISPOSAL SYSTEM CONSTRUCTION A
PERMIT NUMBER
PART Il - SITE PLAN
SHOW THE FOLLOWING:
Existing system configuration and location, building location, property sk
“rights-of-way,” obstructions (buildings, driveways, sidewalks, etc.)
systems, surface water and stormwater retention ’systemb, and repair s|
pri
aw CeeU PA
D INSTALLATION PERMIT
FOR REPAIRS & HOLDING TANKS ONLY
pe (ifany), property lines, easements,
vate and public wells within 100' of
stem configura Qh, Re raage
. @ bn fl h(a
RE Ee é -
¥ ; . WE DLAINEI Gt oe
$ Gnred % 20 /
PID p08 1) FB 120 Liven.
P32? e307 Fr.
* in same devene.
PREM OF EYE,
foc@ SY 87am)
a“, A
. nS s }
Line = pe &
7 WwheArthay &
© 2ce| ra Hed
Fae a aa “CXS ATS pow
EE aN ©
[NE SORFACE WATER gpg S| ®©
PLIABLE WATER BR zp eigen OS .
ete PS Con FEd trey, =
OK PROPCATY ve, Exceey f
AA poreaTen Ly
- — AC Bury OR. _
ORANGE 7107 72 SCALE
& 7O slew GRADING
Title
Site Plan submitted by: 7 / “a ton CRY] Ge erh REAS, CEASE
Plan Approved ____ |
By County Health D
ALL CHANGE
. Signature
Not Approved
partment
Date
MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
)
K)
aS
‘PROPOSED .
ELEVATION
49-90’
4% 7G?
99-50’
‘So. 22!
49: 60"
48-85)
SO -SO
or: rey
$783"
0-667
. .
E.S.H.W.T. SEPARATION /2°/ Jn.
ESHW.T. a
c. Q. R.
BENCHMARK LOCATION ORGeGE- Op? Leer rene. err h/t
BENCHMARK ELEVATION __© 9 ‘00 /gvtumeo)
LIFT STATION? Yes X No!
07/23/200 : : o ; :
TAPERS ON: 55 FAL { 001/001
listoryAWeather Query a (CCU yo
4-MAR-2009
os Fea 200s
_fOSUAN 2009
Is. Dec-2068
jo4-Nov-2008
ent tyre teenie
4
yw
of
al
9
"
Charlie Crist
Governor
NonFeaTion TO SUPPLY ADDITIONAL INFORMATION
Ana M. Viamonte Ros, M._D., M.P.H.
State Surgeon General
{Applicant [ 7??? Permit # 09-365RP |
Address [TRUSI¢e on Property App. | Property - 20282 Albury Dr
; does Not makeh Apolican’| Address
Fax# 941-429-1602 fax ‘Septic Contr. | |.Martin Septic Service
The application for}
for the following re
can be processed
64E-6.015 Perm
(a) A site plan
s
co earation ave
potable water lines, within the existing and proposed drainf
slope of the prope
any surface waterbodies and stormwater
or public wells, o
2 septic system construction permit for the a
iting and Construction of Repairs
location on the property, the building loc
rty, property lines and easements, any 0
onsite sewage system which, restricts replacement or relo
The existing drai
minetal aggregat
- site plan: Slope of Property, Indicate were existing system
field type: shall be described, For exampl
, chambers. or other. Information missing
drainfield to the structure,
son(s): Your application needs to provide th
owing property dimensions, the existing a
ove site cannot be processed
following information before it
d proposed system
ion, potable and non-
eld repair area, the general
structed areas, any private —
systems in proximity to the
tion of the drainfield system.
, mineral aggregate, non-
that must be indicated on
is located, distance from
64E-6.Please verify the irrigation. well will be 55° to: new drainfied,
64E-6.015 Perm
A permit shall be|
the submission of an application accompan
Form DH 4015, 1
itting and Construction of Repairs
issued on Form DH 4016, hereby incorp
ied by the nece
0/96, hereby incorporated by reference, s
ated by reférence, only after
sary exhibits and fees.
all. be used for this purpose,
and can be obtained from the department. Need plotted date on-application.
home and my pr
make sure you a
it was requested
Leslie Beauchary
Environmental S
The application shows that a lift station will not be necessa
permits. We agréed to do so with the 115.00 site evaluatio
to verify please submit the 115.00 and we will gladly perfor
avoid any mishap’s
fessional experience and knowledge | as
that we go and perform a site evaluation
p .
upervisor
Date: July 24, 2009
. Based on the age of the
that you review this to
e certain it will not be needed. Per conversation with Marty and Cindy
rior to, our issuing the
fee paid. If you wish for us
ma site evaluation now to
This information must be supplied to this office on or before 8/24/2009
Charlotte County Health Department « Environmenal Health
18500 Murdock Circle, Rm 203 » Port Charlotte, FL 3 3948-1094
Tel. (941) 743-1266 « Fax (941) 743-1533
Charlie Crist Ana M. Viamonte Ros, M.D., M.P.H.
Govemor State Surgeon General
ATTACHMENT A
. EXISTING SYSTEM/MODTTCATON ae
INSTRUCTIONS FOR COMPLETING AND SUBMITTING YOUR SEPTIC PERMIT
APPLICATION
i. You will need to have ALL tanks pumped by a permitted septage disposal service to
determine the yolume and structural integrity of the tank. volume must be determined
by the actual inside dimensions of the tank, and this informat n must be included on the
certification (
application.. If Y
you have the proper paperwork, you don’t have to have the: pumped again
2. Site information sheet and application filled out completely] signed and-dated.
3. Site plan — This is the most important part of your applicatian, please take the time to —
ensuré you have all features accurately depicted. The site plan (signed and dated) must
show exactly what you propose to do on the site. See below
Draw the location, and show dimensions of lot boundaries. Youlmust show building location,
potable and non-potable waterline, any easements, roads, obstructions, wells (on said, and all
adjacent ptoperties), surface water, driveways, walkways, the lo pation of both existing and
proposed tank(s), and drainfield. In addition to the location, indicate the estirnated distance to
all said features. Yjou must show location of any private utilities have been installed on the
property such as electrical lines, sprinkler lines, etc. The CCHD jis not responsible for damage
to private property; underground utilities must be indicated to. the: CCHD so we can take
action to-avoid thém. This is a Safety concern as well as possible interruption of service.
FOR EXISTING OR MODIFICATION PERMITS
4. Floor plan ~ Attach a copy of both the existing, and proposed floor plan for your house,
Mobile or Manufactured home, or business.
5. Permit Fees: Existing system application $180.00
(Repair system application $360.00, CCHD site evaluation 525.00
Modification without tank replacement system application $380.00
Modification with tank replacement system application $430.00
(Modifications with CCHD performing site+ existing evaluatjon add 165.00)
APPLICATION PACKAGES WILL BE CHECKED FOR ACCURACY PRIOR TO ACCEPTANCE,
INCOMPLETE APFLICATIONS CANNOT BE ACCEPTED,
I have tead the above and understand the aforementiqned regulations.
Charlotte County Health Department * Environmental
18500 Murdock Circle, Rr 203 » Port Charlotte, FL. 339
: Tel. (941) 743-1266 * Fax (941) 743-1533
ATTACHMENT
RR?
Charlie Crist
Governor
Ana M. Viamonte Ros,.M.D., M.P.H.
State Surgeon General
NOTICE TO APPLICANT
Because of the requirements of chapter 556, Florida Statutes, Underground Facility Damage
Prevention and Safety Act, it is mandatory that this office apply for
for your property prioy
days, and up to five days to receive a locate ‘ticket and if any o'
ticket request is incorrect or missing, it will take longer. We realize
There itis a necessary aid in preventing
permitting process.
it to your permit.appii
to performing any site work on your prop
erefore, it is imperative that we have your
tand this notice, please date and sign the bo}
ation. :
and receive a utility locate
ittakes a minimum of 2
required information on the
his will slow down the
ssistance in this process.
s to your property, this
anything that might prevent
I large deg. To ensure you
tom of this page and attach
— injury, and potential
Please note that private utilities are not located: during this process, Any electrical lines
installed under groun
on the site plan any u:
Health Department is
of our evaluation or in
SLM
Revised 6/6/07
bi A. Gugrer
, Sprinkler lines, etc wilt not-be marked by thi
tities youor previous owners may haveit
pection process.
28/69
Kastan
is process. Please indicate
led. The Charlotte County
stall
1ot responsible for damage caused to orivatd property during the course
D/OSTDS2007
: Charlotte County Health Department « Environmental Hath
18500 Murdock Circle, Rm 203 « Port Charlotte, FL 13948-1094
Tel; (941) 743-1266 « Fax (941) 743-1533
Charlie Crist Ana M. Viamonte Ros, M.D., M.P.H.
Governor _ State Surgeon General
; PROPOSED SITE INFORMATION
YorN a "
y 1. [ls there any slope to your lot? :
Slope is the percentage of fall in a specified diane. If the property is flat,
it bas no slope. If the property has slope, indidate the direction with
arrows. :
N
Y 3.
N . 4.
e there any existing or proposed wells on
ease indicate use, irrigation or drinking)
pt yout lot? Ef'so, you must have the “1
2. Are there any public wells within 200 feet of your lot?
t within 75 feet of your lot?
Are there any lakes, streams, canals, or stance water, anor within 75 feet
ual flood line” determined
y this office.or a certified professional surv surveyor and mapper with
experieneé:in the determination-of flood waterlelévation ines. If you wish
¥ have this office determine, initial here |__. (Chapter
$1.0065(4)(i). Florida Statutes)
a 5. Are there any easements on your property?
Y 6. Are there any drainage features (i.c. ditches, swales, drainage retention
areas, storm water piping, ot interceptor drains, etc.) on, or within 75 feet
. ‘of your lot?
N 7, Are there any underground utilities located on your property such as
sprinkler lines or electrical lines?
Name: Clgye aid Seen, S ERYICE
Title: ; Say Fie. Con IR e700
owner, building contractor, septic contractor, other)
—
Date: Vere Y AS 09
Ifyou marked /*Y¥” next to any of the above questions, please draw and locate on
your site plan{s).
tevised 607 1/2/2007 . KASHAREDNOSTDS2007
Charlotte County Health Department « Environmental. Health
Tel, (981) 743-1266 » Fax (941) 743-1533
18500 Murdock Circle, Rm 203 « Port Chartatte, FL 33948, 1094
STATE O
2 ~=DEPAR'
| ONSITE
SITE E
APPLICANT:
CONTRACTOR /
nor: 6
SUBDIVISION: Pp
APPLICATION # AP930420
PERMIT # 08-SM-996650
DOCUMENT # SE793473
FLORIDA
NT OF HEALTH
EWAGE TREATMENT AND DISPOSAL SYSTEM —
UATION AND SYSTEM SPECIFICATION .
Andrea Telman, {Tr . “
AGENT: Martin Septic :
BLOCK: 464
ID#: 402216184001
C Sec 18
TO BE COMPLETED BY ENGINEER, HEALTH DEPARTMENT EMPLOYEE, OR OTHER QUALIFIED PERSON.
REGISTRATION. NUMBER AND SIG
ENGINEERS. MUST -PROVIDE
AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS,
RET USABLE AREA AVAILABLE:
PROPERTY SIZE CONFORMS ‘70 SITE PLAN: [X]YES {[ ]No 0.24 ACRES
TOTAL ESTIMATED SEWAGE PLOW: 300 GALLONS PER DAY ( [nagipences-samnea]/ OTHER-TABLE 2 ]
AUTHORIZED SEWAGE FLOW: 599.98 GALLONS PER DAY [ 1500 GPD/ACRE OR [2800 epp/acez_|})
UNOBSTRUCTED AREA AVAILABLE: 4200.00 SQFT UNOBSTRUCTED! ‘AREA REQUIRED: 800,00 sort
BENCHMARK/REFERENCE POINT) LOCATION: Orange dot cl:lion ter, left pl 60.0 (ass'd
TEM SITE 0.32 [ INCHES / [ee | t[anove |7 BELOW. ] BENCHMARK/REFERENCE POINT
ELEVATION OF PROPOSED SYS!
THE MINIMUM SETBACK WHICH
SURFACE WATER: :
WELLS: PUBLIC:
BUILDING FOUNDATIONS:
SITE SUBJECT: TO FREQUENT hrocpiné?
10 YEAR FLOOD ELEVATION FF
SOIL, PROFILE INFORMATION
USDA SOIL SERIES:Oldsmar a:
Munsell-#/Color
10YR 4/3
10YR 6/1
10YR 7/6
4OYR 4/4
10¥R 5/6
REFUSAI
Gi
OBSERVED WATER TABLE:
ESTIMATED WET SEASON WATER
HIGH WATER TABLE VEGETATION:
SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING:
DRAINFIELD CONFIGURATION:
REMARKS/ADDITIONAL CRI
10YR 7/6 mottling found at 24" in 4
SITs EVALUATED BY:
DH 4015, 09/2006 (Previa
lay Lowi : To
Oalitic Limestone 4 “
CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING ‘FEATURES
i DITCHES/SWAIES: 55 Fr NORMALLY WET: [ ]¥ES [X]NO
ud LIMITED USE: FT PRIVATE: FD NON-POTABLE: ¥T
5 FI PROPERTY LINES: 40 Fr POTABLE WATER LINES: 1.4 FT
t iBs [x ]NO | 410 YEAR FLOODING? [ ]¥ES [XINO,
DR SITE: FR MSL / NGVD] SITE ELgvavion: SO .3% FT t waar gioe
SOLL PROFILE INVORMATION SITE 2 :
USDA SOIL SERIES:Oldsmar sand
| Munsell #iGofor___Textute
1OYR:413: i Fill - Firie-Sand
1OYR'6M Fine Sand
TOYR 7/6 ; EMNIDST RE
| 10YR 4/4, : _ Fine'Sand’
4OYR 56° Clay.Laam
REFUSAL Qolitic:Liméstone
¢
oar
INCHES [ ABOVE / BELOW ] EXISTING GRADE TYPE: { PERCHED / APPARENT J
faBLE ELEVATION: 24 INCHES ABOVE / EXISTING GRADE
{ lyzgs [xk]No MOTTLING: [X]YES [ ]NO DEPTH: 24,00: INCHES
Fine Sand/0.60 ‘(DEPTH OF BXCAVATION: INCHES
{ ] TRENCH
ILTERIA
(X] BED [ ] OTHER (SPECIFY)
OYR 6/1 matrix common and distictive
J : i 07/30/2009
filson, Shawn (Title: Environmental Specialist Il) (Charlotte County Environmental He .
ss Editions May Be Used) Page 3 of 4
AP930420 EIDS96650 v1.02
f
i
SEPTIC SYSTEM ELEVATION WORKSHEET PERMIT
ELEVATION CALCULATIONS: USE 100.00 OR 10.00 ASSUMED FOR REFERRENCE POINT/BENCH MARK
LOCATION OF BM ofane e aot cl vd ale PD
pm= 9 9-0
SHOT (+) yy. aa
HEIGHT OF INSTRUMENT=
(HL) Ht. 52.
EXISTING ELEVATIONS: .
GROUND AT TOP OF TOP OF . BOTTOM OF TOP OF TANK TOP OF TANK
SOIL PROFILE OF COVER DF STONE DF STONE OUTLET INLET
Hil. = BY SH = Hd. = HA. = His $4.52 H..=
«sHoT _ 4.30 (SHOT) SHOT _ (-}SHOT | (-)SHOT _$./@ (-) SHOT
“ELEVATION. |_&O «32, ELEVATICN ELEVATION ELEVATION ELEVATION 49,42 ELEVATION
PROPOSED DRAINFIELD ELE’
‘ATION CALCULATIONS _
ae ELD SIZING. ERIOR TO 4983
EXISTING DRAINFIELE
EXISTING GROUND = 50-BR,
DEPTH TO SHWT (-) A REPAIRS PER COUNTY
W4, ; 2 ORDINANCE 4.00:FT
SHWT ELEVATION 32 7
MODIFICATION 4.00 FT OR
. #REQUIRED SEPARTION (+) I AT EXISTING ELEVATION
. _ IF HIGHER THAN 1.00FT ; FOR DRAINFIELD SIZING
ELEVATION BOTTOM Y9 Br oR —e
OF DRAINFIELD 2.00 SEPARATION IF EXISING
. LESS THAN. 1.00 -
TOP OF EXISTING emery . \
TANK OUTLET PIPE 1S APUMP REQUIRED? YES OR NO
-0.83
EQUALS 78. 59 NEW ELEVATION OF ORAINFIELD MUST BE LOWER OR A PUMP WILL BE REQUIRED
EXISTING ELEVATIONS: NEW ELEVATIONS:
TOP OF BED
BOTTOM OF BED RAISE FIELD BOTTOM INCHES
SOIL COVER OVER BED RAISE YARD ELEVATION INCHES
SHWT SEPARATION | SHWT.SEPARATION INCHES
EXISTING TANK GALLON GALTANK NEW IF REQUIRED
Discharge hours are 24 hour days ‘a week,
All information requested on this and any other form, must, be. complete and accurate without exception.
Iti is very important when ‘the grease switeh is ON. and you! have completed unloading that you éirn your key OFF .
and get areceipt before turning the switch back to RE P REGULAR,
COMPOSITE
ATTACHMENT c
ett OWAAITRR 0. ey PINKS weal DEPT:
“9a3/03--
an
fae?
yery important when the grease switch is ON a:
ee DEES ot
and get a receipt before turning the witch back to
x
ne yo!
u
eted unloading, that yc u turn your:
* PINK-HEALTH DEPT...
in up after a
A
omplete and a curate without exception.
Atis, ‘important when the grease switch is,
“and get a receipt before turning the switch back to
e¢ completed nloading that you tu your key OFF:
ane y
OO Aire ATT
Discharge hours’ re 24h
mplete ‘and accurate without exception,
3. All information requested on this and any other form
your key OF ¥F
t ‘very important when the g ‘ease switch is ON and-you have com
receipt before turning the switch back to REGULAR...”
* 0313/08
WHITE-CCU : 6 + “YELLOW-HAULER |:
03/13/03
urs are 24 hours/7 days aw
Discharge ho
lete and accurate without exception.
All information requested on this and any other form must be comp
“4, ‘It is. very important when the grease switch is-ON and you have ct
( d you ha .p! sted unloading hat you turn your key OFF
‘and get a-receipt before turning the switch-back to REGULAR. fo Teerign ie Ais ea ce, -
WHITE-CCU aa “: : YELLOW-HAULER : - : - PINK-HEALTH DEPT. . “033/04 :
io
@ cn, 7 07 420K?
. PERMIT #: 08-SM-16395
APPLICATION #: AP935301__—
STATE OF FLORIDA
DEPARTMENT OF HEALTH DATE PAID!
/ ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID:
SYSTEM RECEIPT #:
TUGrH AT ALSO pocument #:PR784282
Abn
N bye ostps #: 06-083 06-0831-N
CONSTRUCTION PERMIT FOR: OSTDS Repair ve. LEXL
APPLICANT: Vitaliy Kiktenko
PROPERTY ADDRESS: 9320 AnitaAve Englewood, FL 34224 a
Lor: 15 BLOCK: 3467 SUBDIVISION: PC Sec 74
PROPERTY ID #: eae [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
+ 20648200015007 [OR TAX ID NUMBER]
eee
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. RNY 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 NOLL AND VOID.
ISSUANCE OF THIS PERMTT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL,
STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY.
SYSTEM DESIGN AND SPECIFICATIONS
tl 600 ] GALLONS / GPD Existing Aerobic Unit CAPACITY
AT 0] GALLONS / GED CAPACITY
Ni 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
KI ] GALLONS DOSING TANK CAPACITY i ]GALLONS §@[ ]DOSES PER 24 ARS #Pumps [ J
DE 700 ] SQUARE FEET Replacement Drainfield _ S¥STEM
RT C ] SQUARE FEET SYSTEM
A TYPE SYSTEM: { ] STANDARD { ] FILLED [x] MOUND tJ
I CONFIGURATION: { ] TRENCH [X] BED tl
N
¥F LOCATION OF BENCHMARK: orange dot cl alley right pl 50:0 (ass’d)
I ELEVATION OF PROPOSED SYSTEM SITE (41.30) Lancuss| Fr 1 tlapove}) sELOw }BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE - ¢ 18.60) {rscuss) rr 1 anova) BELOW JBENCHMARK/REFERENCE POINT
L :
D FILL REQUIRED: { 0.00] INCHES EXCAVATION REQUIRED: [ 24.00] INCHES
Remove existing drainfield material and associated spoils to 30" below grade within the drainfield area.
°
Using 233 linear feet of PTI-11 or equivalent
B
R
SPECIFICATIONS BY: Martin A Guffey TITLE: Septic contractor
APPROVED BY: Ayan £ Wr TITLE: Environmental Specialist II Charlotte cH
Shawn EB Wilson :
DATE ISSUED: 09/08/2009 EXPIRATION DATE: 12/07/2009
DH 4016, 10/97 (Previous Editions May Be Used) Page 1 of 3
void APS25301 SEMGLIC
26/ FS ATTACHMENT D ,
a e o
ae
i
STATE OF FLORIDA PERMIT NO, 09-4 30KP
DEPARTMENT OF HEALTH . DATE PAID: 9-9 oF
ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID: 36707
SYSTEM RECEIPT #: 9. og o¢
APPLICATION FOR CONSTRUCTION PERMIT Li BOVIS
APPLICATION FOR:
C J] New System { ] Existing System { ] Holding Tank { ] Innovative
[X] Repair [ ] Abandonment { ] Temporary
apprrcant: _V/7A2) yy RIK TENKO
AGENT : Vdeies “iad SEP FC Vex vil & TELEPHONE: 427 ~ £84 2
MAILING ADDRESS: 2.508 Ten Picnree Ezy
Te SSSR SS SS SS 2
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. If IS THE
APPLICANT'S RESPONSIBILITY TO PROVIDE DOCUMENTATION OF THE DATE THE LOT WAS CREATED OR
PLATTED (MM/DD/ Tx) IF REQUESTING CONSIDERATION OF STATUTORY GRANDFATHER PROVISIONS.
PROPERTY INFORMATION
ot: 7S snock: $467 suaprvistoen: SCA Sec 74 puarrep: 7/6/60
PROPERTY Ip #: F/Z0023770// ZONING: A 774/O r/M OR EQUIVALENT: [ ¥ /@>
PROPERTY Size: 0°2 7 ACRES WATER SUPPLY: [ ] PRIVATE PUBLIC [ x]<=2000epD { ]>2000@PD
7S SEWER AVAILABLE AS PER 381.0065, FS? [ ¥ (®)] DISTANCE TO SEWER: “V//} yp
PROPERTY apprEss: F320 /Sws74 Ave, Enaceossoo FL S¢22g
DIRECTIONS 70 property: VEE yyw ATT AK ED
BUILDING INFORMATION {>%] RESIDENTIAL I 1 commercrar
Unit Type of No. of Building Commercial/Institutional System Design
No Establishment ‘Bedrooms Area Sqft Table 1, Chapter 64E-6, FAC
= See shment —S———=e
L
M1471- KAM, RES 4 2266 W/A
2
ata
3
4
{ ] Floor/Equipment Drains ] Ofher (Specify)
SIGNATURE: DATE: G/ 8/09
FLV A . Gukkey
DH 4015, 10/97 (Previous Editions May Be Used) Page 1 of 4
9.24
ia 4
t
ALIS:
DRAINFIELD
New ORANFAIGCO
(RESIDENCE)
+F ELEVATION = 53.34"
§ Ganed %30'P7TZ mest F:
( = 240 Lineac Fr. ait
, iS)
/ DS pace! p80 ||
g
| wi
| i
| 8
| 3
| zi|
| |
LOT 44 | At
BLOCK 3487 |
|
|
SET 5/8" 1R& CAP }e
PSM #6218 \I
[ "Septic Plan approvel
| Charlotte County Health Db
Inspector __ bk
ee WEF}
A JACENT |
Sep DAINFIELO |
|
Ci SWALE
N60°38'31"E £3.00 (P&M
‘by HLT ant
parinian .
LOT 15
BEOCK 3 3467
(10, 378.00
o-
2
~
PROPOSED
4 BDRM
2258 SF LVG
FFE 53.92 MIN.
6' U&D EASEMENT
re
83.00' (P&M)
NO SUREACE WATER BOT,
PO 7A BLE WATER 1%
IR RIGA HOA! WELL. 18
éocarera wrt 75!
of PRo PGRIY Line.
fog
S
el
N
br} — Cit. SWALE —--—~;
a
SILT rence“|
rr aN
"20" PROPOSED *"
DRIVEWAY
|
BSR ert
DF @0 TANK (OR
(MIN. 8° COVER)
CAT.3 AL
1000 SF AREA
UNOBSTRUGTED
LOT 16
BLOCK 3467
—— SET 5/8" IR &
PSM #6218
C/l-— ANITA AVE.
0 PUBLIC RW 20+ PAVED
PLAN - SITE, DRAINAGE & SEPTIC
Se ee
a : f
{ ,
) @
STATE OF FLORIDA PERMIT #.
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
APPLICANT: Vi7ALiy KIKTENKO AGENT:
a ON EIA Si
uot: /S prock:~376 7 supprvisron: O“/ SZc 7
FROPERTY ID. #: 12ZO0 3377 Of} [Secation/Township/Parcel No. or Tax ID Number]
OS GI - 20
_ 220
TO BE COMPLE'TED BY ENGINEER, HEALTH DEPARTEMENT EMPLOYEE,OR OTHER QUALIFIED PERSON. ENGINNEERS
MUST PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH OF SUBMITTAL. COMPLETE ALL ITEMS.
PROPERTY SIZE CONFORMS TO SITE PLAN: (A) YES [ ] NO NET USABLE AREA AVAILABLE: O-2. 7 acres
TOTAL ESTIMATED SEWAGE FLOW: o GALLONS PER DAY [RESIDENCES-TARBLE 1/OTHER-TABLE2]
AUTHORIZED SEWAGE FLOW: ‘7.
GALLONS PER DAY [1500 GPD/ACRE OR 2500 GPD/ACRE]
UNOBSTRUCTED AREA AVAILABLE: 70200 SOFT UNOBSTRUCTED AREA REQUIRED: 7OS°O — sort
~~ 70S 1 “Ys 0
BENCHMARK/REFERENCE POINT LOCATION: On anee 7 Se. A-CLCeE Riant Fle. [(50-60"
ELEVATION OF PROPOSED SYSTEM SITE IS 40-3" [INCHES /FT] AB BELOW] BENCHMARK/REFERENCE SOINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES
SURFACE WATER: /Y FT DITCHES/SWALES: 32 FT NORMALLY WET? [ ] YES [X%] No
WELLS: PUBLIC: Ly, FT LIMITED USE: VLA Fr PRIVATE: Sf Fr NON-POTABLE: “VW bel FT
BUILDING FOUNDATIONS: S'S’ pe PROPERTY LINES: /S‘ Pf POTABLE WATER LINES: Pr
SITE SUBJECT TO FREQUENT FLOODING: [ ]. YES I no 10 YEAR FLOODING? [ ] YES [*] NO
10 YEAR FLOOD ELEVATION FOR SITE; NSA FI MSL/NGVD SITE ELEVATION: Vf _FT MSL/NGVD
SOIL PROFILE INFORMATION site 1 S2'Zp SOIL PROFILE INFORMATION site 2 S2°4D
MUNSELL #/COLOR TEXTURE DEPTH MUNSELL #/COLOR TEXTURE DEPTH
$ oO” to 7” 10xR Sf} lan Oo” to 9”
T ? To p* ks Ky * 70 73"
AS (22 TO 3 * 70 EZ
Fs Zu" £0 30° 7 _ AS Be tO ge
__£s__ «Sa 80 “0” Ok AS 880 a2"
PRE AY Gwafhl? 40" 20 257 AIR U4 VP be KRE A Gof "43" 00 03"
Es PU (91RYS VP be ES spt t0 ez?
: Ai go" TO. 72 LTRS bam gel Fa 62" 20 777
8G a TO
USDA SOIL SERIES: HPPEO AI p43 aan hs USDA SOIL SERIES: wA7I%EN pt BGS Frayer hS
OBSERVED WATER TABLE: 43” INCHES [ABOVE / @elOW) EXISTING GRADE. TYPE: [PERCHED / APPARENT]
ESTIMATED WET SEASON WATER TABLE ELEVATION: so” INCHES (ABOVE / BELOW] _EXISTING GRADE
HIGH WATER TABLE VEGETATION: [] yes [4] no MOTTLING: [A] YES [ ] NO DEPTH: 40." INCHES
SOIL TEXTURE/LOADING RATE FOR SYSTEM srzInc: “4 f0'6S pepTH OF EXCAVATION: 24 "INCHES
DRAINFIELD CONFIGURATION: [ ] TRENCH tAl BED [ ] OTHER (SPECIFY)
REMARKS / ADDITIONAL RN
RE-
EDOK/ 6 VE FCATURES PB&IERVEO @ GO" jncHea LEtHW
; RWOE hi fYR Ye Wis v7LGR LATIN THE fYR 74 PIATAIR _, Carmen a
OVS ACT Lo
3ITE EVALUATED BY: Piinnkn On deren, AEA S CLAY? onze: IAIULE
eee em A en
2H 4015, 10/96 (Replaces HRS-H Form AO1S {page 3] which may be used) Page 3 of 4
7 ,
STATE OF Font dgsereirr #
TH ‘
DEPARTMENT OF .
“ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM -
EXISTING S¥STEM AND SYSTEM REPAIR EVALUATION
APPLICANT: Ve rag 1¥ KIKTEN Ko
CONTRACTOR / AGENT: Mh Bea rp S EANG SG V/oe
bor: /S BLocK: O44 7 suspiv. “CA/. fEe 7E ID#: 4/2 66 3377 0//
SSS
TO BE COMPLETED By FLORIDA REGISTERED ENGINEER, DEPARTMENT EMPLOYEE, SEPTIC TANK CONTRACTOR OR,
OTHER CERTIFIED PERSON. SIGN AND. SEAT ALL SUBMITTED DOCUMENTS . COMPLETE ALL APPLICABLE ITEMS.
COMPLETE TANK CERTIFICATION BELOW OR ATTACH LETTER FROM A PERMITTED SEPTAGE DISPOSAL SERVICE.
= SES SS SS a Pr
SXISTING TANK INFORMATION
100 ] GALLONS SEPTIC TANK/GPD aTU LEGEND: MATERIAL :COVRC7E BAFFLED :(Y)/ N]
if J GALLONS sEPTic ranK/GppD aru LEGEND: MATERIAL: _ BAFFLED: [Y / N]
[ ] GALLONS GREASE INTERCEPTOR LEGEND: MATERIAL:
{ ] GALLONS DOSING TANK LEGEND: __. MATERIAL: # PUMPS: [ ]
SSS SS
| CERTIFY THAT THE ABOVE NOTED TANKS WERE PUMPED on //4/O9, arve TR VOLUMES SPECIFIED, ARE
STRUCTURALLY § AVE A [CSOLIDS DBFIRCTION DEVICE>/ OUTLET FILTER DEVICE ] INStaTrED.
: AVIA F7 SFP 71 S GRVICE G/E LOFT
JIGNATURE ENSED JONTRACTOR BUSINESS NAME DA’
“GRISTING DRAINFIELD INFORMATION
oo , ’
‘46S } souare rear PRIMARY DRAINFIELD SYSTEM NO. OF TRENCHES { ] Dimensions: /S° x 3v
J SQUARE FEET SYSTEM NO. OF TRENCHES [ -] DIMENSIONS: _ x
'YPE OF SYSTEM: [ STANDARD [ ] FILLED (A] MOUND [ ] :
‘ONFIGURATION: [ ] TRENCH [M4] BED {J
‘ESIGN: [ZX] HEADER [ } D-Box [4] GRAVITY SYSTEM { ] DOSED sysvTEM
MEVATION OF BOTTOM OF DRAINFIELD IN RELATION TO EXISTING GRADE 2.6" INCHES [ ABOVE
YSTEM FAILURE AND REPAIR INFORMATION
2006 ) system INSTALLATION DATE TYPE OF WASTE [>] DOMESTIC [ ] COMMERCIAL
-400 ] GPD ESTIMATED SEWAGE FLOW RASED ON (X] METERED WATER [ ] TABLE 1, 64E~6, FAC
ITE { 1 DRAINAGE STRUCTURES [ }] POOL { ] PATIO / DECK [ } PARKING:
ONDITIONS: [X ] SLOPING PROPERTY { ]
ATURE OF [ ] HYDRAULIC OVERLOAD { ] sorns [ ] MAINTENANCE { ] SYSTEM DAMAGE
AILURE: { ] DRAINAGE / RUN OFF [ ] Roors [ ] WATER Tapiz tj
ALLURE t*] sewace ow GROUND [ ] TANK [ ] D BOX/HEADER [xX ] DRAINFIELD
YMPTOM: {%] PLUMBING BACKUP [ ]
EMARKS/ADDITIONAL CRITERIA
SEP He —_____
JAMITTED By; TITLE/LICENSE fh ROA Cone tenn pare: 7/ 5/39
lar A : 4kKKEY
ATTACHMENT ‘
f e
STATE OF FLORIDA PERMre NO.
DEPARTMENT OF HEALTH .
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FFE PAID. —____
CONSTRUCTION PERMIT meneame
CONSTRUCTION PERMIT FOR:.
J New system I 1] Existing System [ ] Holding Tank [ ] ‘Innovative
[
[A] Repair { ] Abandonment [ ] Temporary ee
APPLICANT: Vi 7A zy AIK TEN KO
EY EATEN KO
property apprrss: 9320 A474 Nve, Frocewves g 74 $422
LOT: 18 BLOCK: 3 $7 SUBDIVISION: POA Sec TF
: [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
PROPERTY ID #: 4*/XOOS3 77 0// [OR TAX ID NUMBER]
ae FON
03-4/-Z0
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 THR APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL, STATE, OR LOCAL PERMITTING
REQUIRED FOR DEVELOPMENT oF THIS PROPERTY.
es weeerectemon
SYSTEM DESIGN AND SPECIFICATIONS
: ATU
t [£00 j catnons / GED SEPTIC TANK MULTI-CHAMBERED/IN-SERIES [Y ] :
AT ] GALLONS / GED . CAPACITY MULTI-CHAMBERED/IN-SERIES [ ]
bane 1 GALLONS GREASE INTERCEPTOR CAPACITY (MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS]
Kf ] GALLONS DOSING TANK CAPACITY [ IGALLONS @ [ ] DOSES PER 24 HRS # PUMPS [ ]
* + $1} Eber
> {700 ] SQUARE FEET REPLACEMENT DRAINFIELD system 233 “ven. £7 O72 mes -/} IV AC &everh
at ] SQUARE FEET SYSTEM
\ TYPE SYSTEM: { ] STANDARD [ ] FILLED [>A] MouND { ]
CONFIGURATION: [ ] TRENCH { AI BED c J
Ct
qT
? LOCATION or BENCHMARK: VXANGE ao7 CL. Altey Rra7 PIL ( S0-08’ Aivat's
; ELEVATION OF PROPOSED SYSTEM SITE [4/3] [INCHES/ET] (ABOVE BELOW] _BENCHMARK/REFERENCE POINT
i BOTTOM OF DRAINFIELD TO BE {/.30] [INCHES/#T] [ABOVE BELOW] BENCHMARK/REFERENCE POINT
ry
) FILL REQUIRED: [ ] INCHES EXCAVATION REQUIRED: [ ] INCHES
1 Kemnve CRMUNG ORATNFIGCY PNTCRIAL PAG Bod! IC/A-7EO SV PO/ES
: © 39 "SINGER 7 KRADG tPA PPV KAM PICA PIE.
t
c PITA OVE0 ORAIN FIEED THR FCA?
s .
Con TRACTOR
IPECIFICATIONS BY:
‘PPROVED BY: CharlotteCHD
TITLE:
saree
ATE ISSUED: EXPIRATION DATE:
—
Se
H 4016, 10/97 (Previous Editions May Be Used) ; Page 1 of 3
)
kK)
EXISTING PROPOSED ITEM
ELEVATION ELEVATION
S260! Se: h0" Plumbing Stub
S230! S2+ op’ tb k Inlet Invert
S224! S$2+24' Tank Outiet invert
(S8-40 S340" Top of Septic Tank
S280 S2./2 "Top of Deana
$/ 30" S780" otiom of Drainfeld
S3-4u,! : S3-ye’ Existing Grade
G7 30 4 730! Swale or Gutter Invert
4-20" OE2O , - Existing G i
48-87! 48-87" ESH.W.T.
Sb-60" 52007 Qo. Re
BENCHMARK LOCATION DR rvae 27 Ye ALLEY Kran? L/e-
60° f AU 6A
BENCHMARK ELEVATION _ S00’ CA )
LIFT STATION? yes *~ No
#
ESH.WT. SEPARATION 27 (in)
e 6 : Page | of 2
Charlotte County _
Property Appraiser |
Real Property Record ©
If a discrepancy is discovered in your property's records, or those of another, please bring it to our attention immediately.
General Parcel Information for 412003377011
pe Parcel (D: 412003377011 eons SE Address: 9320 ANITA AVE
FEMA Flood Zone (Effective 5/5/2003)
[Firm Panet |[ Floodway. ][ SFHA ][ Flood Zone |[_ FIPS COBRA Community || Baye Fon Elevation (ft.
[un |[_1oan |[a20isc [copra our |[ 120061]
O191F Four |{ x |[201sc || copra_our |[__ 120001 _|
*If parcel has more than | flocd zone refer to the flood maps available on the GIS web site by clicking on View Map below. Click here|
for definitions.
For more information, please contact Building Construction Services at 941-743-1201.
Sales Information
[Dts] BootiPage [Sats CoderI[Seting Pre]
711996 _|{1484/538
11/2001 [1974/1152 liMPROVED —|[__$100 |
[énnos |fa737A et VAC-MULTI $100
[672006 |299722 [vacant _|| $100
2009 Value Summary*
| Land imprevemen ts Building = Total
[Cost Approach [$7,309] $6,665|| $220,008 [$234,568] 568
income Approach ss [| — LC | a 500
[Market Approach [dL J WA
[casted Vane ae WA
Preliminary Value Summary,” as of January 1, 2009 *
*Preliminary values within this box are NOT certified (final)
values, Consequently, they can change periodically as records
are updated. Notices of Proposed Property Taxes (TRIM
Notice) are typically mailed mid-August and final values
certified mid-October, Just Value reflects 193.011 adjustment,
Non-School]| Schoo! | [_ Schoo! |
Petes ee —— Just Value: $199,383 Soe ee
Ownership current through: 7/30/2009
2008 Certified Tax Rol) Values, as of January 1,
2008
is]
iy
iu
*Just Value reflects 193.011 adjustment.
ee —
School
(Certified Just Value: $226,899 || $226,899 en)
Coed oe)
[Certified Assessed Value: | Assessed Value: [ $226,899 | [$226,299 | 899
[ns | eas |
http:/Avww.ccappraiser.com/Show_parcel.asp?acet=4 !200337701 1 &gen=T&tax=T&bld=T&oth=T&sal-T&l.., 8/12/2009
f (
Cot @ e Page 2 of 2
Exempt Amount: $0 | $0 [Pretiminary Exempt Amount: IL $50,000|| $25,000
Land Information
sti Land . Unit Unit Table/ Land -
Land Improvement Information
(See rerio id
1320_|[Paving Concrete (sq. Ft.) 1244 2007
1791 ||Residential Cost Walimounts (tow Cost) 2007
Building Information
Buildi i aa —
eS eS es
[1 |[Duplex 2 units i 3.0_|{_ 0800_|[2007][2007][_1 10_|{_ 2266|[ 2266][ 3256
Building Appendage Information Building Component Information
Year
Code! Description Area
[ior ached Gorge S57)
[' | 736 |\Gatage Finish, Attached (SF) | 337 /2o07 9007
Enclosed Porch (SF),
[| 7 Screened Walls 42 07 |, 2007
Enclosed Porch (SF),
| 907 Screened Walls 42 12007 ||2007
[1 foo | Enclosed Porch (SF), (Plumbing Rough-ins (#)
S Slab on Grade (% or SF)
Lega] Description
Short Legal L Legal Description
PCH 074 3467 PORT CHARLOTTE SEC74 BLK3467 LT 15 UNREC WD 1484/538 1974/1152 2597/1231 2737/1161
0015 EAS2997/22
Data Last Updated: 8/12/2009- Printed On: Wednesday, August 12, 2009.
Home @ Send Us Email
(ew i[con| Description id
[Ci [ame [Compostion Shingle |
(i ](S51 Wamet& cooes aed
[| 40109 fern
[| nals Few Gne los]
[1 ]f601 [Piumbing Fixtures (#)
Copyright © 1997-2008 Charlotte County Property Appraiser. All rights reserved.
http://www .ccappraiser.com/Show parcel.asp?acct=4 12003377011 &gen=T&tax=T&bld=T&oth-T&sal=T&... 8/12/2009
Charlie Crist Ana M. Viamonte Ros, M.D., M.P.H.
Governor : State Surgeon General
NOTICE TO APPLICANT
Because of the requirements of chapter 556, Florida Statutes, Underground Facility Damage
Prevention and Safety Act, itis mandatory that this office apply for and recaive a utility locate
for your property prior to performing any site work on your property. it takes a minimum of 2
days, and up to five days to receive a locate ticket and if any of the required information on the
ticket request is incorrect or missing, it will take fonger. We realize this will slow down the
Permitting process. However, it is a necessary aid in preventing serious injury, and potential
Service interruption. Therefore, it is imperative that we have your assistance in this process.
Please ensure you have provided us with complete driving directions to your property, this
must include the closest main intersection. Also, you must indicate anything that might prevent
a locator from performing this service, for example a locked gate, or large dog, To ensure you
have read and understand this notice, please date and sign the bottom of this page and attach
it to your permit application. :
Please note that private utilities are not located during this process. Any electrical.fines
- installed under ground, Sprinkler lines, etc will not be marked by this process. Please indicate
on the site plan any utilities you or previous owners may have installed. The Charlotte County
Health Department is not responsible for damage caused to private property during the course
of our evaluation or inspection process.
, 1/8/09
Sign and ariwW A. Ga FLE~} _
Revised 6/6/07 KASHARED/OSTDS2007
: Charlotte County Health Department « Environmental Health
18500 Murdock Circle, Rm 203 » Port Charlotte, FL 33948-1094
Tel, (941) 743-1266 © Pax (941) 743-1533
Charlie Crist
Governor
Ana M. Viamonte Res, M.D., M.P.H.
State Surgeon General
YorN
Y
Name:_
Title:
PROPOSED SITE INFORMATION
1. Is there any slope to your lot? ;
Slope is the percentage of fall in a specified distance. If the property is flat,
it has no slope. If the property has slope, indicate the direction with
arrows.
2. Are there any public wells within 200 feet of your lot?
3. Are there any existing or proposed wells on ot within 75 feet of your lot?
(Please indicate use, irrigation or drinking)
4. Are there-any lakes, streams, canals, ot standing water, on or within 75 feet .
of your lot? Ifso, you must have the “mean annual flood line” determined
by this office or a certified professional surveyor and mapper with
experience in the determination of flood water elevation lines. If you wish
to have this office determine, initial here . (Chapter :
381.0065(4)(i), Florida Statutes)
5. Are there any easements on your property?
6.. Are there any drainage features (Le. ditches, swales, drainage retention
areas, storm water piping, or interceptor drains, ete.) on, or within 75 feet
of your lot? ; ;
7. Are there any underground utilities located on your property such as
sprinkler lines or electrical lines? :
tern Sepne Ler VICE
Serre lan FRAC 70K
(owner, building contractor, septic contractor, other)
Date: M67 &, 2009
If you marked “Y” next to any of the above questions, please draw and locate on
your site plan(s). _
revised SFO?
10/2f2007 . -KASHARED\OSTDS2007
Charlotte County Health Department « Environmental Health
18500 Murdock Circle, Rm 203 » Port Charlotte, FL 33948-1004
Tel. (941) 743-1266 ¢ Fax (941) 743-1533
Charlie Crist Ana M, Viamonte Ros, M.D., M.P.H,
Governor
State Surgeon General
ATTACHMENT A
EXISTING SYSTEM/MODIFICATION PAIR
INSTRUCTIONS FOR COMPLETING AND SUBMITTING YOUR SEPTIC PERMIT
: APPLICATION
certification (DH 4015, page 4 of 4) that must be submitted to this office with your
application. If your tank(s) have been pumped and certified within the last 3 years, and
you have the proper paperwork, you don’t have to have them pumped again.
2. Site information sheet and application filled out completely, signed and dated.
3. Site plan ~ This is the most important part of your application, please take the time to
ensure you have ail features accurately depicted. The site plan (signed and dated) must .
show exactly what you Propose to do on the site. See below: :
Draw the location, and show dimensions of lot boundaries, You must show building location,
potable and non-potable waterline, any easements, roads, obstructions, wells (on said, and all
adjacent properties), surface water, driveways, walkways, the location of both existing and
Proposed tank(s), and drainfield. In addition to the location, indicate the estimated distance to
all said features. You must show location of any private utilities that have been installed on the
to private property; underground utilities must be indicated to the CCHD so we can take
action to avoid them. This is a safety concern as well as possible interruption of service.
FOR EXISTING OR MODIFICATION PERMITS ;
4. Floor plan — Attach a copy of both the existing, and proposed floor plan for your house,
Mobile or Manufactured home, or business. —-
3. . Permit Fees: Existing system application $180.00 ;
Repair system application $360.00, CCHD site evaluation 525.00
Modification without tank replacement system application $380.00
Modification with tank replacement system application $430.00
(Modifications with CCHD performing sitet existing evaluation add 165.00)
APPLICATION PACKAGES WILL BE CHECKED FOR ACCURACY PRIOR TO ACCEPTANCE,
INCOMPLETE APPLICATIONS CANNOT BE ACCEPTED.
Thave read the above and understand the aforementioned regulations.
18500 Murdock Circle, Rm 203 « Port Charlotte, FL 33948-1094
Tel. (941) 743-1266 # Fax (941) 743-1533
ZL tg g Z
ie
; Fez Wy A GUK CY
i Charlotte County Health Department « Environmental Health
ATTACHMENT
{ (
ome @ @
Receipt Number: R_080480_09082009_6 Encounter# E080480-09082009-0006
Date: 09/08/2009 12:03:46 ,
ENVIRONMENTAL HEALTH Fee Scale: %
18500 MURDOCK CIRCLE Cashier: VLC
PORT CHARLOTTE FL 33948
PHONE: (941)743-1266
.FEDERAL TAX ID#: 593502843
. * CLIENT RECEIPT
Name: 9320 Anita - 09-430RP. : DOB:
Address: . City/State/ZIP:
Previous Balance: $360.00 :
So Vr oF
ve Date Code Provider Amt | Amt | Amt jAmt Due Type
1092 REPAIR NO SE : {|
i 165.60
NO94REPAIRPERMITSEPTIC.OCSCSsC“‘“‘“‘;
B
bat
2
3
[en
re}
y
4
o
fo)
6
<4
Ss
&.
x
rey
Qo
3
Ne}
092 REPAIR NO SE .
vanes | Paes] [ow 8
Amount Received $ 360.00
Amount Paid $ 360.00
Change Given $ 0.00
Current Balance $ 0.00
PAYMENT IS DUE ON THE DAY SERVICES ARE RECEIVED.
Check out our new web site www.CharlotteCHD.com
INVIN2:3rd Party Insurance/MC PY: Payor Fw:Fee Waived
MD: Medicaid CL: . Client ¥R: Fee Reduced
OTH: Other Insurance . CCI%:Client Coinsurance % FI: Fee Increased
ed
. {a aale Address 9320 Anita Ave
. nd Og ; Get Google Maps on your phone
Goc le maps Englewood, FL 34224 Gp ethers MAPS 1466453
Gay
?
. . \ .
: 2329 anita ave englewood fl - Guu, ‘aps @ . Page | of |
|
|
|
|
i
http://mans.google.com/mans?f=a&source=s a&hi=en&geocode=&a=9320+anitatavetenglewood+fl&sll=37.... 8/12/2009
09/08/2009 08:36 FAX { : 003/004
[tp x
cather Guery UOiMas,. a 3.1]
FeNOV2008 ~ <<:
_ 1 OCT-2008
ssp. df ; _e
~ PTAUG-2008
Q222 Anita Aue,
09/08/2009 09:41 FAX
‘QMeter 1 listaryfeathe
Whe 3.710 CUPROLA
“[aTAN-2005
fe-DEC-2008
18-NOV-2008
~~ fel-DET-2008
19-SEP-2008
ARO Anita Aus,
e 6
Charlie Crist Ana M. Viamonte Ros, M.D., M.P.H.
Governor ‘State Surgeon General
September 25, 2009
Vitaliy Kiktenko
9320 Anita Ave.
Englewood, FL 34224
The Department of Health is reviewing open septic permits on repairs for compliance. A
representative of the Department did an inspection of your septic system located at 9320 Anita
Ave., Englewood, FL on _9/25/09_, and discovered that your system is not in compliance with
Florida Administrative Code 64E-6. In order to properly close this permit the following actions
must be completed:
Actions to take
1. Have the drainfield area stabilized by adding sod or Hay and grass
seed, this will prevent the soil from washing away.
- When the above mentioned corrections are completed please call the Department of Health at the
below number so we can inspect the system.
Thank you for your help in this matter, and your time. If we can be of any assistance do not
hesitate to call.
Sincerely,
Shawn E. Wilson
Environmental Specialist II
Charlotte County Health Department
Reference #: 09-430RP
Ce: Martin Septic Service Inc.
. 2308 Tropicaire Blvd
North Port, FL 34286
Charlotte County Health Department » Environmental Health
18500 Murdock Circle, Rm 203 * Port Charlotte, FL 33948-1094
Tel. (941) 743-1266 * Fax (941) 743-1533
_ Revised 2.27.2007 OL ft . Penmit #
~ Installer: Applicant: _
: tems with“ are OK. Items marked with “X” are not OK
Jtems circled giesih Inspection. Items marked with “--” are not applicable, —
Septic Tank N/ATU S| ; Setbacks
01 Capacity: era faiae)
02 [4 [] Material: Conc []FG [] Pol a
03 Outlet device: 90 Sweep [ ] Filter: 29 [ EE] Private Well: __ Ft.
04 Partition Material: Cone [J FG [] Pol H Private. Well 25° Setback to Stem Wal ig
05 Legend: 130-4 FL
06 _{) [] Watertight/ Tamper Resistant Covers/inlet seal 30 [44 Public Well: Ft
07 _{[}-[] Level: . 31 [4-4] Imigation Well: Ft:
08 see filled/mound systems ~_ | 32 [41] Potable Water Lines: Ft..
Dosing Tank (s) / Trash 33 [47[ ] Building Foundation: °°3""_ i
oy -H Capi 34 Prope Lines: /¥
02) ial: \(]Cone Ti FG Tj Poy LSP ¢ of eee ae Parent “Z 94 Ft
BULL tegen Sg ge of Draiffed to Tank ree
- CLO] Pump Types 7 Pan
- CU Floats gi “infield Cover (18
OLE apa . V5 iY TN eae
2. Material -f]Cone—(JFG {jPoy 138 CT
03 Outlet Bl Come LEE LE 1139 fa (f Stbization Material: PSoll[] Hay/seed [TAR |
05 Legeti [40 py Titres: PT Drives
f Drainfield (s) \ 40,1 Unpbstructed Area
vB 7a WE Oa aes sgh ATE 1S Ware Cosas TO
TOM by ede [jase ox ae Ge
Tf | Number of drainlines: PF BA7 «42 TL] Ando and Visual Alarm
12 rainline separation ; 43 Annual Operation Permit
—B drainline slope (1” per 0} ] i g
15 Elevation / ¢'’ Ft.[Above]/[Bwkew] BM 44 | Building Area
16 7T | System Location: P{As Permitted [ |No sessile plan | ampling Port
47{Y{ | Contractor MAavie
“148 [4 ] # of MPS —[4¥] Bundles oy
18 & 21 FT] Aggregate:
) gprepate Washed/Ciean
. : 48 EF ot Ca “FE J8q. %
; . Type: Eq 36 Bio 3 Other:
Fill / Excavation Material
22 Fil Amount : :
23 (4 [] Texture fdonment
w (Y [] Excavation Depth ‘Rumpe
Excavation Area S0{l []Ts
3 Oe
Midpoint Not ot OK/ OK Date: «Bed: Nott _— Ge _ Dates — inte
Midpoint K /OK . Date: . Bed: Not OK /
. Final Not OS) au —4e7 Date axe Final Not OK
sy
_ Final Approval AHEEET specialist POW AGA. Date: a
py
' Fastin <7
[ ]Gutters [ ]Gutters
IMA &OP |[]MA& OP [IMA&OP |[}]MAgeop |
] f]. - 1
[
[YOK Yt Joker"
[ INotOK |{ JNotOK | INotoK
Additional Information
Note:
clean up after a discharge will) result i ina a $50. 00 charge which will be. added to the monthly bill.
Discharge hours are 24 hours/7 days a week.
: 3. All information requested on this and any ‘other form mast. be complete and accurate without exception.
4: iti As very important when the grease switch is ON and you have completed unloading ‘that you u turn your key OFF
and get a receipt before turning the switch back to REGULAR. -
; ; a ae COMPOSITE
x : ok . ey ; ATTACHMENT E
WHITE-CCU YELLOW-HAULER | PINK-HEALTH DEPT. 03/13/03
merrier tT.
ware nett a VRILOW-HAULER’ .- / - ",” PINK-HEALTH DEPT, ee pate
Oo dele deta de ede ae te ak
1. Failure to clean " after a discharge will Fesult i a $50.00 charge which will be added to the monthly bill.
2. Discharge hours are 24 ‘hours/7 days a week.
3.. All information requested on this and any ‘other form must be complete and accurate without exception,
4. Itis very important when the grease switch is ON and you have completed unloading that you turn your key OFF
‘and get a. receipt before turning the switch back to REGULAR. :
rn mY
WHITR-CCU -YELLQW-HAULER . PINK-HEALTH DEPT. "93/13/03: ©
. Truck Ca PINK-HEALTH DEPT.
. Failure to clean up after a discharge will result i in a 2 50. 00 charge which will be added ‘to the ‘inonthly bill.
ge
Discharge hours are 24 hours/7 days a week. . ; a : - : a
All information requested 01 on this and any other form must be complete and s accurate without exception. :
It i is very. important when the grease switch is ON and you 1 have completed unloading that you turn your key OFF ...
and get a receipt before corning the switch back to REGULAR. Te ae
WHITRICOIT “* YELLOW-HAULER. -. > PINK-HEALTH DEPT. nanaina®
‘L. Failure to clean up after a discharge will resultin a $50.00 chatge which will be added to the monthly bill.
2. Discharge hours are'24 hours/7 days a week.
3. All information requested on this and any other form must be complete and ‘accurate without exception.
4, Iti is very important when the greasé switch is ON and you have completed unloading that you turn your key.OFF
and get a-receipt before turning the. switch back to REGULAR. :
WHITE-CCU YELLOW-HAULER
03/13/03 -
Iti is very important when the grease ewiteh i is ON. and you have comple
and get a: + receipt before turning the switch back‘ to REGULAR,
WHITE-CCU . YELLOW-HAULER Bn ALTH DEPT. ; 03/13/03
Charlotte ‘County Utilities
Tim Arrived
Discharge Permit 4,
“witrricc = eo “YBLLOW-HAULER" \ "° PRNK:HEALTH DEPT.
SEPTIC |
WHITE-CCU . YELLOW-HAULER : PINK-HEALTH DEPT. . Laai3i03
‘iat : a 2 |
Note: .
h
‘1, Failure to clean up after a discharge will result in a $50.00 charge which will be added to the monthly bill. F
4. It is very important when the grease switch is ON and you: have completed unloading that you turn your key 0 OFF.
: “and get a receipt pefore: turning the sch back to REGULAR. . ny
Dee Aur rete ep. PINK-HRATTH DEPT. 20-7) narnia
Charlotte County Utilities
—. "In-County" |
Transport Waste Hauler Manifest
TYPE OF DISCHARGE:
. eosin iootiadiaitisioot tion ia nicki ibniaciodi io ica a ia aR a
. “
Note: a — ;
ee Failure to clean up after a discharge will result in a $50.00 charge which will be added to the monthly bill.
2, Discharge hours.are 24 hours/7 days a week.
3. All information requested on this and: any ‘other form must be complete and accurate without exception.
4. Itis very imp ortant when | the grease switch i is ON and you have completed unloading ¢ the it you turn your key OFF
and get a receipt before tarning the switch hack to ‘REGULAR.
vIny URATTU-NEDT fa
* sree nae
tr
Failure to clean up after a discharge will result i ina 850. 00 charge ¥ which will be added to the monthly bill.
Discharge hours are 24 hours/7 days a week,
All information requested 0 on this and any other form must be complete. and accurate without exception.
Iti is very. important when the grease switch is ON and you have completed unloading that you turn your key OFF
and get a receipt before turning the ‘switch back to REGULAR.
WHITE-CCU YELLOW-HAULER . PINK-HEALTH DEPT. 03/13/03
Docket for Case No: 10-000041PL
Issue Date |
Proceedings |
Feb. 15, 2010 |
Order Relinquishing Jurisidiction and Closing File. CASE CLOSED.
|
Feb. 15, 2010 |
Settlement Agreement filed.
|
Feb. 15, 2010 |
Motion to Relinquish Jurisdiction filed.
|
Jan. 21, 2010 |
Order of Pre-hearing Instructions.
|
Jan. 21, 2010 |
Notice of Hearing (hearing set for March 5, 2010; 9:00 a.m.; Port Charlotte, FL).
|
Jan. 21, 2010 |
Request for Copies filed.
|
Jan. 14, 2010 |
Petitioner's Request for Production of Documents to Respondent filed.
|
Jan. 14, 2010 |
Petitioner's First Set of Interrogatories to Respondent Martin Guffey filed.
|
Jan. 14, 2010 |
Petitioner's Request for Admissions filed.
|
Jan. 12, 2010 |
Petitioner's Notice of Production from Non-party filed.
|
Jan. 11, 2010 |
Joint Response to Initial Order filed.
|
Jan. 06, 2010 |
Administrative Complaint filed.
|
Jan. 06, 2010 |
Respondent's Answer to Administrative Complaint and Petition for Administrative Hearing and Appeal filed.
|
Jan. 06, 2010 |
Notice (of Agency referral) filed.
|
Jan. 06, 2010 |
Initial Order.
|