STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, \6 - 30 ga Petitioner vs. CASE: 43- 2015-00001 BRIAN DAVIS MARTIN COUNTY AND BRIAN DAVIS SEPTIC & BACKHOE SERVICE, INC. Respondent. / ADMINISTRATIVE COMPLAINT NATURE OF THE CASE |. This case arises from Respondent's gross negligence, incompetence or misconduct when his company improperly installed onsite sewage treatment and disposal systems (OSTDS) as mandated by applicable sections of the Florida Statutes, 381, and Chapter 64E-6, Florida Administrative Code. 2. YOU ARE HEREBY NOTIFIED that this is an administrative action for the imposition of administrative fines for each violation as authorized in Section 381.0065(4), Florida Statutes and the Department shall request a 90 day suspension or revocation of Respondent's OSTDS Master Contractor’s license no. $M0021413 and Business Authorization no. SA 0021078. FACTUAL ALLEGATIONS AS TO ALL COUNTS 3. 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 (F.S.), and its rules under the Chapter 64E-6, Florida Administrative Code (F.A.C). 4. Respondent is the owner and Master Septic Contractor for Brian Davis Septic and Backhoe Services, Inc. The Respondent was contracted to install new OSTDS systems at five (3) separate locations in Martin County. COUNT I PERMIT NUMBER 43-SS-1531381 3. On or about July 8, 2014, Respondent's office called for the initial inspection of a new OSTDS installation at 3773 NE Barbara Drive, Jensen Beach, Florida. A copy of the permit is attached and incorporated herein as Exhibit “A”. 6. On July 8, 2014, Department's inspectors, Todd Reinhold and Randolph Ball. visited the site for the initia! inspection, Upon measuring the lot, it was determined that the temporary property markers on the southwest side were not in the correct location. The inspector dug and located the official concrete property marker which showed the temporary property marker was erroneously placed at the southwest corner of the property, two (2) feet closer to the road than the actual property line. 7. The Special Conditions for the permit required the drainfield to be at least five (5) feet from property lines. However the concrete marker showed the drainfield was installed with only a three (3) feet setback from the front property line, in violation of the permit. 8. The surveyor of the property stated he had placed the stakes in the proper location next to the permanent markers. This statement was substantiated by the fact that the markers and stakes were correctly noted on the surveyor’s site plan. Consequently only the Respondent would have benefited from the moving of the stakes to make it appear he complied with the required five (3) foot setback to the property line. 9. The Inspectors also found the drainfield installation was too shallow. The system had been permitted for a much deeper drainfield. A shallow drainfield is only used for a mound or filled drainfield system, which is not what had been permitted. Thus, once again, the Respondent failed to adhere to the permit’s requirements. 10. On or about July gt 2014, Todd Reinhold had a conversation with the Respondent regarding the failed inspection. The Respondent admitted he had installed the system by measuring from the house: in violation of the permit requirement that it be from the property lines. The Respondent also, did not follow the elevation requirements set forth in the permit. This violation, nullified the permit by changing the dimensions of the septic system. The Respondent stated he used a stub out to set the drainfield elevations. However, the permit required this be done from the benchmark. 11. As a state certified OSTDS master contractor, the Respondent is mandated to perform all installations per F.S., 381, and Chapter 64E-6, F.A.C. 12. The Respondent violated Section 64E-6.005(2), 64E-6.004(3)(a), F.A.C. by failing to adhere to the permit’s setback requirements and elevations levels. 13. The Respondent violated 64E-6.022(1)(1), F.A.C.. Standards of Practice, as these violations demonstrate gross negligence, incompetence and misconduct which has caused no monetary or other harm to a customer or physical harm to any person, subjecting himself to a fine of Five Hundred Dollars ($500.00). l4. The Respondent’s violated 64E-6.022(1)(p). F.A.C., Standards of Practice, by installing an onsite sewage treatment and disposal system in violation of the standards of Chapter 641-6, and subjecting himself to a fine of Five Hundred Dollars ($500.00). 15. The Respondent corrected the installation violations. The inspector returned to the site for a second inspection on July 14, 2014 and approved the system. COUNT 2 PERMIT NUMBER 43-SS-1522497 16. On or about July 28, 2014, Respondent's office called for the initial inspection of a new OSTDS installation at $350 SE Pine Avenue, Stuart, Florida. A copy of the permit is attached and incorporated herein as Exhibit “B”, 17. On July 28, 2014, the Department's inspector, Nick Clifton, visited the site for the initial inspection. Upon measuring the lot, he found the drainfield two (2) feet from the back property line. 18. The Special Conditions for the permit required the drainfield must be at least five (5) feet from property lines. 19, As a state certified OSTDS master contractor, the Respondent is mandated to perform all installations per F.S. 381, and Chapter 64E-6, F.A.C. 20. The Respondent violated Section Chapter 64E-6.005(2), F.A.C., by failing to adhere to the permit’s setback requirements. 21. The Respondent violated 64E-6.022(1)(I), F.A.C., Standards of Practice, as this violation demonstrated incompetence and misconduct which caused no monetary or other harm to a customer or physical harm to any person, subjecting himself to a fine of Five Hundred Dollars ($500.00). 22. The Respondent’s violated 64E-6.022(1)(p), F.A.C., Standards of Practice, by installing an onsite sewage treatment and disposal system in violation of the standards of Chapter 64E-6, and subjecting himself to a fine of Five Hundred Dollars ($500.00), 23. The Respondent corrected the installation violations. The inspector returned to the site for a second inspection on July 31, 2014 and approved the system. COUNT 3 PERMIT NUMBER 43-SS-1511592 24. On May 23, 2014, Respondent’s office called for an abandonment inspection of an old septic tank at 909 SW 34" Street, Palm City, Florida. The Department’s inspector, Ray Cross, observed the Respondent’s crew working on the installation of the new OSTDS. The system’s location did not seem correct. A copy of the permit is attached and incorporated herein as Exhibit “C”. 25. Ray Cross asked the crew for a copy of the permit, but the crew did not have.a copy onsite. Nevertheless, Mr. Cross determined that the crew was placing the tank and drainfield in the wrong location from the approved permit location, resulting in the wrong setbacks for the side and rear property lines and wrong elevations. 26. Ray Cross stepped the work on site, to avoid any further violation by the Respondent of Chapter 64E-6, F.A.C. 27, On May 30, 2014, after the Respondent made the correction to the installation, Todd Reinhold conducted an official inspection. The system failed the installation inspection, as the ends of the drain lines were not connected. 28. The Respondent violated 64E-6.014(5)(i), F.A.C., which requires drain field lines be connected to produce a continuous circuit. The ends of the two drainfield lines were not connected. 29. As a state certified OSTDS master contractor, the Respondent is mandated to perform all installations per Florida Statutes, 381, and Chapter 64E-6, F.A.C. 30, The Respondent violated 64E-6.022(1)(1), F.A.C., Standards of Practice, as this violation demonstrates gross negligence and incompetence which has caused no monetary or other harm to a customer or physical harm to any person, subjecting Respondent to a fine of Five Hundred Dollars ($500.00). 31. The Respondent's violated 64E-6.022(1)(p), F.A.C., Standards of Practice, by installing an onsite sewage treatment and disposal system not in keeping with the permit in violation of the standards of Chapter 64E-6, and subjecting himself to a fine of Five Hundred Dollars ($500.00). 32. | The Respondent corrected the installation violations. The inspector returned to the site for a second inspection on June 5, 2014 and approved the system. COUNT 4 PERMIT NUMBER 43-SS-1537606 33. On July 21, 2014, the Department’s inspector, Nick Clifton, was onsite for an inspection of a new system at 807 SW 28" Street, Palm City, Florida. The construction of the system was approved and held for final grade of the installation and the construction of the house. A copy of the permit is attached and incorporated herein as Exhibit “D”. 34. On October 22, 2014. the inspector was in the area and witnessed Respondent's crew onsite installing a new tank. The original tank was crushed during construction of the house. As a result, the crew moved the tank’s location to the opposite side of yard. The inspector proceeded to inspect the tank, approve the setbacks, and documented the new location. 35, On December 12, 2014, the inspector returned to verify the drinking water well setbacks, but was unable to locate the tank from his newly documented location on October 22, 2014. The inspector probed the area and finally locates the tank in a different location. The inspector contacted the general contractor, Jeremy LeMaster and the Respondent, and confirmed that the septic tank had been moved to new location. 36. The Respondent violated 64E-6.022(1)(d), F.A.C., Standards of Practice, by failing to call for the required inspections of a relocated septic tank in violations of Chapter 64E- 6, F.A.C., and subjecting him to a fine of Five Hundred Dollars ($500.00). 37. The Respondent violated 64E-6.022(1)(k), F.A.C., Standards of Practice, by practicing fraud and making untrue representations by covering the tank without notifying the department of the change in location, failing to submit the required paperwork, and failing to obtain an inspection in violation of Chapter 64E-6, F.A.C., subjecting himself to a fine of Five Hundred Dollars ($500.00). 38. On December 22, 2014, the general contractor called for a final grade inspection, but the inspection failed due to the tank being in a new location. 39. On December 30, 2014, inspectors, Randolph Ball and Ray Cross, were onsite to reinspect the septic tank. The new location was documented, but they were unable to-complete the visual inspection as the tank was full of water, COUNT § PERMIT NUMBER 43-SS-1537619 40. On July 21, 2014, the Department’s inspector, Nick Clifton, was onsite for an inspection of a new system at 797 SW 28th Street, Palm City, Florida. The construction was approved and held for final grade of the installation and construction of the house. A copy of the permit is attached and incorporated herein as Exhibit “E”, 41. On October 22, 2014, the inspector was in the area and witnessed Respondent's crew onsite installing a new tank. The original tank was crushed during construction of the house. As a result, the crew moved the tank location to the opposite side of yard. The inspector proceeded to inspect the tank, approve the setbacks, and documented the new location. 42. On December 12, 2014, the inspector returned to verify the drinking water well setbacks but was unable to locate the tank from his newly documented location on October 22, 2014. The inspector probed the area and finally locates the tank in a different location. The inspector contracted the general contractor, Jeremy LeMaster and the Respondent, and confirmed that the septic tank had been moved to new location. 43. The Respondent violated 64E-6.022(1)(d), F.A.C., Standards of Practice, by failing to call for required inspections in violations of Chapter 64E-6, F-A.C., subjecting him to a fine of Five Hundred Dollars ($500.00). 44. Respondent violated 64E-6.022(1)(k), F.A.C., Standards of Practice, by practicing fraud and making untrue representations by covering the tank without notifying the department of the change in location, failing to submit the required paperwork, and failing to obtain an inspection in violation of Chapter 64E-6, F.A.C., subjecting himself to a fine of Five Hundred Dollars ($500.00). 45. On December 22, 2014, the general contractor called for a final grade inspection, but the inspection failed due to the tank heing in a new location. 46. | On December 30, 2014, inspectors. Randolph Ball and Ray Cross, were onsite to reinspect the septic tank. The new location was documented and the inspection was completed satisfactory. Request for Relief Wherefore, Petitioner, Department of Health, respectfully requests that this tribunal mandate the Respondent pay a fine of Five Hundred Dollars ($500) for each of the two violations of law for each of the five (5) separate counts. The total fine to date is Five Thousand Dollars ($5,000). The Department shall request a 90 day suspension or revocation of Respondent’s OSTDS master contractor’s license $M0021413. Done this _ 14. day of March 2015. ‘idosia Lidunoe- [fly Victoria Coleman Miller, Esquire Chief Legal Counsel Department of Health Bar No. 0721417 800 Clematis Street West Palm Beach, FL 33401 (561) 671-4007 or Fax (561) 837-5195 CERTIFICATE OF SERVICE Thereby certify that a true and correct copy of the foregoing was delivered by UPS AWB # LZ $0 70 A 1) 4325 to Brian Davis and Brian Davis Septic and Backhoe Services, Inc., 7200 84" Ave, Vero Beach, FL 32967 this. day of March 2015. Dyetoh Li nyy fefe Victoria Coleman Miller, Esquire Notification of Rights 1. Ifyou wish to pay the fees and settle this case, you must contact Janet McCullough, Administrative Assistant, at Martin County Health Department, Environmental Program, phone number 772-221-4090. 2, The Respondent is hereby given full notice of this agency action. Unless a request for a hearing is received within twenty-one (21) days of receipt of this Complaint, the administrative fines in this complaint become immediately effective and final. If the Respondent fails to request a hearing within the time allowed, or fails to appear at any scheduled requested hearing, the Respondent has waived the right to contest the complaint and this complaint becomes a Final Order of the Department of Health requiring the imposition of administrative fines. 3. The Respondent has the right to request an administrative hearing to be conducted in accordance with Sections 120.569, and 120.57, Florida Statutes, to be represented by counsel or other qualified representative, to present evidence and argument, and if an evidentiary hearing is held, to call and cross-examine witnesses, and to have subpoenas and subpoena duces-tecum (production of records) issued on his behalf. 4. All hearing requests shall contain the following information: a. The name address and telephone number of the Respondent named herein. b. The name address and telephone number of the Respondent's representative, if any. c. The name and address of the Agency and references to any notice, order to show cause, administrative complaint, or other communication that the Respondent has received from the Department of Health and the date it was received. d. A statement specifying all issues of material fact, which the Respondent disputes, or a statement that the Respondent does not dispute any of the issues of material fact alleged in the administrative complaint. e. An admission or denial of each factual matter alleged in the administrative complaint. f. A demand for relief. g. A short statement of why the Respondent is entitled to the relief sought including cach relevant affirmative defense the Respondent may have and the applicable Florida Administrative Codes and Florida Statutes that entitle the Respondent to the relief. 5. Mediation is not available as an alternative remedy. 6. All Requests for Hearings shall be made by providing the above information in a legible manner on a white 8% by 11-inch piece of paper and sending the Request to: Department of Health, c/o MCHD Legal Department 3441 SE Willoughby Blvd. Stuart, Florida 34994 Attention: Victoria Coleman-Miller, Esq. 772-221-4090 Fax 772-221-4967 7. This administrative complaint is issued pursuant to Section 120.57 Florida Statutes. Any proceeding concerning this complaint shall be conducted pursuant to Chapter 28-106, Florida Administrative Code. 8. A party who is adversely affected by a final order 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 District Court of Appeal in the appellate district where the party resides or the First District Court of Appeal. The notice must be filed within 30 days of the rendition of a final order. 9. All Final Orders shall be recorded at the County Clerk of Court against the property’s title. ay _ EXHIBIT A... axseuone > > APPLICATION #: AP1142318 @\ STATE OF FLORIDA iB, : | DEPARTMENT OF HEALTH DATE Paes if] ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID: CONSTRUCTION PERMIT RECEIPT 6: pocusent #: PR937524 CONSTRUCTION PERMIT FOR: OSTDS New APPLICANT: (Medalist Building Group) —_— PROPERTY ADDRESS: 3773 NE Barbara Dr Jensen Beach, FL 34957 LOT: 120 BLOCK = SUBDIVISION: Skyline Heights 1st Addn PROPERTY ID #: 1837-44-01 (SECTION, TOWNSHIP, RANGE, PARCEL NUMBER) © 4537744-014-000-01200-7 oR TAX ID NUMBER] SYSTEM MUST BE CONSTRUCTED rn ‘ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION 381.0065, F.S., AND CHAPTER 648-6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOBS NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. Atty 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 DO£S NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL, STATE, OR LOCAL PERMITTING NG REQUTRED FOR DEVELOPMENT OF THIS PROPERTY. SYSTEM DESIGN AND SPECIFICATIONS tT $00 1 GALLONS / GPD Seoter Tank CAPACITY Al ] GALLONS / GPD CAPACITY NI ] GALLONS GREASE INTERCEPTOR omar {MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] KI ] GALLONS BOSING TANK CAPACTTY t }GALLONS @[ }DOSES PER 24 HRS #Pumps [ ] D ( 375 | SQUARE FEZT installed m trenches only _ SYSTEM R ] SQUARE FEET NIA SYSTEM A TYPE SYSTEM: [x] STANDARD { ] FILLED [ ] MouND tJ I CONFIGURATION: [x] TRENCH { ] BRD t) x FP LOCATION OF BENCHMARK: MAG NAIL/WASHER @ 29.28FT NGvD T ELEVATION OF PROPOSED SYSTEM SITE { 6.00 T{axcues Y FT } {Lapove } BELOW |RENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE 1 24.00 1 I[mucues} FT 1. a80ve [BELOW ) BENCHMARK/REFERENCE POINT L D PILL REQUIRED: {0.00} mNcHES EXCAVATION REQUIRED: [ ]_ tNcHES The system is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total estimated flow © fof 300 gpd. The licensed contractor installing the system is responsible for installing the minimum category of tank and T |drainfieid in accordance with 3. 84E-6, FAC. Be aware that sloping of the land from the northeast to the southwest may a effect the drainfield grading g [See attached general and special conditions lists. R SPECIFICATIONS BY: Nicholas L Clifton TITLE: gavironmental Specialist If eee APPROVED BY: ben, veX TITLE: Environmental Specialist 13° Martin cHD Serer pide diaienshineddeacana niananenastaiaeene anny DATE ISSUED: 04/24/2014 EXPIRATION DATE: 10/24/2015 DH 4016, 08/09 (Obsoletes all previews aditions which may not be used} incorporated: 64£-6.003, FAC We Rick Scott Minalon: Governor Tp promt porno & irocove hs heal people in Florda trough integrated race state, County 4 community afforts, aaah =p intel -deeyy tare aan 5 ‘Vision: To be the Healthiest State in the Nation = 3 <5 . % i+ 8 ‘ = “3 ze ( ‘y xaos <3 Y <2 roe SE <3 we fad LLL « No EXHIBIT _0_ permr? #: 43-SS-1522497 APPLICATION #: AP1136649 STATE OF FLORIDA DEPARTMENT OF HEALTH DATE PAID: ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM PEE PAID: CONSTRUCTION PERMIT peceret +: VAR (AN oO pocuan? #: PR933803 CONSTRUCTION PERMIT FOR: OSTDS New APPLICANT: (Medalist Building Group) PROPERTY ADDRESS: Old Lots 5 SE Pine Ave Stuart, FL 34994 Lot: SeeAttachedLe BLOCK: 2 SUBDIVISION; Hibiscus Park Sec. 1 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] PROPERTY ID #: — §4-38-41-001-002-00080-5 [OR TAX ID NUMBER] SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION 362.0065, F.S., AND CHAPTER 645-6, 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 PURMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL, STATE, OR LOCAL PERMITTING & REQUTRED FOR DEVELOPMENT OF THIS PROPERTY. SYSTEM DESIGN AND SPECIFICATIONS T{ 1,050} GALLONS / cep Sent Tank CAPACITY Aft ] GALLONS / GRD CAPACITY we } GALLONS GREASE INTERCEPTOR cane [MAXIMUM CAPACITY SINGLE TANK:1250 GALLOWS] KI ] GALLONS DOSING TANK CAPACITY [ }GALLONS @{ }DOSHS PER 24 HRS = #Pumps [ of 500 ] SQUARE FEET installed in trenches SYSTEM RE }) SQUARE FEET NA SYSTEM A TYPE SYSTEM: { ] STANDARD [ | FILLED bk MOUND of ] I CONFIGURATION: [x} TRENCH [yee of) N & LOCATION OF BENCHMARK: CA. AND P/L BETWEEN LOTS 4 & 5, ELV. 18. 54FT NGVD = 40° I ELEVATION OF PROPOSED SYSTEM SITE { 10.00} FT ] [ ABOVE BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE t 6.00 1(Lawcnes} Ft 1 ((asove } 2EL0W jBENCHARK/REFERENCE POINT L D FILL REQUIRED: (34.00) INCHES BXCAVATION REQUIRED: [ 60.00] INCHES VARIANCE. 12539 %*% The contractor has an option of installing a 500 sqft or larger df. bed. gt |The system is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total estimated fiow of 300 gpd. The licensed contractor installing the systern is responsibte for installing the minimum category of tank and dramnfield in accordance with s. 64E-6, FAC. Lot #4 and #7 must be filled to the fill required above along site of the df. on x lots 5 & 6 prior to the construction visit. k See attached general and special conditions tists. SPECIFICATIONS BY: wicholas L Clifton TITLE: povironsental Specialist TL etme nner APPROVED BY: caus ibs TITLE: Environmental specialise /5. 79” Martin cup Ray R Crowe DATE ISSUED: 06/24/2014 EXPIRATION DATE: 12/24/2015 DH 4016, 08/09 (Obsoletes all previous editions which say not be used) Incerporated: 64£-6.003, FAC Page of permit #:43-S8-1522497 APpLication #: AP 1136649 STATE OF FLORIDA DEPARTMENT OF HEALTH PATE PAID: ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID: CONSTRUCTION PERMIT S vr RECEIET @: $ pocumanr #: PR933803 CONSTRUCTION PERMIT FOR: OSTOS New , py APPLICANT: (Medalist Building Group) aM é PROPERTY ADDRESS: Lots 5&6SEPineAve Stuart, FL 34904 LOT: Sand6 BLOCK: 2 SUBDIVISION: Hibiscus Park Sec. 17) gt _Z PROPERTY ID #: §4-38-41-001-002-00050-5 2 ee ran nner oct : =o pooner SYS:EM MUST BE CONSTRUCTED TN ACCORDANCE WITH Ions / AND STANDARDS oF SECTION 361.9C65, #.S., AND CHAPTER 642-6, F.A.C. DEPARTMENT OF SYSTEM DOES NOT GUARANTEE ANY CHANGE IN MATERIAL FACTS, REQUIRE THE APPLICANT TO MODIFY THE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT APPLICATION. SUCH MODIFICATIONS MAY RE: PERMIT BEING MADE NULL AND VOID. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE, i FROM COMPLIANCE WITH OTHER FEDERAL, STATE OR LOCAL PERMITTING NG REQUIRED FOR DEVELOPMENT. ii S PROPERTY. SYSTEM DESIGN AND SPECIFICATIONS. Tf 900) GALLONS / cpp eptic Tank CAPACITY At } GALLONS / GpD NIA CAPACITY Rt ] GALLONS GREASE INTERCEPTOR CAPACITY MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K ] GALLONS DOSING TANK CAPACITY l GALLONS a }DOSES PER 24 ERS = #Pumps_[ } Bf 375 1 SQUARE FEET installed in trenches SYSTEM RE ] SQUARE FEET NIA SYSTEM A TYPE SYSTEM: ( } STANDARD | ) FILLED fk) MOUND of} I CONFIGURATION: [x] TRENCH { A BED t] Fi F LOCATION OF SENCHMARK: Ci. AND BAL BETWEEN LOTS 4 85, ELV. 18.54FT NGVD = 40" I ELEVATION OF PROPOSED SYSTEM ST { 10.00) Vee FT ] | ABOVE { BBLOW) BENCIMARK/REFERENCE POINT # BOTTOM OF DRAINFIELD TO BE t 6.00 1i{incwes} fT 1 (apove ) BELOW ]BENCHMARK/REFERENCE POINT u gut 69” D FILL REQUIRED: (34.001 Gucres EXCAVATION REQUIRED: [ ] INCHES x The contractor has an option of installing @ 500 sqft or larger df. bed. drainfield in 1 accordance with s 64E-6, FAC. x Lot #4 and #7 must be filled to the fill required above atong site of the df. on lots 5 & 6 prior to the construction visit. Seu attached general and special conditions lists. R SPECIFICATIONS BY: Wicholas L Clifton TITLE: Environmental Specialist 11 ae ete _caneneeerenntnanmeeininiiniinantiiiininaatininamamennmnnenisasaneaniiiiiissitimmmmaanmsiliiNiiNiiiibNiiii APPROVED BY: 2 a. f BS TITLE: Environmental Specialist 7. Oy aL Martin cHD Ray R Cross es DATE ISSUED: 03/21/2014 EXPIRATION DATE: 09/21/2015 DH 4016, 08/09 (Obsoletes ali previous editions which may not be used) Incorporated: 64E-6.003, FAC WA f 3 os ioe Ma REGS Shoo eeih * Mteslon: tse sas sma wo ca in Florkts though intageatad state, county & community effets. ‘sam Sonaon Covert Sacey ‘Wiahon: To be the Healthieal State in tw Nation SEATIC SYSTEM GENERAL CONDITIONS LIST PERMIT 43-88 4) ¢ w + if the minimum fnished floor foundation elevation (F.F.F.E.) Js below the drainfeld Milled elevation of 34 inches (above orginal grade _| 7 F 2), please contact this office to determine possible setback changes from the drainfleld (setback ie. calculated by adding 4:1 slope, 4-foot shoulder and possible berm), Additionally, if the only. * For single-family homes, if the roof drip line js within § feet of the drainfield, shoulder or slope and the roof drains toward the septic system, gutters are required. « Septic system must be installed in unobstructed area as shown on the approved site plan. Alteration of the Information or conditions of thle parmit found to be in non-compliance will be sufficient cause for revocation of this permit. if any information on a permit changes, an arnended application and $50 review fee must be submitted to our office . Future ponds or surtace water created onsite must be greater than 75" from septic system. * The mound area must be sodded prior fo a request for final gradé inapection. « Nor-potable irigation lines must be separated from the drainfield by two feet unless an approved backiow prevention device ls properly installed. « A $75.00 re-inspection fee la required if violations are found during the saptic system inspection. * if an Inspector does not witness the work conducted during @ septic abandonment, the contractor must submit a statement that the work was completed. + if a professional engineer designe the septic system, the engineer must certify that the installed system complies with the design and Installation requirements, » For commercial operations, occupational approval will not be given until all requirements for an onsite public. water syatem, food operation or institutional establishment are met. ADDITIONAL CONDITIONS LIST —Speciat conditons marked “* are in effect 1. Driveway and sidewalk elevation must be at least 6° higher than the top of the drainfield elevation. The driveway cannot be constructed within 4 feet of the system's available area. 2: Prior to final construction approval, the property owner must apply for an operating permit and pay the §. Annual Permit Fee (For ___Indust/Manuf. ___ Aerobic System __. Commercial System __ Performance-Based). Excavation requirements: (Note: Excavation refera to removal of natural or existing soils, not pad fill) , 70! re bo" 17 Tout 1. one foot beyond drainfleld area to.a dapth of | __. inches below natural/ existing grade elevation of 7 * NG.WD. | Assumed, In addition to tem #1, 33% of unsuitable soils at depths grester than inches below Fi amet above muat be removed to a depth of slightly limited salts. 2. If the proposed drainfleld la io be installed within 10 feet of a building foundation or swimming pool structure, the four-foot , Grainfleld shoulder must be filled with suitable soils prior to building construction. __“_ 3. if'a mound + filed drainfietd Is proposed, see folowing akatch. An anginger’s design Is required if @ retaining wall Is propose within the drainflaid slope aress of a mound system. No boulders or trees are allowed within the drainfield or drainfield should: area. Applicant ls responsible for replacing excavated solls with a good grade of soll suitable for drainfield installation. y ; Ree Cope bs 9/1 faek See Reverse Side for Mound or Filled Drainfleld Requiremern Completed By Date Heath 3441 SE Willoughby Boulevard « Stuwt, FL 34904 Fi PHONE: 772/221-4090 « FAX 772/221-4967 YOUTUBE: doh wee SFE fo Fl up fe TA 4g Pl DRAINFIELD MOUND OR FILLED SYSTEM REQUIREMENTS DRAINFIELD DRAINFIELD SHOULDERS DRAINFIELD SHOULDERS House e— 4 iy» WIOTH Fle Pad Fill dA LP — Whiln LEE SOTLLIIZ. — NATIVE\JNFILLED SOIL Note: Soil cover over the drainfield should be slightly limited soil, the same as used on sides and under the drainfield. Moderate Fill amount required as specified on perm PROPERTY LINE limited soil may be use. \specialcondtnew ravised.doc. ravigad 7/22/04 Gevernar Te protec pone b pee he hea pacpia ns Fora fveugh ntayrated Joha 4. Armatrong, MB, FAGS sate, county & community efor Ant -aaneys_ irr aban Viadow: To be he Heathiont State in the Nation SEPTIC SYSTEM SPECIAL CONDITIONS FOR PERMIT 43-s¢-_/O 22497 The licensed contractor installing the system /s responsible for Installing the minimum category of tank in accordance with s. 64E-6.01K3K(0, FAC. ____ CONDUCT SOIL BORINGS DURING INSPECTION TO VERIFY SOIL TYPE AND WATER TABLE FROM OTHERS. _1/ FILL REQUIRED NOTED ABOVE MUST SE OF SUGHTLY LIMITED QUALITY IN THE INSTALLATION AREA WITH A MINIMUM OF 4 FOOT SHOULDER BEYOND THE DRAINFIELD SIDE WALL (ANY UNSUITABLE PAD FILL IN THE SHOULDER AND UNDER THE ORAINFIELD MUST 6E REMOVED AND REPLACED WITH SUITABLE SOIL), ___ DRAINFIELD MUST BE A MINIMUM OF TEN FEET FROM BUILDING FOUNDATION. ___ MAINTENANCE SERVICE AGREEMENT REQUIRED. ____ ANNUAL OPERATING PERMIT FROM MARTIN CO, HEALTH OEPARTMENT IS REQUIRED. ____ MAINTAIN A MINIMUM OF ___ FEET FROM SURFACE WATER. wlan _ THE ORAINFIELO MUST 88 AT LeAsT _< FEET FROM “PROPERTY LINES “ BUILOING FOUNGATION _ OTHER. ( NOTE: For Mounded Orainfleide Sethack, Use four foot shoulder and 4:1 slope plus 1.5 foot Swaial Berm Unless Appites to Repaire Using Shoulder Setback Reductions From Table V.) __7 INSTALL AN APPROVED OUTLET FILTER DEVICE IN THE SEPTIC TANK. __/ A MINIMUM OF @ INCHES AND MAXIMUM OF 18 INCHES OF MODERATLEY OR SLIGHTLY LIMITED SOM. CAP IS ALLOWED OVER ORAINFIELD. ——.. STATE CODE REQUIRES A MINIMUM ORAINFIELD SIZE OF _____ SQUARE FEET. THE DRAINFIELD MUST BE PROPERLY GRADED ANO STABLIZED PRIOR TO FINAL APPROVAL. __~ PoTAsLe WATER LINES WITHIN 10 FEET OF THE SYSTEM MUST 8 SLEEVED AND SEALED UNLESS THE WATER LINES THEMSELVES CONSIST OF SCHEDULE 40 PVC OR STRONGER MATERIAL AND NEVER LESS THAN 24 INCHES FROM THE SYSTEM. —Arorave nar LINES WITHIN 5 FEET OF A ORAINFIELD SHALL NOT BE LOWER THAN THE DRAINFIELD ELVEVATION, ’ POTAQLE WATER LINES MUST BE INSTALLEO AND EXPOSED AT THE TIME OF THE INITIAL INSTALLATION INSPECTION. —___. REPAIREG MOUND ANO FILLED ORAINFIELOS MUST BE PROPERLY GRADED AND SODDEDV STABLIZED WITHIN 14 DAYS OF SYSTEM CONSTRUCTION APPROVAL. Fleride of Health wore. MartinCountyHealt.com in MARTIN COUNTY + Enveonmental Hest TWITTER HeatthyFiA Mat SE Willoughby Souleverd « Stuart, FL 34994 EAP ERAN 8 Nani tis ~ RECOMMEND ORAINAGE FEATURE PREVENT RUNOFF INTO FOUNOATIONS. PE. SYSTEM DESIGN REQUIRED. ____. MAXIMUM OOSE CYCLE + @ TIMES PER CAY. __ PUMP(S) REQUIRED, OOSE ENTIRE ORAINFIELD EACH CYCLE, PUMP(S) MUST BE CERTIFIED AS SUITABLE FOR DISTRIBUTION OF SEWAGE EFFLUENT. i AN OPERATIONAL TEST OF THE PUMPS AND HIGH WATER ALARM (AUDIBLE AND VISUAL) IS REQUIREO PRIOR TO FINAL CONSTRUCTION APPROVAL, ____ EFFLUENT TRANSMISSION LINES MUST SE 5 FEET AWAY FROM POTABLE WATER LINES UNLESS THE 18 SCHEOULE 40 PVC OR STRONGER ANO iT 'S. AT LEAST 12 INCHES LOWER THAN THE ~~ TRANSMISSION POTABLE WATER UNE. _- SEPTIC TANK MUST BE PUMPED PRIOR TO INSTALLION OF THE DRAINFIELD, ___ AGGREGATE, SOIL, ANO OTHER COMPONENTS OF SPOIL MATERIALS FROM DRAINFIELO REPAIRS CANNOT 5E USED IN SYSTEM REPAIR IN ANY MANNER, CONTRACTORS MUST PROPERLY DISPOSE OF SPOILS MATERIAL BEFORE FINAL INSPECTION AND NEVER CREATE A SANITARY NUISANCE WITH STORAGE OF SPOILS (SEE HSES MEMO 06-010). —_—— SYSTEM REPAIRS MUST INSTALLATION MUST BE COMPLETED WITHIN 30 CAYS OF SYSTEM _7 TERMITTING OR CONTRACT DATE UNLESS OTHERWISE EXTENDED BY THE APPLICANT LANDSCAPE FEATURES SUCH AS BOULDERS OR TREES ARE NOT ALLOWED ON FILLED OR MOUNDED ~_DRAINFIELS OR SHOULDERS, _— VEGETATION COVER ON ORAINFIELDS OTHER THAN SOD MUST BE APPROVED BY THE STATE HEALTH ___ PUMP SEPTIC TANK (DONE BY CERTIFED COMPANY), CRUSH OR RUPTURE TANK BOTTOM, SUBMIT TANK PUMPOUT RECEIPT, CONTACT DEPARTMENT FOR INSPECTION. _ 7 ,DOTIONAL FEES MAY APPLY. > $ 50 2 INSPECTION FEE. ~ ALL ATTACHED GENERAL AND SPECIAL CONDITIONS MUST BE COMPLETED PRIOR TO FINAL INSPECTION ANO APPROVAL, ———. OTHER: 4, Agr NAME: Cas Fs OATE: oy }a) [bs 7 PAGE 2 J RHOOC SFORME SEPTIC ASEPTIC SYSTEM SPECIAL CONDITIONS NEW DOC REV 08301! ' . NOTICE OF RIGHTS A party whose substantial interest is affected by this order may petition for an administrative hearing pursuant to sections 120.569 and 120.57, Florida Statutes. Such proceedings are governed by Rule 28-106, Florida Administrative Code. A petition for administrative hearing must be in writing and must be received by the Agency Clerk for the Department, within twenty-one (21) days from the receipt of this order. The address of the Agency Clerk is 4052 Bald Cypress Way, BIN # AO2, Tallahassee, Florida 32399-1703. The Agency Clerk’s facsimile number is 850-410-1448. Mediation is not available as an alternative remedy. Your failure to submit a petition for hearing within 21 days from receipt of this order will constitute a waiver of your right to an administrative hearing, and this order shall become a ‘final order’. Should this order become a final order, a party who is adversely affected by it is entitled to judicial review pursuant to Section 120.68, Florida Statutes. Review proceedings are govemed 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. » ee ee 7 (. wrt oe — lors | si! { BLOCK 2 ) al i ‘ i 7 -~— LOT 3 | BE ee lots x $66°54'28"W (TT 425.00" f : At ni | REMAINDER OF LOT 4~*J\ 0s) ao Ais) — ( BLocK 2 ) By go é f Lor 4 t — _ — eI . 4 i a \ | lor 5 ex 3 ———, IL TRerogass 7 | . : REWAINDER OF Lots fs BOWS ISO bee nt i 8 | Evel 2205, 245) ay | v4 i : (Block 2) | < oe 134i t i ! fi ep OP ti ; i — | — 7. — 3 = o tee . ° i ao tse s | 7. . t \ . r o a it a | : iM e300 ES oa ee anil REMAINDER OF LOT 6 pen ey ei \) 3 ( BLOCK 2) 7). oO Oe | +14 ‘ : 3 we ne Bl ‘ “olen te ; s See ra May be A oo g Zhi | ~ GS Capo | : RB { * wai : a2 : a : REMAINDER OF LOT 7 [7 - — 5, —~ oe ty 3 BLOCK 2 ? > ‘ , ot $66°54'28"W aa 7! _ 125.007 x : i TT enn nee te ne soe =I 7-7 = 3 r a Qe . got? LOT 8 a | yy (pLocx 2) | \ 5 S) l ‘ EXHIBIT _C___ zm 142s8-t5tts02_ AID: |) DEPARTMENT OF HEALTH DATE PAID ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FRE PAID: CONSTRUCTION PERMIT AS Sew RECEIPT #: pocuuent #: PR933392 CONSTRUCTION PERMIT FOR: OSTDS New APPLICANT: (Medalist Buiilding Group, LLC) PROPERTY ADDRESS: Lot 18 SW34St Palm City. FL 34990 Lot: 18 BLOCK: 19 SUBDIVISION: PALM CITY AMENDED [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER) PROPERTY ID #: 17384100101900189000 [OR TAX ID NUMBER] SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION 381.0065, F.S., AND CHAPTER 64E<-6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF ‘TIME. ANY CHANGE IN MATERIAL FACTS, WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE PERMIS APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL, STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY. SYSTEM DESIGN AND SPECIFICATIONS t 900 ) GALLONS / GPD Septic Tank CAPACITY if 1 GALLONS / GPD NiA CAPACITY { ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] { ] GALLONS DOSING TANK CAPACITY { ]GALLONS @[ ]DOSES PER 24 HRS #Puapa [ 1 { 375 1 SQUARE FEET installed in trenches (nly) SYSTEM ( } SQUARE FEET NIA S¥STEM TYPE SYSTEM: { ] STANDARD { ] FILLED tx] MOUND Le a CONFIGURATION: (x] TRENCH { ] BED t) - Pa | LOCATION OF BENCHMARK: NAIL AND TAB IN 34TH STREET, ELV. 5.79FT = 42.5" ELEVATION OF PROPOSED SYSTEM SITE { 3.00 1{rwcues) FT }{ ABOVE {BELOW ) BENCHMARK/REFERENCE POINT BOTTOM OF DRAINFIELD TO BE ( 18.003 (acums } FT 1 (above } BELOW | BENCHIMARK/REFERENCE POINT a i ee] FILL REQUIRED: (36.00) INCHES EXCAVATION REQUIRED: [ 6.00 ] INCHES Must maintain 75ft from the delinated wetland boundtry on lat 20, Blk 19, Palm City Amend, The system is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total estimated flow of 590 gpd. The licensed contractor installing the systern is responsible for installing the minimum category of tank and drainfield in accordance with 8. 64E-6, FAC. Ron Oyo nN See attached general and special conditions lists. R SPECIFICATIONS BY: Nicholas L Clifton TITLE: environmental Specialist IT APPROVED BY: Ro~ , 25 TITLE: Environmental Specialist /f- oft Martin cuD Ray R Cross DATE ISSUED: 03/18/2014 EXPIRATION DATE: DH 4016, 08/09 (Obscletes all previous editions which may not be used) Incorporated: 64E~6.003, FAC Pea « co permit #:43-SS-1511592 appLicarion #:AP1129981 $@RG\ STATE OF FLORIDA ATE PAID: pS @G\ DEPARTMENT OF HEALTH ° : ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID: CONSTRUCTION PERMIT RECEIPT #: vocua #:PROSS481 CONSTRUCTION PERMIT FOR: OSTDS Abandonment APPLICANT: (Medalist Building Group, LLC. PROPERTY ADDRESS: Lot 18 SW34 St Palm City, FL 34990 wen Lot: 18 BLOCK: 19 SUBDIVISION: PALM CITY AMENDED (SECTION, TOWNSHIP, RANGE, PARCEL NUMBER) PROPERTY ID #: = 17384100701900189000 [OR TAX ID NUMBER] SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION 381.0065, #.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 PACTS, WHICH SERVED AS A BASIS ¥OR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE PERMIT APPLICATION, SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL, STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY. SYSTEM DESIGN AND SPECIFICATIONS tt ] GALLONS / GPD CAPACITY at ] GALLONS / GPD CABACITY Rt ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS) KI } GALLONS DOSING TANK CAPACITY { ]GALLONS = ¢[ ]DOSES PER 24 HRS #Paumps [ } ne } SQUARE FEET SYSTEM RE ] SQUARE FEET SYSTEM A TYPE S¥STEM: { ] STANDARD { ] FILLED {] MouND {1 annem I CONFIGURATION: t ] TRENCH { ] BED U1 ee x P LOCATION OF BENCHMARK: I ELEVATION OF PROPOSED SYSTEM SITE { HC é ]{ ABOVE / BELOW ) BENCHMARK/REFERENCE POINT & BOTTOM OF DRAINFIELD TO BE ie it / | | ABOVE / BELOW } BENCHMARK/REFERENCE POINT L D FILL REQUIRED: £0.00} INCHES EXCAVATION REQUIRED: [ ]_INcnEs Have the tank abandoned in accordance with the following procedures:(a) The tank shall be pumped out.(b) The bottom © ot the tank shall be opened or ruptured, or the entire tank collapsed $0 as to prevent the tank from retaining water, and(c) t [The tank shall be filled with clean sand or other suitable material, and completely covered with soil Have the system 4 inspected by the health department after i has been pumped and ruptured but before it is filled with sand and covered g R SPECIFICATIONS BY: Nicholas L Clifton TITLE: pyvironmental Specialist II A®PROVED BY: Boy TITLE: Environmental Supervisor Ir Martin CHD Todd A Reishold —— DATE ISSUED: 07/18/2014 EXPIRATION DATE: 10/16/2014 DH 4016, 08/09 (Obscletas all previous editions which may not be used) Incorporated: 648-6.003, FAC Page 1 of /3 vib? ABI UP GaBL BE-4 Vv » Miselon: Governor ~ Yo protect. promote & improve the haalth of alt people in Florida through integratnd John H. Armatrong, MD, FACE Vialon: To be the Healthiest Strtwin the Nation SEPTIC SYSTEM GENERAL CONDITIONS LIST PERMIT 43-88. be | (Se . i? ¢ If the minimum finished floor foundation elevation (F.F.F.E.) is below the drainfield filled elevation of 46 inchas (above original grade 5.“ £1), please contact this office to determine possible setback changes from the drainfleld (setback Is calculated by adding 4:1 slope, 4-foot shoulder and possible berm), Additionally, if the driveway or sidewalk Ip proposed to be lower than the drainfield filled elevation, please contact the department to determine possible setback changes. Note: Local building authority determines minimum F.F.F.E. and stub out requirements. Health Department recommendations are used for drainfield fill and setback requirements only. « For single-famity homes, if the roof drip line is within § feet of tha drainflaid, shoulder or slope and the roof drains toward the septic system, gutters are required. « Septic system must be installed in unobstructed area as shown on the approved site plan. Alteration of the Infarriation or conditions of this permit found to be in non-compliance will be sufficient cause for revocation of thie permit. If any information on a permit changes, an amended application and $50 review fee must be submitted to our office Immediately. « Future ponds or surface water created onsite must be greater than 75° from septic system. * The mound area must be sodded prior to 4 request for final gradé Inspection. « Nor-potabie Irrigation lines must be separated from the drainflald by two feet unless an approved backflow pravention device Is property inatalled, « A $75.00 re-inapection fee le required if violations are found during the septic system inspection. » ff an Inapactor does not witness the work conducted during a septic abandonment, the contractor must submit a statement that the work was completed. « = If a professional engineer designs the septic system, the engineer must certify that the installed aystem complies with the design and installation requirements, « For commercial operations, occupational approval will not be given until all requiremente for an onsite public water system, food operation or Institutional establishment are met. ADDITIONAL CONDITIONS LIST special conditions marked °X* are in effect 1. Driveway and sidewalk elevation must be at least 8" higher than the top of the drainfield elevation. The driveway cannot be constructed within 4 feet of the system's available area, 2. Prior to final construction approval, the property owner must apply for ani operating permit and pay the §. Annual Permit Fee (For ___Indust./Manuf. ___ Aerobla System __ Commercial System __ Performance-Based). Excavation requirements: (Note: Excevation refers to removal of natural or existing soils, not pad fill) “4. ts one foot beyond drainfleld ares to a depth of _@ __ inches below natural/ existing grade elevation of 5 *_ feet N.G.VD. / Assumed. In addition to tam #1, 33% of unsuitable scils at depths greater than Inches below #1 elevat above must be removed to # depth of slightly limited sols. 2, if the proposed drainfleid is to be Installed within 10 feet of a building foundation or swimming pool structure, the four-foot drainflaid shoulder must be filled with suitable solls prior to building construction. 3. if a mound oF filed drainfleld is proposed, see following sketch. An enginger’s design Is required if a retaining wall Is propose within the drainfieid slope areas of a mound systam. No boulders or trees are allowed within the drainfleld or drainflekt should area. Applicant ls responsible for replacing excavated soils with a good grade of soil suitable for drainfield inatallation. Ruy Loss) FS 94 (refer ) See Reverse Side for Mound or Filled Drainfleld Requiremen Completed By a of Health | www. MartinCountyHealth.com Fortda is MARTIN COUNTY + Environmental Healt TWITTER HealttyFLA 3441 SE Willoughby Boulevard + Stuart, FL 34904 FACEBOOK: PHONE: 772/221 4090 * FAX 772/221-4967 YOUTLBE: Rein ep 17151 Ame > pe CLK Arp Pp DRAINFIELD MOUND OR FILLED SYSTEM REQUIREMENTS DRAINFIELD DRAINFIELD SHOULDERS DRAINFIELD SHOULDERS House — Fy» WIDTH A ce te j “a YBRLES Pad Fil Yay Oe $e ULATED tapes & SK Yj, DRAINFIELD WS), Note: Soil cover over the drainfield should be slightly limited soil, the same as used on sides and under the drainfieid. Moderate NATIVE\UNFILLED SOIL Fill amount required \ as specified on perm limitad soil may be use. \speciaicondinew revised.doc. revised 7/22/04 Mtsatom Vifa, mish Seats Hf preysenirto amar rr _ fhrough integrated Armstrong, MB, Tate, county A comeruy afore, sealed bniabe's tery sored Vialoct fo be he Heathiont State in te Nason SEPTIC SYSTEM SPECIAL CONDITIONS FOR PERMIT 43-SS-__/S ! [342 The licensed contractor installing the system s responsible for installing the minimum catagory of tank in accordance with 6. 64E-6.01N3}\(f, FAC. ___ CONOUCT SOIL BORINGS DURING INSPECTION TO VERIFY SOI TYPE ANO WATER TABLE FROM OTHERS. _\c] FILL REQUIRED NOTED ABOVE MUST BE OF SLIGHTLY LIMITED QUALITY IN THE INSTALLATION AREA WITH A MINIMUM OF 4 FOOT SHOULDER SEYOND THE DRAINFIELD SIDE WALL (ANY UNSUITABLE PAD FILL IN THE SHOULDER AND UNDER THE DRAINFIELD MUST 6& REMOVED AND REPLACED WITH SUITABLE SCit). ____. DRAINFIELD MUST BE A MINIMUM OF TEN FEET FROM BUILDING FOUNDATION, _._. MAINTENANCE SERVICE AGREEMENT REQUIRED. ____. ANNUAL OPERATING PERMIT FROM MARTIN CO, HEALTH DEPARTMENT I$ REQUIRED. _/ MAINTAIN A MINIMUM OF 7_ FEET FROM SURFACE WATER, (WES*LAZ? ), _ THE DRAINFIELO MUST 8€ AT LEAST _ FEET “_PROPERTY LINES gUILDING FOUNDATION _ OTHER ( NOTE: For Setback, Use four foot shoulder and 4:1 slope plus 1.5 foot Swale! Berm Untess Repairs Using Shoulder Sock Radaations From Tatte V3 J [bre 51V8 PE (7S Ff pent PL ___. INSTALL AN APPROVED OUTLET FILTER DEVICE IN THE SEPTIC TANK. __7 AMINIMIM OF 6 INGHES AND MAXIMAIM OF 18 INCHES OF MODERATLEY OR SLIGHTLY LIMITED SOIL CAPS ALLOWED OVER ORAINFIELD. STATE CODE REQUIRES A MINIMUM DRAINFIELD SIZE OF SQUARE FEET. 7 THE ORAINFIELD MUST BE PROPERLY GRADED AND STABLIZED PRIOR TO FINAL APPROVAL _ poraaus WATER LINES WITHIN 10 FEET OF THE SYSTEM MUST BE SLEEVED AND SEALED UNLESS THE WATER LINES THEMSELVES CONSIST OF SCHEDULE 40 PVC OR STRONGER MATERIAL AND NEVER LESS THAN 24 INCHES FROM THE SYSTEM. _v CARON LUNES WITHIN 5 FEET OF A ORAINFIELD SHALL NOT BE LOWER THAN THE ORAINFIELD ELV . a. POTABLE WATER LINES MUST BE INSTALLED AND EXPOSED AT THE TIME OF THE INITIAL INSTALLATION INSPECTION. _—_. REPAIRED MOUND ANO FILLED ORAINFIELOS MUST BE PROPERLY GRADED AND SODDEDV STABLIZED WITHIN 14 DAYS OF SYSTEM CONSTRUCTION APPROVAL Fiarida Department of Health www. MartinCountyHealth.com TWITTER: HeathyfLA M41 SE Witlgughby Boulevard + Stuart, FL 4034 PERERA EE awn RECOMMEND DRAINAGE FEATURE PREVENT RUNOFF INTO FOUNOATIONS. PG. SYSTEM CESIGN REQUIRED. MAXIMUM DOSE CYCLE = @ TIMES PER DAY. __ PUMP{S) REQUIRED, OOSE ENTIRE ORAINFIELO EACH CYCLE. PUMP(S) MUST BE CERTIFIED AS SUITABLE FOR DISTRIBUTION OF SEWAGE EFFLUENT. 3 __. AN OPERATIONAL TEST OF THE PUMPS ANO HIGH WATER ALARM (AUDIBLE AND VISUAL) I$ REQUIRED PRIOR TO FINAL CONSTRUCTION APPROVAL. __~_. EFFLUENT TRANSMISSION LINES MUST GE 5 FEET AWAY FROM POTAGLE WATER LINES UNLESS THE 1$ SCHEDULE 40 PVC OR STRONGER ANGIT iS AT LEAST 12 INCHES LOWER THAN THE ~~ TRANSMISSION POTABLE WATER LINE. SEPTIC TANK MUST BE PUMPED PRIOR TO INSTALLION OF THE DRAINFIELD, ___. AGGREGATE, SOK, AND OTHER COMPONENTS OF SPOIL MATERIALS FROM DRAINFIELD REPAIRS CANNOT BE USED IN SYSTEM REPAIR IN ANY MANNER. CONTRACTORS MUST PROPERLY DISPOSE OF SPOILS MATERIAL BEFORE FINAL INSPECTION AND NEVER CREATE A SANITARY NUISANCE WITH STORAGE OF SPOILS (SEE HSES MEMO 05-010), ___._ SYSTEM REPAIRS MUST INSTALLATION MUST BE COMPLETED WITHIN 30 DAYS OF SYSTEM PERMITTING OR CONTRACT DATE UNLESS OTHERWISE EXTENDED BY THE APPLICANT. _/ LANoSCAPE FEATURES SUCH AS BOULDERS OR TREES ARE NOT ALLOWED ON FILLEO OR MOUNOED / OR SHOULDERS. ____. VEGETATION COVER ON ORAINFIELOS OTHER THAN SOO MUST BE APPROVED BY THE STATE HEALTH ____ PUMP SEPTIC TANK (DONE BY CERTIFED COMPANY), CRUSH OR RUPTURE TANK BOTTOM, SUBMIT TANK _PUMPOUT RECEIPT, CONTACT OEPARTMENT FOR INSPECTION. _/ potions FEES MAY APPLY. 35026 INSPECTION FEE, AU, ATTACHED GENERAL AND SPECIAL CONDITIONS MUST BE COMPLETED PRIOR TO FINAL INSPECTION ANO APPROVAL, anne OTHER: wane: ry Cpere DS are, 2 [69/200 PAGE 2 J EHOOC SH ORME SEPTICSSEPTIC SYSTEM SPECIAL CONOITIONS NEW DOC REV CANKIT ‘ s OTICE OF RIGHT: . A party whose substantial interest is affected by this order may petition for an administrative hearing pursuant to sections 120.569 and 120.57, Florida Statutes. Such proceedings are governed by Rule 28-106, Florida Administrative Code, A petition for administrative hearing must be in writing and must be received by the Agency Clerk for the Department, within twenty-one (21) days from the receipt of this order. The address of the Agency Clerk is 4052 Bald Cypress Way, BIN # A02, Tallahassee, Florida 32399-1703. The Agency Clerk's facsimile number is 850-410-1448. Mediation is not available as an alternative remedy. Your failure to submit a petition for hearing within 21 days from receipt of this order will constitute a waiver of your right to an administrative hearing, and this order shall become a ‘final order’. Should this order become a final order, a party who is adversely affected by it is entitled to judicial review pursuant to Section 120.68, Florida Statutes. Review proceedings are governed by the Florida Rules of Appellate Procedure. Such proceedings may be commenced by filing one copy of a Notice of Appeal with the Agency Clerk of the Department of Health and a second copy, accompanied by the filing fees required by law, with the Court of Appeal in the appropriate District Court. The notice must be filed within 30 days of rendition of the final order. Loe — 7 I \ a +7 LOT 14 | LOT 13 Lock 4 BLOCK 19 BLOCK 19 gue xX ee “1s ¢ (Forel U 35 ra ef Low W vf Pia rs LOT 17 BLOCK 19 fe)] in Dwereise © ! weve | Ble eRe ae | 2 : we ran z=} | Rrceoses ly are a EXHIBIT _2_ PERMIT #: 43-SS-1 537606 AppLication #: AP{146227 (Sie STATE OF FLORIDA DATE PAID: it DEPARTMENT OF HEALTH on is) ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FRE PAID: CONSTRUCTION PERMIT Gu ra RECEIPT @: VALI A NCE cocument #:PR943424 CONSTRUCTION PERMIT FOR: OSTDS New APPLICANT: {Medalist Building Group, LLC) PROPERTY ADDRESS: 2769 SW Cornell Ave — Paim City, FL 34990 Lor: § BLOCK: 4 SUBDIVISION: Palm City Amended [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER) (OR TAX ID NUMBER) PROPERTY ID #: 17-36-41-001-004-00050-8 SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION 361.0068, F.S., AND CHAPTER 642-6, F.A.C. DEPARTMENT APPROVAL Of SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS, WHICH SERVED AS A HASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID. ISSUANCE OF THIS. PERMIT DOES NOT EXEMPT THE APPLICANT. FROM COMPLIANCE WITH OTHER FEDERAL, SNARE OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY. SYSTEM DESIGN AND SPECIFICATIONS 1050 ] GALLOWS / GPD Septic Tank CAPACITY t { } GALLONS / GED N/A CAPACITY C ] GALLONS GREASE INTERCEPTOR CAPACITY (MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS) if ] GALLONS DOSING TANK CAPACITY { ]GALLONS &[ ]DOSES PER 24 HRS Pumps [ ] Rmwea { 500 ] SQUARE FEET installed in trenches SYSTEM t ] SQUARE FEET N/A SYSTEM TYPE SYSTEM: ( ] STANDARD { ] FILLED fx} MOUND { } CONFIGURATION: [xe] TRENCH ( ) BED ft) LOCATION OF BENCHMARK: CROWN OF ROAD ON 28TH STREET AT THE EAST PROPERTY LINE, ELV. 6.29FT NGVD ELEVATION OF PROPOSED SYSTEM SITZ { 10.701 FT ][ ABOVE BENCHMARK/REFERENCE POINT BOTTOM OF DRAINFIELD TO BE [ 130 lifaucues } eT 1 {LaBove) BELOW ) BENCHMARK/REFERENCE POINT FILL REQUIRED: (30.001 INCHES EXCAVATION REQUIRED: [ ]_ INCHES VARIANCE: 12541 The contractor has an option of installing a 667 sqft or largere df bed The system is sized for 4 bedrooms with a maximum occupancy of 8 persons (2 per bedroom), for a total estimated flow lof 400 gpd. The licensed contractor installing the system is responsibie for installing the minimum category of tank and drainfieid in accordance with 3. 64E-6, FAC. Lot 6 must be properly filled prior to the construction of the septic on lot 5. See attached general and special conditions lists. a eC ce ee SPECIFICATIONS BY: Nicholas L Clifton TITLE: gevironmental Specialiat If APPROVED BY: Ede iS TITLE: Environmental Specialist 1%, ah Martin CHD ny hoe NNT Sinwinsitiin DATE ISSUED: 06/26/2014 EXPIRATION DATE: 12/25/2015 DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64B-6.003, FAC Page L, 3 ' y Hiselon: Rak Scott Sovemor John M. Arnmetrong, MD, FACS Stata Surgeon General & Secrwiary ‘Vielen: To be the Heakhlest State is the Nation PERMIT 43-33. ° . * SEPTIC S YSTEM GENERAL CONDITIONS LIST If the minimum finished floor foundation elevation (F.F.F.E.) is below the drainfleld filed sievation of » Inches (above orginal grade _$./ *)__), please contact this office to determine possible setback changes from the drainfleld (setback 's calculated by adding 4:1 slope, 4-foot shoulder and possible berm). Additionally, if the driveway or sidewalk Is proposed to be lowar than the drainflald fillad slavation, please contact the department to determine possible setback changes. Note: Local building authority determines minimum F.F.F.E, and stub out requirements, Health Department recommendations are used for drainfleld fill and setback requirements onty. For single-family homes, if the roof drip line Is within 5 feet of the drainfieid, shoulder or slope and the roof drains toward the septic system, gutters are required. Septic system must be installed in unobstructed area as shown on the approved site plan. Alteration of the Information or conditions of this permit found to be In non-compliance will ba sufficient cause for revocation of this permit. If any Information on a pertnit changes, an amended application and $50 review fee must be submitted to our office immediately, Future ponds or surface water created onsite must be greater than 75° from septic system. The mound area must be sodded prior to @ request for final gradé Inepection. : Nor-potable ligation lines must be separated from the drainfleid by two feet unless an approved backflow prevention device le property installed. A $75.00 re-inepection fee ie required if violations are found during the septic system inspection. If an inepector does not witness the work conductad during a septic abandonment, the contractor must submit a statement that the work was completed. if a professional engineer designe the septic system, the engineer must certify that the Installed system complies with the design and installation requirements. For commercial operations, occupational approval will not be given until all requirements for an onaite public water system, food operation or institutional establishment are met. ADDITIONAL CONDITIONS LIST Special conditions marked "X° are in effect 1. Oriveway and sidewalk elevation must be at least @° higher than the top of the drainfieid elevation. The driveway cannot be constructed within 4 feet of the system's available area, 2. Prior to final construction approval, the property owner must apply for an operating permit and pay the $______ Annual Permit Fee (For __indust/Manuf. ____ Aerobie System ___s Commercial Systam __ Performance-Gased). Excavation requirements: (Note: Excavation refers to removal of natural of existing salle, not pad Al) 1. Excavate one foot beyond drainiield area ta a depth of Inches below natural/ existing grade elevation of _____ feet N.G.V.D. / Assumed. In addition to item #1, 33% of unsuitable solls at dapthe greater than Inches below #1 eievat above must be removed to # depth of slightly limited soils, 2. Hf the proposed drainfield is to be Installed within 10 feat of @ building foundation or swimming pool structure, tha four-foot a drainfield shoulder must be filled with suitable soile prior to building construction. 3. If a mound or filled drainfleld Is proposed, see following sketch. An enginger's design is required Hf a retaining wall 1s propose: within the drainflald slope aress of a mound system. No boulders or vees are allowed within the drainfleld or drainflelkd should area. Applicant \s rasponsible for replacing excavated soils with a good grade of Soil suitable for drainflaid installation. Remers, 93 S261" gy, Reverse Side for Mound or Filled Drainfleld Requiremer. Completed By Bate Florida Department of Health wwvw.MartinCountyHesith.com in MARTIN COUNTY = Environmental Heath TWITTER HealhyFLA 1441 SE Witloughby Boulevard » Stuart, FL 34964 FACEBOOK: PHONE: 772/221-4090 « FAX 772/221-4967 VAUITH OR: Arad 11(K robert | acary PL DRAINFIELD MOUND OR FILLED SYSTEM REQUIREMENTS DRAINFIELD DRAINFIELD SHOULDERS DRAINFIELD SHOULDERS House — 4 i» WIDTH ——4) » Pad Fill Note: Soil cover over the drainfield should be slightly AONE limited soil, the same as AINFIEE Fill amount required usec on sides and under as specified on permi the drainfield. Moderate PROPERTY LINE limited soil may be use. bers tiberrtslierithitdd eaprssiocinertartegs, ete seaactatacstes priiemiesiensitiels: \apecialcondtnew revised.doc, revised 7/22/04 Te promck, proete 6 crane fa ream people i Ponda ‘ Jota i Armetrang, MO, F. am, county & comemunty efor, Suu upon Onedatane ‘Visdoo To ba tw Haakhiient State in he Neton SEPTIC SYSTEM SPECIAL CONDITIONS FOR PERMIT 43-88-__/64 76.00 _ The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance with 3, ME-E.OTHINA, FAC. _- CONDUCT SOIL BORINGS DURING INSPECTION TO VERIFY SOIL TYPE ANO WATER TABLE FROM OTHERS, ann REQUIRED NOTED ABOVE MUST BE OF SUGHTLY LIMITED QUALITY IN THE INSTALLATION AREA WITH A MINIMUM OF 4 FOOT SHOULDER BEYOND THE ORAINFIELO SIDE WALL (ANY UNSUITABLE PAD FILL IN THE SHOULDER ANO UNDER THE ORAINFIELD MUST SE REMOVED AND REPLACED WITH SUITABLE SOIL). _—— DRAINFIELD MUST BE A MINIMUM OF TEN FEET FROM BUILDING FOUNDATION. MAINTENANCE SERVICE AGREEMENT REQUIRED. __— ANNUAL OPERATING PERMIT FROM MARTIN CO, HEALTH OEPARTMENT |S REQUIRED. MAINTAIN A MINIMUM OF ___ FEET FROM SURFACE WATER. eo mempaniacsy Fe Pg _Z__ TWEORAINFIELO MUST BE AT LEAGT” “FEET FROM __ PROPERTY UNES ° BUILDING FOUNDATION _ OTHER ___( NOTE: For Mounded Orainfleide Setback, Use four foot shoulder and 4:1 slope / bus 1.5 foot Swalel Berm Uniees Appites to Repalre Using Shoulder Setback Reductions From Table V.) ——— |NSTALL AN APPROVED OUTLET FILTER OEVICE IN THE SEPTIC TANK. ma MINIMUM OF 6 INCHES AND MAXIMUM OF 18 INCHES OF MODERATLEY OR SLIGHTLY LIMITED SOIL CAP IS ALLOWED OVER ORAINFIELD. ——— STATE CODE REQUIRES A MINIMUM DRAINFIELD SIZE OF _____ SQUARE FEET. _Z tHE ORAINFIELD MUST 8E PROPERLY GRADED ANO STABLIZED PRIOR TO FINAL APPROVAL, a POTABLE WATER LINES WITHIN 10 FEET OF THE SYSTEM MUST BE SLEEVED ANO SEALEO UNLESS THE WATER LINES THEMSELVES CONSIST OF SCHEDULE 40 PVC OR STRONGER MATERIAL AND NEVER LESS THAN 24 INCHES FROM THE SYSTEM. ene WATER LINES WITHIN 5 FEET OF A ORAINFIELD SHALL NOT BE LOWER THAN THE ORAINFIELD VEVATION. . 5 a. POTABLE WATER LINES MUST BE INSTALLED ANO EXPOSED AT THE TIME OF THE INITIAL INSTALLATION INSPECTION, ——~ REPAIRED MOUND ANDO FILLEO ORAINFIELOS MUST BE PROPERLY GRADED ANO SOCDEDY STABLIZEO WITHIN 14 DAYS OF SYSTEM CONSTRUCTION APPROVAL. geen tihin pn stssenemununaas Florida Gepartment of Health wore. MartinCountyHeaith. com ‘a VARTIN COUNTY » Envecewrental Fait TAITTER HenithyPLA MAN SE itougty Soviqerd «Start PL Ua84 FACEBOK FLCecartrenia team RECOMMEND ORAINAGE FEATURE PREVENT RUNOFF INTO FOUNDATIONS. P E. SYSTEM DESIGN REQUIRED. MAXIMUM DOSE CYCLE = TIMES PER DAY. __ PUMP(S) REQUIRED. OOSE ENTIRE ORAINFIELD EACH CYCLE. PUMP(S)} MUST BE CERTIFIED AS SUITABLE FOR DISTRIBUTION OF SEWAGE EFFLUENT. __. AN OPERATIONAL TEST OF THE PUMPS AND HIGH WATER ALARM (AUDIBLE ANO VISUAL) IS REQUIRED PRIOR TO FINAL CONSTRUCTION APPROVAL, EFFLUENT TRANSMISSION LINES MUST GE 5 FEET AWAY FROM POTABLE WATER LINES UNLESS THE TRANSMISSION I$ SCHEDULE 40 PVC OR STRONGER ANO IT IS AT LEAST 12 INCHES LOWER THAN THE POTABLE WATER LINE. ___. SEPTIC TANK MUST BE PUMPED PRIOR TO INSTALLION OF THE ORAINFIELD. AGGREGATE, SOIL, ANO OTHER COMPONENTS OF SPOIL MATERIALS FROM ORAINFIELD REPAIRS CANNOT BE USED IN SYSTEM REPAIR IN ANY MANNER. CONTRACTORS MUST PROPERLY DISPOSE OF SPOILS MATERIAL BEFORE FINAL INSPECTION ANO NEVER CREATE A SANITARY NUISANCE WITH STORAGE OF SPOILS (SEE HSES MEMO 06-010), —- SYSTEM REPAIRS MUST INSTALLATION MUST BE COMPLETED WITHIN 30 DAYS OF SYSTEM PERMITTING OR CONTRACT DATE UNLESS OTHERWISE EXTENDED BY THE APPLICANT. LANDSCAPE FEATURES SUCH AS BOULDERS OR TREES ARE NOT ALLOWED ON FILLED OR MOUNDED DRAINFIELDS OA SHOULDERS. — VEGETATION COVER ON ORAINFIELDS OTHER THAN 600 MUST BE APPROVED BY THE STATE HEALTH ———— PUMP SEPTIC TANK (DONE BY CERTIFED COMPANY}, CRUSH OR RUPTURE TANK BOTTOM, SUBMIT TANK PUMPOUT RECEIPT, CONTACT DEPARTMENT FOR INSPECTION. — _—_ ADOITIONAL FEES MAY APPLY, _2F- § 50 20 INSPECTION FEE. | | ~&_ ALL ATTACHED GENERAL AND SPECIAL CONDITIONS MUST BE COMPLETED PRIOR TO FINAL INSPECTION ANO APPROVAL. ww OTHER: ? name: __Rcpr0sy, yar oare,_¢/25/@ PAGE 2 ‘ J EHOOC SF ORME SEPTIC SEPTIC SYSTEM SPECIAL CONOITIONS NEW O0C FEV OAKK!T ‘ NOTICE OF RIGHTS A party whose substantial interest is affected by this order may petition for an administrative hearing pursuant to sections 120.569 and 120.57, Florida Statutes. Such proceedings are governed by Rule 28-106, Florida Administrative Code. A petition for administrative hearing must be in writing and must be received by the Agency Clerk for the Department, within twenty-one (21) days from the receipt of this order. The address of the Agency Clerk is 4052 Bald Cypress Way, BIN # A02, Tallahassee, Florida 32399-1703. The Agency Clerk's facsimile number is 850-410-1448. Mediation is not available as an alternative remedy. Your failure to submit a petition for hearing within 21 days from receipt of this order will constitute a waiver of your right to an administrative hearing, and this order shall become a ‘final order’. Should this order become a final order, a party who is adversely affected by it is entitled to judicial review pursuant to Section 120.68, Florida Statutes. Review proceedings are governed by the Florida Rules of Appellate Procedure. Such proceedings may be commenced by filing one copy of a Notice of Appeal with the Agency Clerk of the Department of Health and a second copy, accompanied by the filing fees required by law, with the Court of Appeal in the appropriate District Court. The notice must be filed within 30 days of rendition of the final order. en CONCRETE SIDEWALIC 8 FAD 4" x Ir vem CM NO 10 Lo OA NS. - 1 $89°46'37"E 50.00" x! sh neal NOO°00'46"W i . roo axa! 2 CM PR RLS 1272 a 0.02 N 0.07 8 . Pal 5B = “R00 EXHIBIT = cscs. sass-tssreis appLication #:AP1146239 DATE PAID: oe we, STATE OF FLORIDA =| DEPARTMENT OF HEALTH 3; ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID: 4 A RECEIPT @: 45 Sy.ov Vata A yee DOCUMENT \PROaS CONSTRUCTION PERMIT FOR: OSTDS New APPLICANT: (Medalist Building Group, LLC) PROPERTY ADDRESS: 2769 SW Cornell Ave — Pain City, FL 34990 lot: 6 BLOCK; 4 SUBDIVISION: Paim City Amended (SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] {OR TAX ID NUMBER) PROPERTY ID #: 17-38-41-001-004-00050-8 SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION 361.0065, F.S., AND CHAPTER 648-6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEZ SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS, WHICH SERVED AS A BASIS OR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL, STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY. SYSTEM DESIGN AND SPECIFICATIONS 1,050 ] GALLONS / GPD Septic Tank CAPACITY TIE is ] GALLONS / GPD N/A CAPACITY C C ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] ] GALLOMS DOSING TANK CAPACITY { JGALLONS §@f ]DOSES PER 24 HRS #Pomps [ } Ro > [ 500 ] SQUARE FEET installed in trenches «SYSTEM t ] SQUARE FEET NA SYSTEM TYPE SYSTEM: ( 1] STANDARD { ] FILLED fx] MOUND [J CONFIGURATION: tx] TRENCH ( 1] BED {) LOCATION OF BENCHMARK: | CROWN'OF THE ROAD AT THE EAST PROPERTY LINE, ELV: 6.29FT NGVD ELEVATION OF PROPOSED SYSTEM SITE ( 10.00) ((amcugg f FT ) ( ABOVE BENCHMARK/REFERENCE POINT BOTTOM OF DRAINFIELD TO BE t 200 1({aycues} FT 1 ((aBove ) BELOW }BENCHMARK/REFERENCE POINT PILL REQUIRED: (30.00) INCHES EXCAVATION REQUIRED: [ ]_INcues WARIANCE: # 12540 the contractor has an option of installing a 667 sqft or larger d.f bed. The system is sized for 4 bedrooms with a maximum occupancy of 8 persons (2 per bedroom), for a total estimated flow of 400 gpd. Lot 5 must be filled to the required fille for septic system contruction on lot 6The licensed coniractor installing the system is responsible for installing ithe minimum category of tank and drainfield in accordance with 5. 64E-6, FAC. See attached general and special conditions list. oom zu orm na en ena SPECIFICATIONS BY: Nicholas L Clifton TITLE: gnvironmental Specialist II tr eeeneenenatemmnantettt Envir onmentad Sree te APPROVED BY: 12