Item G2
BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
Meeting Date: June 18. 2003
Bulk Item: Yes D No [gI
Division: Manaaement Services
Department: Administrative Services
AGENDA ITEM WORDING: Reviewand discussion of the Final Recommendations and
Action Plan to Improve Health Care Delivery in Monroe County. prepared by the Health
Council of South Florida under contract with Monroe County; approval of invoice for
$10.000.00 for final deliverable.
ITEM BACKGROUND: This is the final deliverable in the contract with the Health
Council to perform a study of the health care needs of Monroe County. Dr. Jake
Rutherford. Chair of the task force. and Sonya Albury. director of the Health Council of
South Florida. will address the BOCC.
PREVIOUS RELEVANT BOCC ACTION: Approval of oriainal contract at Dec. 2001
meetina; approval of amendment to contract to include payment schedule at Jan. 2002
meetina; approval of fundina at July 31. 2001 budaet hearina; approval of task force
appointments at March 2002 meetina: approval of invoice for second deliverable at
Auaust 2002 meetina; approval of invoice for third deliverable at November 2002
meetina.
CONTRACT/AGREEMENT CHANGES: n/a
STAFF RECOMMENDATION: Approval.
TOTAL COST: $10.000.00
COST TO COUNTY: $10.000.00
BUDGETED: Yes [gI No D
SOURCE OF FUNDS: aeneral revenue
fund/ad valorem taxes
REVENUE PRODUCING: Yes D No [gI
AMOUNT PER MONTH
YEAR
APPROVED BY: COUNTY A TTY 0 OMB/PURCHASING ~ RISK MANAGEMENT D
DIVISIONDIRECTORAPPROVAL~~ O~
Sheila A. Barker
DOCUMENTATION: INCLUDED: [gI TO FOLLOW: D NOT REQUIRED: D
DISPOSITION: AGENDA ITEM #: G-J ~
OS/23/03 12:27 FAX 3055920589
HEALTH COUNCIL
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8095 NW 12th Street
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Miami, FL 33126
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To: From:
David OWens Vianca Stubbs
J:ax: 305.292.4515 Pages: 3 including cover sheet
Monroe County Community
RE: Health Initiative . Date: May 23, 2003
Dear David,
Attached please find an invoice for the Health CDUDCil of South Florida's final deliverable for the Monroe
County Community Health Initiative. The final delivecable is the Final R.ecommeodatiODS and Action
Plan to 'nwmve Health Care Dclivexy in Momoe County. as approved by the M01I1'De COlDlty Commvnity
Health lnitiamB Task Fo,.ce.
The Council requests to present this document to the Board of County C.nmmissioDcrs . its June UI, 2003
meeting at the MaIathon Governme!d: Center. Ifpossible, it would be greatly apprcciatediftbc Council',
presentation could be scheduled toward the beginning oftbc Bee meeting.
Tbank you.
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Da.vid P. Owens
GTants Administrator, Momoe County
1100 Simonton Street. Room#2-210
Key West, Florida 33040
Dear Mr_ Owens,
Per requirements of the contract agreement between the Board of County
Commissioners of Monroe County, Florida and the Health Council of
South Florida. Inc., attached is the Final Recommendations and Action
Plan to Improve Health Care Delivery in Monroe COUDtv. as approved
by the Monroe Counly Community JIealJh Initiative Task Force and
invoice #4 in the amOunt of $10,000.00. If you have any comments or
questions. please feel free to contact me at (305) 592-1452 ext. 112.
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Attn: Mr. David p, OWens
Monroe County Gr8nIs MniniSIraIar
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HEALTH COUNCIL
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REQUEST FOR PAYIIIEt.IT INVOICE
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HEALTH COUNCIL OF SOUTH FLORIDA. INC.
111195 NW 12 strwt, Suite aGO
IlIAMI. FLORIDA 33121
Final Recammendalians and ActitI'l Plan \0 Improve He8Ith CIIre
OIIivery In MoMle County.
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Final Recommendations and
Action Plan to Improve Health
Care Delivery in Monroe County
A Report of the
Community Task~ Force for the
Monroe, County Comm'unity
Health Initiative
April 29, 2003
Prepared by:
The Health Council of South Florida, Inc.
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ACKNOWLEDGEMENTS
The Final Recommendations and Action Plan to Improve Health Care in Monroe County report
was made possible through a grant from the Monroe County Board of County Commissioners. It
was completed with the support and participation of local agencies and the active contributions of
members from the Monroe County Community Health Initiative Task Force.
Task Force Chair and Co-Chair
R.C. Jake Rutherford, M.D., Chair
Monroe County Department of Health
Keith Douglass, Co-Chair
Rural Health Network of Monroe County
Members of the Task Force
Julio Avael
City of Key West
Al Brotons
EMS of Monroe County
Cheryll Cottrell, R.N.
Mariner's Hospital
Tracey Greene
Plantation Key Convalescent Center
Reverend Jim Gustafon
Mariner's Hospital
Liz Kern, R.N.
Hospice of the Florida Keys, Inc.
Meylan Lowe-Watler
Lower Keys Medical Center
Julia Pranschke
Senior Advocate
Debra Premaza, R.N.
Lifeline Home Health Care
2
Members of the Task Force (cont'd)
David Rice, Ph.D.
Guidance Clinic of the Middle Keys
Rick Rice
Fisherman's Hospital
Charla Rodriguez
Monroe County Department of Children and Families
Mayor Dixie Spehar
Monroe County Board of County Commissioners
Louis La Torre
Monroe County Social Services
Debra S. Walker, Ph.D.
Monroe County School Board
Robert Walker
AIDS Help, Inc.
Jane Mannix Lachner
Monroe County Prison Health Services
Special thanks are extended to Bill Kwalick of the Key Largo Chamber of Commerce and Michael
Cunningham, Director of the Florida Keys Area Health Education Center (AHEC) for their
participation during the Task Force meetings.
Staff Acknowledgements
Health Council of South Florida, Inc.
Sonya R. Albury
Executive Director
Vianca H. Stubbs, MPH
Senior Health Planner
Rob Harris
Data Manager
Shaleen R. Hamilton
Research Associate
3
MONROE COUNTY
COMMUNITY HEALTH INITIATIVE
Final Recommendations and Action Plan
to Improve Health Care Delivery in Monroe County
Introduction and Purpose Overview
As part of an ongoing effort to assess the health care needs in Miami-Dade and Monroe Counties,
the Health Council of South Florida, Inc. with the financial support of the Monroe County Board
of County Commissioners launched the Monroe County Community Health Initiative (MCCHI) in
February 2002. The goal of the Initiative was to outline the current health care delivery system
and the health care needs of residents in the Upper, Middle and Lower Keys and develop
recommendations/strategies for improving the health care delivery system in Monroe County.
The Monroe County Board of County Commissioners met in March, 2002, at which time they
reviewed and unanimously approved the slate of members to serve on the MCCHI Task Force.
The Task Force met between February 2002 and April 2003 and served as an advisory body to the
MCCHI in order to assure that the information presented in the Initiative's reports provided an
accurate description of the Monroe County community and that it was portrayed in a culturally
sensitive manner. The role of the Task Force was to provide guidance within a local community
driven approach to coordinate and enhance the health care delivery system in Monroe County.
Task Force members included public and private health care providers, community advocates,
religious leaders, and government representatives.
Between the months of February and August 2002, the MCCHI Task Force worked on developing
the Monroe County Community Health Perspectives Reportl. The report outlines the results of the
1,132 Personal Interviews/Community Surveys conducted or collected between March and June
2002, the Physician Focus Group sessions held on May ih and June 19th; and the three-site Town
Hall Meeting conducted in Key Largo, Marathon and Key West on May 23rd. Collectively, these
personal interviews, surveys, focus groups and community meetings succeeded in obtaining
valuable community participation and information on access to health insurance and the
availability of affordable health care as addressed by the MCCHI Task Force.
A second document developed by the MCCHI Task Force was the Monroe County Community
Health Profile2. This report presents a snapshot of the general level of health and health care
resources available in Monroe County. In addition to providing a socio-demographic overview of
the area and an analysis of health status indicators, the Profile contains an inventory ofthe primary
health care delivery services available throughout Monroe County and quantifies the utilization of
these services by area residents. Also included is a review of social and support services, as well
as some of the other factors that have a direct impact on the community's health care.
1 The Monroe County Community Health Perspectives Report was reviewed and unanimously approved by the
Monroe County Board of County Commissioners on August 21, 2002.
2 The Monroe County Community Health Profile was reviewed and unanimously approved by the Monroe County
Board of County Commissioners on November 20,2002.
4
After extensive review of the myriad of issues present in Monroe County, the MCCHI Task Force
developed specific recommendations and strategies in the areas of Public Health! Prevention,
Direct Services, Insurance/Health Plan, as well as Elder Care. These efforts were designed to
promote service delivery enhancements and improve the health of residents in Monroe County.
These community-driven strategies are contained in this Final Recommendations and Action Plan
to Improve Health Care Delivery in Monroe County document and serve as a blueprint for
implementing changes to improve the health status of Monroe County residents.
Intended Audiences and Use of Materials
It is the intent of the MCCHI Task Force that this Action Plan serve all residents of Monroe
County in several capacities. Health care providers, including private. practitioners, community-
based organizations, hospitals, assisted living facilities, home health providers, and trauma centers
can support and/or implement the outlined strategies to advocate for additional school-based
health services; reduce child abuse rates; assure access for trauma transport services countywide;
expand the availability of assisted living facilities; and increase access to primary and specialty
care servIces.
Recommendations and strategies geared toward health educators address disseminating user
friendly materials in English, Spanish and Creole, establishing a telephone support network to
provide educational information on the debilitating effects of substance abuse; as well as, utilizing
existing tools (e.g., music) to develop public health messages.
Advocates addressing the County's growing number of uninsured are provided with specific
Insurance/Health Plan related recommendations and strategies to mitigate this mounting concern.
Finally, grant funders, including state and local governments, private foundation and other
organizations, can use these recommendations/strategies in their decision-making process of
awarding monies to grant applicants.
5
SUMMARY OF FINAL RECOMMENDATIONS
Part I: Public Health/Prevention
Recommendation 1
Provide education for prevention of chronic diseases, communicable diseases,
unintentional injuries, and substance abuse.
Recommendation 2
Reduce infant mortality rates countywide.
Recommendation 3
Provide young adults with the necessary tools to make informed decisions regarding their
sexual health.
Recommendation 4
Reduce the number of low birth weight babies and improve birth outcomes.
Recommendation 5
Advocate for additional school-based health services in Monroe County.
Recommendation 6
Reduce child, adult and elder abuse rates countywide.
Part II: Insurance/Health Plan
Recommendation 1
Develop a countywide health care coverage model including the uninsured and
underinsured, regardless of employment status.
Recommendation 2
Encourage the establishment of a federally qualified health center working in collaboration
with local private and public providers, including the Monroe County Health Department
and the Rural Health Network.
Recommendation 3
Expand Health Flex Plan to include Monroe County.
Part III: Direct Services
Recommendation 1
Increase access to primary, secondary, specialty and dental care services.
6
Recommendation 2
Advocate for increased cultural sensitivity and competency among providers by
encouraging them to develop linguistically and culturally appropriate services in concert
with public health, social services and school systems.
Recommendation 3
Increase mental health and substance abuse services for children, teens, and adults.
Recommendation 4
Assure access for trauma transport services countywide.
Part IV: Elder Care
Recommendation 1
Increase access to licensed in-home services, including home health in Monroe County.
Recommendation 2
Expand the availability of adult day care centers and assisted living facilities (ALFs)
countywide.
7
Monroe County Community Health Initiative
FINAL RECOMMENDATIONS AND ACTION PLAN
Part I:
Public Health/Prevention
Recommendation 1
Provide education for prevention of chronic diseases, communicable diseases,
unintentional injuries, and substance abuse.
Strategies
1. Support the "Know Your Numbers3" campaign sponsored by the Monroe County
Health Department and funded by the CDC's Bureau of Chronic Disease Prevention.
2. Attend certification classes to become a Wellness Education Counselor.
3. Collaborate with local community education system (e.g., college community, faith
based groups/health ministries).
4. Enhance technology usage and make it work for public health. Be creative and utilize
existing tools (e.g., music) to develop public health messages (e.g., high cholesterol
blues, Rural Health Network's "Wash your Hands" jingle).
5. Disseminate user friendly materials in English, Spanish, and Creole.
6. Establish a telephone support network to provide educational information on the
debilitating effects of substance abuse (e.g., tobacco, alcohol, food).
7. Promote education on effects of club drugs4 (e.g., MDMAlEcstasy, GHB, Rohypnol) to
the body, particularly when used in combination with alcohol.
8. Streamline data collection and reporting systems to accurately identify high-risk groups
at the zip code and/or census track levels.
Process and Outcome Measures
1. Monroe County attains four-year goal of reaching approximately 40,000 residents
through the "Know Your Numbers" campaign.
2. Twenty licensed health care professionals in Monroe County become certified as
Wellness Education Counselors by 2007.
3. Increased collaborative educational efforts with local health ministry groups and
community college.
4. A 10% decrease in deaths due to unintentional injuries from 55.72 per 100,000
population (1996-2000) to 50.15 per 100,000 population (2003-2007).
Healthy People 2010 Target: 20.8 deaths per 100,000 population.
5. A 10% decrease in the number of hospitalizations due to alcohol and drug abuse or
dependence, detoxification from 106 in 2001 to 95 in 2007.
Healthy People 2010 Objective for State and Local Efforts: Increase the proportion
of persons who are referred for follow-up care for alcohol problems, drug problems
3 The "Know Your Numbers" campaign is aimed at increasing an individual's awareness of his/her blood pressure,
pulse, body mass index, cholesterol, waist circumference, and weight measurements.
4 A collective tenn used for the drugs that are often associated with rave or dance parties. Source: National Institute
on Drug Abuse, 2000.
8
or suicide attempts after diagnosis or treatment for one of these conditions in a
hospital emergency department.
6. A countywide data warehouse to maintain morbidity and mortality data, as well as
health services utilization data is established.
Recommendation 2
Reduce infant mortality rates countywide.
Strategies
1. Preserve high Healthy Start screening rates for prenatal care.
2. Advocate for consistent adherence to well child protocols (e.g., vision screenings up to
18 months for tumor detection).
3. Encourage health fairs to include information on well child screenings. .
4. Promote the provision of well child care by Monroe County Health Department nurse
practitioners and nurses.
5. Address funding constraints that limit access to well child care.
Process and Outcome Measures
1. A 5% decrease in infant mortality rates from 4.9 per 100,000 population (1996-2000)
to 4.7 per 100,000 population (2003-2007).
Healthy People 2010 Target: 4.5 per 100,000 population.
2. A 10% increase in the number of well child care screenings performed by Monroe
County Health Department nurse practitioners and nurses by 2007.
Healthy People 2010 Objective: Ensure appropriate newborn bloodspot screening,
follow-up testing, and referral to services.
Recommendation 3
Provide young adults with the necessary tools to make informed decisions regarding their
sexual health.
Strategies
1. Increase awareness among young adults of services available at Teen Clinics5 (e.g., sex
education); consider collaborating with the school system.
2. Encourage parents to educate their children during the early years about sexual heath,
including contemporary environmental risk factors (e.g., HIV/AIDS).
3. Establish an interactive website that offers resource materials, includes links to other
social service programs and provides an educational forum on sexual health.
Process and Outcome Measures
1. From a baseline of 360 teens in calendar year 2002, increase the number of young
adults utilizing the Teen Clinic for sexual health services by 10%.
2. A quantifiable increase in the number of teenagers receiving efficient, non-judgmental,
risk reduction professional services at the Teen Clinic.
3. An interactive website offering resource materials on sexual health is established.
5 The Teen Clinics are sponsored by the Monroe County Health Department & Womankind. The clinics, which are
both located in Key West, provide free and confidential services for all teens with regards to their sexual and
reproductive health.
9
Recommendation 4
Reduce the number of low birth weight babies and improve birth outcomes.
Strategies
1. Support the Florida Keys Healthy Start Coalition in its efforts to reduce the number of
low birth weight babies and improve birth outcomes
2. Increase the number of prevention strategies, including education efforts,
environmental controls on smoking, and restrictions on tobacco availability, including
increased tobacco excise taxes and bans on cigarette vending machines.
3. Explore best clinical and administrative practices toward improving birth outcomes.
Process and Outcome Measures
1. A 7% decrease in the percentage oflow birth weight babies from 5.7% (1996-2000) to
5.3% (2003-2007).
Healthy People 2010 Target: 5.0%.
2. A quantifiable decrease in the number of adverse birth outcomes including birth defects
related to alcohol, tobacco, and drug use.
Healthy People 2010 Objective: Increase abstinence/rom alcohol, cigarettes, and
illicit drugs among pregnant women.
Recommendation 5
Advocate for additional school-based health services in Monroe County.
Strategies
1. Expand school nurse programs.
2. Consider impact/limitations as a result of the nursing shortage.
3. Advocate for increased pregnancy prevention programs for at-risk youth.
4. Address funding issues that limit the amount of school-based health services offered.
5. Collaborate with schools, the local health department, and the local Area Health
Education Center to expand Wellness Screening Program mini-fairs.
6. Expand health education programs to address obesity, diabetes, nutrition, smoking and
drinking behavior, hypertension and blood pressure.
7. Expand screening efforts (e.g., dental, vision, hearing, physical development) for
children in child care programs.
Process and Outcome Measures
1. At a minimum, one health nurse should be available in every school with sufficient
operational funds appropriated through resources such as those from the Tobacco
Settlement Funds.
2. A 5% decrease in the percentage of live births to adolescents aged 10 to 17 years from
3.2% (1996-2000) to 3.0% (2003-2007).
Healthy People 2010 Target: 43 pregnancies per 1,000 live births.
(Note: Healthy People 2010 target is for female adolescents aged 15 to 17 years)
3. A 5% increase in funding for school-based health services in Monroe County from
$518,7676 in 2003 to $544,705 in 2007.
6 The majority of these funds are provided by the Monroe County Health Department. Source: Finance Department,
Monroe County School Board, March 2003.
10
Recommendation 6
Reduce child, adult and elder abuse rates countywide.
Strategv
1. During the month of April, participate in Child Abuse Prevention Month activities.
2. Support the Blue Ribbon Campaign sponsored by the Wesley House Families
Available for Children in Emergency Shelter (FACES) Program, in conjunction with
the Wesley House Family Services Neighborhood Centers and the Department of
Children and Families, to increase awareness among Monroe County residents of the
need to prevent child abuse.
3. Refer at-risk families to attend child abuse prevention education classes offered
through Wesley House Family Services' Neighborhood Centers located in Key West,
Marathon, and Tavernier.
4. Offer additional support services to distressed families after natural disasters (e.g.,
hurricanes) occur.
5. Collaborate with the Wesley House FACES Program to increase the number of
licensed foster homes7 in Monroe County.
6. Conduct abuse screenings at health department clinics.
7. Offer child abuse risk screenings through the Healthy Start Program and provide
referrals to appropriate programs.
8. Encourage training/education of medical personnel for screening and referrals for
suspected abuse and neglect among children and elders.
9. Support Healthy Families Monroe, a child abuse prevention program offered by
Wesley House for targeted high risk families with newborns and children up to age
five.
Process and Outcome Measures
1. A quantifiable decrease in the number of occurrences and reoccurrences of child abuse.
2. A 10% increase in the number of families attending child abuse prevention education
classes at Wesley House Family Services Neighborhood Centers.
3. A quantifiable decrease in the number of child abuse incidents occurring after a natural
disaster (e.g., hurricane).
4. A 20% increase in the number oflicensed foster homes in Monroe County from 31 (as
of June 2002) to 40 by June 2005.
7 As of June 2002, there were 31 licensed foster homes in Monroe County. Through a grant from the Florida
Department of Children and Families, Wesley House administers and operates the Wesley House Families Available
for Children in Emergency Shelter (FACES) Program which aims to recruit 16 new licensed foster homes in Monroe
County, through conununity outreach presentations to social organizations, church groups and a media campaign to
promote interest in foster care.
11
Part II:
Insurance/Health Plan
Recommendation 1
Develop a countywide health care coverage model, including the uninsured and
underinsured, regardless of employment status.
Strategies
1. Support the work of the Health Insurance Task Force to identify solutions to the
challenges of obtaining affordable health care coverage for Florida Keys residents.
2. Explore best practices to identify health insurance crisis solutions.
3. Examine established Trust Fund models and adapt to Monroe County.
4. Preserve private base of health care providers.
5. Coordinate efforts with the Insurance Commissioner and other partners (e.g., insurance
companies, hospitals, businesses, physicians).
Process and Outcome Measures
1. A new countywide health care plan for the uninsured and underinsured
2. An actuarial analysis that identifies the total number of individuals anticipated to
participate, and the overall yearly and monthly cost of providing health care coverage
similar to that provided to Monroe County employees.
3. A Trust Fund, which would include both public and private funds, is established in
Monroe County to help defray the plan cost.
Recommendation 2
Encourage the establishment of a federally qualified health center working in collaboration
with local private and public providers, including the Monroe County Health Department
and the Rural Health Network.
Strategies
1. Build on existing infrastructure by utilizing the Good Care Clinic as a model for a pilot
project.
2. Apply for Medically Underserved Area redesignation by the u.S. Department of
Human Services, Bureau of Primary Health Care.
Outcome Measures
1. A federal qualified health center that builds on a local model is established.
2. Monroe County is redesignated as a Medically Underserved Area under new federal
guidelines.
Recommendation 3
Expand Health Flex Plan8 to include Monroe County.
8 The Health Flex Plan was created by the 2002 Legislature (Senate Bi1146-E) as a pilot program for the north, central
and southern areas of the State that have the highest levels of uninsured residents and includes Miami-Dade County.
Plans developed will not be as expensive as current health care insurance since the plans are not subject to mandates
of the Florida Insurance Code and the law regulating Health Maintenance Organizations and insurance plans. To
qualify an individual must be a resident of the State and 64 years of age or younger, with a family income of up-to 200
percent of the poverty level, have not been covered by a private insurance policy for the past 6 months and not be
eligible for coverage by a public health care program (Source: Agency for Health Care Administration, April 2003).
12
Strategy
Support Monroe County in its efforts to be included in the Health Flex program since
Miami-Dade and Monroe County's health care systems are intertwined.
Outcome Measure
The Health Flex Plan is expanded to include Monroe County.
Part III:
Direct Services
Recommendation 1
Increase access to primary, secondary, specialty and dental care services.
Strategies
1. Encourage more primary care physicians, particularly in the Middle Keys, to offer
extended evening and weekend hours to accommodate the schedules of working
families.
2. Advocate for more physicians to accept KidCare and Medicaid.
3. Increase the participation by physicians in the care of the medically indigent, including
the provision of preventive care.
4. Address reimbursement issues (e.g., Medicaid).
5. Expand KidCare outreach.
6. Increase dental services.
7. Study waiver possibility to expand coverage to KidCare parents.
8. Provide coverage to immigrant children currently on KidCare waiting list.
9. Increase primary and secondary care women's health services.
Process and Outcome Measures
1. Extended evening and weekend hours among Middle Keys physicians.
2. A 15% increase in the number of physicians who accept KidCare from 51 in 2002 to
59 in 2007.
3. A 10% increase in the number of physicians who accept Medicaid from 62 in 2002 to
68 in 2007.
4. KidCare coverage is expanded to cover KidCare parents and immigrant children.
Recommendation 2
Advocate for increased cultural sensitivity and competency among providers by
encouraging them to develop linguistically and culturally appropriate services in concert
with public health, social services and school systems.
Strategies
1. Promote the recruitment, hiring and retention of medical and other personnel, including
mental health therapists, from minority groups.
2. Educate providers on the need for cultural responsiveness according to local
community populations served.
3. Endorse outreach activities in areas where there are few providers targeting high risk
populations.
13
Process and Outcome Measures
Cultural competency training programs; outreach conducted among high-risk groups;
culturally competent health and human service personnel.
Recommendation 3
Increase mental health and substance abuse services for children, teens and adults.
Strategies
1. Increase utilization of available grant funding for mental health services by
identifying individuals with unmet needs (i.e., case finding).
2. Engage in early prevention activities through collaborative efforts with schools,
parents, and juvenile court system.
3. Address reimbursement issues.
4. Advocate for the expansion of mental health and substance abuse programs
available through the Department of Children and Families' contractual service
providers.
5. Increase the number of quantifiable indicators regarding the incidence and
prevalence of mental illness among populations.
6. Support the National Mental Health Association and advocate for comprehensive
health insurance parity.9
7. Promote the recruitment, hiring and retention of mental health therapists from
minority groups.
8. Expand crisis services for suicide reduction.
9. Obtain child/adolescent substance abuse beds for inpatient substance abuse services
and secure appropriate funding.
10. Advocate for better reimbursement rates for mental health and substance abuse
servIces.
11. Assure collaboration between social service agencies and mental health clinics
through multi-disciplinary staffing and referrals to assure services for families.
Process and Outcome Measures
1. A measurable increase in the number of mental and substance abuse services
available for kids and teens.
2. The availability of at least two child/adolescent substance abuse beds in Monroe
County by 2007.
3. Passage of a Mental Health Parity bill; expanded coverage.
4. Increased reimbursement rates for mental health and substance abuse services
provided to Monroe County residents of all ages.
9 According to the National Mental Health Association, comprehensive mental health parity "would ensure that
mental health care, including substance abuse treatment, would have the same insurance coverage as physical health
care".
14
Recommendation 4
Assure access for trauma transport services countywide.
Strategies
1. Secure dedicated flight crews to assure coverage of multiple incidents within same
geographic area.
2. Reexamine law pertaining to health taxing districts and consider possible applications
countywide and at the local levels.
Outcome Measure
Increased access in the Middle and Lower Keys for trauma transport services.
Part IV:
Elder Care
Recommendation 1
Increase access to licensed in-home services, including home health in Monroe County.
Strategies
1. Adopt sliding fee scale to increase access to in-home services among the working poor.
2. Decrease waiting lists for in-home services.
3. Explore best practices models of home based services that integrate physician home
visits and disease management for chronic disease (e.g., congestive heart failure,
advanced diabetes, hypertension, stroke).
4. Support the development of a network of elder care that provides 24-hour assistance by
on-call physicians and nurses via a telephone triage help line.
5. Encourage public/private partnerships to maximize resources provided through Older
American Act funds and private home health agencies.
6. Explore cost-effective and comprehensive prescription assistance programs for the
elderly.
7. Explore the formation of a Memory Disorders CliniclO.
8. Institute abuse screening and referral services.
Process and Outcome Measures
1. A quantifiable increase in the number of in-home services provided to the working
poor in Monroe County.
2. A quantifiable reduction in unlicensed and unsupervised in-home services provided in
Monroe County.
3. A reduced waiting list for in-home services.
4. Better management of resources coupled with enhanced clinical outcomes.
5. The establishment of a telephone triage help line to facilitate the provision of elder care
to Monroe County residents facing barriers to accessing care (e.g., transportation).
6. The creation of public/private partnership for the provision of in-home services.
7. A quantifiable increase in access to prescription assistance services for the elderly.
10 Memory Disorder Clinics provide state of the art diagnosis and treatment of memory disorders (e.g., Alzheimer's
Disease) and age associated memory impairment.
15
8. The establishment of a Memory Disorders Clinic to provide diagnosis and treatment
services for memory disorders and age associated memory impairment.
Recommendation 2
Expand the availability of adult day care centers and assisted living facilities (ALFs)
countywide.
Strategies
1. Support the development of a 52 bed ALF in Key West.
2. Support church/faith-based and other adult day care program development.
3. Promote full services at ALFs; expand number of medical and support services offered.
Process and Outcome Measures
1. An increase in the number of medical and support servIces offered at ALFs
countywide.
2. A 150% increase in the number of ALF beds available countywide from 35 to 87.
16
fl't1~ tA-r1f
Implementation of Chapter 99-395, Laws of Florida
The Florida Keys
Submitted to:
'Honorable Jeb Bush, Governor
Honorable James E. King, Jr., President, Florida Senate
Honorable Johnnie B. Byrd, Jr., Speaker, Florida House of Representatives
Prepared by:
-~~
------------------
This report has been prepared as required by section 8 of chapter 99-395, Laws of Florida.
December 2002
D.d.
Contents
Page
Executive Summary and Florida Keys Depiction
Map of Florida Keys
Section 1 - Department of Environmental Protection
1.1 Water Quality
1.1.1 Introduction
1.1.2 Water Quality Protection Program Document for
the Florida Keys National Marine Sanctuary
1.1.3 Water Quality Concerns in the Florida Keys:
Sources, Effects and Solutions
1.1.4 Florida Keys Carrying Capacity Study
1.1.5 Little Venice Water Quality
1.2 Fate and Transport of Nutrients in Florida Keys Groundwater
1.3 Wastewater Treatment Technology
1.3.1 Introduction and Existing Facilities
1.3.2 Treatment Technology
1.3.3 Estimated Construction Costs
1.3.3.1 BAT Systems
1.3.3.2 A WT Systems
1.3.4 Estimated Operation and Maintenance Costs
1.3.4.1 BAT Systems
1.3.4.2 A WT Systems
1.3.5 Actual Performance in the Florida Keys
1.4 Treatment Plant Staffing
1.5 Managerial Arrangements
1.6 Implementing Authority
1.6.1 Local Government
1.6.2 State Government
1.7 State and Federal Assistance for Wastewater Management
1.8 Recommendations
4
6
7
7
7
8
8
8
9
10
10
10
12
13
13
13
14
14
14
15
17
17
18
18
18
18
19
2
Section 2 - Department of Health
2.1 On-site Wastewater Treatment Technology
2.1.1 Introduction
2.1.2 Estimated Construction and Maintenance Costs
2.2 Research Background and Summary
2.2.1 Phase I
2.2.2 Phase II
2.3 Cesspit EliminationlWastewater Improvement Program
2.3.1 History
2.3.2 Results
2.4 Recommendations
Section 3 - Literature Cited
Appendix - Glossary of Terms and Abbreviations
21
21
21
22
22
22
24
25
25
26
27
29
30
3
Executive Summary
Section 8 of Chapter 99-395, Laws of Florida, requires the Department of Environmental
Protection and Department of Health to report to the legislature no later than January 1,2003, on
wastewater treatment in the Florida Keys. The specific issues to be addressed in this report are:
. The state of wastewater treatment technology.
. Treatment capabilities and operation and maintenance requirements of various
sizes and types of wastewater facilities and onsite sewage treatment and disposal
systems, with emphasis on individual and smaller systems.
. Status of research on fate and transport of nutrients associated with wastewater
disposal in the Keys.
. Assessment of overall water quality in the Keys.
Chapter 99-395, Laws of Florida, also requires the two departments to make specific
recommendations on any changes to wastewater treatment and disposal that may be warranted.
The substantive provisions of the report address these matters to the extent possible given the
inconclusive nature of available evidence. A map of the Florida Keys is included after this
section to aid in understanding the geographical relationship among the areas referenced.
This report inCludes sections prepared by the Department of Environmental Protection (section 1)
and the Department of Health (section 2). Each section contains individual observations and
conclusions. Jointly endorsed recommendations supported by this report are as follows:
. Maintain and enforce the existing wastewater treatment and disposal
requirements set forth in Chapter 99-395, LOF.
. Continue to support monitoring and research activities to establish the basis for future
decisions regarding wastewater treatment and disposal requirements.
. Encourage the use of the most effective wastewater treatment and disposal systems,
considering economics and reliability, to protect water quality and public health in the
Florida Keys.
The Department of Environmental Protection's supplementary conclusions are summarized
below:
. There is insufficient scientific evidence on the effects of nutrient and other pollutant
loading on the nearshore waters of the Keys to serve as a basis for developing alternative
water quality criteria to those in chapter 99-395, LOF.
. There is insufficient evidence of permanent fixation of phosphorus in submerged
limestone to justify adjustment of the phosphorus effluent limit in Chapter 99-395, LOF.
. There is no reason to doubt that "advanced waste treatment" (A WT) can be successfully
implemented in the Florida Keys by the larger facilities for which it is required.
4
. Technology for achieving "best available technology" (BAT) treatment exists and there
are a number of manufacturers. The limited information available to date for construction
costs indicates that BAT facilities may not be as expensive as initially estimated. Until
newly permitted facilities have a history of operation during design conditions, judging
their adequacy from a permitting standpoint must be withheld. Minimal information is
available for the operating and maintenance costs for BAT facilities and no reliable
conclusions can be drawn.
. Operator training and attendance as well as monitoring requirements should be upgraded.
The Department of Health's supplementary conclusions are summarized below:
. Significant numbers of cesspits remain in place throughout the areas designated to be
sewered in the Master Wastewater Plan. It is unlikely that all of these areas will be
sewered by 2010. Local government and state agencies should assess this situation and
plan accordingly.
. Significant numbers of permitted onsite systems requiring upgrade for nutrient removal
by 2010 are in designated "cold" spot areas. Local governments should address the
requirement to upgrade these systems and identify funding sources to assist homeowners.
. Local governments and utilities should pursue the concept of decentralized or clustered
systems to provide wastewater treatment in those areas where sewers are not financially
feasible and lot size prohibits or limits onsite sewage treatment options.
. The EP A has adopted voluntary guidelines for management of on site systems and is
encouraging state and local government to adopt these guidelines. Local governments
should consider adoption of ordinances to manage onsite systems like any other utility,
assessing monthly fees to cover maintenance, sampling and repair.
5
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Section 1 - Department of Environmental Protection
1.1 Water Quality
1.1.1 Introduction
There are numerous actions, documents, and studies addressing water quality in the
Florida Keys, the most noteworthy of which are discussed herein. Florida's original
designation of the Florida Keys as an Area of Critical State Concern was done
administratively in 1979. As a result ofa challenge, the designation was made
legislatively under the Florida Keys Area Protection Act (s. 380.0552, F.S.) in 1986,
establishing the need to conserve and protect the natural environment, historical and
economic resources, scenic beauty, and public facilities. The 1990 Florida Keys National
Marine Sanctuary and Protection Act (P.L. 101-605) established 2,800 square nautical
miles of coastal waters as the Sanctuary. Ajoint federal-state role was created for
devel,oping a Water Quality Protection Program and the U.S. Environmental Protection
Agency (EPA) and the Department of Environmental Protection (DEP). became the
responsible entities to adopt the program as a result of additional federai legislation in
1992.
Monroe County adopted a Comprehensive Plan, Rule 28-20.100, F.A.C., in 1991
addressing the needs for the Area of Critical State Concern. Revisions (1993) of the
Comprehensive Plan resulted in an often referenced 1995 Final Order and
Recommendation by a Hearing Officer. The Hearing Officer found that the nearshore
waters had exceeded their carrying capacity for additional nutrient (phosphorus and
nitrogen) loads. Sewage and storm water from then-existing development in the Florida
Keys were degrading nearshore waters that were at or over carrying capacity. Further
revisions to the Comprehensive Plan (Administrative Commission Rule) have been made.
That rule requires the use of advanced waste treatment (A WT) or best available
technology (BAT) for wastewater treatment.
The Water Quality Protection Program Steering Committee, established pursuant to
federal law, approved a water quality protection program document in 1996 that
identified major environmental and land development related concerns in the Florida
Keys. Then, the EP A (1998) reported on a number of conditions, many relating to
anthropogenic (human-introduced) nutrients, in the Florida Keys that were leading to
undesirable changes in the ecological balance in the nearshore waters. About 100 studies,
reports, and publications, many of which relate to ecological conditions and especially to
water quality in the Florida Keys, are cited in the EP A report.
The interest in managing land development using a carrying capacity approach was
emphasized in Gubernatorial Executive Order (EO) 96-108. As directed by subsequent
EO 98-309, the Department of Health (DOH) and DEP worked with the Water Quality
Protection Program Steering Committee to develop wastewater treatment and disposal
standards for the Florida Keys. That effort resulted in Section 6 of Chapter 99-395, LOF.
7
Also in response to the EO, the Department of Community Affairs and the U.S. Army
Corps of Engineers sponsored a carrying capacity study. The report on the three-year
study, currently undergoing revision, deals with a broad range of issues in an attempt to
determine the ability of the entire Florida Keys ecosystem to withstand impacts of land
development.
There also is an important, but incomplete, study of water quality in canals and adjacent
nearshore water in the Little Venice Neighborhood of Marathon, begun in 2001. The
study focuses on the impact of eliminating individual on-site treatment and disposal
systems (including cesspits) and providing centralized A WT facilities. More detailed
information on each of these major efforts is summarized in the subsections below.
1.1.2 "Water Quality Protection Program Document for the Florida Keys National
Marine Sanctuary" (1996)
Continental Shelf Associates, Inc., under EPA's direction, identified corrective actions,
monitoring, research/special studies, and public education/outreach as essential to a water
quality protection program for the Florida Keys. Recommendations were made for
actions to carry out a Water Quality Action Plan. The document noted a number of
threats to water quality, including inflows from Florida Bay, landfills, hazardous
materials, mosquito spraying, canals, marinas and live-aboards, stormwater, and domestic
wastewater. Much of the current water pollution control effort, including the studies
supported by the Water Quality Protection Program Steering Committee, may be traced
back to the recommendations contained in this early study.
1.1.3 "Water Quality Concerns in the Florida Keys: Sources, Effects, and Solutions"
(1998)
The EP A reported that sewage treatment and disposal methods combined with
stormwater discharges were significant contributions to contaminating groundwater and
nearshore waters, including canals and other surface water having low circulation. The
contamination included nutrients and human pathogens. Sewage discharges from boats
were identified as degrading water quality in marinas and other anchorages in are3:s where
relatively little water circulation takes place. Additional nutrients to the surface waters of
the Florida Keys were attributed to the discharge from Florida Bay and currents in the
Gulf of Mexico. The reported noted that coral habitats were in declining health, but no
definitive studies had been completed to establish a link to, or the geographical extent of,
the impact of anthropogenic nutrients.
1.1.4 "Florida Keys Carrying Capacity Study" (2002; under revision)
The carrying capacity study develops a variety of concepts in an effort to address the level
of land use development in the Florida Keys that could occur without significant adverse
impacts to natural and human resources. The study has as its centerpiece an analytical
model with socioeconomic, fiscal, human infrastructure (traffic), integrated water,
8
marine, and terrestrial modules. Ideally, the model output would establish a set of
maximum impacts than can be tolerated by these resources. The model implies that
impacts could be modified through the informed implementation of existing technologies.
However, the problem of identifying specific impacts and discrete thresholds for complex
marine and terrestrial ecological systems remains unsolved. Despite the level of interest
in the marine environment, the model is unable to generate predictions of nearshore water
quality impacts from stormwater and wastewater. To paraphrase a portion of the study's
conclusions:
The model scale does not permit an assessment of the effects ofnutrient and
pollutant loading on the very-near shore waters, including canals and other
areas with low circulation. Studies indicate eutrophication in some canals,
as well as the presence of human pathogens. Sporadic beach closings remind
us of localized episodes of contamination.
DueJo the concern over the validity of any conclusions about water quality in the
immediate nearshore marine environment, a cana} impact assessment module was added
to the study. The effects of different pollutant loads on water quality in dead-end canals
were estimated in an attempt to address water quality in circulation-limited waters and in
the area extending about 250 feet from the open end of the canals. Tidal flushing was
used to predict the pollutant concentrations generated by wastewater discharges from the
adjacent waste-shed to the canals. Estimates were made for ten of the 480 canals in the
Florida Keys. The difference in wastewater pollutant loading between existing conditions
and that occurring if wastewaters were treated as proposed in the Monroe County Sanitary
Wastewater Master Plan was significant. (The Master Plan recommended facilities that
would comply with Chapter 99-395, LOF, and that wastewater would be transported,
treated and disposed of external to the canal wastesheds.) Total nitrogen and total
phosphorus in the ten representative canals would be reduced by 69% and 73%,
respectively, by complete implementation of the Master Plan.
1.1.5 "Little Venice Water Quality" (under development)
Baseline data is currently being collected to establish existing water quality in the canals.
Bacteriological data also is being collected. After the treatment plant currently under
construction is operating, the changes in water quality and bacteriological characteristics
are to be documented to demonstrate the value of improving wastewater treatment. The
sampling program began in 2001 and will continue for two years after the treatment plant
is in operation. Elevated levels of fecal bacteria have been documented. As expected,
water quality in the canals is not as good as that outside of the canals. The worst water
quality is being found near the head end (furthest from open water) of the canals. The
head end ofthe canals also has the poorest water circulation. Use of the study results to
predict potential water quality improvements in other hot spot areas in the Florida Keys
having canals may be possible. '
9
1.2 "Fate of Wastewater Nutrients in Florida Keys Groundwater" (1999)
Researchers at Pennsylvania State University and Florida State University studied the fate and
transport of wastewater nutrients after underground injection. Wastewater was given secondary
treatment at the Key Colony Beach facility before its injection at depths between 60 feet and 90
feet below ground. (Secondary treatment removes many contaminants but has minimal effect on
nutrients.) The freshwater effluent plume rose through the heavier saline groundwater to the mud
layer capping the limestone formation. The plume moved in a dominant easterly-southeasterly
direction. Plume dispersion occurred in all directions.
Nutrients were diluted and removed from the effluent plume as it migrated through the
limestone. Phosphate was partially sorbed (taken up and held) to the calcite surface of the
limestone and where it is believed to have precipitated to rock surfaces and become immobile.
While transport and fate of phosphate was the focus of the study, results for nitrate found it, in
contrast, to be relatively mobile. Nitrate reduction apparently occurred as a result of
microbiological processes in the groundwater. The author concluded that secondary treatment
followed by injection into Key Largo Limestone resulted in reduction of phosphate and, to some
extent, nitrate from the effluent. However, the researchers recognized the need to better
determine the transport and fate of nitrate in order to understand the impact of injected
secondarily treated wastewater in Key Colony Beach.
1.3 Wastewater Treatment Technology
1.3.1 Introduction and Existing Facilities
DEP regulates about 250 treatment plants in the Florida Keys. Existing facilities must
meet, at a minimum, secondary treatment requirements. Chapter 99-395, LOF, requires
higher treatment standards for facilities that are newly permitted or expanded subsequent
to the effective date of the law (June 18, 1999). These higher standards must be met for
all facilities no later than the July 1,2010. The vast majority (95%) of existing facilities
in the Keys provide secondary treatment and the mandatory disinfection of wastewater.
Secondary treatment reduces suspended solid matter and oxygen demanding substances
from wastewater and must meet effluent limits of 20 milligrams per liter biochemical
oxygen demand and 20 milligrams per liter total suspended solids (on an annual average
basis). This is accomplished by supplying air to a cultivated growth of waste reducing
organisms and by settling out the organic and inorganic matter. Mandatory disinfection
kills about 99.99% of the fecal bacteria indicators in the treated wastewater. Chlorination
is the most common means of achieving disinfection. Secondary treatment does not
significantly reduce nitrogen or phosphorus nutrients from wastewater.
The useful lives of wastewater treatment facilities vary with the quality of the initial
equipment and materials, the level of ongoing attention given to repair and replacement
(especially for electrical and mechanical equipment), and the need for greater capacity or
treatment level. Well-built and maintained facilities that are not subject to expansion and
upgrade demands should have useful lives in excess of 20 years.
10
The definition of advanced waste treatment (A WT) in Chapter 99-395(6)(a), LOF,
establishes effluent limits of 5 milligrams per liter biochemical oxygen demand, 5
milligrams per liter total suspended solids, 3 milligrams per liter total nitrogen, and 1
milligram per liter total phosphorus (on an annual average basis). An intermediate level
of treatment is defined in the same paragraph of Chapter 99-395 and is referred to as
"BAT" (best available technology) throughout this report. The effluent limits for BAT
are 1 0 milligrams per liter biochemical oxygen demand, 10 milligrams per liter total
suspended solids, 10 milligrams per liter total nitrogen, and 1 milligram per liter total
phosphorus (on an annual average basis). Both of these treatment levels are intended to
significantly reduce nutrients, which have been identified as primary pollutants of
concern in the Keys. The processes that reduce nutrients also increase the reduction of
suspended solids and biochemical oxygen demand beyond that achieved by secondary
treatment.
There are over two hundred small DEP permitted wastewater treatment facilities in the
Flori~a Keys having wastewater flows less than 100,000 gpd (gpd). Facilities of this size
are subject to the requirements for the BAT intermediate level of treatment. There are
fewer than ten larger DEP permitted wastewater treatment plants having wastewater
flows greater than 100,000 gpd in the Florida Keys. Facilities of this size are subject to
the requirements for the A WT level of treatment. Several of the small facilities already
have been designed and permitted to meet BAT. Only two large facilities (Key West and
Key Colony Beach) have been designed to remove nutrients but neither is required by
permit to produce A WT. (As noted previously, only new facilities and expansions of
existing facilities are immediately required to achieve treatment beyond secondary
according to Chapter 99-395, LOF.) No domestic wastewater treatment plant directly
discharges treated effluent to surface water in the Florida Keys.
Outside the Keys, treatment plants generally are permitted based on site-specific
"wasteload allocations" and, thus, have a wide variety of effluent limitations designed to
meet local water quality conditions. Other treatment plants are permitted to meet
technology based standards such as secondary treatment or A WT. Advanced waste
treatment, while uncommon in the Florida Keys, has been used on the mainland for more
than 20 years, where there now are about 60 facilities operating with the same A W!
effluent limits set forth in Chapter 99-395, LOF. (Perhaps double that many facilities
currently produce or are capable of producing this qualify of effluent.) Most of these
(about two-thirds) are relatively large facilities with flows exceeding 500,000 gpd. A
review of reported effluent limit violations over the past few years indicates that both
large and small plants produce effluents that generally meet at least the BAT nutrient
limits.
The number of A WT facilities with flows less than 100,000 gpd is limited and most of
them involve wetlands as part of the treatment. A performance comparison of such
"wetland" facilities to treatment plants in the Florida Keys would be inappropriate as
wetland treatment would impact surface water and would be prohibited by the
Outstanding Florida Water designation for the Florida Keys.
11
Notably, the Hiawatha Condominiums (36,000 gpd design flow) located in Palatka,
Florida, is not a wetlands facility and thus more comparable to potential Keys facilities.
It is permitted for discharge at A WT limits and would reliably meet the BAT limits
established for small treatment plants in the Florida Keys. This treatment plant serves a
residential complex and a restaurant.
1.3.2 Treatment Technology
Concern for the practicalities and costs of protecting water quality in the Florida Keys led
the DEP to contract for an engineering consultant, CH2MHill, to evaluate the
technologies available for small (2,000 to 100,000 gpd) wastewater treatment facilities to
reduce nitrogen and phosphorus. Such small facilities would typically serve 10 to 600
residences. The substance ofthe resulting report, "Evaluation of Nitrogen and
Phosphorus Removal Technologies for Small Wastewater Treatment Plants," is
sumJ)larized below.
Nitrogen reducing technology is generally a two-step process involving biological
transformations of organic nitrogen and the oxidation of ammonia nitrogen and then
biological denitrification in an oxygen deficient environment. Phosphorus reducing
technology generally involves chemical precipitation by mixing a metal salt such as alum
into the wastewater. Final effluent filtration generally is recommended for use with these
technologies to reliably achieve the 10 milligram per liter total suspended solids
limitation associated with BAT. The contractor evaluated approximately 25
manufactured systems. (Manufactured systems are often referred to as "package plants"
as they are delivered to the treatment site in some stage of preassembly.)
Seventeen site visits were made to operating plants in Florida, New York, New Jersey,
and Massachusetts. The Hiawatha Condominiums sewage treatment plant previously
noted was inspected. Only one (Hiawatha Condominiums) of the inspected facilities was
required to produce effluent within the BAT envelope of 10 milligrams per liter
biochemical oxygen demand, 10 milligrams per liter total suspended solids, 10
milligrams per liter total nitrogen, and I milligram per liter total phosphorus. The ~ther
inspected facilities generally were subject to nitrate and ammonia limits but a few were
required to reduce total nitrogen.
The consultant developed costs for constructing, operating and maintaining new treatment
systems and retrofitting existing secondary treatment plants to accommodate the nutrient
reducing technologies. Note that the cost comparisons presented below do not
incorporate the costs associated with sewer systems (collection facilities). Sewer system
costs would be common to both secondary and nutrient treatment systems and are thus
irrelevant to the treatment cost comparison. Sewer systems constructed in the public
right-of-way in the Florida Keys represent 60% to 80% of the total costs to build
centralized wastewater management systems.
12
1.3.3 Estimated Construction Costs
Cost comparisons are extremely complicated and variable, especially in the case of
retrofitting existing facilities. Costs vary based on performance requirements, design,
size (capacity), existing components, site characteristics, financing terms, etc. Relative
costs are presented below as ranges to give an idea of the variability. The CH2MHill
report referenced under paragraph 1.3.2 above contains detailed information about the
available technologies and their costs.
1.3.3.1 BAT Systems
A new BAT system is estimated to be roughly 20% to 100% more expensive to
construct than would be a conventional secondary treatment facility, depending on
circumstances. However, BAT facilities generally will cost about 50% more to
build than will secondary treatment facilities. The cost to build treatment facilities
greatly varies with the performance level, design, size, site characteristics, and
financing. For example, the construction cost for secondary treatment per
residential unit ranges from about $7,700 to serve about 20 residences to less than
$1,300 to serve about 480 residences. The smaller the facility, the greater the cost
differential.
The cost to retrofit an existing secondary treatment plant with BAT capability
cannot be directly benchmarked to secondary treatment since there would be no
change (zero cost) to the existing base facility. However, retrofit costs can be
compared to the cost of new secondary treatment plants. The cost to upgrade
(retrofit) plants would be on the order of30% to 40% of the cost of new
secondary treatment facilities.
1.3.3.2 A WT Systems
New A WT systems for flows in the range of 100,000 gpd to 2 million gpd are
estimated to be roughly 60% to 90% more expensive to construct than would be a
conventional secondary treatment facility. As with BAT systems, the smal!er the
facility, the greater the cost differential between secondary treatment and A WT.
Most large facilities incorporate suspended growth technology.
The cost to retrofit an existing secondary treatment plant with A WT capability is
even more difficult to predict than that for the BAT situation noted above. For
example, the upgrade of the existing 10.0 million gpd Key West plant cost $6.6
million while the upgrade of the existing 340,000 gpd Key Colony Beach plant
cost $2.7 million. A comparison on a cost per 1,000 gpd (gpd) basis of the two
upgrades ($660 per 1,000 gpd for Key West; $7,941 per 1,000 gpd for Key
Colony Beach) demonstrates the extreme variation in costs.
13
1.3.4 Estimated Operation and Maintenance Costs
1.3.4.1 BAT Systems
A new BAT system is estimated to cost from 10% to 90% more than that of a
conventional secondary treatment facility to operate and maintain but, generally,
about 30% more. Even the cost to operate and maintain secondary treatment
facilities greatly varies with size reflecting economies of scale. For example, the
cost per month per residential unit ranges from about $90 to serve about 20
residences to less than $15 to serve about 480 residences. These costs do not
include that for operating and maintaining the necessary sewer system nor do they
include any debt service component associated with building the treatment
facilities.
The cost to operate and maintain a retrofitted treatment plant to achieve BAT can
be made using the assumption that operation and maintenance costs for a new
secondary treatment plant would approximate that for an existing secondary
facility. Based on that assumption, the cost to operate and maintain BAT
(modified secondary treatment plus anoxic tank and chemical feed) ranges from
30% to 70% more expensive than to operate and maintain a conventional
secondary treatment plant The typical cost will be towards the high end of the
range because most BAT facilities in the Keys will be small.
1.3.4.2 A WT Systems
Operating and maintaining a new A WT system is estimated to cost 60% to 80%
more than that for a conventional secondary treatment facility. Economies of
scale dampen the cost range and account for the relatively narrow A WT cost
ratios (60% - 80%) compared to BAT cost ratios (10% - 90%) despite the higher
level of treatment required. As with most other cost comparisons, the higher cost
ratios are for smaller facilities.
The relative cost differential to operate and maintain a retrofitted treatment plant
to achieve A WT vs. secondary treatment can be made using two assumptions.
First, the operation and maintenance costs for new secondary treatment plant
would approximate that for an existing secondary facility. Second, the operation
and maintenance costs for a retrofitted A WT plant would approximate that for a
new A WT plant. Then, the cost differential (with respect to secondary treatment)
to operate and maintain A WT at retrofitted plants would be roughly the same 60%
to 80% range as for new A WT plants noted in Subsection 1.3.4.1 above. It is
possible that the reported cost range (but not necessarily the upper end-point) is
understated because of the case-by-case nature of upgrading large facilities.
14
1.3.5 Actual Performance in the Florida Keys
The treatment plants that recently have been built with nutrient removal capabilities do
not have long enough operating histories to draw firm conclusions as to the practicality of
achieving high levels of nutrient reduction. Biological processes at treatment plants
require time to establish. Higher performance systems require greater attention and
should be expected to have longer start-up periods than conventional secondary treatment
processes. Start-up periods, complete with.hardware and operational adjustments, can
require six months of careful attention before design capability is reliably evident.
Further, start-up periods can vary greatly depending on the ratio of initial loading of
wastewater flows to design capacity. It also should be noted that new facilities do not
have the normal repaIr and replacement expenses that older facilities have. Start-up
expenses are not typical of long-term steady state operations.
A small number (six) of BAT facilities in the Florida Keys have been designed and
permitted in accordance with DEP's requirements. The DEP's compliance inspections
indicate that operating protocols are being followed. All are new facilities even though
they generally replaced existing treatment plants. All are operating at flows that are
relatively low with respect to design conditions. Comments on these faCilities and one of
the two upgraded large (flows exceeding 100,000 gpd) A WT facilities are presented
below. The other large facility (Key Colony Beach) is not currently being operated in an
A WT ~ode, and it has yet to be equipped with chemical feed for phosphorus removal.
· The new 12,000 gpd Island Tiki Bar (Marathon) suspended growth treatment
plant has been in operation since November 2001. The facility is performing as
required under the operating permit. However, it is receiving less than 20% of the
design flow. The construction cost was below the estimate for this size facility as
presented in the report entitled "Evaluation of Nitrogen and Phosphorus Removal
Technologies for Small Wastewater Treatment Plants" prepared by CH2MHill. A
comparison of the actual cost to operate and maintain the facility to that estimated
by CH2Mhill is not possible because the operation and maintenance contract
excludes power costs, and the owner does not separately track power bills f9r the
treatment plant.
· The new 15,000 gpd Boy Scouts of America (Brinton Center) uses a suspended
growth process for wastewater treatment. Operation of the treatment plant began
in June 2001. The facility is used intermittently throughout the year, and was in
the shut-down mode during the fall of2002. Effluent during the summer of2002
did not meet the phosphorus limitation. The construction cost was well below the
estimate for this size facility as presented in the report cited above for the Boy
Scout installation. A comparison of the costs to intermittently operate a facility to
that for continuously meeting effluent requirements should not be attempted. Any
comparison would be further complicated due to the aggregation of billing for
power for the treatment plant with other Brinton Center power costs.
15
. The new 3,000 gpd Waffle House treatment plant (Key Largo) uses a suspended
growth process for wastewater treatment. Operation of the treatment plant began
in January 2000. Flow is less than 50% of design capacity. The Waffle House
facility is not achieving permitted nitrogen limits. The construction cost was well
below the estimate for this size facility as presented in the CH2MHill nutrient
removal report. Until the treatment plant consistently meets the permit limits, a
comparison of operation and maintenance costs to those estimated by the
CH2MHill engineers should not be made.
. The new 14,000 gpd John Pennekamp State Park suspended growth treatment
plant (Key Largo) has been operating since November 2000. "Off-the-scale"
ammonia nitrogen influent loading has been experienced. (The Pennekamp
facility receives boating pump-out waste, recreational vehicle waste, park waste,
and has closed system reuse.) Subsequent to the DEP's formal noncompliance
notification for the Park's failure to meet effluent limits, progress has been made
in bringing down the nitrogen content of the effluent. An engineering report has
_ been issued as part of the process to enforce compliance with effluent limits. An
application for'a permit to construct the facility modifications recommended by
the Park's consulting engineer is under review. Major design and process control
adjustments are expected to be necessary to fix the problem. While the initial
construction cost for the treatment plant is consistent with the estimates found in
the CH2MHill report, the need for additional treatment may push the costs above
the reported estimates. The facility has not reduced total suspended solids to the
.level required for reuse. As a result, the reuse system has been out of service.
Since the treatment plant has yet to meet effluent requirements, any comparison to
estimated operation and maintenance costs is premature.
. The new 49,500 gpd Islander Resort suspended growth treatment plant
(Islamorada) has been operating since January 2002. Due to continued property
construction and renovations, the facility has not yet reached full operational
status. Flows have yet to reach even 10% of the design capacity. Effluent limits
for nitrogen, phosphorus, and suspended solids were not met during the fall of
2002. The construction cost was below the estimate for this size facility as
presented in the CH2MHill report. Evaluating operation and maintenance costs is
complicated by the fact that there is a very low utilization of design capacity and
thus a comparison with the operation and maintenance estimates contained -in the
referenced engineering report cannot reasonably be made.
. The new 6,000 gpd Ziggie's Conch Restaurant suspended growth treatment plant
(Islamorada) has been operating since October 2001. The facility is not achieving
the required limits for nitrogen. Flow to the plant is highly variable (no flow is
recorded for some days). As with the Waffle House facility, this treatment plant
was constructed for well below the CH2MHill cost estimate. Until the treatment
plant consistently meets the permit limits, a comparison of operation and
maintenance costs to those estimated by the engineers should not be made.
. The 10 million gpd Key West treatment plant was upgraded at an approximate
cost of $6.6 million. Since larger plants were not included in the CH2MHill
16
study, that addressed facilities having flows less than 100,000 gpd, analogous cost
comparisons cannot be made. The facility is achieving A WT effluent limits. .
1.4 Treatment Plant Staffing
All sewage treatment plants permitted by the DEP must have one or more operators having
appropriate skills. For the small BAT facilities of concern (less than 100,000 gpd), a single Class
C Operator is required. There are four operator skill levels ("A" through "D"). A Class C
Operator has at least one year of operating experience, a high school diploma, and has taken a
training course. Class C Operators are not required to have specific knowledge or skill with
respect to nutrient reduction technologies.
There are two different flow related sets of requirements for operator attendance at small BAT
facilities having flows up to 100,000 gpd. One-half hour per day for five days per week and a
weekend visit are required for facilities having flows less than 50,000 gpd. Three hours per day
for five day~ per week and two weekend visits are required for facilities having flows between
50,000 and 100,000 gpd. The difference between the operator attendance requirements is
significant. The attendance requirement is not related to the level of automation, the complexity
of the technology/processes involved, or the required treatment plant performance. In developing
the costs for operation and maintenance referenced above, the consultant, CH2MHill, concluded
that greater skill and operator attendance would be needed at BAT plants than would be needed
at secondary treatment plants.
1.5 Manag~rial Arrangements
There are a variety of entities responsible for wastewater management in the Florida Keys. There
are five incorporated municipalities: Key West, Marathon, Islamorada, Layton, and Key Colony
Beach. The Florida Keys Aqueduct Authority has wastewater jurisdiction for wastewater
management in the unincorporated county, with the exception of the Key Largo area, which is
discussed below. There also are several private utilities providing wastewater service. The
Monroe County Government ultimately is responsible for implementation of its Comprehensive
Plan and Sanitary Wastewater Master Plan.
The enactment of House Bill 471 by the 2002 legislature established the Key Largo Wastewater
Treatment District and authorized creation of a District Board for wastewater management. An
election of the District Board members was held in November 2002. The District Board now has
the jurisdiction for wastewater management that was formerly held by the Florida Keys Aqueduct
Authority. Unfortunately, the electorate declined to provide any funding of the District Board's
administrative activities. The limited funding potentially to be made available from Monroe
County and the South Florida Water Management District for the operation of the District Board
is inadequate to make it fully functional.
The Aqueduct Authority has agreed to continue the wastewater management planning and design
work begun in Key Largo for the Trailer Village subdivision under a Federal Emergency
Management Agency "unmet needs" grant and for the Park subdivision targeted for funding with
17
a State grant. The County may have to sponsor project construction and related activities if the
financial constraints facing the District Board cannot be quickly resolved. The County and
Florida Keys Aqueduct Authority must act in concert throughout unincorporated Monroe County
if the pace of bringing about centralized wastewater management in the Florida Keys is to
accelerate.
1.6 Implementing Authority
1.6.1 Local Government
The Florida Keys Aqueduct Authority, Monroe County, and the City of Marathon have
adopted rules and ordinances to implement the authorizations and requirements of
Chapter 99-395, LOF. The Aqueduct Authority obtained a August 26,2002, Final
Judgment from the 16th Judicial Circuit Court validating its financing for construction of
the centralized wastewater management system, including an advanced waste treatment
plant with deep well injection of treated effluent, to serve the City of Marathon. The
Final Judgment also establishes that the Aqueduct Authority has the ppwer to require
connection of improved properties to the proposed system. Further, authorization for the
imposition of the system of rates, fees, charges, and assessments associated with such
connections and the ensuing wastewater management services was upheld. The ruling
has been appealed to the Supreme Court of Florida and awaits final disposition
1.6.2 . State Government
The Department of Environmental Protection uses the authorization in Chapter 99-
395(6)(a) and (6)(b), LOF, in setting the effluent limits for the facilities that it has
recently permitted in the Florida Keys. Thus, the DEP has participated in implementing
the Monroe County Comprehensive Plan, Rule 28-20.100, F.A.C., which requires the use
of A WT and BAT for wastewater treatment.
1.7 State and Federal Assistance for Wastewater Management
State and Federal appropriations for infrastructure to protect the environment of the Floricl.a Keys
over the past few years have been significant. The grantors have been the U.S. Environmental
Protection Agency, Federal Emergency Management Agency, the South Florida Water
Management District, the Department of Community Affairs, and the Department of
Environmental Protection. (State funding has, of course, been appropriated by the legislature.)
This funding, which is intended to generally assist in the correction of wastewater related
problems, is summarized below and does not include funding made available strictly for planning
or water quality studies. Nor does the list include the $100 million federal authorization (yet to
be appropriated) for Monroe County that would be administered by the U.S. Army Corps of
Engineers and the South Florida Water Management District. It is noteworthy that obligation of
a very significant amount of appropriations awaits local completion of funding prerequisites.
. $2.1 million to Monroe County for cesspit identification and elimination (1999)
18
. $4.3 million to the Florida Keys Aqueduct Authority to construct the Little Venice
neighborhood wastewater management system (1999)
. $74 thousand to Islamorada for cesspit identification and elimination (1999)
. $8.5 million to Key West for sewer system rehabilitation (various years)
. $900 thousand to Islamorada for a wastewater management system (2000)
. $55 thousand to Marathon for cesspit elimination in Little Venice (2000)
. $100 thousand to Florida Keys Aqueduct Authority for Big Coppitt wastewater
management system (2001)
. $6.4 million to Florida Keys Aqueduct Authority in transition to Key Largo Wastewater
Treatment District for wastewater management system (pending)
. $3.5 million to Florida Keys Aqueduct Authority for Baypoint wastewater management
system (pending)
. $1.6 million to Florida Keys Aqueduct Authority for Conch Key wastewater management
system (pending)
. $2.3 million to Islamorada for wastewater management system (pending)
. $11.8 million to local governments in Monroe County for wastewater and stormwater
improvements (pending)
. $4.2 million to Monroe County for wastewater treatment to serve clusters of homes and
centralized management of on-site treatment and disposal systems (pending)
. $1.5 million to Key West for advanced waste treatment upgrade (2000)
1.8 Recommendations
There was some hope that the carrying capacity study sponsored by the U.S. Army Corps of Engineers
and the Department of Community Affairs would provide insight into wastewater treatment and disposal
questions. However, despite years of intensive study and the expenditure of millions of dollars, there is
not a scientifically defensible, quantifiable assessment of the effects of nutrient and pollutant loading on
the nearshore waters, including canals and other areas with low water circulation, upon which to base
water quality based effluent criteria. For that reason, definitive "big picture" recommendations for
changes simply are not possible at this time. Nonetheless, certain observations should guide immediate
action:
· There is no water quality or public health based information that justifies changes .to the
effluent limits set forth in Chapter 99-395, LOF, for Florida Keys wastewater treatment
plants.
· There is no water quality or public health based information that justifies changes to the
injection well requirements set forth in Chapter 99-395, LOF, for Florida Keys
wastewater treatment plants.
· There is insufficient evidence of permanent fixation of phosphorus in submerged
limestone to justify an adjustment to the phosphorus effluent limit in Chapter 99-395,
LOF.
· There is no reason to doubt that A WT can be successfully implemented in the Florida
Keys by the larger facilities for which it is required.
19
· Technology for achieving BAT exists and there are a number of manufacturers that can
provide tanks and equipment. Few BAT facilities have been put in operation in the
Florida Keys. The limited information available for the construction costs indicates that
BAT facilities may not be as expensive as initially estimated. Until the newly permitted
facilities have a history of operation during design conditions, judging their adequacy
from a permitting standpoint should be withheld. Minimal information is available for
the operating costs for BAT facilities. No reliable conclusions can be drawn regarding
operation and maintenance costs.
. Consolidation of treatment plants and service areas into larger units utilizing A WT
should be encouraged based on cost-effectiveness, the difficulties encountered in meeting
effluent limits for small facilities, the need for increased operator training and attendance
as well as monitoring at BAT facilities, and the permit compliance/enforcement effort.
. Operator training and attendance as well as monitoring requirements should be upgraded.
The Department of Environmental Protection has the authority under Chapter 99-395 to
require proper operation.
}o- At a minimum, require at least one visit per week by a Class B Operator and
require the plant otherwise to be staffed by a minimum of a Cl~ss C Operator who
works under the supervision of the Class B Operator. Limit the number of plants
the Class B Operator can oversee as well as specifying a minimum level of contact
between the Class B and Class C Operators. Alternatively, establish an
intermediate license between Class C and Class B that includes basic nutrient
removal and filtration training.
~ . Require operator training for nutrient removal processes and for filter
maintenance.
~ Increase the minimum plant staffing time for facilities having flows less than
50,000 gpd.
~ Monitoring both influent and effluent characteristics for nitrogen and phosphorus
would assist in process control and the evaluation of different technologies under
different conditions.
In summary, based on all available evidence, the Department of Environmental Protection
recommends maintaining and enforcing the existing wastewater treatment and disposal
requirements in Chapter 99-395, LOF. Data from the ongoing operating reports and water
quality studies as well as the results of any future research should be factored into an ongoing
evaluation of the most effective means by which to protect water quality and public heath in the
Florida Keys.
20
. Section 2 - Department of Health
2.1 Onsite Wastewater Treatment Technology
2.1.1 Introduction
The Department of Health has jurisdiction to permit onsite sewage treatment and disposal
systems where sewer is not available as defined by 381.0065, F.S., and domestic
wastewater flow is less than 10,000 gallons per day or commercial wastewater flow is
less than 5,000 gallons per day. In accordance with Chapter 99-395 the department
currently requires that all permits issued in designated "cold" spots or those areas where it
is not considered feasible to provide sewer in the Florida Keys meet the following
minimum standards:
Biochemical Oxygen Demand (CBOD5)
- Suspended Solids
Total Nitrogen, expressed as N
Total Phosphorus, expressed as P
10 mg/L
10 mg/L
1 0 ~mg/L
1 mg/L
Chapter 99-395, Laws of Florida, was amended in 2001 to allow for aerobic treatment
units to be used as interim standard systems in "hot" spots or those areas that are
scheduled to be served by sewer in an adopted comprehensive plan. The population in
the hot. spots represents 97.8 percent of the total for the Florida Keys. Aerobic treatment
units provide reduction in CBOD and Suspended Solids over a conventional septic tank
and sand lined drainfield but are not designed to provide nutrient reduction (nitrogen and
phosphorus).
The department currently permits engineer designed onsite wastewater nutrient reduction
systems that utilize nutrient reducing material and discharge into a conventional
drainfield or with disinfection by chlorination or other disinfection method into an
injection well. The department has authority to permit injection wells for domestic
wastewater flows not exceeding 2000 gallons per day. The Department of
Environmental Protection is the permitting authority for injection wells for domestic
wastewater flows over 2000 gallons per day or commerCial wastewater. -
By rule all such systems require a biennial operating permit from the department and an
ongoing maintenance contract with an approved maintenance entity. The department
monitors the maintenance entity's activities through quarterly reports and performs an
annual inspection of the system for any visible sanitary nuisances. The department does
not have fee authority to support sampling of the systems. The maintenance entity must
at a minimum inspect all systems biannually. Systems utilizing injection wells require
three inspections annually.
21
2.1.2 Estimated Construction and Maintenance Costs
Estimated costs for installation of these onsite wastewater treatment systems are:
Aerobic treatment unit and drainfie1d or injection well
Onsite Wastewater Nutrient Reduction System
$7,200 - $10,000
$11,000 - $15,000
Ayers Associates (1998) reported that the annual estimated operation and maintenance
costs ranged from $1,044 for a septic tank with subsurface drip irrigation to $1,507 for a
nutrient reduction unit with surface drip irrigation. Estimated costs included operational
and maintenance labor costs, annual energy costs, and equipment / media replacement
costs. Their estimates also included annual sampling costs not currently required under
law or rule and annual operating permit fees of $200 which have been reduced to $50.
Adjusting for these factors annual operating and maintenance costs are estimated to range
from $794 - $1507.
2.2 Research Background and Summary
2.2.1 Phase I
In 1997, the Florida Department of Health initiated the Florida Keys Onsite Wastewater
Nutrient Reduction System (OWNRS) Demonstration Project in response to the need for
a dem<?nstration of nutrient-reducing onsite wastewater treatment systems in the Floriaa
Keys. The study was conducted in two phases from October 1996 to October 1997 and
from August 1998 to December 1998.
The results of the original OWNRS Demonstration Project are described in a report by
Ayres Associates dated March 1998 and in Anderson et. al (1998). Details of the
OWNRS design and monitoring, and test facility construction can be found in Ayres
Associates (1998).
The Florida Keys OWNRS Demonstration Project was designed to demonstrate the use
and capability of alternative onsite wastewater treatment system technologies for tl)e
Florida Keys. In Phase I several wastewater treatment processes, which provide a-level of
treatment superior to conventional onsite wastewater treatment systems, were tested to
evaluate their potential to reduce organic, solids, and nutrient loading to near-shore
waters of the Keys. An original goal ofthe project was to determine if the Florida
advanced wastewater treatment (A WT) standards for effluent quality were feasible for
onsite wastewater treatment systems. The A WT standards are defined as 5 milligrams
per liter (mg/L) for Carbonaceous Biochemical Oxygen Demand (CBOD) and Total
Suspended Solids (TSS), 3 mg/L for Total Nitrogen (TN), and 1 mg/L for Total
Phosphorus (TP).
The project was conducted at a central testing facility (CTF) designed and constructed by
Ayres Associates at the Big Pine Key Road Prison. The wastewater influent source for
22
the CTF is obtained from the Big Pine Key Road Prison lift station prior to discharge into
the prison's wastewater treatment plant (WWTP). Approximately one-third of the
WWTPs influent is routed to the CTF influent mixing tank (IMT) prior to wastewater
loading (dosing) of the OWNRS treatment systems.
The CTF on Big Pine Key was designed to allow comparative evaluations of numerous
onsite wastewater treatment processes simultaneously, under controlled conditions, with a
common wastewater source. The CTF allowed accurate monitoring of influent
wastewater flows and the capability for flow-composited effluent sampling to determine
treatment performance. A 200-gallon per day (gpd) wastewater flow was used for testing
in Phase I. In addition to treatment performance, the operation, maintenance, and costs
associated with each system were monitored over a one-year test period.
Based on the evaluation conducted during Phase I of the OWNRS Project, the following
conclusions were drawn (Ayres Associates, 1998):
· A WT effluent standards for CBODs, TSS, and TP can be met consistently with
the engineered media SUBSURFACE DRIP IRRIGATION system or by
combining other of the systems/processes evaluated;
· TN reductions of>70% are achievable by biological nitrification/denitrification
systems and could be increased with process optimization and/or supplemental
carbon addition. The most effective technology reduced the total nitrogen
.concentrationfrom 38.4 mg/L (influent) to a mean of 11.0 mg/L (effluent).
· A combination of various unit processes evaluated would achieve treatment
performance by onsite wastewater systems, which approached A WT effluent
standards. A biological treatment system designed for nitrification/denitrification
(>70% TN reduction) that discharges to an engineered media subsurface drip
irrigation bed should consistently meet the A WT standards for CBODs, TSS, and
TP, and reduce TN by over 85 percent. With process optimization and/or
supplemental carbon addition, such a system should produce effluent close to the
A WT nitrogen standard, as discharged from the subsurface drip irrigation bed.
· Construction and operation costs of OWNRS will be considerably greater than
conventional onsite wastewater treatment system. Estimated total annual costs for
the OWNRS evaluated, including effluent disposal and phosphorus remova1 by an
engineered media subsurface drip irrigation system, ranged from $1,730 to $2,841
per year. In comparison, annual cost for a conve~tional mounded onsite
wastewater treatment system in the Keys has been estimated at approximately
$600 per year (Ayres Associates, 1998). These original estimates from Ayers for
operation and maintenance appear high based on costs figures obtained from
maintenance entities in the Florida Keys.
Based on the results of this research Chapter 99-395, Laws of Florida, was enacted
requiring all onsite systems permitted in the Florida Keys to meet the following minimum
standards:
23
(a) Biochemical Oxygen Demand (CBODS)
(b) Suspended Solids
(c) Total Nitrogen, expressed as N
(d) Total Phosphorus, expressed as P
10 mg/L
10 mg/L
10 mg/L
1 mg/L
The Department of Health amended Chapter 64E-6, Florida Administrative Code, in
April 2000 to implement permitting and construction of performance based treatment
systems in the Florida Keys meeting these standards. These systems are referred to as
onsite wastewater nutrient reduction systems (OWNRS).
2.2.2 Phase II
A field evaluation of several onsite wastewater nutrient reduction systems (OWNRS) was
continued for a second phase to evaluate longer-term treatment effectiveness by OWNRS
in the Florida Keys. The results are described in a report by Ayres Associates dated April
2000. Results indicated that the systems evaluated provided excellent treatment but no
individual system was capable of meeting all effluent standards curren~ly in place for the
Florida Keys (10 mg/L CBODs, 10 mg/L TSS, 10 mg/L TN, and 1 mg/L TP). However,
all systems were able to meet the CBODs and TSS requirements. Based on the evaluation
conducted at the Big Pine Key testing facility to date, theJollowing conclusions are
presented:
. florida Keys effluent standards for CBODs, TSS, and TP can be met consistently
with the engineered media subsurface drip irrigation system or combining other
systems/processes evaluated;
. TN reductions of> 70 % are achievable by biological nitrification/denitrification
and could be increased with process optimization and/or supplemental carbon
addition; the F ASTTM combined with a NiteLess™ ABF unit averaged 7.1 mg/L
TN during the Phase II Study.
. A combination of various unit processes evaluated would achieve treatment
performance by onsite wastewater systems, which meets current effluent
standards. A biological treatment system which incorporates
nitrification/denitrification (>70% TN reduction) and discharges to an engineered
media subsurface drip irrigation bed should consistently meet the current Florida
Keys standards for CBODs, TSS, TN and TP. With process optimization and/or
supplemental carbon addition, such a system should produce effluent close to the
A WT nitrogen standard, as discharged from the subsurface drip irrigation bed.
. Construction and operation costs of OWNRS will be considerably greater than
conventional onsite wastewater treatment system. Estimated total annual costs for
the OWNRS evaluated, were described in detail in the Phase I OWNRS Report
(Ayres Associates, 1998) and ranged from $1,730 to $2,841 per year.
. The phosphorus adsorption subsurface drip irrigation beds were estimated to have
a useful life of approximately 10 years based on study conditions during the
OWNRS project. This conclusion was based on estimates from core samples of
24
the crushed brick media subsurface drip irrigation bed and analyses of P migration
with depth.
· Continued monitoring of the OWNRS should be conducted to further quantify
phosphorus removal capacities and treatment performance longevity, solids
handling requirements, and long term maintenance requirements of OWNRS at
the facility.
2.3 Cesspit EliminationlWastewater Improvement Program
2.3.1 History
In 1994 Monroe County and the Monroe County Health Department assessed the extent
of cesspit use throughout the county. Through a DCA grant, a records matching activity
between building department files and health department onsite system files was
conducted by a contractor producing a computerized list of developed properties without
an a~sociated approved means of wastewater disposal. The original list contained 17,000
properties. A letter was sent to the owners of record for each of the properties enlisting
their assistance in identifying the method of sewage disposal for the property. This
succeeded in reducing the list to 12,000 properties. Anyone wishing to remodel or
expand on property on the list was required to demonstrate an acceptable sewage system
or install a replacement before approval of the remodeling application. This produced an
average of 175 cesspit replacements per year for two years.
.
In 1996 a Final Order was issued on the Monroe County Comprehensive Plan requiring
new development to be tied to nutrient reduction. The Administration Commission ruled
that the county's proposed rate of growth was acceptable with the caveat that for every
new residential unit built one cesspit be eliminated. A work plan was created to assure
the county addressed the elements of the hearing officer's ruling. The Department of
yommunity Affairs was required to coordinate an annual report on compliance with the
work plan to the Administration Commission. The Department of Health was asked to
institute an interim standard for new onsite systems in the Keys pending outcome of the
Big Pine Key Onsite Wastewater Nutrient Reduction System (OWNRS) project. Aerobic
treatment units, as the best available treatment, were required as an interim standard.
In 1997 Monroe County adopted an ordinance to require systematic, progressive removal
of cesspits from properties on the unknown systems list. The health department began
implementation of the ordinance by mailing notice to the first group of property owners
identified in the ordinance. On the assumption that older homes were more likely to have
cesspits, the ordinance required notification based upon year-built according to the
property appraisers records. Letter recipients had the option of demonstrating a legitimate
system by producing the original installation approval document for the existing system,
pumpout and drainfield inspection by a licensed contractor or installing a new aerobic
treatment unit and drainfield if there was enough room on the property. If there was not
enough room on the property for a standard system then an aerobic treatment unit and
borehole had to be installed. The Monroe County Health Department signed a
25
memorandum of understanding with Monroe County establishing a system to track
cesspit eliminations and nutrient credits.
In 1998 Monroe County began development of a Wastewater Master Plan. Phase I of the
OWNRS research project was completed. Results indicated that the systems evaluated
provided excellent treatment but no individual system was capable of meeting all effluent
standards currently in place for the Florida Keys (10 mg/L CBODs, 10 mg/L TSS, 10
mg/L TN, and 1 mg/L TP). Florida Keys effluent standards for CBODs, TSS, and TP can
be met consistently with the engineered media subsurface drip irrigation system or
combining other systems/processes evaluated. DOH began the process of modifying its
rules to implement the research results.
In 1999 DOH implemented engineer designed OWNRS for all new construction. Chapter
99-395, Laws of Florida, was passed implementing consistent treatment standards for
both DEP and DOH systems. Monroe County rescinded the original cesspit replacement
ordi~ance and passed one consistent with the master wastewater plan targeting cesspits in
"cold" spots for replacement. A grant program was created as an incentive to owners of
the approximately 200 unknown systems in the "cold" spot areas. -
In January 2000 the Monroe County Health Department mailed notice to 123 property
owners in the cold spots advising them of the cesspit replacement requirement. Of the
123 properties, 24 were found vacant, 2 were dismissed by the Special Master, and 15
had approved permits. Of the remaining 82 properties, 56 systems have been replaced, 2
are under enforcement action by Monroe County, and the remaining 24 have signed
contracts with an engineer and replacement is expected by December 31,2003.
In January 2001 the Monroe County Health Department mailed notice to the remaining
94 cold spot property owners. Of the 94, eleven properties were vacant, 23 had approved
permits, 58 have signed contracts with an engineer, and 2 have brought suit against the
county. Forty-one systems have been installed. Completion of the remainder is expected
by June 30, 2003. Representative Sorensen sponsored an amendment to Chapter 99-395
allowing aerobic treatment units as an interim standard in areas identified as "hot" spots
in the Master Wastewater Plan.
2.3.2 Results
Attached is a summary sheet of onsite system upgrades and cesspit replacements
throughout Monroe County. Of the 4436 estimated cesspits in the Florida Keys, 727 have
been replaced or removed from service. The majority of the Florida Keys has been
designated to be sewered by 2010 under the Master Wastewater Plan. Under the nutrient
reduction program each cesspit replacement has been used to generate a new building
permit. By June 30, 2003, the DOH will have completed all available cesspit
replacements in the designated "cold" spots. The only source of additional nutrient
credits will be when onsite systems are taken off line and establishments are connected to
central sewer.
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2.4 Recommendations
. There is no water quality or public health data to support changes to treatment standards
established in Chapter 99-395 for onsite wastewater treatment systems.
· Significant numbers of cesspits remain in place throughout the areas designated to be
sewered in the Master Wastewater Plan. Ids unlikely that all of these areas will be
sewered by 2010. Local government and state agencies should assess this situation and
plan accordingly.
· Significant numbers of permitted systems requiring upgrade to OWNRS by 2010 are in
the designated "cold" spot areas. Local governments should address the requirement to
upgrade these systems and identify sources of funding to assist these homeowners.
· Local governments and utilities should pursue the concept of decentralized or clustered
systems to provide wastewater treatment in those areas where sewers are not financially
feasible and lot size prohibits or limits on site sewage treatment options.
· The US EP A has adopted voluntary guidelines for management of ons~te systems and is
encouraging state and local government to adopt these guidelines. Local governments
should consider adoption of ordinances to manage onsite systems like any other utility,
assessing monthly fees to cover maintenance, sampling and repair. The OWNRS are
mechanical systems requiring ongoing maintenance and oversight to operate properly and
provide the designed treatment. Continued monitoring of the OWNRS should be
condu<;ted to further quantify phosphorus removal capacities and treatment performance
longevity, solids handling requirements, and long term maintenance requirements of
OWNRS at the facility.
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