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PL-08-677Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Date: 05/27/2008 Inspector: Levrock, James Owner: HELLER, DAVID & JUDE Job Address: 1300 94 Street NE Miami Shores Village, FL 33138- Project: <NONE> Block: Contractor: A AMERICAN SEPTIC & PLUMBING Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Septic Phone Number 3305 - 757 -8142 Parcel Number 1132050100120 Lot: Phone: (305)866 -5600 Building Department Comments Install 1 1350 gal septic tank, install 1 599 sq drainfield, install 1 475 gal laundry tank, install 1 250 sq ft drainfield. Passed,/ Ir peCtor Comments ° Failed Correction Needed J Re- Inspection Fee ($75) No Additional Inspections can be scheduled re- inspection fee is paid . until Friday, May 30, 2008 Page 2 of 2 MIAMI SHORES VIL GE BLDG DEPT 10050 NE 2nd.AVE — MAN SHORES, FL 33138 PHONE (305) 795-n04; FAX (305) 7564972 VVINWISMISHORESVILLAGE COM 'ERMIT PROCESS #: br SUBMITTAL DATE 4111, CLERK: NOTE: MUST BRING BACK THIS TICKET TO PICK UP YOUR PERMIT STATE OF FLORIDA PERMIT NO9 DEPARTMENT OF HEALTH DATE PAID: ONS1 E SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID: CONSTRUCTION INSPECTION AND FINAL APPROVAL RECEIPT #: 1 APPLICANT: 1 AGENT: PROPERTY ADDRESS: LOT: BLOCK: SUBDIVISION: °" .1 PROPERTY ID #;h 3)O CHECKED 1x] ITEMS 4RE NOT IN COMPLIANCE WITH STATUTE , OR RULE AND MUST BE CORRECTED. TANK INSTALLATION ] [0 -1/-7- TANK SIZE [11 7-5- ° [2] ) [02) TANK IUTATERIAL - s- -- 1 [Q3] 6,JTLET DEVICE - - ] 0,041. \ MULTI - CHAMBERED / N j 1 9'I�05� =OUTLET FILTER �=-- e-- 1 e [06�]f- LEGEND --''; 7 �. ,? 0/ S--,a, r 1 [07] .WATERTtGHTAYL`'--.. ] [08] o° LEVEL... a - 1---us v. ] 1 [09] f DEPTH', TO LID t I DRAIINIFIEL.D INSTALLATION 1 4[10] AREA [h] d, , [2] `< '16'SOFT 11 ... . DISTRIBUTION- B9X-7°� - HEAbER h 1 '1 .[12] I � NUMBtER',�OFtDRAINLINES ' 1 i [13 1 DRAINLINE SEPARATIO' ^.- ] t- .1 DRAHW.INE- E�. - j [15] DEPTH OF CO 'i c -Z ' •• .—,.. j [16] ELEV TION [ABOV ELOWFBM ] ._ [17] SYST LOCATION -._: " r ] [18] DOSING PUMPS 1 [19] AGGREGATE SIZE--AF' IZE C` '. ei , r., ] [20] AGGREGATE EXCESSIVE FINES ] [21] AGGREGATE DEPTH _' FILL / EXCAVATION 'MATERIAL [22] FILL AMOUNT 11, P ) [23] FILL TEXTURE [24] EXCAVATION DEPTH [25] AREA REPLACED [26] REPLACEMENT MATERIAL EXPLANATION OF VIOLA71ONSttiEMARKS: [ 1 [ 1 t ) t I CONSTRUCTIO N„[�PPRoVEI /DISAPPROVED] FINAL SYSTEM [ APPROVED /DISAPPRQVED]:° SETBACKS ] [27] SURFACE WATER FT 1 [28] DITCHES FT 1 [29] PRIVATE WELLS FT 1 [30] PUBLIC WELLS FT 1 [31] IRRIGATION WELLS FT 1 [32]- POTABLE WATER LINES / C. FT 1 [33] BUILDING FOUNDATION _5` FT ] [34] PROPERTY LINES. FT ] [35] OTHER FT FILLED / MOUND SYSTEM [36] DRAINFIELD COVER [37] SHOULDERS [38] '. ,SLOPES [39] STABILIZATION ADDITIONAL INFORMATION [40] UNOBSTRUCTED AREA [41] STORMWATER RUNOFF [42] ALARMS [43] MAINTENANCE AGREEMENT [44] BUILDING AREA [45] LOCATION CONFORMS WITH SITE PLAN [46] FINAL SITE GRADING [47] CONTRACTOR [48] OTHER ABANDONMENT ] [49] TANK PUMPED ] [50] TANK CRUSHED & FILLED,_ OH 4016 (Page 2), 10/97 (Previous Editions May Se Used) Stock Number 5744 - 002 - 40116 -4 a n CHD DATE. CHD DATE.' Page 2 of 3 it .' PT 1: Applicant PT 2: Installer /Contractor PT 3: Building Department PT 4: Health Department STATE OF FLORIDA DEPARTMENT OF HEALTH ON SITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION INSPECTION AND FINAL APPROVAL APPLICANT: AGENT: PERMIT NO DATE PAID: FEE PAID: RECEIPT #: PROPERTY ADDRESS- LOT:) / BLOCK: SUBDIVISION- PROPERTY ID # -/ /- ' CHECKED [X], ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED. TANK INSTALLATION 0 ] T j KSIZE [1]'' [2], p] r NK -DEVICE r CHAMBERED\ ! N FILTER 07]ATEIGHT -�-. [08] 11 [09] dEPT14 TO UD D INFIE iNTALLATION [ I [10] EA V -5-X 114' [2] 1 SOFT [ j [111 IS UTION - [ 1 [12] MBR OF DRAINLINES [ 1 [1 ]s "`: �'D I NE SEPARATION -34 `' [1].„.? t 1 D INUNE SLOPE 1 [ 1 [151 D PTH OF c9x0, [163 ELEVATION [A }V t` tg • . BM [ ] [17] SYSTEM LOCATION [ ] [18] DOSING PUMPS [ . ] [19] [ ' ] (20] [ 1 [21] AGGREGATE SIZE 4s- AGGREGATE EXCESSIVE FINES AGGREGATE DEPTH 1 FILL / EXCAVATION MATERIAL 1 [22] FILL A CUNT 1 [23] FILL T TURE ] [24] EXCAVATION DEPTH 3 [25] AREA REPLACED [ 1 [26] REPLACEMENT MATERIAL EXPLANATION OF VIOLITIONS / REMARKS: [ 1 L [ 1 [ 1 [ 1 SETBACKS [ 1 [27] SURFACE WATER FT [ l [28] DITCHES FT [ ] [29] PRIVATE WELLS FT [ 1 [30] PUBLIC WELLS FT [ l [31] IRRIGATION WELLS FT [ ] [32] POTABLE WATER LINES Fr 1 [33] BUILDING FOUNDATION > FT [ ] [34] PROPERTY LINES - FT [ ] [35] OTHER FT [ FILLED / MOUND SYSTEM 1 [38] DRAINFIELD COVER 1 [37] SHOULDERS [ 1 [38] SLOPES 1 ] [39] STABILIZATION ADDITIONAL INFORMATION [ 1 [40] UNOBSTRUCTED AREA [ ] [41] STORMWATER RUNOFF [ ] [42] ALARMS [ ] [43] MAINTENANCE AGREEMENT 1 [44] BUILDING AREA [ I [45] LOCATION CONFORMS WITH SITE PLAN { [46] FINAL SITE GRADING I ] [47] CONTRACTOR J j'dm : -•c d [ ] - [48] OTHER ABANDONMENT [49] TANK PUMPED [50] TANK CRUSHED & FILLED -. CONSTRUC1:ON1APPR9V /DISAPPROVED]: FINAL SYI$TEM IAPPROUED/DISAPPROVED]: OH 4016 (Page 2), 10197 (Previous Editio Stock Number: 5744-002.4018-4 May Be Used) CHD DATE: CHD DATL; Page 2 of 3 PT 1: Applicant PT 2 Installer /Contractor PT 3: Building Departnteiu P7 4: Health Department 05/23/2008 11:05 FAX 3058916905 IA 001 /002 MIAMI SHORES VILLAGE BLDG DEPT 10450 NE 2"°'AVE - MIAMI SHORES, FL 33138 PHONE (305) 195.2204; FAX (305) 756 -99/2 M is -MI .ucunaGwu u+c3E COM 'ERMIT PROCESS #: SUBMITTAL DATE: ` lG CLERK; NOTE; MUST BRING BACK THIS TICKET TO PICK UP YOUR PERMIT 05/23/2008 11:05 FAX 3058916905 STATE OF FLORIDA DEPARTMENT OF HEALTH ..ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM. CONSTRUCTION INSPECTION AND FINAL APPROVAL APPLICANT: AGENT: PROPERTY ADDRESS; 4� O c7 1\1/- - 2 % 1j 002/002 PERMIT NO< 7- .00 // / N DATE PAID' _ FEE PAID' RECEIPT !I' LOT: % i BLOCK: I SUBDIVISION' • PROPERTY ID 1i10- 3z 03---01°- 0/20 CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED'. . TANK INSTALLATION �r K SIZE [1]/ 3' 0 [2) NK MATERIALC���c TLE1T -jam CHAMBERE T FILTER Z D LTI. TL GE ATE [06] (09] I NFIE TIGHT TO LID '7' " TALLATION A I 1.sceze [2] C c9" SQFT ISTRI i, UTION B MEIER OF DRAINLINES Y" AINLINE SEPARATION _.1'6% 1' AINLINE SLOPE PTH OF CIS VEff L ELEVATION [ SYSTEM LOCATION DOSING. PUMPS AGGREGATE SIZE S AGGREGATE EXCESSIVE FINES AGGREGATE DEPTH "2 ' FILL / EXCAVATION MATERIAL [22] FILL AMOUNT 5/.2 • [23] FILL TEXTURE 424] EXCAVATION DEPTH [26] AREA REPLACED (26) REPLACEMENT MATERIAL EXPLANATION OF VIOLATIONS / REMARKS: [ 1 [ l [ 1 [ l ) 1' SETBACKS [27] SURFACE WATER FT [28] DITCHES FT [29] PRIVATE WELLS _ FT [30] PUBLIC WELLS FT [31] IRRIGATION WELLS FT [32] POTABLE WATER LINES / b FT [33] BUILDING FOUNDATION 6 FT (34) PROPERTY LINES ST FT [35] OTHER _ FT FILLED'/ MOUND SYSTEM [36] DRAINFIELD COVER [37] SHOULDERS [38] SLOPES [39] STABILIZATION ADDITIONAL INFORMATION (40] UNOBSTRUCTED AREA [41] STORMWATER RUNOFF [42] ALARMS [43) MAINTENANCE AGREEMENT [441 BUILDING AREA [45] LOCATION CONFORMS WITH SITE PLAN- - [46] •' FINAL SITE GRADING [47] ,3INTRACTOR (48] OTHER _ ABANDONMENT y [49] TANK PUMPED 1 [50] TANK CRUSHED & FILLED _ L CONSTRUC19 RO / DISAPPROVED]: FINAL SY ) CHD DATE: 5 Ci ISAPPROVED1' d 1 �� [ )� �Q CHD DAT Page 2 of 3 DH 4019 (Page 2), 10/97 (Previous Edlllons May Be Used) Block Number: 5744 - 002 -4016-4 PT 1: Appliconi PT 2: InmelIedConlainlor P7 3' Building Depgnmenl P1' l: Noslin dopanmenl Nwytlni vs nip■ 411710, . Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING PERMIT APPLICATION FBC 2004 Permit Type: Plumbing REEG t 1 6 2001 Ur era am Permit No. O t -(T1 Plaster Permit No. Owner's Name (Fee Simple Titleholder) 1- teller Phone # q.) q q3 5-q6/ Owner's Address 1300 joe qt-t City in;14/✓] . , 3110te5 ° State - IUna q Zip 3 3 8 Tenant/Lessee Name E -MAIL: Job Address (where the work is being done) 13 0 0 Phone # City Miami Shores Village County Miami -Dade FOLIO / PARCEL # - 0 t4 zip 3.3 l 3 Is Building Historically Designated YES NO Contractor's Company Name 01l✓tA(,y\ j �SZ. PI Phone # 31A— —9106Q - 51'00 j Contractor's Address (<3,�" j' `.. roe ��p�1, � ±C ap City A fM 1 State (, Zip 13 I el Qualifier Name W'i `` ` ALIA. W Uvc:Ca7Tit State Certificate or Registration No.5.EPOCO q E -MAIL: Architect /Engineer's Name (if applicable) Phone # _3D' g(I) —c1120`) Certificate of Competency No. Value of Work For this Permit $ 1;130 Phone # Square / Linear Footage Of Work: Type of Work: ❑Addition ❑Alteration ['New ❑ Repair /Replace Describe Work: 51 l 1 1 C) (1 ❑ Demolition *is is* is *** **: xxrxy. Feesrxrx*xrrx*rrx rxrxrxxx *rxx *Yxrrxrxxxr*****xrx y Submittal Fee $ Permit Fee $ 1 75 ab 4_ ' 700 CCF $ '3.0) r�C+IO /CC Technology Fee $ 17.50 Scanning $ 3•0D Radon $ DPBR $ Zoning $ Bond $ # (fat Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ Ilb2J • 50 See Reverse side - Notary $ 0 Training /Education Fee $ too Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State 1 Zip Application is hereby made to obtain a permit to do thee>f'drk atict in'gtat1ations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit anal that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which oc urs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved a a reinspection fee will be charged. Signature IlL ak Owner or Agent The foregoing instrument was acknowledged before me this /(J day of7 . ), r , 20c e , by t.,..). 4 %1 %�''G /�N� , who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Z�Ce`� rrrr Print: My Commission Expires: OF FLORIDA Woodard #DD446314 s: JUNE 30, 2009 U ATLANTIC BONDING CO., INC, x xr. xx x r. x xr. xx xk APPLICATION APPROVED B(: (Revised 02/08/06) Signature Contractor The foregoing instrument was acknowl dged before me this 76 day of /3 f , 200 t� , by Bali /t v Witkd who is personally known to me or who has produced f, 145 5� iS70 as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Exp ...•``— MONICALISSEfHDIAZ i�� �L COMMISSION # DD 483995 t I' o EXPIRE : t 'Nu Public Underwriters dk tir /0�r: uNOta rxxr.xkkkxr.krkkkkkk,:kxxxx xxx rrrxxxxxxxxxxxxxkx /PAP Plans Examiner Engineer Zoning 02/21/2008 14:52 3055133472 OSTDS STATE OF FLORIDA DEPARTMENT OF HEALTH e ONSITE SEWAGE, TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT PAGE 01/02 CENTRAX #: 13-SG-31545 DATE PAID: FEE PAID : $ RECEIPT OSTDSNBR : 07-00114-N CONSTRUCTION PERMIT FOR: [ X ]New System [ )Existing System [ ]Holding Tank [ ] Innovative Other [ ]Repair [ ]Abandonment [ ]Temporary [ NA ] APPLICANT: Heller, David AGENT: CHAPMAN, Chapman PROPERTY STREET ADDRESS: 130D NE 94 St Miami FL 33138 LOT: 14 BLOCK: 7. SUBDIVISION: Miami Shores Ha Par [Section /Township /Range /Parcel No.) PROPERTY ID #: 11 -3205 -010 -0120 [OR TAX ID NUMBER] SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 64E -6,FAC DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC TIME PERIOD. ANY CHANGE IN MATER::,AL FACTS WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MOD::FY THE PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL, STATE OR LOCAL PERMITTING REQUIRED FOR PROPERTY DEVELOPMENT. SYSTEM DESIGN AND SPECIFICATIONS T [ 1350 ]Gallons SEPTIC TANK A [ 475 ]Gallons LAUNDRY CAPACITY N [ 0 )GALLONS GREASE INTERCEPTOR CAPACITY K [ 0 1 GALLONS DOSING TANK CAPACITY [ 0 MULTI-CHAMBERED /IN SERIES: [ y MULTI- CHAMBERED /IN SERIES: [Y ] ] GALLONS @ ( 0 ) DOSES PER 24 HRS # PUMPS[ 0 ) D [ 559 )SQUARE FEET PRIMARY DRAINFIELD SYSTEM R [ 250 )SQUARE FEET LAUNDRY CAPACITY SYSTEM A TYPE SYSTEM: [ Y ]STANDARD [ N ]FILLED [ N 1MOUND [ N I CONFIGURATION: [ N )TRENCH [ Y )BED [ N ] N F LOCATION TO BENCHMARK: 5,48' NGVD T ELEVATION OF PROPOSED SYS'.'EM SITE [ 27.8 ] [ INCHES ] [ ABOVE )BENCHMARK /REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 2.2 1 [ INCHES ] [ BELOW]f3ENCHMARK /REFERENCE POINT L D FILL REQUIRED:[ 0.0 ]INCHES EXCAVATION REQUIRED: [ 72.0 3 INCHES OTHER REMARKS: 1.- Install 1350 gal. category-3 septic tank and a 475 gal laundry tank equipped with, an approved filter. 2. -Tile licensed contractor installing the system is responsible for installing the minimum category of tank in accordance with sec. 64E- 6.013(3)(f), FAC. 3.- Install 599 sf of drainfield and 250 sf drainfield for the laundry system, in bed configuration. 4.- Install 42" of slightly limited soil at the bottom of drainfield. 5.- Perimeter of excavation area shall be at least 2 ft. wider and longer than the proposed absorption beds. 6.- Invert elevation of drainfield to be no less than 5.80' NGVD. 7.- Bottom of drainfield elevation to be no less than 5.30' NGVD. SPECIFICATIONS BY: EDWARDS, ASTRID TITLE: tErst. rL ti '•1PPROVED BY: Edwards, Astrid „0[G 4.sJ )ATE ISSUED: 4/5/07 TITLE: 314 4016, 03/9/ (Ohsoletes previous editions wh;ECh may not oo usoct) ( StoC): Number: 5744- 001 - 40:_60) I',, td,$_tona_A(11f,. -1) Dade EXPIRATION DATE: 10/5/08 CHO Page 1 of 2 02/21/2008 14:52 3055133472 OSTDS STATE OF FLDRIDA DEPARTMENT OF HEALTH ONSITE SEWAGE DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS PPLICANT: Heller, David AGENT: Chapman, Chan LOT: 14 BLOCK: 1 PAGE 02/02 CENTRAX #: 13 -33-31545 OSTDSNBR : 07- 00114 -N CHAPMAN SUBDIVISION: Miami Shores Bay Pax ID #: 11 -3205- 010 -0120 TO BE COMPLETED BY ENGINEEP, HEALTH DEPARTMENT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEER'S MUST PROVIDE RE.G.ISTBATI. N K_ —__ Z. 1. II =u _ •u- PROPERTY SIZE CONFORMS TO SITE TOTAL ESTIMATED SEWAGE FLOW: AUTHORIZED SEWAGE FLOW: UNOBSTRUCTED AREA AVAILABLE: PLAN:[X]YES [ ]NO NET USABLE AREA AVAILABLE: 0.40 558 GALLONS PER DAY [64E -6, TABLE 1] 1000 GALLONS PER DAY [1500GPD/ACRE OR 2500GPD /ACRE] 1250 SQFT UNOBSTRUCTED AREA REQUIRED: 1594 ACRES SQFT BENCHMARK /REFERENCE POINT LOCATION: 5.48' NGVD ELEVATION OF PROPOSED SYSTEM SITE IS 27.84 [ INCHES ] [ ABOVE ]BENCHMARK /REFERENCE POINT THE MINIMUM SETBACK WHICH SURFACE WATER: 120 FT WELLS: PUBLIC: N /A FT BUILDING FOUNDATIONS: CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES: DITCHES /SWALES: N/A FT NORMALLY WET? [ ]YES [ X NO LIMITED USE: N/A FT PRIVATE: N/A FT NON- POTABLE: N/A FT 5 FT PROPERTY LINES: 5 FT .POTABLE WATER LINES: 3 FT SITE SUBJECT TO FREQUENT FLOODING: [ )YES [ X ]NO 10 YEAR FLOODING? [ ]YES [ X JNO SITE ELEVATION: 8 FT NGVD 10 YEAR FLOOD ELEVATION FOR SITE: 0 FT NGVD SOIL PROFILE INFORMATION SITE 1 Munsell # /Color Texture - 1.aYR- l /a-fl 7Ys Sane; 111Y1ft- 7 /6TYW ( 3i-Min t,imwc USDA SOIL SERIES: 10 Udort:hents, Depth _ 0 to ,fl 9n t0 79 to to to to to to SOIL PROFILE INFOMATION SITE 2 Mansell # /Color Texture Depth 1 nvR- 3/3 -1] AM Aartrl t) tO 7n 1 (111I ; 4 - 4 n -74E T.i me.q 20 to 7? tO USDA SOIL SERIES: 10 Udorthents, to to t0 to to OBSERVED WATER TABLE.58.00 INCHES [ BELOW ) EXISTING GRADE TYPE: [APPARENT ESTIMATED WET SEASON WATER 'FABLE ELEVATION :58.00 INCHES [ BELOW ] EXISTING GRADE. HIGH WATER TABLE VEGETATION;[ 'YES [X)NO MOTTLING: [ ]YES [X]NO DEPTH: 0.0 SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING:Replacement/0.70 DEPTH OF EXCAVATION:72.0 DRAINFIELD CONFIGURATION: [ ]TRENCH [ X ]BED [ JOTHER (SPECIFY)_ REMARKS /ADDITIONAL' CRITERIA INCHES INCHES SITE EVALUATED BY: CHARLES CHAPMAN DH 4015, 03/97 (Obsoletes previous editions which may not he used) (Stock Number: 5744- 003 - 4015 -1) stds eval 4015 -3] DATE: 1/18/07 Page 3 of 3