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PL-13-2559Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 203492 Scheduled Inspection Date: November 27, 2013 Inspector: Diaz, Osvaldo Owner: AGRAS, ALFONSO Job Address: 1182 NE 92 Street Miami Shores, FL Project: <NONE> Permit Number: PL -11 -13 -2559 Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Septic Phone Number Parcel Number 1132050270450 Contractor: MR C'S PLUMBING & SEPTIC INC Phone: (305)651 -7859 Building Department Comments DRAINFILED INSTALL NSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP- 202959. HRS APPROVAL IN FILE NO ACCESS, NO PERMIT, SOD SHALL BE DOWN FOR FINAL Failed ❑ use side gate for access, not locked. Correction l l� Needed Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. November 26, 2013 For Inspections please call: (305)762 -4949 Page 14 of 23 �►�' CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 11114/13 THIS CERTIFICATE 15 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: N the certificate holder is an ADDITIONAL INSURED, the policy((es) must be endorsed. If SUBROGATION IS WANED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Carolyn Rummel Agency 3970 State Road 64 East Bradenton, FL 3420E Phone (941) 748 -85M Fax (941) 748 -8553 CONTACT E: Tim Jones PHONE 941 748- 8555.1001 FAX C No 941 748 8553 ADDRESS: tim.lones0si natureinsagency.com PRODUCER CUSTOMER In V INSURERS AFFORDING COVERAGE NAIC It INSURED Mr. C's Plumbing & Septic, Inc PO Box 693239 Miami, FL 33269 -0239 INSURER A: Bridgefleld Employers Ins INSURER B: INSURER C: INSURER D: $ INSURER E: ❑ COMMERCIAL GENERAL LIABILITY ❑ ❑ CLAIMS-MADE ❑ OCCUR ❑ INSURER F: GwcRw%7c0 GER 1 RIGAr C NUMBER: REVISInN NIIMRFR- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE KWWVD POLICY NUMBER MMIDww Y I MODPEK LIMITS GENERAL LIABILITY EACH OCCURRENCE -MMAGE $ ❑ COMMERCIAL GENERAL LIABILITY ❑ ❑ CLAIMS-MADE ❑ OCCUR ❑ I0 PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ ❑ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: 11 POLICY El ❑ LOC =CT PRODUCTS - COMPIOP AGG $ $ AUTOMOBILE LIABILITY ❑ ANY AUTO COMBINED SINGLE LIMIT (Ea accident} $ BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ ❑ SCHEDULED AUTOS PROPERTY DAMAGE (Per accident) $ 0 HIRED AUTOS NON -OWNED AUTOS $ ❑ $ ❑ UMBRELLA LIAR ❑ OCCUR ❑ EXCESS LIAR ❑ CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ ❑ DEDUCTIBLE $ $ RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN �CEwMEMBBEREXC UDE�cuTl� Y NIA Y M1-0 12/22!2012 12/22/2013 MUMS OTH T O — E.L. EACH ACCIDENT $ 100000 E.L. DISEASE - EA EMPLOYE $ 500000 (Mandatory in NH) My describe under DE3�RIPTION under OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 100000 i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) VGR r Ir"rVi%r L nyLUCR CANCELLATION Miami Shores Village 10050 NE 2nd Ave Miami Shores, FL. 33138 ACORD 26 (2009/09) QF SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988 -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD OP ID: SS CERTIFICATE OF LIABILITY INSURANCE 1 DAT 11 /14DIYYYY) 11/14/13 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 305 - 477 -0444 Combined Underwriters of Miami 305 - 599 -2343 8240 N.W. 52 Terr, Suite 408 Miami, FL 33166 RONALD M. LASTER CNAMONTACT E: PHONE FAX Arc No Ext : Arc No): PROF CUSTOMER IDM MRCSS -1 INSURERS AFFORDING COVERAGE NAIC # EACH OCCURRENCE INSURED Mr. C'S Plumbing & Septic Inc. INSURER A: HERMITAGE INSURANCE CO. $ 100,00 P.O.Box 693239 Miami, FL 33269 INSURER B: PERSONAL & ADV INJURY INSURER C: INSURER D GENERAL AGGREGATE $ 2,000,000 INSURER E - COMP /OP AGG $ 1,000,00 INSURER F: $ COVERAGES CERTIFICATE NUMBER! RFVISInN NUMRFR- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE JOR 10050 NE 2nd Ave POLICY NUMBER POLICY EF MIDD POLICY EXP MIDD LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FK OCCUR X D @d: $500 per SCP0720863 01/11/13 01/11/14 EACH OCCURRENCE $ 1,000,00 PREMISES Ea occurrence $ 100,00 MED EXP (Anyone person) $ 1,00 PERSONAL & ADV INJURY $ 1,000,00 Claim GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PEP. POLICY PRO- LOC - COMP /OP AGG $ 1,000,00 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ $ UMBRELLA I" EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTNE OFFICERIMEMBER EXCLUDED? El (Mandatory In NH) If yes, escribe under DESCRIPTION OF OPERATIONS below NIA WC STATU- OTH- I S E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101. Additional Remarks Schedule, If more space Is required) Septic Tank Systems4nstallation, CERTIFICATE HOLDER rANCFLLATIeN ©1988 -2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village g THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Ave Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE i5& a e,-(-i5& ©1988 -2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD P- Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION Permit Type: PLUMBING FBC 20 t 0 ®��mmo ®oo Permit No. Master Permit No._ ..- C, JOB ADDRESS: �r City: Miami Shores County: Miami Dade Zip: 331*3g Folio/Parcel #: t/" JJOIT —Oct % — D Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder):_.Af1fu60 A4094 Address: $�- City: State: Tenant/Ussee Name: ne#: Email: CONTRACTOR: Company Name: _ Address: I f 1113-2 Ala e City: Qualifier Name: _ A Zip: 3J &f Phone#• State Certification or Registration #: _5k 0 4 ( r5(6 Certificate of Competency #: Contact Phone#: Email Address: DESIGNER: Architect/Engineer: -�— Phone#: Value of Work for this Permit: $ 1240-" Square/Linear Footage of Work:. - Type of Work: DAddress OAlteration ONew Acpair/Replace ODemolition Description of Work: 912', , L� / 1 Submittal Fee $ Permit Fee CCF $ CO /CC $ Scanning Fee $ Notary $ Radon Fee $ Training/Education Fee $ DBPR $ Bond Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) Bonding Company's Address City Mortgage Lender's Name (if applicable) Mortgage Lender's Address City Zip Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and 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 occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature a " Si ature Owner or A ent Contractor The foregoing instrument was acknowledged before me this ./_ day of -",L , 20 a by -1 who is personally known to me or who has pr&duced As identification and who did take an oath. The foregoing instrument was acknowledged before me this day of , 20 -, by I Lie�: M ,eC , who is personally known to me or who has produced 1'' identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print: Print: fti =0* r� LZ ata of Flafida My Commission Exp . KEraetE ETTRICK My Co es � ; Notary Public State of Flo[ida EE0473M My Comm. Expires Sep 19, 2017 A44 A PPROVED BY - ®- - : Plans Examiner Zoning Structural Review Clerk (Revised3 /12/2012)(Revised (Y7 /10/07)(Revised 06 /10/2009)(Revised 3/15/09) .-`K� F F) A 0 MIAMI -DADE GOUNW WALTH IDEPARMW STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: Alfonso Agras PROPERTY ADDRESS: 1182 NE 92 St Miami, FL 33138 LOT: 7 BLOCK: 3 SUBDIVISION: PROPERTY ID #: 11- 3205 - 027 -0450 PERMIT #:13 -SC- 1504454 APPLICATION #:AP1125666 DATE PAID: FEE PAID: RECEIPT #• DocUMENT #. PR921695 Bay Lure [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] [OR TAX ID NUMBER] SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION 381.0065, F.S., AND CHAPTER 64E -6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS, WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL, STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY. SYSTEM DESIGN AND SPECIFICATIONS T [ 750 ] GALLONS / GPD Septic CAPACITY A [ 0 ] GALLONS / GPD CAPACITY N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps D [ 300 ] SQUARE FEET Bed confiquration drainfiel SYSTEM R [ 0 ] SQUARE FEET SYSTEM A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ] I CONFIGURATION: [ ] TRENCH [xl BED [ ] N F LOCATION OF BENCHMARK: FFE 7.9' NGVD I ELEVATION OF PROPOSED SYSTEM SITE [ 25.20][ INCHES FT ] [ ABOVE BELOW BENCHMARK /REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 49.20][ INCHES FT ][ABOVE BELOW BENCHMARK /REFERENCE POINT L D E O T H E R ILL REQUIRED: [ U.UU J INCHES EXCAV"XION REQUlkMIJ: L Sb.UU J 1=runmb 1.- Existing 750 gal. septic tank, certified by "Mr. C's Plumbing and Septic" on 11/5/2013 to remain. 2.- Install 300 sf of drainfield in bed configuration. 3.- Install 12" of slightly limited soil at the bottom of the drainfield. 4.- Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed or drain trench. 5.- (Comments Continued on Page 2.) SPECIFICATIONS BY: Kemble Ettrick TITLE: APPROVED BY: V0L._,,,.D Q TITLE: Engineering Specialist II Dade CHU Be6 tey Lang6� DATE ISSUED: 11/08/2013 EXPIRATION DATE: 02/06/2014 DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E - 6.003, FAC The contractor (or designee) is required to perR'a;p($f 3 v 1.1.4 AP1125661bering adjacent to tWWAfield exCavatiOn at the time Of final inspection. Prior to Final Approval, the FDOH inspector shall Nitness the scil boring and compare the results to the original site evaluation submitted. A reinspection fee will be assessed if the contractor is not at the jobsite at the arranged time. DOCUMENT #: PR921695 nvert elevation of drainfield to be no less than 4.3' NGVD. i. -Bottom of•drainfield elevation to be no less than 3.8' NGVD. The system is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total estimated flow of 300 gpd. THIS PERMIT IS NOT FOR ANY ADDITIONS. NOTICE OF RIGHTS A party whose substantial interest is affected by this order may petition for an administrative hearing pursuant to sections 120.569 and 120.57, Florida Statutes. Such proceedings are governed by Rule 28 -106, Florida Administrative Code. A petition for administrative hearing must be in writing and must be received by the Agency Clerk for the Department, within twenty -one (21) days from the receipt of this order. The address of the Agency Clerk is 4052 Bald Cypress Way, BIN # A02, Tallahassee, Florida 32399 -1703. The Agency Clerk's facsimile number is 850 -410 -1448. Mediation is not available as an alternative remedy. Your failure to submit a petition for hearing within 21 days from receipt of this order will constitute a waiver of your right to an administrative hearing, and this order shall become a 'final order'. Should this order become a final order, a party who is adversely affected by it is entitled to judicial review pursuant to Section 120.68, Florida Statutes. Review proceedings are governed by the Florida Rules of Appellate Procedure. Such proceedings may be commenced by filing one copy of a Notice of Appeal with the Agency Clerk of the Department of Health and a second copy, accompanied by the filing fees required by law, with the Court of Appeal in the appropriate District Court. The notice must be filed within 30 days of rendition of the final order. STATE OF FLORIDA APPLICATION # AP112666 DEPARTMENT OF HEALTH PERMIT # 13 -SC- 1504454 ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM DOCUMENT # SE912392 SITE EVALUATION AND SYSTEM SPECIFICATION APPLICANT: Alfonso Agras CONTRACTOR / AGENT: MrC LOT: 7 BLOCK: 3 SUBDIVISION: Bay Lure ID #: 11- 3205 - 027 -0450 TO BE COMPLETED BY ENGINEER, HEALTH DEPARTMENT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEERS MUST PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS. PROPERTY SIZE CONFORMS TO SITE PLAN: [X]YES [ ]NO NET USABLE AREA AVAILABLE: 0.21 ACRES TOTAL ESTIMATED SEWAGE FLOW: 300 GALLONS PER DAY [ RESIDENCES-TABLE1 / OTHER -TABLE 2 ] AUTHORIZED SEWAGE FLOW: 525.02 GALLONS PER DAY [ 1500 GPD /ACRE OR 2500 GPD /ACRE] UNOBSTRUCTED AREA AVAILABLE: 450.00 SQFT UNOBSTRUCTED AREA REQUIRED: 450.00 SQFT BENCHMARK /REFERENCE POINT LOCATION: FFE 7.9' NGVD ELEVATION OF PROPOSED SYSTEM SITE 25.20 [FINCHES] / FT ] [ ABOVE / BELOW ] BENCHMARK /REFERENCE POINT THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES SURFACE WATER: FT DITCHES /SWALES: FT NORMALLY WET: [ ]YES [ ]NO WELLS: PUBLIC: FT LIMITED USE: FT PRIVATE: FT NON - POTABLE: FT BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: 5 FT POTABLE WATER LINES: 60 FT SITE SUBJECT TO FREQUENT FLOODING? 10 YEAR FLOOD ELEVATION FOR SITE: SOIL PROFILE INFORMATION SITE 1 ]YES [X]NO 10 YEAR FLOODING? [ ]YES [X]NO] _FT [ MSL / NGVD ] SITE ELEVATION: 5.80 FT [ MSL / NGVD SOIL PROFILE INFORMATION SITE 2 TT;T QnTT. QVVTWQ• TTr11 1-A USDA SOIL SERIES: Munsell # /Color Urban land Texture Depth 10YR 3/1 Sand 0 To 8 10YR 5/4 Sand 8 To 24 10YR 5/4 Oolitic Limestone 24 To 72 Munsell #/Color Texture Depth 10YR 3/1 Sand 0 To 8 10YR 5/4 Sand 8 To 24 10YR 5/4 Oolitic Limestone 24 To 72 OBSERVED WATER TABLE: INCHES [ ABOVE / BELOW ] EXISTING GRADE TYPE: [ PERCHED / APPARENT ] ESTIMATED WET SEASON WATER TABLE ELEVATION: 33 INCHES [ ABOVE / BELOW ] EXISTING GRADE HIGH WATER TABLE VEGETATION: [ ]YES [X]NO MOTTLING: [ ]YES [X]NO DEPTH: INCHES SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: Replacement 4-FS/0.60 DEPTH OF EXCAVATION: 36 INCHES [ ] OTHER (SPECIFY) DRAINFIELD CONFIGURATION: [ ] TRENCH [XI BED REMARKS /ADDITIONAL CRITERIA SITE EVALUATED BY: Ettrick, Kemble (Title: ) (Mr. Max Septic Servi) DH 4015, 06/09 (Obsoletes previous editions which may not be used) Incorporated: 64E- 6.001, FAC DATE: 11/05/2013 Page 3 of 4 A x%1125666 EID1504454 v 1,0 ,2 F —� �' ,•• DIVISION OF • •' Environmental Health o Florida Department of Health Miami -Dade County Health Department OSTDS /Well Division 11805 SW 26 St. • Miami, FL 33175 Inspector Q oSeiD \ �%i'_ ( Date _ Address A.. I EZ OSTDS # Comments: l '3 -11'�,