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PL-13-2627J Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 nspection Number: INSP- 203359 Permit Number: PL -11 -13 -2627 Inspection Date: May 15, 2014 Permit Type: Plumbing - Residential Inspector: Diaz, Osvaldo Owner: TIMS, DONALD $ MELANIE Job Address: 301 NE 93 Street Miami Shores, FL 33138- Project: <NONE> Contractor: ARF PLUMBING INC Building Department Comments Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132060136230 install new drainfield Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed s Failed El SGC _DJE�- L-� { Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. For Inspections please call: (305)762-4949 May 14, 2014 Page 1 of 1 CERTIFICATE OF LIABILITY INSURANCE 1 11/MH3 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFItMiATIVELY 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), AUTHORED iATNE OR PRODUCER, AND THE CEKMgCATE HOLDER WANT: N the osrtFRede hokler Is an ADDITIONAL. INSURED, the po{ky(tes) nwst be andorsecl. N SUBROGA7I01I IS WAIVED, fwd to the terms and eondilbu of the po0ay, carlain poWes may requL+e an andomemeft A slabunent an this cardficals, does not confer rights to the PRODUCER Brawn S Brown of Flory, hm. 12M W Cypress Creels Rd S 130 P.O. Box bm FL Lame, FL 33310-6727 Ian ARF PhuvM" Company, b. MMWM A: 800 hlsteaitce Co LTD+ 2203 SW Slfit Terrace 1Rnts :Hanford Casuahty hts. Ca+. FL 33023 1 s e! Hartford Its. Co. Of:he S.E.+ COVERAGES TE NUMBER: REVISM NUM-SM THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE MISURED NAMED ABOVE FOR THE POLICY PERIOD 00)ICATED. NOTWRHSTANDING ANY REQUIR131ENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO VII THIS CI3LTFICATE MAY BE ISSUED OR MAY PERTAAS, THE INSURANCE AFFORDED BY THE POL.ICMS DES HEREIN M SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAD CLAW. MAIMIS l TYPEOPINSURANCE vim POLWY1 ACCORDANCE MATH THE POLICY PROVISIONS. pWbnm Attu: Building Dept LIMITS B GENERAL LIARRW X COMMERCIALGENERAL UABLITY q,Ams mAm Fx—1 OCCUR MNand Shares, FL 33138 21UEN007298 000V13 14iM4 EACH OCCURRENCE $ 11000 PF434M ffa f 3!M MID EXP WW one f PER�N%L &ADVeLWRY S 1,�0 GENERAL AfTE f 2,t� GM AGGREGATE UWT APPUES PEk POLICY M PRO- LOC PRODUCTS- AM S 2,000, f A mffam1Bu uA m X ANY AUTO ALLOWNEDAUrOS SCHEOULEVAUTOS HIRED AUTO NON•O%?M AUr08 21UEN007298 0001H3 0001114 CDra3INED SINGLE I.Wr (Essaddem $ 500 BOD ymmRY(ftp=m) s BOOELYeLfNiif(Poreeddeld) $ PAY CAS f f S ummm"LIAB mwmuu OCCUR p qp pE EACHOCCIIRV&NCE f AGGREGATE $ OEOUCMBLE RETENTION $ C WORKERS CO SAT Y� i lnss) a denials OF O N/A WE007299 0001H3 OU01H4 WCSrATU. OTF4 mwuml E.LFACHAmmea s E.L. DMEASE -EA EMPLOYEE f 5mr EL DISEASE- PDUCYUrar $ 500 DMCNWW MOFOPLRA7X=ILOQATr IVENM= P A00110 111,AdmmRdRsnmbfslydsI gclassspinsis"**@Q W -1aYPb„1,7 ACORD 26 (2009108) The ACORD rwne and logo arcs regislead marks of ACORD 4 MAIMIS l SHOULD ANY OF THE ABOVE DESCRIBIED POLICIES BE CANCELLED Btu THE EXPIRATION DATE TIC, NOTICE VML INE DELIVERED IN Mined Shares VI1 p Building D t ACCORDANCE MATH THE POLICY PROVISIONS. pWbnm Attu: Building Dept AUTHORssDREPIESENTATRIE 10050 NE 2nd Avenue MNand Shares, FL 33138 ..J W -1aYPb„1,7 ACORD 26 (2009108) The ACORD rwne and logo arcs regislead marks of ACORD s Registered Septic Tank Contractor CHARLES CAW 4750 SW 72ND AVENUE x3 DAVIE FL 33314 A.R.F. PLUMBING COMPANY, INC. BuSIness Audwfiration: SA0900458 SR0890866 Registration Expires on September 30, 2014 A N Report Undo. c conaac�ng: t ;7 1- x-9813 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 B ILDING . PERMIT APPLICATION Permit Type: PLUMBING FBC 20 NGV 19 Permit No. Master Permit No. l -3 JOB ADDRESS: � y t �r, q3 srtezr City: Miami Shores County: Miami Dade Zip: 53 Folio/Parcel #: Is the Building Historically Designated: Yes OWNER: Name (Fee Simple City: 1Yl04 l State: Tenant/Lessee Name: Email: NO Flood Zone: %6 �!Jl7, O. 11�5rsg- CONTRACTOR: Company Name: A R F m L !A% Phone #: 7:5±t Q�PZ 73 3 ,k— Address: � S� SY _rZ44.1 City: 6L a% &AX State: jcL Zip: 3502-3 Qualifier Name: State Certification or Registration #: %-) N ® (J 6 Certificate of Competency #: Contact Phone #: Email Addy't A 'R r Pt, t9m 6 t,JG ( DESIGNER: Architect/Engineer: AIA Phone #: Value of Work for this Permit: Square/Linear Footage of Work: r (f _XLC_d �Ic e-of Work: ❑Address s, DAlteration ONew b(Repair/Replace ODemolition ��`I .: .�'.`. -. tilt. ��;.�'- `-Tl�� _•d c 31A Submittal Fee $ Permit Fee $� n/ ��` CCF $ CO /CC $ t Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ DBPR $ Bond Technology Fee $ TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address zip City State 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 afier the building permit is issued. the absence of such s e ce, the inspection will not be approved and a reinspection fee will be charged. Signature Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this day of WO- , 201�, by Q —[l rn-S who is personally known tome or who has produced 1� I D As identification and who did take an oath. NOTARY Sign: \ Print: My Commission Expires: �I mission # ,:� cpy; .,EE173o5s�o; The foregoing instrument was acknowledged before me this y of MUVL1' yi 20 t3, by , ho is ersonally known to me who has produced as id. cation and who did take an oath. APPROVED BY 7) Plans Examiner Structural Review (Revised3 /12/2012)(Revised 07 /10 /07XRevised 06 /10 /2009)(Revised 3/15/09) NOTARY PUBLIC: My Commission Exp CJD/ 2FJ1(o SHONORIA INGRAHAM NOW* Public —state-0 Roft My Comm. Expire dun 28, 201 CommissMn # EE 212483 Bonded Throuah National Ndmv Am Zoning Clerk REPAIR MIAMI -DACE COUNTY 14F1l1.TH DEPARTWIff STATE OF FLORIDA DEPARTMIvNT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: (Madelene Babcock Estate of) PROPERTY ADDRESS : 301 NE 93 St Miami, FL 33138 LOT: 17 BLACK: 46 SUBDIVISION: PROPERTY ID 0: 11- 3206 -013 -6230 PERMIT #:13 -SC- 15031" APPLICATION #: API 124912 DATE PAID: FEE PAID: RECEIPT 4' DOCUMENT #: PR921667 Miami Shores Sec 1 Amd {SECTION, TOWSHIP, 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 642 -6, F.A.C. DEPARTDdZNT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TINE. 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 BEINts MADE NULL AND VOID. ISSUANCE OF THIS PERMIT DOES NOT 2=07 THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL, STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY. SYSTEM DESIGN AND SPECIFICATIONS T [ 750 I GALLONS / GPD Septic tank CAPACITY A { 0 I GALLONS / GPD CAPACITY N I 0 ] GALLONS GREASE INTERCEPTOR CAPACITY {MAXICM CAPACITY SINGLE TANK-.1250 GALLONS) K r ] GALLONS DOSING TANK CAPACITY { GAALLONS #t IDOSES PER 24 HRS #Pumps { D r 225 1 OQUARE MMT Trench configuration drain SYSTEM R r 0 I SQUARE FEET SYSTEM A TYPE SYSTEM: 1XI s°PAam— ( ` y'TZ= " t ]ism I CONFIGURATION: lid 'Pl CB t I BED [ ] N F LOCATION OF BENCHMARK: FFE 12.80' 14GVD {I 5� `1,34 k I ELEVATION OF PROPOSED SYSTEM SITE { 46.50] 4 INCHES FT If ABOVE E BOTTOM OF DRAINFIELD TO BE F7 j 3 t 65.52 1 INCHES FT I t ABOVE L c/ D 1 O T H E R BENCHMARK /REFERENCE POINT BENCHMARK/ REFERENCE POINT '1" M4P=FjW:. t O.UU I INCHES EXCAVATION REQUIRED: { 19.00 I INCHES 1: Existing 750 gal. septic tank, certified by "A.R.F. Plumbing Company, Inc` on 10129/2013 to remain. 2--install 225 sf of drainfield in trench configuration. 7,3V- 3.-Invert elevation of drainfield to be no less than 7.84' NGVD. 4.- Bottom of drainfieki elevation to be no less than 7.34 NGVD. , p The system is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total essti U flow of 300 gpd. THIS PERMIT IS NOT FOR ANY ADDITIONS. SPECIFICATIONS BY: Charles (Was) Case TITLE: APPROVED BY: AA Q TITLE: Engineering Specialist II Dade CHD get DATE ISSUED: 11/00/2013 ZXPIRATION DATE: 02/0612014 DH 4016, 08/09 (Obsoletes all jiii;; Zss 4icWtions wbich any not be used) Incorporated: 64E- 6.003, FAC The Contractor (or designee) is requirlmperdf A Spil V 1.1.4 AP1124912 .soborin6 adjAWA ?ib"the drainfield excavation at the time of final inspection. Prior to Final Approval, the I:OOtr inspector shall witness the soil boring and compare the results to the original PLUMiNc PLANS site evaluation submitted. A reinspettion fee will be assessed ArOVtd if the contractor is not at the jobsite at the arranged time. PP .� del= -1.47 Disapprovwd Date DIVISION OF Environmental Health Florida Department of Health Miami -Dade County Health Department �I� OSTDS /Well Division o`� 11805 SW 26 St. • Miami, FL 33175 O Inspectors. �Qo&,k n&E q Date Address �� 1 r a OSTDS # ,I+ 112y g L Z Comments: ! ki W— SPATE Or rLORIDA APPLICATICU # API X12 DEPARTMENT OF HEALTH mwmm i 13SC-150144 CUBITS SE19413 TP=214M AND DISPOSAL SYSTEM Dot2h002 # SE0123M SITE EVALUATION AND SYSTEM SPECIBICATION APPLICANT: Madeiene Babcock E.etabe Of CONTRACTOR / AGENT: ARF Plu:fting LOT: 17 BLOCK: AR ARK/ POINT LOCATION: FFE 12.80' NOW ELEVATION or PROPOSED SYSTEM SITE 46.50 t sib / PT ] I ABOVE / 8m-m- ] mix/ 8OZM THE mmm SETBACK mum CAW BE DiAINumm mcm TSS PROP'Osm sYs"m TO TBE FOLLOW= BSS sORTSCS WATER: PT DITCM /smws: PT DALLY WET: I ]YEs I ]NO mxLS: PUBLIC: PT LIMITED USE: PT PRIVATE: PT NOO- POTABLE: PT BUILDING PCURDATIONS: 5 PT PROPERTY LINES: 2.5 PT POTABLE WATER LIb18s: 10 PT SITE SUBJECT TO PEST PLOODII(G? I ] YES t x l uo 10 YEAR SLOOOnm I ] YES I x inq 10 YEAR FLOOD 31"MOE POR SITE: PT t WL /a] SITE 8.92 IT t NSL /Fw7D so%L PROFILE nmrawasm SITE i SOIL PROFILE INVOSIVAIMON SITE 2 UeDA 90IL : utban Sand 1Dnmg t1/Qotor T&3dm Depth. 10YR 8M saw 0 To 18 10YR 811 Said 18 TO 88 10YR 212 Sam 88 To 72 usm 90IL SMU=: Uzbm land t r T03dwe Depth 10YR 6M sera 0 T015 10YR 811 send 15 TO 87 10YR 22 Sand 67 To 72 ossmww WATaB TADLZ: INC8E8 t Aims /Q] RxZmmic mm TYPE: t BF.mm Mmom WT ex"m mmm mm zZmal:os: t ABOVE /�] EXISTING GRADE HIGH WATER TABLE VSGETAT3OR: t ly" 1X]NO KYV.M=.- I ]YES IX]NO DEPTB: INCAS som TEltmm /L mma RATS B+oR SYs sm siry SwxW-80 DEPTH OF EXCAVATION' 19 INCSEs DBAnwxw ooSazomkmou: ' • I ] BED t l OTEM (SP8CI8Y) REls►RRS /AUDITIORAL CRITERIA SI28 ZVAL1 MMM By: DAM: 10/092013 Cass, Clwdw W4 mft } jARF. Y. kw.] on 4025. 09/00 (Opsoutes psavims aaltlwu *blob may not be awaf Yw*zpmstmd: s4Z- 6.002, sae Pa" 3 of d APIIZO12 0015=44 v 1.6.2 NOT199 QF RI "HTS A party whose substantial interest Is affected by this order may petition for an administrative hearing pursuant to sections 120.559 and 120.57, Flodde Statutes. Such proceedings are governed by Rule 28 -105, Florida Administrative Code. A petition for administrative hewing must be In waiting and must be received by the Agency Cie* for the Department, within twenty -one (21) days from the receipt of this order. The address of the Agency Clerk Is 4052 Said Cypress Way, BIN # A02, Tallahassee, Florida 32399 -1743. The Agency Clerk's facsimile number Is $50,414 -1448. Mediation is not available as.an alternative remedy. Your failure to submit a petition tier bring within 21 days from receipt of this order will cow a wralver 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 120.58, Florida Statutes. Review proceedings are governed by the Florida Rules of Appellate Procedure. Such proceedings may be corinnenced by fang one copy of a Notice of Appeal with the Agcy Clerk of the Department of Health and a second copy, accompanied by the Ming fees required by low, with the Court of Appeal In the approve DIWct Court. The notice must be filed within 30 days of rendition of the final order. '314ME ■ ■■ ■ ■■■r ■■�i�■ �.a_ MEN im &Room NEEME IUAIA 10"w""wmiflon MEN WOMEN MEN HLOAKKAI SEEN MEN AA 7, -7,77,77 �o ©L, LOT- fS " F.6P fir a) BLOCIt•10 ' NO CAP ua0 /7d1tMfNIN1: x .. Uplir i LOT• 11 BLOCK-40 t 4e �q Lor -a »e a BLOCK -10 Lor- to 8 Lor- r .. startfS BLaCK•Id 10801 �. � � owd • ,rem � - 8 ! � LOT : 10 BLOCK -10 ; ':. CJP Fi• So NOCMit,1'g!" 00'40'f0'• NOW WPM 011 o t �' M v o . 1 STATE Or FLORIDA DEPARTI4M OF HEALTH ONSITE SEWAGE TRZAMCM AND DISPOSAL SYSTSK CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: (Madeiene Babcock Estate 00 PROPERTY ADDRESS: 301 NE 93 St Muni, FL 33138 LOP: 17 BLOCK: 46 SUBDIVISION: PROPERTY ID 8: 11- 3206 - 013$230 JET #..13 -SC- 1503144 APPLICATION #:AP1124912 DATE PAID: FEE PAID: Docomm e: PR921667 Miarrd Shores Sec 1 Amd [SECTION, sONNSHIP, RAM, PARCEL NUMBER) [OR TAX ID Hamm] SYSTEM MOT BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AM STANDARDS OF SECTION 381.0065, P.O., AND CHAPTER 642 -6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMNCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN Ml'!'ERIAL FACTS, WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO NODIST THE PERMIT APPLICATION. SUCH MODIFICATIMS MAY RESULT IN THIS PERMIT BEING mm NULL AND VOID. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROa4 OMOLMMM WM'H OTHER MWERAL, BIRTH OR LOCAL FERNITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY. SYSTEM DESIGN AND SPECIFICATIONS T E 730 ] GALLONS / Gan Septic tank CAPACITY A t 0 ] GALLONS / GM CAPACITY N E 0 ] GALLONS GREASE INTERCEPTOR CAPACITY D9=V t CAPACITY SINGLE TANK: 1250 GALLONS) K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS 0[ ]DOSES PER 24 ORS #Pmts [ I D [ 225 ] OQUARS VENT Tnanch configuration drain BY82 M R [ 0 ] SQUARE SENT SYSTEM A TYPE SYSTEM: x 8 [ ] MOUND E ] I CONFIGURATION: 1 [] D E I LL Lt Vi LOCATION OF BENC c: FFE 12.80' NGVD L -y ,3 k` i I ELEVATION OF PROPOSED SYSTr� SITE E 46.60 ] INCHES FT) E ABOVE EELOhil POINT E BOTTOM of DRAINFIELD To BED 3 i 65.62 ] aaaCHE$ FT ] E ABOV£ L — Da O T H E R L REQDIRED: t 0.001 INCHES EXCAVATION REQUXMD: t 79.UU J INGnusi Existing 750 gal. septic tank, certified by °A.R.F. Plumbing Company, Ine° on 10/28/2013 to rmnain. ,lns WI 225 of of drainfiele in trench contigurstlam -71 dnved elevation of drainiield to be no less than 7.84' NGVD. •Bottom of drairftid elevation to be no less than 7.34' NGVD. '7, S a system le sized for 3 bedrooms with a maxhnum occupancy of 6 persons: (2 per bedroom), for a total time 300 gpd. US PERMIT IS NOT FOR ANY ADOMONS. BY: Charles (Was) Case TITLE: APPROVED BY: :z Le-u ,Q _ h TITLE: Engineering Specialist: II Dade CHD Be DATE ISSUED: 11/08=13 EXPIRATION DAM: 02108=4 OR 4016, 08/09 (Obsoletes all previous editions which may not be used) rnaoxporated: 64E- 6.003, FAC ...040 The contractor (or designee) is recIuir&Vpkrdfm 3 a sail boring adjAWAR63the drainfield excavation at the time pf final Inspection. Prior to Final Approval, the M ON Inspector shall pLODINGPIANS �,,�Witn,,ess the soil boring and compare the results to the arigMat D o -t`°"5ite' evaluation submitted. A reinspection tee will be assessed Approved �-"" i the contractor is not at the jobsite at th* arranged time. Disapproved ate n I STATE OF FLORIDA APPLICATICK 0 AP1124812 DEPARTMENT OF HEALTH PERMIT 8 13-SC-1503144 ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM DOCMMT # SE012383 SITE EVALUATION AND SYSTEM SPECIFICATION APPLICANT: Madelene Babcock Estate of CONTRACTOR / AGENT: ARF Piun*ing LOT: 17 BLOCK: 46 THE DCM MtM SETBACK WHICH cam BE boiruchrmlD NUM THE PROPOSED SYSTEM TO THE FOLLOWING FSATURBS SURFACE WATER: FT DITCHES /SWALES: FT NORMALLY WET: t )I= t )NO WELLS: PUBLIC: FT LIMITED USE: FT PRIVATE: FT NON - POTABLE: IT BUILDING FOU11DATIONS: 5 FT PROPERTY LINES: 2.5 FT POTABLE WATER T. 8: 10 NT SITE SUBJECT TO FREQUENT FLOODING? l IYes tx]NO 10 YEAR FLOODING? t ]YES tx]NOj 10 YEAR FLOOD ELEVATION FOR SITE: FT [ [43L /[;WvqI SITE ELEVATION: 8.92 8T [ MSL /F son PROFILE INPORERTION BITE 1 SOIL PROFILE nuMagMan SITE 2 QsDB SOIL SMIES: Usbm lsas( Munseg #!Color Texture f>"M 10YR B01 Sww 0 Ta 18 10YR 8N Sand 18 TO 88 10YR 202 sww 88 To 72 15 To 87 10YR 202 USDA SOIL SERIES: Vrbm Is" m n "0 0cafor Texture 09A 10YR an amw O To 15 10YR 801 Sww 15 To 87 10YR 202 Sww 87 To 72 OBSERVED EATER BASLE: INCHE$ [ ABOVE %Ql EXISTING MUM TYPE: [ PERCHED / A88ARSNT I ESTIId►TED WET BRAWN RATER TABLE ELEVATION: 59 INCHES [ ABOVE / Q] EXISTING GRADE HIGH WATER TABLE VEGETATION: t YYEs [KIND MOTTLING: t ]YES [KIND DEPTH: INCHES SOIL TEXTURE /LOADING RATl- D utwzzELD c mwzouamcm : 4 t Ic I T r- REMARKS /ADDITIONAL CRItmK Sand/0.80 DEPTH OF EXCAVATION' 19 INCHES t l BED t I OTHER (I] BITE EVAMMTM B!: DATS: cam. owdo NJ* (rfta:) (n". Pub c«apow. ua:.) DR 4015, 09/09 (0bMiSt" VgWiMS ®ditiOto vbicb MMY Mt b® U9") XD00ZParst0d: 648 - 6.001, SAC 10009/2013 Page 3 of 4 AP1124912 EID1MI" v 1.0.2 t NOTICE OF RIGHTS A party whose substantial interest Is affected by this order may petition for an administrative hearing pursuant to sections 120.569 and 120.57, Florida Statutes. Such proceedings are governed by Rule 28 -106, Florida Administrative Code. A petition for administrative hearing must be in writing and must be rived by the Agency Cleric 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 avaHable 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 Rum 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 low, with the Court of Appeal M the appropriate District Court The notice must be filed within 30 days of rendition of the final order. 11]6 MOMMENMEMMommNsme noun Nor INN mwm MEESE 22 as EMB MMMMMRMMMMMMMMMMMMMMMOMNI e a � '—Nl �o m