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PL-15-151 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-229808 Permit Number: PL-1-15-151 Scheduled Inspection Date: July 16, 2015 Permit Type: Plumbing - Residential Inspector: Diaz, Osvaldo Inspection Type: Final Owner: GREENBERG, DAVID Work Classification: Septic Job Address:534 NE 95 Street Miami Shores, FL Phone Number (786)333-8567 Parcel Number 1132060140820 Project: <NONE> Contractor: MR C'S PLUMBING &SEPTIC INC Phone: (305)651-7859 Building Department Comments SEPTIC TANK& DRAIN FIELD INSTALL. Infractio Passed Comments INSPECTOR COMMENTS False nspector Comments Passed CREATED AS REINSPECTION FOR INSP-226938. side walk requires ED/ repairs sod ok hrs ok Failed ❑ 07/15/2015-ADDITIONAL BOND ISSUED WITH MASTER PERMIT FOR SIDEWALK AND GRASS. Correction ❑ r Needed 4 Re-Inspection /� ��Vf Fee No Additional Inspections can be scheduled until re-inspection fee is paid. July 15,2015 For Inspections please call: (305)762-4949 Page 2 of 37 Miami Shores Village x�c� t 112k I JAN 2 2Q15 Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY* - Tel:(305)795-2204 Fax: (305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 CC) BUILDING Master Permit No.-P(-7 �� I PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP j , 1V n r /� y- CONTRACTOR DRAWINGS JOB ADDRESS: 53 �1 6 "!Jr City: Miami Shores County: Miami Dade Zip: 3 3 1 3 d Folio/Parcel#: i -31111104 -1�'4 -ORC Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: K-v Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder):] y�( �`�Z(��T�\f�1 � �' �' �� Phone#: jZLMI7 Addresss^: (o el byes n(1fias R1 v d . `� z s City: ,�k6Ni` +i State: N-cl r-prew i A Zip: q 2-0 2= Tenant/Lessee Name: Phone#: Email: / ( J ? / CM CONTRACTOR:Company Name: AA r GJ AV-91/11 fdfDT2 Phone#: ✓ 7fS� Address: f� a IUGJ 2?A& ? City: State: Zip: Qualifier Name: Aiai Nd Phone#: M-f State Certification or Registration#: Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: d rens: , City: State: Zip: alue 6#+Wsbf�ew I , quareV1 4 /Linear Footage of Work: 30a „ , .Y . p`eo6Wc�ekst,;K: o� Iteration ;' ❑ New ® Repair/Replace ❑ Demolition �Sd4pi101't;l��r�: r L a , Specify color of color thru tile: Submittal Fee$ Permit Fee$ _ - r' CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ ((\\ Structural Reviews$ Bond$�Oy ` TOTAL FEE NOW DUE$ (Revised02/24/2014) —49 4 0 Bonding Company's Name(if applicable) Bonding Company's Address City State IV I Zip Mortgage Lender's Name(if applicable) it Mortgage Lender's Address 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 ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS,TANKS,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." w. 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 Signature WNE r AG T CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of to l 1201-S by day of 5kW4111 1 20 S by I M/_ �✓AM� ` vwho is personally known to &".6L C (1G1— i!y �s narc_,o�, ally known to me or who has produced as me or who has produced as identification and who did take an oath. identification and whAdidtakeanoopto ESNOTARY PUBLIC: NOTARY PUBLIC: of FWW 23,2018FF 1130597 "MY .Sign: " Sign: Print: .4/� //,m Print: 0 d w0T.10!,vaSd,e10Nep1o1j C9 LO-96C Seal: gWe'81,ARFV S32j!dX.3 vim' 09996033#NGiSSIYVYVC�7 �•� _' �`�': � r�U'4:: DONALD MARTIN NIJ 21b'W C4WAFO MY COMMISSION#EE095550 CI '' '' �t � EXPIRES May 18,2015 ******************************** (4*7)398015#3*****Fl ordallofaryservlcoc*om***** ******************************** APPROVED BY LL Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) +CFN 2015ROO28926 OR 9k 29465 Pss 3758 - 3761; (49s) RECORDED 01/15/2015 10:14:19 DEED DOC TAX 2x730.00 HARVEY RUUINr CLERK OF COURT Returnto: MIAMI-DADE COUNTYr FLORIDA CHRISTOPHER P. KELLEY, P.A. 11098 Biscayne Boulevard,Suite 205 Miami, FL 33161 Instrument Prepared By: CHRISTOPHER P. KELLEY, Esquire 11098 Biscayne Boulevard,Suite 205 Miami, Florida 33161 Folio No. 11-3206-014-0820 WARRANTY DEED THIS INDENTURE, Made this /_3 day of T,7,hljgrV 2015, Between CHARLES DAVID WATSON,a single man and WILLIAM RONALD WA SON,a si ngle man,individually and as Successor Co-Trustees Under the ELEANOR C.WATSON REVOCABLE LIVING TRUST dated the 21'�t day of April, 1997,the GRANTOR, and 1031 FUNDING& REVERSE CORP., a California Corporation,whose post office address is 5355 Avenida Encinas, Suite 203, Carlsbad, CA 92008, the GRANTEE, WITNESSETH, That said GRANTOR, for and in consideration of the sum of Ten and 00/100 Dollars,and other good and valuable considerations to said GRANTOR in hand paid by said GRANTEE,the receipt whereof is hereby acknowledged,have granted,bargained and sold to the said GRANTEE, and GRANTEES' successors and assigns forever, the following described land,situate, lying and being in Miami-Dade County, Florida to-wit Lots 8 and 9, Block 55, of MIAMI SHORES SECTION 2, according to the Plat thereof,as recorded in Plat Book 10, Page 37, of the Public Records of Miami-Dade County, Florida SUBJECT TO: Applicable zoning and/or restrictions and prohibitions imposed by governmental authority; Conditions, Restrictions limitations, reservations, easements,and other matters appearing on records, if any, Utility easements of record, taxes for the year 2015 and subsequent years. Book29465/Page3758 CFN#20150028926 Page 1 of 4 Warranty Deed Eleanor C.Watson Revocable Living Trust sit 1031 Funding&Reverse Corp. Page 2 of 3 and said GRANTOR does hereby fully warrant the title to said land,and will defend the same against the lawful claims of all persons whomsoever. IN WITNESS WHEREOF, GRANTOR has hereunto set GRANTOR'S hand and seal the day and year first above wrrtten. seal an deliv in o presence: /T ess Name CHARLES DAVID WATSON Grantor O Individually and as Successor Co Trustee Print Under the ELEANOR C.WATSON REVOCABLE LIVING TRUST dated the 213�'day of April 1997 Address:6241 Mammoth Avenue Witness Name Valley Glen,CA 91401 Print STATE OF CALIFORNIA ) COUNTY OF L_2s,4n$-e 5' ) I HEREBY CERTIFY that on this day,before me,an officer duly authorized in the State aforesaid and in the County aforesaid to take acknowledgments,personally appeared CHARLES DAVID WATSON, individually and as Successor Co-Trustee Under the ELEANOR C.WATSON REVOCABLE LIVING TRUST dated the 21s'day of April 1997,who produced CA T n r&P4 as identification,and who executed the foregoing instrument and acknowledged before me that he executed the same. Witness my hand and official seal in the County and State last aforesaid this day of �clYly y 2015. NOTARY PUBLIC,State of CALIFORNIA My Commission Expires:Tu/.e Z6jLar.S MARK BRYAN FF Commission#1941677 a ra _f Notary Public.California z Los Angeles County a My Comm.Expires Jun 20,2015 Book29465/Page3759 CFN#20150028926 Page 2 of 4 Warranty Deed Eleanor C.Watson Revocable Living Trust s/t 1031 Funding&Reverse Corp. Page 3 of 3 j Signed seale nd delivered in our presence: Wit ess Na WILLIAM RONALD WATSON Grantor 'J Individually and as Successor Co-Trustee Print Under the ELEANOR C.WATSON REVOCABLE LIVING TRUST dated the 21"t day of April 1997 Address:674 NE 75 Street Wi Nam Miami, FL 33138 CH USTOMM P_KELLEY Print STATE OF FLORIDA ) COUNTY OF MIAMI-DADE ) I HEREBY CERTIFY that on this day, before me,an officer duly authorized in the State aforesaid and in the County aforesaid to take acknowledgments, personally appeared WILLIAM RONALD WATSON, individually and as Successor Co-Trustee Under the ELEANOR C. WATSON REVOCABLE LIVING TRUST dated the 21"day of April 1997,who produced L.i as identification, and who executed the foregoing instrument and acknowledged before me that he executed the same. 14 ,Witness my hand and official seal in the County an to last aforesaid this day of Jc d&,_,- 2015. NOTA ELIC, ate of FLORI at ge My Commission Expires: Notary?ubloc State of Florida Christopher P�elfey L kty Comm ssion EE 193335 rv,},•.'wi cxonos G5i2'2G36 �h.rtiJ''.ehJ' 1V Book29465/Page3760 CFN#20150028926 Page 3 of 4 File No. 2014-1207 CONSTRUCTION MANAGEMENT AGREEMENT THIS CONSTRUCTION MANAGEMENT AGREEMENT (the Agreement ), is made January 7, 2015, by and between 1031 Funding & Reverse Corp., a California company ( Owner ), and Miryam Rojas ( Manager ). WITNESSETH: WHEREAS, Owner is the owner of certain real property as more particularly described on Exhibit A attached hereto (the Property ); and WHEREAS, in accordance with that certain Qualified Exchange Accommodation Agreement dated January 7, 2015 between Owner and Miryam Rojas (the QEAA ), Owner desires to retain Manager to manage and supervise the construction of certain improvements on the Property (the Improvements ) in accordance with plans for the construction of such Improvements approved by Manager (the Plans ). NOW, THEREFORE, in consideration of the premises and the mutual covenants, agreements, and undertakings herein contained, and in further consideration of the mutual benefits to accrue to each of the parties hereto, Owner and Manager hereby agree as follows: 1. Owner hereby retains Manager to manage and supervise the construction of Improvements on the Property in accordance with the Plans and such construction contracts as may be entered into pursuant to paragraph 2 hereof. Manager hereby agrees to cause the Improvements to be constructed on the Property at such cost as shall be approved by Manager (the Construction Cost ) and in accordance with the Plans, subject to such changes to the Plans as Manager deems reasonable or necessary. 2. Manager, acting as agent for Owner and on behalf of Owner, shall: (a) Select or approve any and all general contractors, in its sole discretion, and select or approve all construction means, methods, techniques, sequences and procedures for the construction of the Improvements. Owner hereby agrees to enter into such construction contracts, as Manager shall request with respect to the construction of the Improvements; (b) Obtain either directly or through the contractor or subcontractors, all labor, materials, equipment, tools, construction equipment and machinery and other facilities and services necessary or incidental to the completion of the Improvements; (c) Coordinate the scheduling of the construction of the Improvements and exercise the rights of Owner under all construction contracts entered into by Owner pursuant hereto; (d) Submit to Owner for payment all invoices received by Manager in connection with the construction of the Improvements and approved for payment by Manager which invoices Owner hereby agrees to pay promptly upon receipt of such invoices from Manager; Page 2 (e) Submit for payment by Owner, all sales, consumer, use and other similar taxes for materials used in the construction of the Improvements, as required by law (which taxes Owner hereby agrees to pay promptly upon such submission) and obtain all permits and licenses necessary for the construction of the Improvements; (f) Comply and enforce all contractors compliance with all laws, ordinances, rules, regulations and orders of any public authority bearing on the performance of the work or the Improvements under construction; and (g) Perform such other tasks, as Manager shall deem necessary or appropriate in connection with the construction of the Improvements on the Property. 3. Manager, and any contractor retained in connection with the construction of the Improvements, shall maintain such insurance as will protect Manager or such contractors, as applicable, from claims under workmen s compensation acts and other employee benefit acts, from claims for damages because of bodily injury, including death, which may arise out of or result from Manager s or such contractors operations under this Agreement, whether such operations be those of Manager, the contractor or subcontractor or of anyone directly or indirectly employed by any of them and from claims for damages to property. The insurance to be maintained by Manager and such contractors must be reasonable and customary for the jurisdiction in which the Improvements are to be constructed. Owner shall be named as an additional insured under all such insurance policies. 4. Manager agrees to complete the construction of the Improvements substantially in accordance with the Plans and the construction contracts entered into pursuant to paragraph 2 hereof, subject to change orders approved by Manager for additions, deletions or modifications to the Plans and with such other deviations from the Plans that are acceptable to Manager. 5. This Agreement is solely a management agreement whereby Manager shall serve as construction manager for the construction of the Improvements on the Property and shall not be construed to create any partnership, joint venture or association between Owner and Manager. 6. This Agreement shall terminate automatically upon conveyance of the Property to Manager in accordance with the QEAA. 7. Manager agrees to protect, indemnify and hold Owner and its agents and employees free and harmless from and against any and all claims, liens, demands, liabilities, losses and causes of action of every kind and character including the amounts of judgments, penalties, interest, court costs and legal fees incurred by Owner in defense of same, arising in favor of governmental agencies or third parties (including of taxes, claims, liabilities, liens, debts, personal injuries, death, or damage to tangible property occurring or in any wise incident to, in connection with or arising our of the construction of the Improvements on the Property, including claims brought by any contractors or subcontractors, except insofar as responsibility may be expressly assumed by Owner under the provisions of this Agreement or from such claims arising out of the gross negligence or willful misconduct of the Owner. Page 3 8. All notices, demands or documents which are required or permitted to be given or served hereunder shall be in writing and either personally served, sent by commercial courier with receipt requested or sent by registered or certified mail addressed as follows: If to Manager: Miryam Rojas Telephone: 305-498-1227 If to Owner: c/o 1031 Funding & Reverse Corp. Attn: David P. Greenberger, Esq. Telephone: (866) 944-1031 5355 Avenida Encinas, Suite 203 Facsimile (858) 332-1777 Carlsbad, CA 92008 The addresses may be changed from time to time by either party by serving notice as heretofore provided. Service of such notice or demand shall be deemed complete on the date of actual delivery as shown by the addressee s registry or certification receipt or at the expiration of the second day after the date of mailing, whichever is earlier in time. 9. No consent or waiver, express or implied, by either party to this Agreement or of any breach or default by the other in the performance of any obligation hereunder shall be deemed or construed to be a consent or waiver to or of any other breach or default by such party hereunder. Failure on the part of any party hereto to complain of any act or failure to act of the other party or to declare the other party in default hereunder, irrespective of how long such failure continues, shall not constitute a waiver of the rights of such party hereunder. 10. Any provisions hereof to the contrary notwithstanding, Manager shall observe and abide by and perform all of its obligations hereunder in accordance, with all applicable laws, rules, and regulations of all governmental authorities having jurisdiction. 11. Manager shall on a timely basis establish appropriate insurance policies, in commercially reasonable amounts, on the Property and Owner shall be named as the primary insured party. All insurance shall be issued by a Company with a B+ or better rating from Best s Insurance rating. The policy will require ten (10) days written notice to Manager prior to material change of coverage or cancellation. 12. When it is necessary to cross curbing or sidewalks, protection against damage shall be provided by Manager, and any damage caused will be, as soon as reasonably possible, repaired by Manager. All existing sidewalks, curbs and pavements which are disturbed, broken, removed or otherwise damaged by Manager by or during the construction of the Improvements shall be replaced by Manager. Replaced sidewalks, curbs and pavements shall be smooth, shall blend into the existing work and shall not present depressions or bumps, and shall be constructed of similar materials and by methods utilized in the original construction. All construction work, materials, forms, etc., used in repairs and replacement shall conform to the Plans. Page 4 13. Manager may store materials on the job site. Any temporary buildings shall be removed by Manager when no longer needed and all storage areas shall be kept clean of unreasonable accumulations of debris and rubbish by Manager. Any damage to the ground where sheds were constructed shall be repaired by Manager. 14. This Agreement constitutes the entire agreement between the parties hereto with respect to the matters covered hereby. All prior negotiations, representations, and agreements with respect hereto not incorporated herein are hereby canceled. This Agreement can be modified or amended only by a document duly executed by duly authorized officers of Manager and Owner. 15. Except with the express written consent of Owner, Manager shall not assign or otherwise transfer any of its obligations hereunder or right to receive payments hereunder; provided, however, Owner hereby consents to the assignment by Manager of this Agreement to the parent of or any affiliate of Manager, provided, that an assignment of this Agreement to the parent of or an affiliate of Manager shall not relieve Manager of its obligations hereunder. Owner shall not assign this Agreement without the consent of Manager. Subject to the foregoing, this Agreement shall inure to the benefit of and be binding on the parties hereto and their respective successors and assigns. 16. If either Owner or Manager employs an attorney to enforce any of the provisions under this Agreement, or to protect such party s interest hereunder, the losing party in any final judgment agrees to pay to the prevailing party all reasonable costs, charges and expenses, including attorneys fees, expended or incurred by the prevailing party in connection therewith. This Agreement will be construed and enforced according to the internal laws of the State of California (without regard to conflicts of law provisions thereof). The parties consent to venue in the Superior Court in San Diego California and, to the extent there is subject matter jurisdiction, to the United States District Court for the Southern District of California. 17. In the event of a conflict between the provisions of this Agreement and the provisions of the QEAA, the provisions of the QEAA shall control. IN WITNESS WHEREOF, this Construction Management Agreement is hereby executed effective as of the date first above set forth. MANAGER: OWNER: Mi a as 1031 Funding & Reverse Corp. By: David P. Greenberger, President 6648 SUTRO HEIGHTS LN., LLC Filing Information Document Number L08000059826 FEIMIN Number NONE Date Filed 06117/2008 state FL statin INACTIVE Effective Date 0611712008 Last Event ADMIN DISSOLUTION FOR ANNUAL REPORT Event Date Filed 09125/2009 Event Effective Date NONE Principal Address 681 ENCINITAS BLVD SUITE 403 ENCINITAS, CA 92024 Mailing Address 681 ENCINITAS BLVD SUITE 403 ENCINITAS, CA 92024 Registered Agent Name & Address GREENBERGER, DAVID 6648 SUTRO HEIGHTS LANE MELBOURNE, FL 39240 Authorized Person(s) Detail Name & Address Title MGRM 1031 FUNDING AND REVERSE CORP. 681 ENCINITAS BLVD SUITE 403 ENCINITAS, CA 92024 t PERMIT #: 13-SC-1580847 APPLICATION #:AP1172096 STATE OF FLORIDA DEPARTMENT OF HEALTH DATE PAID: ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID: CONSTRUCTION PERMIT RECEIPT #: . 1P DOCUMENT #: PR961121 CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: Eleanor Watson PROPERTY ADDRESS: 534 NE 95 St Miami, FL 33138 LOT: 8 9 BLOCK: 55 SUBDIVISION: PROPERTY ID #: 11-3206-014-0820 (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 [ 900 ] GALLONS / GPD new septic tank 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 new bed confiq.drainfield SYSTEM R [ 0 ] SQUARE FEET SYSTEM A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND ( ] I CONFIGURATION: [ ] TRENCH [x] BED [ ] N F LOCATION OF BENCHMARK: FFE 10.7'NGVD I ELEVATION OF PROPOSED SYSTEM SITE [ 19.20 ] ( INCHES FT ] [ ABOVE BELOW BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 69.24 ] [ INCHES FT ] [ABOVE BELOW BENCHMARK/REFERENCE POINT L D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: [ 62.001 INCHES 1.-Install a 900 gal min. septic tank with an approved filter. O 2.-The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance T with s.64E-6.013(3)(f), FAC. 3.-Install 300 sf of drainfield in bed configuration. H 4.-Install 12"of slightly limited soil at the bottom of the drainfield. E 5.-Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed or drain trench. (Comments Continue on Page 2.) R SPECIFICATIONS BY`\ C' 's Plumbing TITLE: APPROVED BY: \j TITLE: Engineering Specialist II Dade CHD ei Martin DATE ISSUED: 01/20/20 5 EXPIRATION DATE: 04/20/2015 DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64r-6.003, FAC Page 1 of 3 v 1.4 RPlt."15'OgG SjZ'Ah^55 r DOCUMENT #: PR961121 6.-Invert elevation of drainfield to be no less than 5.43'NGVD. T-Bottom of drainfield elevation to be no less than 4.93'NGVD. 8.-This permit includes the abandonment of the existing septic tank. 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 010 STATE OF FLORIDA APPLICATION # AP1172096 DEPARTMENT OF HEALTH PERMIT # 13-SC-1580847 ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM DOCUMENT # SE948155 SITE EVALUATION AND SYSTEM SPECIFICATION wig APPLICANT: Eleanor Watson CONTRACTOR / AGENT: MrC"s LOT: 8 9 BLOCK: 55 SUBDIVISION: ID#: 11-3206-014-0820 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: 0.29 ACRES TOTAL ESTIMATED SEWAGE FLOW: 300 GALLONS PER DAY [ RESIDENCES-TABLEI / OTHER-TABLE 2 ] AUTHORIZED SEWAGE FLOW: 724.98 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 10.7'NGVD ELEVATION OF PROPOSED SYSTEM SITE 19.20 [ INCHES / 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: 30 FT SITE SUBJECT TO FREQUENT FLOODING? [ ]YES [X ]NO 10 YEAR FLOODING? [ ]YES [X]NO] 10 YEAR FLOOD ELEVATION FOR SITE: FT [ MSL / NGVD ] SITE ELEVATION: 9.10 FT [ MSL / NGVD SOIL PROFILE INFORMATION SITE 1 SOIL PROFILE INFORMATION SITE 2 USDA SOIL SERIES: Urban land USDA SOIL SERIES: Urban land Munsell#/Color Texture Depth Munsell#/Color Texture Depth 10YR 3/1 Sand 0 To 8 10YR 3/1 Sand 0 To 8 1 OYR 5/4 Sand 8 To 28 10YR 5/4 Sand 8 To 28 10YR 5/4 Oolitic Limestone 28 To 72 10YR 5/4 Oolitic Limestone 28 To 72 OBSERVED WATER TABLE: INCHES [ ABOVE / BELOW ] EXISTING GRADE TYPE: [ PERCHED / APPARENT ] ESTIMATED WET SEASON WATER TABLE ELEVATION: 67 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: 62 INCHES DRAINFIELD CONFIGURATION: [ ] TRENCH [X] BED [ ] OTHER (SPECIFY) REMARKS/ADDITIONAL CRITERIA SITE EVALUATED BY: DATE: 01/14/2015 Mr C"s Plumbing, (Title:)(Mr C"s Plumbing) DH 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated: 64E-6.001, FAC Page 3 of 4 AP1172096 E€D1580847 v 1.0.2 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.