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PL-15-3012 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone:(305)795-2204 Fax: (305)756-8972 Inspection Number. INSP-249588 Permit Number: PL-12-15-3012 Scheduled Inspection Date: December 2%2015 Permit Type: Plumbing - Residential Inspector. Diaz,Osvaldo Inspection Type: Final Owner. LUCIO,ASHLEY Work Classification: Septic Job Address:578 NE 93 Street Miami Shores,FL 33138- Phone Number Parcel Number 1132060141050 Project <NONE> Contractor. ALLSTATE DIVERSIFIED ENGINEERING INC Phone:(305)256-0306 Building Department Comments SEPTIC SYSTEM REPAIR Inftactlo Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed HRS IN FILE. Failed Correction Needed Re-Inspection Fee No Additional Inspections can be scheduled until re-Inspection fee is paid December 18,2015 For Inspections please call: (305)762-4949 Page 28 of 51 No �• DIVISION Of • Environmental Health �O Florida Department of Health 'ID Miami-Dade County Health Department 10� �Q OSTDS/Well Division h 11805 SW 26 St.•Miami,FL 33175 O Inspector CA- • t —';Z�ckZA Date Address -7 8 N 3 OSTDS#,A-P -i o%-t\o l- 112� (Comments:�:7 41 1 .a' s�� �ser��-.c '��►r'-r Signature d APPLICATION #:AP1214101 1 PERMIT #:13-SC-1644758 QQ TH 0� DocumENT #:F11029526 D � TMENT AND DISPOSAL SYSTEM -{ ECTION AND FINAL APPROVAL DATE PAID:11/25/2015 FEE PAID:200.00 Q RECEIPT #:13-PID-2852908 E FL 33138 D is BLOCK: 57 CIO x A o Q p. Q ID#: 11-3206-014-1050 0 y �, ., .: c M A f ' T IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED. " RA ri: �) { _ SETBACKS = =. U] N J 0 [2] [ ] [27] SURFACE WATER FT 0 o a+ o A ez Lr A C.J 3 f Concrete [ ] [28] DITCHES FT WC% W "C °C C)0 o S [ 1 [29] PRIVATE WELLS FT O A N l 11 [30] PUBLIC WELLS FT �, • J 2 EF-4 [ ] [31] IRRIGATION WELLS FT „� ♦ 2• [ 1 [32] POTABLE WATER 30 FT [ ] [33] BUILDING FOUNDATIONS 20 FT r+ [ ] [34] PROPERTY LINES 8 FT [ ] [35] OTHER FT FILLED / MOUND SYSTEM �D o y -r ,- 2] SQFT [ ] [36] DRAINFIELD COVER R ka ¢ HEADER X [ ] [37] SHOULDERS .EiQ U yin 1. 5.00 2. [ 1 [381 SLOPES [ ] [39] STABILIZATION [ ] [15] DEPTH OF COVER ADDITIONAL INFORMATION [ ] [16] ELEVATION [ ABOVE / SELOW ]BM 41.04 [ 1 [40] UNOBSTRUCTED AREA [ ] [17] SYSTEM LOCATION [ ] [41] STORMWATER RUNOFF [ ] (18] DOSING PUMPS [ l [42] ALARMS I 1 [19] AGGREGATE SIZE [ ] [43] MAINTENANCE AGREEMENT I ] [20] AGGREGATE EXCESSIVE FINES [ l„ [44] BUILDING AREA [ ] [21] AGGREGATE DEPTH [ ] [451 LOCATION CONFORMS WITH SITE PLAN FILL / EXCAVATION MATERIAL FINAL, STTE- GRADING [ l [22] FILL AMOUNT [ ] [47] CONTRACTOR Guillermo Suarez(A League [ ] [23] FILL TEXTURE ( l [481 OTHER ADS ARC 24 ( ] [24] EXCAVATION DEPTH ABANDONMENT I 1 [25] AREA REPLACED I 1 [49] TANK PUMPED 12/08/2015 [ 1 [26] REPLACEMENT MATERIAL [ ] [501 TANK CRUSHED & FILLED 12/08/2015 Comments: Comments are on page 2. CONSTRUCTION I APPROVED / DISAPPROVED l: Dade CHD DATE: 12/15/2015 Carlos M Ica Depa 6nerd of Health ISM&County) Ul FINAL SYSTEM DISAPPROVED ]; Dade CHD DATE: 12/15/2015 (Explanation of Violations on following page) Carlos Health in Dadeoun DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E-6.003, FAC Page 2 of 3 EH Database v 1.0.1 AP1214101 EID1644758 1 ve*;OS i, Miami Shores Village ,av' t'eritllf Piurr►bingrttial 10050 N.E.2nd Avenue NE it Miami Shores,FL 33138-0000 � Ap PiQED z � Phone: (305)795-2204 Expiration: 06/01/2016 F: issue oote.12/412010 Project Address Parcel Number Applicant 578 NE 93 Street 1132060141050 ASHLEY LUCIO Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell ASHLEY LUCIO 10651 NE 10 Court MIAMI SHORES FL 33138- 10651 NE 10 Court MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone ALLSTATE DIVERSIFIED ENGINEERIP 305 256-0306 Valuation: 1,500.00 ( ) (305)258-7797 _.. . .._.__.,__.. . __..... _..,..,,. ._,... _.. Total Sq Feet: 45 Type of Work: Available Inspections: Type of Piping: Inspection Type: Additional Info: HRS Approval Bond Return: Final Classification:Residential Scanning:3 Review Plumbing Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Bond Type-Owners Bond $500.00 Invoice# PL-12-15-57927 CCF $1.20 DBPR Fee $2.25 12/04/2015 Credit Card $616.70 $50.00 DCA Fee $2.28 12/03/2015 Check#:4969 $50.00 $0.00 Education Surcharge $0.40 Bond#:2919 Permit Fee $150.00 Scanning Fee $9.00 Technology Fee $1.60 Total: $666.70 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFF T: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction d zoni Futh re,I authorize the above-named contractor to do the work stated. December 04, 2015 tho ' di natur Owner / Applicant / Contractor / Agent Date Building Dep ment Copy December 04,2015 1 t Midi I II JI IUI C, V IIIdgC -- -- Building Department DEC ® 3 2015 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 BY: INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20Y BUILDING Master Permit No. ,L PERMIT APPLICATION Sub Permit No. BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [—]RENEWAL [PLUMBING [:] MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 671 A/ 9& -ilt City Miami Shores County: Miami Dade Zip: 3.3 Folio/Parcel#: (� —�ai�c -OI'�—/�6� Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): L-U-" Phone#: Address: gy N i=ce 9 City: I�1 )( State: Zip: .�.� Tenant/Lessee Name: Phone#-az Email: II CONTRACTOR:Company Name: l R, l !! Phone#: '50s Address: — S City: ��Qr )ftj t State: rl Zip: Qualifier Name: )10' Phone#: .305 Lt d State Certification or Registration#: Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: ity: State: Zip: Value of Work for this Permlt• Square/Linear Footage of Work: Type of Work: ❑ Addition .� El Alteration s 13 New Repair/Replace ❑ Demolition Description of Work: 64� A cc1 (^ Specify color of color thru tile: Submittal Fee$ Permit Fee$ ��� CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE S I (ice 19 0 G1 G 6�i® 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 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." 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 sen c of such posted notice, the inspection will not be ved and a reinspection fee will be charged. Signature Signature 101 NER r ENT CONTRACTOR The foregoing instru{mom t was ac owledged before me this The foregoing instrument was 1a-cknowledged before me this l day of 1�1.MMVR—C .201S— .by ( day of 40C 20 19— ,by ___,who is personally known to )1 S wh s personally k to me or who has produced Dl-'. L7po•Oo •73•q(I.0 as me or who has produced as identification and w id take an oath. identification and w o id take an oath. NOTARY PUBLI NOTARY PUBLI.i . Sign: Sign: Print: Print: ARI Seal: � �h�;= SARIMABATISTA .__ MY COMMISSION#EE 873354 Seal: • EXPIRES:May 11,2017 .; +� MY COMMISSION EE 873154 Bonded Thor Na W POW undembs y ;•: EXPIRES:May 11,2017 :� p•• Bonded Thru Nofa7 Pahtic UndenwYeW ************************************************************************************************************ APPROVED BY ®� ` Plans Examiner Zoning Structural Review Clerk I: rr1l—ted State.<+af.�itirld ' -T�II$15 f�iQrT A Bili.=QO NOT.PAY. `�; 6925987 ' , ; ppt StNE58 ptAllllti/L.00ATIOt4 RECEIPT]YO. E�P��1ES ALL6-tATE I3tvERs4FIEoRENEWALEI'tM6R 3Q,,2016 ENONEERINd' NC 68209E34 Must displayed at frlace of wainesa 25$25 SW 141,4UE Pursuant to county code MIAMI,FL, -:-330 32 Chapter 8A-Arts&10 OWNER SEC.TYPE OF BUSINESS PAYMENT RECEIVED ALLSTATE DIVERSIFIED 196 PLUMBING BY TAX COLLECTOR ENGINEERING INC CONTRACTOR 75,00 09/14/2015 Worker(i) CFC1426847 0229-15-008090 This Locaf:8ushtese Tax Receiploniy cordirres payment of the Local Bashross 7M VIe Receipt is nota license, permit,ore cemcation of tha holders qualifications,to do business,Holder east oemplY with any governmental m nongoveramreaol regulaEary laws and runs Which apply to the business. The RECEIPT NO.above mut be displayed an all commercial vehicles-f iami-Bade Code Sec So-276. For more intonation,vM um amldii�� �.oca[ Business Toxp# To Miami-Dade County,State of Florida �Tk119iS N0f A BILL-OO NOT PAY -L' 'B 6925961 BUBtti111=851�tAtfAE/k�CAT1011E RECEIPT NO. �rXPIRES' ALLS7ATE DIVERSIFi RENEWAL SE��rMBER 30., 2016. ENGINEERING INC 3741886 ivluat be displayed at place of'buainess 25525 SW 141 AVE Pursuant to County Code MIAMI,FL, 33032 chapter 8A-Art.9&to OWNER SEC.TYPE OF BUSINESS PAYMENT RECEIVED ALLSTATE DIVERSIFIED 196 GENERAL BUILDING BY TAX COLLECTOR ENGINEERING INC CONTRACTOR 75,00 09/14/2015 Worker(s) 1 CGCO58347 029-15-008090 This Local Business Tax Receipt only confirm payment of the Local Business Tax.The Raceipt is not a license, permit or a certification of tie holders qualifications,to do business.Holder maul comply with any governmental or nongoYaramentai regulatory laws and which apply to the business. The RECEIPT NO.above must be displayed on all clercial vabicies-Mishit-Dede Code See 6a-276. MtAM Mak For more Information,visitymaFwalaml 1 ACORO® DATE(MN MA'YYY) `40 CERTIFICATE OF LIABILITY INSURANCE F11/17/2015 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 endorsements. PRODUCER David M. Lopez Eastern Insurance Group, Inc. PHONE , (305)595-3323 F 0.(305)595-7135 9570 SW 107 AvenueE-MAIL .amanda@easterninsurance.net Suite 104 INSU S AFFORDING COVERAGE NAIL 0 Miami FL 33176 INSURERAColony Insurance Company INSURED INSURERB:Torus National Insurance Company Allstate Diversified Engineering, Inc. INSURER CBri field Employers Insuranc 25525 SW 141 Ave INSURER D: INSURER E: Homestead FL 33032 INSURER F: COVERAGES CERTIFICATE NUMBERMaster 15/16 REVISION NUMBER: 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. rA POLICY EFF POLICY EXP TYPE OF INSURANCE POLICY NUMBER LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE ®OCCUR p I Eg $TO RENTED 100,000 103GL0007204-01 11/13/2015 11/13/2016 MED EXP LAny one person $ 5,000 PERSONAL BADV INJURY $ 1,000,000 GEN'_AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 x POLICY 0 JEl'aT F-1 LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COINEDISINGLE $ IF ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS (Peraccident) UMBRELLA LIAR OCCUR EACH OCCURRENCE $ 11000,000 B g EXCESS LIAR HCLAIMS-MADE AGGREGATE $ 11000,000 DED ON 89000N150ALI 4/20/2015 4/20/2016 $ WORKERS COMPENSATION P AND EMPLOYERS'LIABILITY YIN T ANY O I PCERIMEMBER EXRTNERI? C�VE N 1 A E.L.EACH ACCIDENT $ 11000.000 C (Mandatory In NH) 830-50170 1/27/2015 1/27/2016 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 h describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMB 11000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached H more apace Is required) Septic tank systems, installation servicing or repair CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Deptartment ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2 Avenue Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE David Lopez/ANA --�� ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD IN3025 mnwit PERMIT #:1USC-1 644758 APPLICATION #:AP 1214101 STATE OF FLORIDA DATE PAID DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID: CONSTRUCTION PERMIT RECEIPT #: DOCUMENT #:PR996161 CONSTRUCTION PERMIT FqR: OSTDS Repair APPLICANT: Ashley Luclo PROPERTY ADDRESS: 578 NE 93 St Miami, FL 33138 LOT: 1 BLOCK: 57 SUBDIVISION: PROPERTY ID #: 11-3206-014-1050 [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 LADE 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 [ 1,050 ] GALLONS / GPD new septic tank CAPACITY A [ 0 ] GALLONS / GPD CAPACITY N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIM[M 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 []c] BED [ ] N F LOCATION OF BENCHMARK: C.O.R.9.33'NGVD I ELEVATION OF PROPOSED SYSTEM SITE [ 1.56 ] [ INCHES FT ] [ABOVE BELOW BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 46.56 ] [ INCHES FT ] [ABOVE JBELOW BENCHMARK/REFERENCE POINT L D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: [ 45.001 INCHES 1.-Install a 1050 gal min.septic tank with an approved filter. 0 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)(0, FAC. H 3.-Install 300 sf of drainfield in bed configuration. 4.-Bottom of drainfield and invert elevations to be no less than 5.45'and 5.95'NGVD respectively. E 5.-This permit includes the abandonment of the existing septic tank. System sized for 3 bed with a maximum occupancy of 6 persons(2 per bedroom),for a total estimated flow of 400 gpd. R SPECIFICATIONS BY: ILLERMO SUAREZ TITLE: APPROVED BY: TITLE: Engineering Specialist II Dade CHD Be i4 Lange-O no DATE ISSUED: 12/02/2015 EXPIRATION DATE: 03/01/2016 DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E-6.003, FAC Page 1 of 3 v 1.1.4 AP1214101 SE978354 STATE OF FLORIDA APPLICATION # AP1214101 DEPARTMENT OF HEALTH PERMIT # 13-SC-1644758 ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM DOCENT # SE978354 SITE EVALUATION AND SYSTEM SPECIFICATION APPLfCANT: Ashley Lucio CONTRACTOR / AGENT: Allstate Diversified LOT: 1 BLOCK: 57 SUBDIVISION: ID#: 11-3206-014-1050 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: 0.32 ACRES TOTAL ESTIMATED SEWAGE FLOW: 400 GALLONS PER DAY [ RESIDENCES-TABLEI / OTHER-TABLE 2 ] AUTHORIZED SEWAGE FLOW: 799.99 GALLONS PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE ] UNOBSTRUCTED AREA AVAILABLE: 450.00 SOFT UNOBSTRUCTED AREA REQUIRED: 450.00 SOFT BENCHMARK/REFERENCE POINT LOCATION: C.O.R.9.33'NGVD ELEVATION OF PROPOSED SYSTEM SITE 1.56 [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: 10 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: 9.20 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 3/3 Fine Sand 0 To 72 10YR 3/3 Fine Sand 0 To 72 OBSERVED WATER TABLE: INCHES [ ABOVE / BELOW ] EXISTING GRADE TYPE: [ PERCHED / APPARENT ] ESTIMATED WET SEASON WATER TABLE ELEVATION: 62 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: 45 INCHES DRAINFIELD CONFIGURATION: [ ] TRENCH [X] BED [ ] OTHER (SPECIFY) REMARKS/ADDITIONAL CRITERIA SITE EVALUATED BY: DATE: 11/25/2015 SUAREZ,GUILLERMO(TMe:)(G.SUAREZ SEPTIC TANK) DH 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated: 64E-6.001, PAC Page 3 of 4 AP1214101 EID1844758 v 1.0.2