Loading...
PL-14-1567 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972CIQ 0-- 14 - inspection Number. INSP-226467 PermitNumber: PL-7-14-1567 Inspection Date:January 13,2015 Permit Type: Plumbing- Residential Inspector: Diaz, Osvaldo Inspection Type: Final Owner: PALMISANO, INGRID&ERIC Work Classification: Septic Job Address:1035 NE 96 Street Miami Shores, FL Phone Number Parcel Number 1132060143730 Project: <NONE> Contractor: EMPIRE ENGINEERING SERIVICES CORP Phone: (786)488-8657 Building Department Comments ROUGH IN AND COMPLETE NEW SEPTIC TANK FOR Infractio Passed Comments NEW HOME INSPECTOR COMMENTS True ,Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-216256. provide hrs approval submit green tag hrs on file Failed El Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. For Inspections please call: (305)762-4949 January 13,2015 Pagel of 1 I ` ,_��, x�'v�\"�i*r�`'`�: �W .,'FsQ."*`�°gE3�d � � ���n•�ir;�ry*� .���'�'�' ,g°r.'w 6._.' ,'. .. ,,�.,�:.. 3 ..u ���a�,;� ,.*° ,it',�t"ia�,4`R'C�. nx.s, i-s"y�'' t ° s =;.: �>r` F '$; .,.j i` .. ,. xi'. .;y @e y> } f.,s3'�'_ ''..: * ytE,:,'+n' s `•5' ;.:� s .'., a. ";;.F "' � s¥, a E .. a '•_ , -,.' w� ma.t ��+' .",�,a ,,,x,•u. s,<k <,d �F `t tyg a,�. x "'�,�.�` 3i ts'' a •v ' ,\`: ,.. 3a.j•`t"a��a 'ia 1�k`s a 't n a' .'.`i�:• a j#: ',, '�:-� 3 1� r L.� ": �5�ON§�e,^ - 'R,N�x -+Rs \< 1'` e *s L ;rt r`• n i e >ry cd a tiv, ryt .�.�� ISM,� `$��� � ..�` � (rs� ��i:,,:..w �.¢a -. x-.� ��a.� r�c5� �� >`'�a,,�ti. �+. ���C�°�'4" a�;di�� ;;�.- �:�' ��, '-•��.:�'as��' `rt -.,+" 'a�E:.v.f-7.�.<,' ., d l a;' .'�.§`` ci'✓, ,,v>n 4430 - 3y'{ 49,;; y,, F4,. ea � '> "`` a .sx'•'' .: ,. .it ,p.. ra¢ �,.: v�' ,t<, � �•��- .l�. ,'�.z ..,;k'�° .y�� .w '� s•�..�� ' ,..i 8 �". r ys€„l,.�*: � h` s '- ,,� '. f C.� �a�$a� .ay,;rv. ��' <,.l •m. c ,:���, ,, .s.::� $x.�tii':f�t"^4u ',�.`S',:'���:�' ., �k .%: <,,. tx �,c��`"t;a ^•;�' .,. �,5�7 '� *,. � .! � "�. x s f :F'l,: .�`,�, `.._ t,�, ,�`z S -'�&"4�,r7"as- ;^�.. ?+� +k�'•..-.v`�,.sk. �� '�.:.�. ``�a � �H.,t .,�.';a" .# +�e�t.y S,ra0 y s� �..�;��Y 6+`{,� r i� � � ..>h 3.. ��'�•3-a �^r ;.��%�,, :51,a�'„$+ �, _'}+,N ,E` ta�'� y� � �'..� r.3•i�.=>�" �. a �3 �*� a xyr a:. ,a �i5`?.,+,� n� ' �t : +� � �4 �� \ h�� Y F vt ..rzs,� ,;,'� ,- , .x ,x"Is `;*K -•�'x'h ::..,:nx9 .,,N.3,�.v„ilxt :-_ y'u s> ii ,.`�, :,4 F ,,.:,irk ' tt i '..s - :,., ;<•g r s,°t°t s � Sx c h :•4 3nx ^tom"-�a�` � _'�"�, � ,,'�..+t� :a; `{� �,. r .•t� '� 5,. ,�:.s4�' �s �:;p� _ '�''@�t: r � ,%n`' '>���'yy� '?:-:�>' u �,. ;�:, s«:•.3..,,,r 3��r v.�:,�� ..,a. 'h,. �.. :•1 lm a a. ,� c�7 .;ai�,.�:' i•� R .�,�'� t.b'x � 3.�""-g''P'� ° s >r�:,x,atssw ��,'.�':;n r s..'k-.`v� ... `P-: :, -;. !.ti e:� � ;:. ..-;�•,.�- is.,�srM '�. .,.�tx t'.., t�$r.}x°s.. � w�k:���i'a`;x � .Na ..: .. ��', €: ".V .�,-;N s p�', 'x 1".. x�.V;�' '' �':.;`il s ``r. ;�:�r �: :.,h�y �, G"�;.S:r,�'z__h- '.� �'� �,n• �:.. .; �rrx,`t�,i�`�".,�"s,�aF,':. a§'; R�P��' ,:'� >k#,�:: a �'���.�,t<: ,'`.Fuss'':X13 s, v,9�^'.k'� ;,. . �..t ,a':r¢ �,.,» ? ...ra 8€` »��, ,r��`•a`'vt„"?�i�d�a,.. '�" . � t,�.�..,�,'. �, � '��., �?• _.� ��t a a� ..'>��. r� `��.S,i�m`s s ' � 'A;;g.,.: I '-1,�.�' i',:'::�'..�.;t._. a'E��2I�.•'d�.ra3 � e� .ft..:° �.°a't�s;a�a�? �'` �r��c�'.'Y��,'EP;� .ma�h.w._r ate.� K>�::,�i:�.s'i``+t���r.�.�' r .�-� :'r'? 'l �.1i it � .�.�, Ea �> J x x�&, � n' �.rc• rs' s. s ..... �»..:v �,.,��. .. ,4, .'°�> 5•�U?. f.. �"vA,��- �.'�s,'�y�.��t �:„� # ;'�i��rySJ, zr '~r �} ,�i�,�a'; 3.?,;��' ',s��4���2 .> s���€,�t�# �;,� °•,��, v�^" � �sd~��...�', �;,. "€-,� .�E<„c .3'}�, � �:. b., c„� ���&� �.{ ��� r �ss's�,*�a. �' �'�$'�' ti3 .�Y`,'"4 t �,��^•ar, �at.,,,r, �.'�; ,.., a �`��'�„�” �,�*�t:��...a�;�. tks, .�3� .�z3-�"= ,t�l'4,3 ,..,.,��I; .R �, _a.s>,. 1�'<�}-�_ssr �. � { � ��<�.: +.t< �' $7;"�""`�fit .} :... .�,.w= ;s�,',4�, ,tm; , g�r,: . � �� �r r-,"� ��}• �k?i s'�'�'4.�`ta'N'' •4,;•�'y Miami Shores Village CEIVED Building Department L 212 14 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY,,!- Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(30S)762-4949 FBC 201L> BUILDING Master Permit No. `?-6 , )q_S'4j PERMIT APPLICATION Sub Permit No.'P L--1--4— �`5"o-4— ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL LUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑CANCELLATION E] SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 103S 1 J L �t ST City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): �=�l G 7 1,V l) PAI-M15A14 Phone#: 901S—77 t—A 3 Address: 1035 A/C- 96 5 City: A?1 ylaAl _<Y*04.f State: zip: Tenant/Lessee Name: Phone#: Email: PACM1S AA/O S (j M MINI GaJ,�7}/ i7/4Y. %G CONTRACTOR:Company Name: 6+J-e ®41r 5���' s `� d P Phone#: Address: NL5­1 14-A A V e It 3LI y City: I\A%A l State: Zip: 33l $ Qualifier Name: -�°P N1, MAI- Phone#: 391P 4S5'96s'q State Certification or Registration#: SM 01-+12 17- Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ '4'7'P'2 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration New ❑ Repair/Replace ❑ Demolition Description of Work: 1 Al GOA SLE T-b �F�( S`fa� �f}it/� j-o�- ,�/�A✓ f�6vtF_ y Specify color of color thru tile:,_ Submittal Fee ��. Permit_F#e.$ 3�` `y CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond TOTAL FEE NOW DUE$ �� (Revised02/24/2014) 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 ofkommencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is is ed. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. PSignature JJ�- Signature NER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of lJ,�/ .._.__._. ,,-. 20 144 ,by.. '� day of _.Ochi 20 /q ,by IAAE-lb ?*4&fIS,4A)0 ,who is oersonatly known tcs � �Q dKrA&J ,who is personally known to me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: a Sign: Print: ?03E2 i t�[U ll Print: IRoi�E'27 Ma I?-i>;4 Seal: Seal: Notary Public State of Florida Notary Public State of Florida • ` RoCommi MurpnyEE 2oto66 • Robert Murphy OF Expires 0=2@016 � �� ��05/22120MY COMM"orl�201066 APPROVED BY / a/a-•ZZ 1-f Plans Examiner Zoning Structural Review Clerk (RevisedO2/24/2014) A`C DATE DIYYY1r) CERTIFICATE OF LIABILITY INSURANCE o7i09/2osi2o14 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 terns 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 CONTACT jig Distler NAME: Rovner&Company,LLC PHONE Phone:(561)287-6279 ext. FAX No): E- L1499 W Palmetto Park Road Suite 408 ADDDRREESS; ldistler@ravnerco.com Boca Raton Florida 334M INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:CanopluS US Insurance Inc INSURED INSURER B: Empire Engineering Services,Corp 2423 SW 147 ave Unit 344 INSURER C: Miami Florida 33185 INSURER 0: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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. INSR TYPE OF INSURANCE ADDL USR POLICY EFF POLICY EXP LIMBS LTR POLICY NUMBER MMIDD MIDD GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE RE D 10(l X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ X CLAIMS-MADE F]OCCUR MED EXP(Any one person) $ 5, 000 A X N JVRAH-I 06/27/2014 06/27/2015 PERSONAL a ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000.000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2'000'000 X POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIMB OCCUR EACH OCCURRENCE $ EXCESS LI1B HCLAIMS-MADE AGGREGATE $ DED I I RETENTION $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY LIM ER ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? F N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS glow E.L.DISEASE-POLICY LIMIT 1$ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,ff more space is required) Septic tank installation CERTIFICATE HOLDER CANCELLATION Miami shores Village Building Department SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 10050 NE 2nd Ave THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Florida 33138 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD USD 07-03-2014 JEFF ATWATER STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA. WORKERS COMPENSATION LAS/ CONSTRUCTION INDUSTRY EXEMPTION 7Elis certifies tttet the individual listed below has elected to be exempt from Florida Workers' Compensation law. 3.:.. EFFECTIVE DATE: 07/03/2014 EXPIRATION HATE: 07/02/2016 i PERSON: MILLAN JORGE M FEIN: 471001618 BUSINESS NAME AND ADDRESS: EMPIRE ENGINEERING SERVICES CORP 2423 SW 147 AVE #344 MIAMI FL 33185 SCOPES:OF BUSINESS OR TRADE: 1- IRRIGATION OR DRAINAGE SYSTEM IMPORTANT: Pursuant to Chapter 444 . 0604), F.S., an officer of a corporation who elects exemption from this chapter by foie a certificate of election under this section may not recover bemafits or compensation under this chapter. Pursuant to Chapter 440.051121, F.S., Certificates of election to be exempt... apply only within the scope of the business or trade listed on the "*lice of election to be exempt. Pursuant to Chapter 440.051131, F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation If, at say time after the filing of the notice or the issuance of the certificate, the person named on the notice%aY certificate no longer meets the requirements of this sectfoa for Issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. QUESTIONS? (850) 413-1609 OWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 PLEASE CUT OUT THE CARD BELOiN AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA IMPORTANT DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COME ENSATION F Pursuant to Chapter 440:05(14), F.S, an officer of a corporation who CONSTRUCTION INDUSTRY O elects exemption from this chapter by filing a certificate of election CERTIFICATE OF ELECTION TO 13E EXEMPT FROM FLORIDA L under this section may not recover benefits or compensation under this W61kAG6ktS'COMPENSATION LAW D chapter. EFFECTIVE: 07/03/2014 EXPIRATION DATE: 07/02/2016 Pursuant to Chapter 440.05(12), F.S., Certificates of election to be RERSM dORGE M MILLAN H exempt... apply only within the scope of the business or trade listed on FEIINk 471=001818 R the notice of election to be exempt BUSINESS NAME AND ADDRESS: E Pursuant to Chapter 440.051131, F.S., Notices of election to be exempt EMPIRE ENGINEERING SERVICES CORP and certificates of election to be exempt shall be subject to revocation 2423 SW 147 AVE #344 if, at any time after the filing of the notice or the issuance of the MIAMI, FL 33185 certificate, the. person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the SCOPE OF BUSINESS OR TRADE: person named on the certificate to meet the requirements of this 1- IRRIGATION OR DRAINAGE SYSTEM section. QUESTIONS? (850) 413-1609 CUT HERE Carry=bo a -portion anthe job,: , Rper Portlon:for your rdiOords. OWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 N €s E•:'} E, KD � E n t E' 3 {3 �. W fi dw.. 3 a 4 j LIJ �.• .. W _ LIJ Q LJ LULJ £ rx, i�I�iil VIII iy'l �,. UA ; �.. 'A ar PERMIT #:13-SC-1628392 APPLICATION #:AP1140398 STATE OF FLORIDA DEPARTMENT OF HEALTH DATE PAID: ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID: CONSTRUCTION PERMIT RECEIPT #: QO DOCUMENT #:PR936411 CONSTRUCTION PERMIT FOR: OSTDS Now APPLICANT: Eric Palmisano PROPERTY ADDRESS: 1035 NE 96 St Miami, FL 33138 LOT: 1516 BLOCK: 82 SUBDIVISION: PROPERTY ID #: 11-3206-014-3730 [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 [ 700 ] GALLONS / GPD Aerobic Unit. CAPACITY A [ ] GALLONS / GPD N/A CAPACITY N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ] D [ 575 I SQUARE FEET bed configuration drainfiel SYSTEM R [ I SQUARE FEET N/A SYSTEM A TYPE SYSTEM: [X] STANDARD [ ] FILLED [ ] MOUND [ I I CONFIGURATION: [ I TRENCH [u] BED [ I N F LOCATION OF BENCHMARK: CL NE 96 St.,-9.36'NGVD I ELEVATION OF PROPOSED SYSTEM SITE [ 11.5011 INCHES FT ] [ABOVE BELOW BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 41.50 ][ INCHES FT ] [ABOVE BELOW BENCHMARK/REFERENCE POINT L D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: [ 30.001 INCHES It is required a maintenance agreement and Annual Operating permit before final approval. 0 *Invert elevation of drainfield to be no less than 6.40'NGVD. T *Bottom of drainfield elevation to be no less than 5.90'NGVD. H The system is sized for 3 bedrooms with a maximum occupancy of 6 persons(2 per bedroom),for a total estimated flow of 460 god. E The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance with s.64E-6.013(3)(0, FAC. R SPECIFICATIONS BY: Jorge '11 TITLE: APPROVED BY: TITLE: Dade CHD C os ICa DATE ISSUED: 04/1 0 rtnr p EXPIRATION DATE: 10/15/2015 DH 4016, 0$/09 (Obsolete 5le"fp i ieli �ar be used) of 1(1 adlac m to he ram lel excavation t Incorporated: 64E-6.003trm final inspection.Prior to Final Aooroval the DOH Page 1 of 3 inspector slhah4 tness the soil borinr&WEMpare the SE92577 8 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. r � STATE OF FLORIDA APPLICATION # AP1140398 DEPARTMENT OF HEALTH PERMIT # 13-SC-1528392 ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM DOCUMENT # SE925778 SITE EVALUATION AND SYSTEM SPECIFICATION APPLICANT: Eric Palmisano CONTRACTOR / AGENT: Empire Engineering LOT: 1516 BLOCK: 82 SUBDIVISION: ID#: 11-3206-014-3730 TO BE COMPLETED BY ENGINEER, HEALTH DEPARTMENT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEERS MUSK PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS. PROPERTY SIZE CONFORMS TO SITE PLAN: CX]YES [ ]NO NET USABLE AREA AVAILABLE: 0.21 ACRES TOTAL ESTIMATED SEWAGE FLOW: 460 GALLONS PER DAY [ RESIDENCES-TABLET / OTHER-TABLE 2 ] AUTHORIZED SEWAGE FLOW: 525.02 GALLONS PER DAY [ 1500 GPD/ACRE OR 1 2500 GPD/ACRE ] UNOBSTRUCTED AREA AVAILABLE: 1000.00 SQFT UNOBSTRUCTED AREA REQUIRED: 864.00 SQFT BENCHMARK/REFERENCE POINT LOCATION: CL NE 96 St.,9.36'NGVD ELEVATION OF PROPOSED SYSTEM SITE 11.50 [ INCHES / FT ] [ ABOVE / BELOW ] BENCSt+DIRR/REFERENCE POINT THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES SURFACE WATER: FT DITCHES/SWALES: FT NORMALLY NET: [ ]YES [ ]NO WELLS: PUBLIC: FT LIMITED USE: FT PRIVATE: FT NON-POTABLE: FT BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: 5 FT POTABLE WATER LINES: 41 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: 8.40 FT [ MSL / NGVD SOIL PROFILE INFORMATION SITE 1 SOIL PROFILE INFORMATION SITE 2 USDA SOIL SERIES: Udorthents, limestone substrat USDA SOIL SERIES: Udorthents, limestone substrat Munsell#/Color Texture Depth Munsell#(Color Texture Depth 1 OYR 6/2 Sand 0 To 72 1 OYR 6/2 Sand 0 To 72 OBSERVED WATER TABLE: INCHES [ ABOVE / BELOW ] EXISTING GRADE TYPE: [ PERCHED /FAPP&RENT ] ESTIMATED NET SEASON WATER TABLE ELEVATION: 58 INCHES [ ABOVE /F13EZGql EXISTING GRADE HIGH WATER TABLE VEGETATION: [ ]YES [X]NO MOTTLING: [ ]YES [X]NO DEPTH: INCHES SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: Sand/0.60 DEPTH OF EXCAVATION: 30 INCHES DRAINFIELD CONFIGURATION: [ ] TRENCH [X] BED [ ] OTHER (SPECIFY) REMARKS/ADDITIONAL CRITERIA SITE EVALUATED BY: DATE: 03/20/2014 Millan,Jorge(Title:)(Ace Engin) Da 4015, 08/09 (obsoletes previous editions which may not be used) Incorporated: 64E-6.001, FAC Page 3 of 4 API 140399 EID1528392 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.