STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, Petitioner, (4 17 25 Pu pes | lio vs. DOH Case No.: 2009/5 TIMOTHY M. BEEBE, Respondent. / ADMINISTRATIVE COMPLAINT Nature of the Case YOU ARE HEREBY NOTIFIED that this is an administrative action. This case arises from Respondent’s unlawful acts and practices and failure to comply with Section 381.0065 Florida Statutes, Chapter 489 Part III Florida Statutes and Chapter 64E-6 Florida Administrative Code. This action is authorized pursuant to Sections 381.0061 and 489.556 Florida Statutes, and Rule 64E-6.022 Florida Administrative Code that govern disciplinary actions against registered septic contractors. Factual Allegations as to All Counts 1. The Petitioner, State of Florida, Department of Health, is the administrative agency of the State of Florida charged with the duty to enforce the provisions of Chapter 381 Florida Statutes, Chapter 489 Part III Florida Statutes and the applicable rules contained in Chapter 64E-6 Florida Administrative Code. 2. The Respondent, Timothy M. Beebe, is a registered septic tank contractor, Registration Number SR0001364. He is authorized to provide septic tank contracting services through the corporation Dixie Drainfields Inc. Authorization Number SA0000969, 3. The Respondent advertises and holds himself out to the public as a septic tank contractor and engages in the practice of septic tank contractor services in at least Collier County. The Respondent is permitted to provide septage collection and hauling Beebe Timothy 4-09 Page | of 23 and discharge services via Operating Permit Number 11-QN-00262 issued by Collier County Health Department. 4. The Respondent has been a registered septic tank contractor since October 4, 2000. The Respondent has had previous disciplinary action taken against him. On September 10, 2002 the Department issued a Final Order No. DOH-02-1380-S-HST imposing administrative fines in the amount of $2,500.00 for failing to obtain a required Department of Health inspection before covering up a the repair work he performed on a septic system. In the Stipulation For Settlement in that proceeding the Respondent “recognizes that the violation of the afore mentioned code will constitute a prior violation in any subsequent disciplinary action or disciplinary proceeding taken against the Respondent and will constitute a prior violation for the purpose of subsequent violations constituting a “repeat violation” in subsequent disciplinary actions as used in Rule 64E- 6.022 Florida- Administrative Code, as it may be amended in the future.! 5. Accordingly, the violations described herein are “repeat violations” in determining the range of disciplinary action stated in the Disciplinary Guidelines set forth in Rule 64E-6.022 Florida Administrative Code. Rule 64E-6.022(3) Florida Administrative Code states: As used in this rule, a repeat violation is any violation on which disciplinary action is being taken where the same licensee had previously had disciplinary action taken against him or received a letter of warning in a prior case. This definition applies regardless of the chronological relationship of the violations and regardless of whether the violations are of the same or different subsections of this rule. The penalty given in the above list for repeat violations is intended to apply only to situations where the repeat violation is of a different subsection of this rule than the first violation. Where the repeat violation is the very same type of ' Purthermore, in Department of Health and Rehabilitative Services Final Order No:93-0028S dated May 26, 1993 the Department imposed a $500.00 fine and six month probation for dumping septage into a collection system at a camping resort. Then in Department of Health and Rehabilitative Services Final Order No 94-0045S the Department imposed a $4,000.00 fine and revoked the Respondent’s Septic Contracting Registration for dumping septage into a utilities collection system. The Department obtained a permanent Injunction against the Respondent for illegally practicing septic contracting services April 24, 1995 and an Order of Contempt dated August 7, 1996. (See State of Florida Department of Health and Rehabilitative Services v. Tim M. Beebe, Case No. 95-687 LG Lee Circuit Court) The Department granted the Respondent application to become a septic tank contractor in October 4, 2000. Beebe Timothy 4-09 Page 2 of 23 violation as the first violation, the penalty set out above will generally be increased over what is shown for repeat violations. COUNT I 6. On January 30, 2009 the Department received an Application to Repair Septic System, submitted by the property owner, PAC of Collier Inc.’s, agent Reliable Drainfield Design, LLC, for a commercial strip mall located at 13260 Immokalee Road, Naples, Florida (hereinafter referred to as the 13260 Immokalee Road repair job). See Application and Permit attached and incorporated herein as “Attachment A”. Upon review of the Application, the Department determined that the Application could not be processed as submitted as it was incomplete. On February 2, 2009 the Department notified Reliable Drainfield Design in writing that the application could not be approved because of needing the following information: 1. The application must contain details to substantiate flow into the system by each business using the system, and, 2. Form DH 4015 Repair Evaluations required to be completed in full by a licensed septic tank contractor or plumber. All five of the septic tanks in the system must be pumped out and certified by the contractor as being structurally sound for continued usage. See Correspondence dated February 2, 2009 attached and incorporated herein as “Attachment B”. 7. On February 2, 2009 Reliable Drainfield Design provided the information substantiating the flow into the system. The Department in a phone call reminded Reliable Drainfield Design that Form DH 4015 was still needed before the application could be reviewed and the permit issued. 8. Early in the week of February 9, 2009 the Department received a telephone _call from the Respondent asking for an installer’s copy of the repair permit for the 13260 Beebe Timothy 4-09 Page 3 of 23 Immokalee Road repair job. The Respondent was told that the repair permit had not been issued yet because the repair evaluation form (Form DH 4015) had not been received yet. 9. On February 19, 2009 a Collier County Code Enforcement Officer reported that she had observed the septic system being dug out at 13260 Immokalee Road even though no Repair Permit had been issued by the Department. 10. On February 20, 2009 at approximately 9:45 a.m. an inspector from the Department went to 13260 Immokalee Road and observed the Respondent and two of his employees beginning to fill the huge hole they had excavated where the old drainfield had once been. The old drainfield material including the old spoiled fill had already been removed from the site. They were beginning to fill the hole with the new sand fill material. The Respondent was instructed to stop all work until the required DH 4015 was completed and the repair permit could be issued by the Department. Another one of the Respondent’s dump trucks arrived driven by Respondent’s employee, full of sand for fill. Eventually, the Department allowed the Respondent to continue to fill the hole due to safety concerns, but no drainfield materials were to be installed until the Repair Permit that would specify the design of the drainfield could be issued. 11. On February 20, 2009 the Respondent went to the Collier County Health Department and completed the Form DH 4015. See Certification attached and incorporated herein as “Attachment A-1”. The Respondent certified on this form that he pumped out all five septic tanks on February 10, 2009 and that he inspected all five septic tanks and that they were structurally sound. The Department then prioritized and expedited the permit process to avoid a potential sanitary nuisance at the site since all eight businesses were open and using the septic system, that now did not have a drainfield. The Department immediately reviewed the Application and issued the Repair Permit authorizing the repair to be constructed as specified on the permit. 12. The Respondent’s acts and practices described in the above paragraphs herein violate Section 381.0065(4) Florida Statutes and Rule 64E-6.003(1) Florida Beebe Timothy 4-09 Page 4 of 23 Administrative Code that requires all construction and repair constructions of septic systems be permitted by the Department prior to the repair construction and/or installation being performed. These violations subject the Respondent to the discipline mandated in Rule 64E-6.022(1)(b)1 Florida Administrative Code which is revocation for a repeat violation. The Department hereby imposes revocation of the Respondent’s Septic Contractor’s registration for these violations. COUNT II 13. On February 20, 2008, the Respondent went to the Collier County Health Department and completed the Form DH 4015 for the 13260 Immokalee Road repair job. The Respondent certified on this DH 4015 form that he pumped out all five septic tanks on February 10, 2009, and that he inspected all five septic tanks and that they were structurally sound. See “Attachment A-1”. The septic system at this location services at least eight commercial businesses, including a restaurant and deli and supermarket. The septic system has five septic tanks. The tanks are sized at follows: 1) 3,300 gallons septic tank; 2) 1,500 gallons septic tank; 3) 750 gallons grease interceptor tank; 4) a second 750 gallons grease interceptor tank; and 5) 3000 gallons dosing tank. The Respondent certified on the Department form DH4015 that he pumped out all five septic tanks on February 10, 2009 and that he inspected all five septic tanks and that they were structurally sound. The Respondent’s two septage hauling trucks that have 3,600 to 4,000 gallons in capacity. a. During the Department’s Apri! 2, 2009 inspection of the Respondent’s records the Respondent advised the Department that the five septic tanks were empty (being recently pumped by some one else), except for some grit in the bottoms that he pumped out, when he certified the septic tanks as structurally sound. Beebe Timothy 4-09 Page 5 of 23 b. The Respondent told the Department that he pumped the grit out on February 9, 2009, as opposed to February 10, 2009 in his written certification. On February 9, 2009 from 4:00 to 5:00 p.m. the Respondent’s hand written log list being at the 13260 Immokalee Road job referenced on the log as “Armando.” The handwritten log indicates one discharge on this date at 2:00 p.m. The Respondent’s typed log does not include an entry for collection of septage at this location on February 9, 2009 or February 10, 2009. Cc. Only the 3,000 gallon dosing tank had been recently pumped out on February 9, 2009 by E. & F. Septic Tank Inc. The other four septic tanks had not been recently pumped at all. E. & F. Septic Tank Inc. previously pumped the dosing tank and the 750 gallon grease trap #1 on January 15, 2009 and the dosing tank on January 29, 2009. No other septic tank at this location had been recently pumped to allow the Respondent to be able to inspect to certify that they were structurally sound. 14. The Respondent falsified and/or provided untrue statements on Health Department Form 4015. The Respondent certified that he had pumped the five septic tanks, when in fact, the Respondent did not pump the tanks. The Respondent also certified that the five tanks were structurally sound, when in fact, the Respondent had not pumped the tanks in their entirety to properly inspect for structural soundness. The Respondent’s information provided in the signed certification on Form 4015 dated February 10, 2009, contains false, misleading and untrue representations and subjects the Respondent to the discipline mandated in Rule 64E-6.022(1)(k) Florida Administrative Code which is revocation for a repeat violation. The Department hereby imposes revocation of the Respondent’s Septic Contractor’s registration and his septage collection Beebe Timothy 4-09 Page 6 of 23 and hauling and discharge services operating permit number 11-QN-00262 for these violations. COUNT I 15. Inthe septic system repair application, permit number AP903682, on Form DH 4015, the Respondent certified that on September 18, 2008 he had pumped the septic tank located at 420 25" Street N.W., Naples, Florida and that he had inspected the tank and that it was structurally sound. See composite exhibit attached and incorporated herein as “Composite Attachment C”. The Respondent’s information provided in the signed certification on Form 4015, contains false, misleading and untrue representations and subjects the Respondent to the discipline mandated in Rule 64E-6.022(1)(k) Florida Administrative Code which is revocation for a repeat violation. Alternatively, these acts and practices subject the Respondent to the discipline in Rule 64E-6.022(1)(n), (1) and (0) Florida Administrative Code which is revocation for a repeat violation. The Department hereby imposes revocation of the Respondent’s Septic Contractor’s registration and his septage collection and hauling and discharge services operating permit number 11-QN- 00262 for these violations. 16. In the septic system repair application, permit number AP904609, on Form DH 4015, the Respondent certified that on September 18, 2008 he had pumped the septic tank located at 3745 15" Ave. S.W., Naples, Florida and that he had inspected the tank and that it was structurally sound. See composite exhibit attached and incorporated herein as “Composite Attachment D”. The Respondent’s information provided in the signed certification on Form 4015, contains false, misleading and untrue representations and subjects the Respondent to the discipline mandated in Rule 64E-6.022(1)(k) Florida Administrative Code which is revocation for a repeat violation. Alternatively, these acts and practices subject the Respondent to the discipline in Rule 64E-6.022(1)(n), (1) and (0) Florida Administrative Code which is revocation for a repeat violation, The Department Beebe Timothy 4-09 Page 7 of 23 hereby imposes revocation of the Respondent’s Septic Contractor’s registration and his septage collection and hauling and discharge services operating permit number 11-QN- 00262 for these violations. 17. Inthe septic system repair application, permit number AP903201, on Form DH 4015, the Respondent certified that on October 18, 2008 he had pumped the septic tank located at 7931 Friendship Lane, Naples, Florida and that he had inspected the tank and that it was structurally sound. See composite exhibit attached and incorporated herein as “Composite Attachment E”. The Respondent’s information provided in the signed certification on Form 4015, contains false, misleading and untrue representations and subjects the Respondent to the discipline mandated in Rule 64E-6.022(1)(k) Florida Administrative Code which is revocation for a repeat violation. Alternatively, these acts and practices subject the Respondent to the discipline in Rule 64E-6.022(1)(n), (1) and (0) Florida Administrative Code which is revocation for a repeat violation. The Department hereby imposes revocation of the Respondent’s Septic Contractor’s registration and his septage collection and hauling and discharge services operating permit number 11-QN- 00262 for these violations. 18. In the septic system repair application, permit number AP903192, on Form DH 4015, the Respondent certified that on October 21 2008 he had pumped the septic tank located at 3499 Sunset Blvd., Naples, Florida and that he inspected the tank and that it was structurally sound. See composite exhibit attached and incorporated herein as “Composite Attachment F”. The Respondent’s information provided in the signed certification on Form 4015, contains false, misleading and untrue representations and subjects the Respondent to the discipline mandated in Rule 64E-6.022(1)(k) Florida Administrative Code which is revocation for a repeat violation. Alternatively, these acts and practices subject the Respondent to the discipline in Rule 64E-6.022(1)(n), (1) and (0) Florida Administrative Code which is revocation for a repeat violation. The Department hereby imposes revocation of the Respondent’s Septic Contractor’s registration and his Beebe Timothy 4-09 Page 8 of 23 septage collection and hauling and discharge services operating permit number 11-QN- 00262 for these violations. 19. In the septic system repair application, permit number AP903206, on Form DH 4015, the Respondent certified that on October 21, 2008 he had pumped the septic tank located at 2619 53 Terrace S.W., Naples, Florida and that he had inspected the tank and that it was structurally sound. See composite exhibit attached and incorporated herein as “Composite Attachment G”. The Respondent’s information provided in the signed certification on Form 4015, contains false, misleading and untrue representations and subjects the Respondent to the discipline mandated in Rule 64E-6.022(1)(k) Florida Administrative Code which is revocation for a repeat violation. Alternatively, these acts and practices subject the Respondent to the discipline in Rule 64E-6.022(1)(n), (1) and (0) Florida Administrative Code which is revocation for a repeat violation. The Department hereby imposes revocation of the Respondent’s Septic Contractor’s registration and-his septage collection and hauling and discharge services operating permit number | 1-QN- 00262 for these violations. 20. In the septic system repair application, permit number AP903186, on Form DH 4015, the Respondent certified that on November 20, 2008 he had pumped the septic tank located at 4527 Alhambra Circle East, Naples, Florida and that he had inspected the tank and that it was structurally sound. See composite exhibit attached and incorporated herein as “Composite Attachment H”. The Respondent’s information provided in the signed certification on Form 4015, contains false, misleading and untrue representations and subjects the Respondent to the discipline mandated in Rule 64E-6.022(1)(k) Florida Administrative Code which is revocation for a repeat violation. Alternatively, these acts and practices subject the Respondent to the discipline in Rule 64E-6.022(1)(n), (1) and (0) Florida Administrative Code which is revocation for a repeat violation. The Department hereby imposes revocation of the Respondent’s Septic Contractor’s registration and his Beebe Timothy 4-09 Page 9 of 23 septage collection and hauling and discharge services operating permit number 11-QN- 00262 for these violations. 21. Inthe septic system repair application, permit number AP905128, on Form DH 4015, the Respondent certified that on December 12, 2008 he had pumped the septic tank located at 2101 51% Ter. S.W., Naples, Florida and that he had inspected the tank and that it was structurally sound. See composite exhibit attached and incorporated herein as “Composite Attachment I”, The Respondent’s information provided in the signed certification on Form 4015, contains false, misleading and untrue representations and subjects the Respondent to the discipline mandated in Rule 64E-6.022(1)(k) Florida Administrative Code which is revocation for a repeat violation. Alternatively, these acts and practices subject the Respondent to the discipline in Rule 64E-6.022(1)(n), (I) and (0) Florida Administrative Code which is revocation for a repeat violation. The Department hereby imposes-revocation of the Respondent’s Septic Contractor’s registration and his septage collection and hauling and discharge services operating permit number 11-QN- 00262 for these violations. 22. Inthe septic system repair application, permit number AP906603, on Form DH 4015, the Respondent certified that on December 29, 2008 he had pumped the septic tank located at 3401 11™ Ave. S.W., Naples, Florida and that he had inspected the tank and that it was structurally sound. See composite exhibit attached and incorporated herein as “Composite Attachment J’. The Respondent’s information provided in the signed certification on Form 4015, contains false, misleading and untrue representations and subjects the Respondent to the discipline mandated in Rule 64E-6.022(1)(k) Florida Administrative Code which is revocation for a repeat violation. Alternatively, these acts and practices subject the Respondent to the discipline in Rule 64E-6.022(1)(n), (1) and (0) Florida Administrative Code which is revocation for a repeat violation. The Department hereby imposes revocation of the Respondent’s Septic Contractor’s registration and his Beebe Timothy 4-09 Page 10 of 23 septage collection and hauling and discharge services operating permit number 11-QN- 00262 for these violations. 23. In the septic system abandonment application, permit number AP908449, on Form DH 4015, the Respondent certified that on January 5, 2009 he had pumped the septic tank located at 752 Hull Court, Naples, Florida. See composite exhibit attached and incorporated herein as “Composite Attachment K”. The Respondent’s information provided in the signed certification on Form 4015, contains false, misleading and untrue representations and subjects the Respondent to the discipline mandated in Rule 64E- 6.022(1)(k) Florida Administrative Code which is revocation for a repeat violation. Alternatively, these acts and practices subject the Respondent to the discipline in Rule 64E-6.022(1)(n), (1) and (0) Florida Administrative Code which is revocation for a repeat violation. The Department hereby imposes revocation of the Respondent’s Septic Contractor’s registration and his septage collection and hauling and discharge services operating permit number 11-QN-00262 for these violations. 24, Inthe septic system repair application, permit number AP909445, on Form DH 4015, the Respondent certified that on January 23, 2008 (2009) he had pumped the septic tank located at 2757 53 Ter. S.W., Naples, Florida and that he had inspected the tank and that it was structurally sound. See composite exhibit attached and incorporated herein as “Composite Attachment L”. The Respondent’s information provided in the signed certification on Form 4015, contains false, misleading and untrue representations and subjects the Respondent to the discipline mandated in Rule 64E-6.022(1)(k) Florida Administrative Code which is revocation for a repeat violation. Alternatively, these acts and practices subject the Respondent to the discipline in Rule 64E-6.022(1)(n), (1) and (0) Florida Administrative Code which is revocation for a repeat violation. The Department hereby imposes revocation of the Respondent’s Septic Contractor’s registration and his septage collection and hauling and discharge services operating permit number 11-QN- 00262 for these violations. Beebe Timothy 4-09 Page 11 of 23 25. In the septic system abandonment application, permit number AP909942, on Form DH 4015, the Respondent certified that on February 1, 2009 he had pumped the septic tank located at 817 Swan Drive, Naples, Florida. See composite exhibit attached and incorporated herein as “Composite Attachment M”. The Respondent’s information provided in the signed certification on Form 4015, contains false, misleading and untrue representations and subjects the Respondent to the discipline mandated in Rule 64E- 6.022(1)(k) Florida Administrative Code which is revocation for a repeat violation. Alternatively, these acts and practices subject the Respondent to the discipline in Rule 645-6.022(1)(n), (1) and (0) Florida Administrative Code which is revocation for a repeat violation. The Department hereby imposes revocation of the Respondent’s Septic Contractor’s registration and his septage collection and hauling and discharge services operating permit number 11-QN-00262 for these violations. COUNT IV 26. On March 2, 2009 the Department made a written request to the Respondent to provide the Department with the septage collection and hauling logs from January 1, 2008 through March 1, 2009, along with other records, as required by Rule 64E-6.010(7)(e) Florida Administrative Code. On March 10, 2009 Respondent delivered records that he reports to Collier County Pollution Control, but did not provide any of the requested documents including the septage collection and hauling logs. On March 11, 2009 the Department issued a “Final Notice” to the Respondent to provide all of the documents originally requested in the Department’s March 2, 2009 request. 27. On March 25, 2009, the Respondent’s attorney delivered some of the documents requested to the Department. At this meeting, the Department’s attorney was allowed to look at the Respondent’s septage collection and hauling logs but was not Beebe Timothy 4-09 Page 12 of 23 allowed to make any copies. On March 31, 2009 the Respondent's attorney provided the Department copies of the Respondent’s septage collection and hauling logs from February 6, 2009 through February 28, 2009. 28. On April 2, 2009 the Respondent made his septage collection and hauling logs available for the Department’s inspection at the Respondent’s office, but the Department was not allowed to make any copies of these logs. On April 9, 2009 the Respondent provided the Department with a typed septage collection and hauling log dated from January 1, 2008 through March 1, 2009 that were created by the Respondent from his hand written log. 29. The Respondent’s hand written septage collection and hauling log and the typed version of this log, for the period of January 1, 2008 through March 1, 2009 does not comply with the minimum requirements stated in Rule 64E-6.010(7)(e) Florida Administrative Code. In accordance with the Rule, the Respondent is required to maintain a collection and hauling log that at minimum contains a list of the date and address for each septage and water he has collected, indicate if the address is a business or residence, indicate the estimated gallons collected at each address, and the date and time of the discharge to the approved treatment facility. These records are crucial for the Department to be able to monitor the Respondent’s septage hauling and discharge practices to protect the public against illegal dumping of septage and other sanitary nuisances. The log should record for each hauling truck, for each day of hauling the date, the complete addresses of the locations that septage was picked up, the estimated gallons that were collected at each address, and when that load was taken for discharge at the treatment facility. Records are required to be maintained for a period of five years. Beebe Timothy 4-09 Page 13 of 23 30. A copy of the Respondent’s actual hand written septage collection and hauling log from February 6, 2009 through February 28, 2009 is attached. See “Attachment N” attached and incorporated herein. A copy of the Respondent’s typed septage collection and hauling log from February 6, 2009 through February 28, 2009 is attached. See “Attachment ©” attached and incorporated herein. At the Department’s March 25, 2009 and April 2, 2009 inspections it was verified that the attached hand written copy is representative of the information contained in the log consistently from January 1, 2008 through March 1, 2009. 31. Both of the logs have dates and times and addresses, although many of the addresses are incomplete. The log is kept and maintained by one employee and serves as his time record. According to the Respondent not all addresses listed on the hand written log are locations that actually had sewage collection services. Nothing on the handwritten log indicates that sewage was or was not collected at the addresses listed. There is no estimation of gallons of sewage collected for the addresses the Respondent claims are collection locations. At the Department’s April 2, 2009 inspection the Respondent made the determination as to what addresses listed in the handwritten log for any given day were collection jobs either by his personal knowledge or by looking at back up work invoices for the location that were not provided to the Department. The Respondent’s typed version of the septage and hauling log from January 1, 2008 through March 1, 2009 eliminated all the addresses that are in the hand written log that the Respondent claims are not location where septage was collected. 32. The Respondent’s septage collection and hauling logs are only maintained by one employee. The Respondent has two approved trucks for collecting and hauling Beebe Timothy 4-09 Page 14 of 23 septage. When the second truck collects and hauls septage, by a different employee, there is no log kept at all. There is no way to know which truck is being used to do the hauling by the Respondent’s logs or by his discharge records. For example sometimes his discharge records indicate two discharges being made with in a 30 minutes (example February 16, 2009) and both trucks would have to be hauling, but there is no record of this. 33. The Respondent’s septage collection and hauling logs do not reconcile with the actual discharges that were made at J.C. Drainfield, Inc., the Respondent’s approved treatment facility. The Respondent’s typed collection and hauling log from January 1, 2008 through March 1, 2009 reports collecting at least 35 truck loads of sewage that Respondent has no record of a lawful discharge actually being made at the treatment facility. (a) For example, just for the month of February 2009, on February 2, 2009 the Respondent has no collection records for one of the two sewage discharge he made on that date. On February 6, 2009 at 3:30 p.m. Respondent recorded a discharge at the treatment facility, but the Respondent has no record of a lawful discharge actually being made at the treatment facility. On February 9, 2009 the Respondent has no collection records for two of the three sewage discharge he made on that date. On February 10, 2009 the Respondent has no collection records for one of the two sewage discharges he made on that date. On February 12, 2009 the Respondent has no collection records for one of the two sewage discharge made on that date. On February 18, 2009 the Respondent has no collection records for one of the two sewage discharge made on that date. On Beebe Timothy 4-09 Page 15 of 23 February 22, 2009 the Respondent has recorded a discharge at the treatment facility, but the Respondent has no record of a lawful discharge actually being made at the treatment facility. On February 23, 2009 the Respondent has no collection records for one of the two sewage discharge made on that date. The Respondent has recorded a discharge being made on February 24, 2009, however, the treatment facility has no record of this discharge being made. This same violation exist from January 1, 2008 through March 1, 2009. 34. The Respondent’s septage collection and hauling logs and records for the repair job located at 13260 Immokalee Road are not able to be reconciled. (a) During the Department’s April 2, 2009 inspection of the Respondent’s records the Respondent advised the Department that the five septic tanks were empty, except for some grit in the bottoms that he pumped out, when he certified the septic tanks as structurally sound. (b) The Respondent told the Department that he pumped the grit out on February 9, 2009, as opposed to February 10, 2009 in his written certification. On February 9, 2009 from 4:00 to 5:00 p.m. the Respondent’s hand written log list being at the 13260 Immokalee Road job referenced on the log as “Armando.” The handwritten log indicates one discharge on this date at 2:00 p.m. The Respondent’s typed log does not include an entry for collection of septage at the repair job location on February 9, 2009, (c) There is no entry on the hand written log or typed log for collection of septage on February 10, 2009 at the repair job location. Beebe Timothy 4-09 Page 16 of 23 (d) The typed log indicates septage was collected at the repair job location on February 16, 2009 (no time specified) and that this collected septage was discharged at the treatment facility in two separate loads, one at 11 a.m. and one at 1:30 p.m. on this same day. It was reported that both of the loads discharged contained only the septage from this location. The Respondent’s hand written log does not have any recording for septage collection at the repair job site on this day or for septage discharge for the repair job site (e) The hand written log indicates on February 17, 2009 being at the repair job location from 7:00 a.m. to 3:00 p.m. and then one other location from 3:00 to 4:00 p.m. before it indicates that septage was disposed at the treatment facility at 4:00 p.m. that same day. This corresponds to with what the Department was told at the April 2, 2009 inspection. However, in the typed log there is no typed entry for the repair job location on February 17, 2009. There is no record at the treatment facility for any discharge this date. (f) On February 19, 2009 the handwritten log indicates the repair job location from 7:00 a.m. to 6:00 p.m. but not discharge on this date. There is no typed entry for February 19, 2009. This is date that Collier County Code enforcement witnessed the Respondent digging in the drainfield. With no drainfield in place and eight open businesses, with an average daily sewage flow of 3,496 gallons, using the septic system the dosing tank at the very least would have had to be pumped to avoid a sewage spill. (g) On February 22, 2009 the handwritten log attached to the complaint does not have any entry made for this day. However, on April 2, 2009 during the Beebe Timothy 4-09 Page 17 of 23 Department’s inspection of the Respondent’s records the Respondent added an entry for this date for the repair job location and a discharge being made at 10:00 am. this date. This corresponds with the typed log for this date. The treatment facility’s invoice does not have a discharge being made for this date. The treatment facility records indicate that the Respondent only made discharges on February 20, 21, and 23, 2009. . 35. From February 6 through 28, 2009 there are numerous addresses listed on the hand written log that the Respondent claims are not collection services when in truth and fact they were locations where he collected septage. February 6, 2009 two locations, February 9, 2009 two locations; February 10, 2009 one location; February 11, 2009 one location; February 12, 2009 three locations; February 13, 2009 one location; February 17, 2009 four locations; February 18, 2009 four locations; February 19, 2009 one location; February 20, 2009 six locations, February 21, 2009 one location; February 23, 2009 three locations; February 26, 2009 two locations and February 27, 2009 one location. There is nothing provided to the Department to verify that septage was not in fact collected at some or all of these locations and that no discharge record exists for this septage. (a) On February 12, 2009 Respondent pumped out the septic tank at 673 Palm Ave. West, Goodland, Florida. This address is not on either of his logs. He has no discharge record for this septage. (b) On February 17, 2009 Respondent pumped out the septic tank at 673 Palm Ave., West, Goodland, Florida. This address was excluded by the Respondent on the typed log because he claimed no septage was collected at this location. The Respondent has no discharge record for this septage. Beebe Timothy 4-09 Page 18 of 23 (c) On February 17, 2009 Respondent pumped out the septic tank at 473 Barfield Drive, Marco Island, Florida. This address was excluded by the Respondent on the typed log because he claimed no septage was collected at this location. The Respondent has no discharge record for this septage (d) On February 17, 2009 Respondent pumped out the septic tank at 4578 30 Ave., Naples, Florida. This address was excluded by the Respondent on the typed log because he claimed no septage was collected at this location. The Respondent has no discharge record for this septage. (e) On February 26, 2009 Respondent pumped out the septic tank at 4120 434 Ave., N.E., Naples, Florida. This address was excluded by the Respondent on the typed log because he claimed no septage was collected at this location. The Respondent has no discharge record for this septage. (f) In just the month of February 2009 there are at least 13 addresses that the Respondent has listed on the hand written log, that are locations that his employee went to, that are very likely addresses where septage was collected. These addresses were excluded by the Respondent on the typed log because he claimed no septage was collected at this location. The Respondent has no discharge record for this septage. On February 17, 2009 the Respondent collected septage from the three addresses listed above which is close to a full truck load of septage. The Respondent has no discharge record for this load of septage. (g) The Department was denied copies of any other portion of the Respondent’s hand written log. It is likely and will be established through continued investigation that the above stated violations occurred in all other Beebe Timothy 4-09 Page 19 of 23 months as well and will be established through discovery and continued investigation. 36. The Respondent has failed to maintain complete records of septage collection and disposal activities from January 1, 2008 through March 1, 2009 as set forth in the above stated paragraphs, in violation of Rule 64E-6.010(7)(e) Florida Administrative Code and subjects the Respondent to the discipline mandated in Rule 64E-6.022(1)(o) Florida Administrative Code which is revocation for a repeat violation. This violation also subjects the Respondent to have his septage collection and hauling and discharge services operating permit number 11-QN-00262 revoked pursuant to Rule 64E- 6.010(3) Florida Administrative Code. The Department hereby imposes revocation of the Respondent’s Septic Contractor’s registration and his septage collection and hauling and discharge services operating permit number 11-QN-00262 for these violations. 37. The Respondent has collected septage as set forth in the above stated paragraphs and has failed to properly dispose of the septage. These acts and practices subject the Respondent to the discipline in Rule 64E-6.022(1)(n) Florida Administrative Code which is revocation for a repeat violation. This violation also subjects the Respondent to have his septage collection and hauling and discharge services operating permit number 11-QN-00262 revoked pursuant to Rule 64E-6.010(3) Florida Administrative Code. The Department hereby imposes revocation of the Respondent’s Septic Contractor’s registration and his septage collection and hauling and discharge services operating permit number 11-QN-00262 for these violations. 38. | The Respondent has made false, untrue and misleading statements in the typed septage collection and discharge log that he provided to the Department as is set Beebe Timothy 4-09 Page 20 of 23 forth in the above stated paragraphs. These acts and practices subject the Respondent to the discipline in Rule 64E-6.022(1)(k) Florida Administrative Code which is revocation for a repeat violation. This violation also subjects the Respondent to have his septage collection and hauling and discharge services operating permit number 11-QN-00262 revoked pursuant to Rule 64E-6.010(3) Florida Administrative Code. The Department hereby imposes revocation of the Respondent’s Septic Contractor’s registration and his septage collection and hauling and discharge services operating permit number 11-QN- 00262 for these violations. 39. The Respondent has acted grossly negligent and incompetent in conducting his septage collection hauling and discharge business as is set forth in the above stated paragraphs. These acts and practices subject the Respondent to the discipline in Rule 64E-6.022(1)(1)(1) Florida Administrative Code which is revocation for a repeat violation. This violation also subjects the Respondent to have his septage collection and hauling and discharge services operating permit number 11-QN-00262 revoked pursuant to Rule 64E-6.010(3) Florida Administrative Code. The Department hereby imposes revocation of the Respondent’s Septic Contractor’s registration and his septage collection and hauling and discharge services operating permit number 11-QN- 00262 for these violations. COUNT V 40. On December 12, 1994 the Collier Circuit Court in State of Florida Department of Environmental Regulation vs Timothy Beebe and American Sanitation & Repair _Inc., Case No. 93-00959-CA entered an Ordered against the Respondent individually and his corporation to never engage in the septage or sludge hauling Beebe Timothy 4-09 Page 21 of 23 business. See Order marked “Attachment P” attached and incorporated herein. Further the Department of Health in_Timothy M. Beebe vs Department of Health, DOH/DOAH Case No. 00-346, Final Order dated August 31, 2000 the granted the Petitioner’s application to become a registered septic tank contractor but states: “if Respondent grants Petitioner’s application for registration, Petitioner cannot haul septage because he is permanently enjoined from doing so by the circuit court in Collier County.” The Collier County Health Department erred when it granted Timothy Beebe’s Application For Operating permit for septage hauling and discharge service. The Department staff involved in the evaluation, review and approval of his application had no knowledge of the Collier Circuit Order or the Department’s Order. The Department hereby revokes the Respondent’s septage collection and hauling and discharge services operating permit number 11-QN-00262 revoked under the authority of and pursuant to the above mentioned circuit court order. REQUEST FOR RELIEF Wherefore, the Department of Health hereby imposes revocation against Respondent Timothy M. Beebe, Registration Number SR0001364 and revocation of the Respondent’s septage collection and hauling and discharge services operating permit number 11-QN-00262. Beebe Timothy 4-09 Page 22 of 23 Done this ax tay of May, 2009, by the Department of Health, Collier County Health Department. STATE OF FLORIDA DEPARTMENT OF HEALTH Dusan Mast. Gott SUSAN MASTIN SCOTT Florida Bar #0000736 Chief Legal Counsel 2295 Victoria Avenue, Room 206 Fort Myers, Florida 33901 (239) 461-6118 (239) 461-6102 Facsimile CERTIFICATE OF SERVICE I hereby certify that the true and original Administrative Complaint herein was furnished via FedEx Tracking # i q lol 2 2355 2570 to Timothy M. Beebe, Dixie Drainfields, Inc., 245 22" Avenue NE, Naples, Florida 34120; and a true and correct copy herein was furnished via FedEx Tracking # 74lole 2255 BO)3 to Louis S. Erickson, Esquire, Golden Gate Legal Center, 11725 Collier Blvd., Suite F, Naples, Florida 34116, this ao" day May, 2009. Swann Mathtin Sco 4 Susan Mastin Scott NOTICE OF RIGHTS TO APPEAL A party whose substantial interest is affected by this order may petition for an administrative hearing pursuant to sections 120.569 and 120.57, Fla. Stat. 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 FL 32399-1703. The Agency Clerk’s facsimile number is 850-410-1448. Mediation is not available as an alternative remedy. Your failure to submit 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, Fla. Stat. 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. Beebe Timothy 4-09 Page 23 of 23 permtt #; 11-SN-0985¢ appLtcation #: AP909666__ STATE OF FLORIDA DEPARTMENT OF HEALTH : DATE PAID: — ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID: SYSTEM OM AL 27 A le Sy RECEIPT #: pocument #: PR764743 ostps #:02-1619-N CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: (PAC of Collier County) _ PROPERTY ADDRESS: 13260 Immokalee Rd Naples, FL 34119 LoT: 0 BLOCK: 54 SUBDIVISION: 709 - Golden Gate Estates [SECIION, TOWNSHIP, RANGE, PARCEL NUMBER] PROPERTY ID #: ---37744040001_ 0 fOR 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 CAPACITY CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] 6 ]DOSES PER 24 HRS #Pumps [ 2 1] 3,300 ] GALLONS / GPD Septic 1,500 ] GALLONS / GPD Seotic 750 ] GALLONS GREASE INTERCEPTOR CAPACITY 3,000 ] GALLONS DOSING TANK CAPACITY [559.67 ]GALLONS @[ AA2pa 2,220 ] SQUARE FEET Quick 4 EQ-36 SYSTEM { 2,220 ] SQUARE FEET Quick 4 EQ 36 SYSTEM TYPE SYSTEM: [x] STANDARD L ] FILLED [ ] MOUND [] CONFIGURATION: [x] TRENCH [ ] BED i LOCATION OF BENCHMARK: Disc and Nail at EOP in Parking lot, see plot plan ELEVATION OF PROPOSED SYSTEM SITE t 9,00 1 tLoncuns } FT] tLazove } BELOW ] BENCHMARK/REFERENCE POINT { 18.001 {Lawcues ) FT 11 apove [ppLow) BENCHMARK/REFERENCE POINT BOTTOM OF DRAINFIELD TO BE UHM HM RHP DO FILL REQUIRED: { 0.00] INCHES EXCAVATION REQUIRED: [ 42.00] INCHES if the required minimums of this permit cannot be met contact inspector prior to installation. All changes to the design must be approved by the design engineer and this department prior to installation. Maintain all minimum and required setbacks. Installer responsible to verify that there is 42 inches of clean suitable slightly limited material beneath the bottom of the drainfield prior to installation. Each drainfiled is to have 185 panels Quick 4 Eq-36. Each drainline shall have 1.5 inch PVC pipe running the entire lenght othe trench strapped to the top of the chambers. (Comments Continued on Page 2.) im H O SPECIFICATIONS BY: Beau Keene TITLE: P.E. eS eS, APPROVED BY: Cra Kiwtoie TITLE: Environmental Supervisor II Collier CHD Erin R Kirbec DATE ISSUED: 02/20/2009 EXPIRATION DATE: 05/21/2009 DH 4016, 10/97 (Previous Editions May Be Used) Page 1 of 3 vili.d AP909666 BE780227 ATTACHMENT A DOCUMENT #: PR764743 s eet on center with spray holes pointing up to crown of chamber. Provide 90 degree sweep with at distal tain a current commercial system operating Provide 3/16 inch hole end with female threaded cap set in valve box brought to final grade. Must main permit. All pumps and filters must be visible at time of inspection. Each pump serves 1/2 of required absorption area pumps to dose alternately. Pumps must be certified as suitable for distributing sewage effluent. PE Design Required.The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance with s. 64E-6.013(3)(f), FAC. There are two 750 gallon grease traps installed on the system. RECEIVED PERMIT #. STATE OF FLORIDA 13260 IMMOKALEE RD. DEPARTMENT OF HEALTH A ONSITE SEWAGE TREATMENT andANs 33.988. SYSTEM (REPAIR) SITE EVALUATION AND SYSTEPviGREGEF GAT IONS Engineering AGENT: RELIABLE DRAINFIED DESIGN, LLC APPLICANT: PAC OF COLLIER INC. LOT: BLOCK: SUBDIVISION: EAST 1/2 OF TRACT 54 LESS R/W, GGE, UNIT #23 PROPERTY ID #:37744040001 [Section/Township/Parcel No. or Tax ID Number] HEALTH DEPARTEMENT EMPLOYEE,OR OTHER QUALIFIED PERSON. ENGINNEERS eee ee eee TO BE COMPLETED BY ENGINEER, TTAL. COMPLETE ALL ITEMS. MUST PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMI PROPERTY SIZE CONFORMS TO SITE PLAN: [x] YES {[ ] NO NET USABLE AREA AVAILABLE: 2.50 ACRES TOTAL ESTIMATED SEWAGE FLOW: 3,539 GALLONS PER DAY [RESIDENCES-TABLE 1/OTHER-TABLE2] AUTHORIZED SEWAGE FLOW: 3,750 GALLONS PER DAY [1500 GPD/ACRE OR 2500 GPD/ACRE] UNOBSTRUCTED AREA AVAILABLE: N/A SQFT UNOBSTRUCTED AREA REQUIRED: N/A : SQFT DISC & NAIL AT E.O.P. IN PARKING LOT {SEE PLOT PLAN) BENCHMARK/REFERENCE POINT LOCATION: [INCHES/FT] [ABOVE/BELOW] BENCHMARK/REFERENCE POINT ELEVATION OF PROPOSED SYSTEM SITE IS_ 9 THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES SURFACE WATER: N/A_FT DITCHES/SWALES: 18 FT NORMALLY WET? [] YES [ X] NO WELLS: PUBLIC: N/A FT LIMITED USE: 112 FT PRIVATE: N/A FT NON-POTABLE: N/A FT BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: 17 FT POTABLE WATER LINES: 34 FT SITE SUBJECT TO FREQUENT FLOODING: [ ] YES [xX] NO 10 YEAR FLOODING? [] YES [X] NO 10 YEAR FLOOD ELEVATION FOR SITE: N/A FT MSL/NGVD SITE ELEVATION: N/A FT MSL/NGVD SOIL PROFILE INFORMATION SITE 2 SOIL PROFILE INFORMATION SITE 1 MUNSELL #/COLOR TEXTURE DEPTH MUONSELL #/COLOR TEXTURE DEPTH 10YR_ 2/1 FS 0 TO 4” 1OYR 2/1 Fs 0 TO 3” 10¥R_ 5/2 - FS 4 TO 14 1oyR 5/2 FS 3. TO 14 10¥R 6/1 Fs 14 TO 72 10¥R 6/1 FS 14 TO 72 TO TO TO TO TO TO TO TO TO TO TO TO USDA SOIL SERIES: #27 HOLOPAW F-.S. USDA SOIL SERIES: #27 HOLOPAW F.S. — | OBSERVED WATER TABLE:NOT FOUND INCHES [ABOVE / BELOW] EXISTING GRADE. TYPE: [PERCHED / APPARENT] ESTIMATED WET SEASON WATER TABLE ELEVATION: 51 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: 0.80 DEPTH OF EXCAVATION: N/A INCHES DRAINFIELD CONFIGURATION: [ X ] TRENCH [ ] BED [ ] OTHER (SPECIFY) REMARKS/ADDITIONAL CRITERIA: RECOMMENDED BOTTOM OF DRAINFIELD ELEVATION = 18 INCHES BELOW SEPTIC BENCHMARK. INSTALLER TO VERIFY 42 INCHES OF SLIGHTLY LIMITED MATERIAL BELOW BOTTOM ELEVATION OF DRAINFIELD PRIOR TO INSTALLATION SITE EVALUATED BY: JASON REYNOLDS patz:REGBIVED Beau Keene, P.E. Certificate of Authorization No. 00007812 JAN 4 0 2009 3900 E. Diamond Ln. Hernando, FL 34442 vist Health 239.403.0123 office; 352.341.3806 fax Beau Keene, P.E. #46831 Envir ge 9 > ngineering eg LL File No. RE 09.100 FEB-2-2289 @7:52P_FROM:RELIABLE 239-352-0382 TO: 6436878 P.t Une GV mom rt rw. | Gar oe ws! OLF Lous 03.00 4£5704a00rU omar 20. PP (0G ole STATE OF FLORIDA DEPARTMENT OF HEALTH . DATE PAID: ONSITE SEWAGE TREATMENT AND DISPOSAL PEE PAID: : SYSTEM . . RECEIPT #: APPLICATION FOR CONSTRUCTION PERMIT APPLICATION FOR: [ } New Gysten [ 1 Sxisting system { ] Holding Tank { J] Innovative [ X] Repair { ] Abandonment { J Tomporary I appircant: PAC OF COLLIER INC, ___ 239-404-6255 AGENT: RELIABLE DRAINFIELD DESIGN, LLC 3890 19" Avenue S.W. - Naples, FL 34117 239.253.3566 office; 352.0302 fx MATLING ADDRESS: $$ —_ $$$ aan coWemtein ss Sennen ero OCR ee REGS RESO RNR SAAR SMA BES SRSA RSE SOT SRSS SSSR S RS TO BE COMPLETED BY APPLICANT CR APPLICANT’ & AUTHORIZED AGENT. SYSTEMS MOST BZ CONSTRUCTED BY A PERSON LICENSED PURSUANT TO 489.205 (3) (m) OR 489.552, FLORTDA STATUTES. IT IS THE APPLICANT’ S RESPONSTSIUZTY TO PROVIDE DOCUMENTATION OF THE PATH THE LOT WAS CREATED OR PLATTED (MM/DD/YY) I¥ REQUESTING CONSIDERATION OF STATUTORY GRANDFATHER PROVISIONS. om mmMase neces Ses ROSS RRR RARE SSS SSeS wes oeares SUR RE REST SUN R TEE eRA A SRRS Ee Ko CSS aS IIMS: PROPERTY INFORMATION LEGAL DESCRIPTYON: BAST % OF TRACT 54 LESS R/W, GGR. UNIT #23 PLATTED: APTER 1972 PROPERTE ID #: 37744040002 ZONING: B T/# OR EQUIVALENT: [Y/N] ' PROPERTY SIZE: 2.50 ACRES WATER SUPPLY: [x] PRIVATE PUBLIC [ jJ2000GRD IS GEWER AVAILABLE AS PER 382.0065, Fre? [x / NJ} DIBTANCE TO SEWER: N/A PT. PROPERTY ADDRESS: 13260 IMMOKALEE RD. - DIRECTIONS TO PROPERTY: i T, BULLYING IAFORMALTTON : { ] ReESXpENTTAL { % 2 Commmrcran Unit Type of No. of Building Commercial/Institutional System Dasign No Establishment Bedrooms Araa Sqft Table 1, Chapter 648-6, FAC 1 Tord STRIP MALL frou6l K 2 Foe. 3600 Ged C ] Floeor/Eqaipment Drains { ] Other (Specity} sroMan: Qoe he Cetestte sare: (PYF Paga 1 DH 4615, 10/97 (Previous Bditions May Be Used) RECEIVED FEB 02 2008 jronmental Health enw Engineering STATE OF FLORIDA RECEIVED penurt no. A? 106 lolp DEPARTMENT OF HEALTH DATE PAID: ONSITE SEWAGE TREATMENT AND SP FEE PAID: SYSTEM JAN 2683 RECEIPT #: APPLICATION FOR CONSTRUCT IaNromRmRM Health Engineering APPLICATION FOR: [ ] New System { ] Existing System { 1] Holding Tank [ ] { X] Repair { ] Abandonment { ] Temporary [ J Innovative appircant: PAC OF COLLIER INC. 239-404-6265 AGENT : RELIABLE DRAINFIELD DESIGN, LLC 3890 19" Avenue S.W. - Naples, FL 34117 239.253.3566 office; 352.0302 fax MAILING ADDRESS: TO BE COMPLETED BY APPLICANT OR APPLICANT’S AUTHORIZED AGENT. SYSTEMS MUST BE CONSTRUCTED BY A PERSON LICENSED PURSUANT TO 489.105 (3) (m) OR 489.552, FLORIDA STATUTES. IT IS THE APPLICANT’S RESPONSIBILITY TO PROVIDE DOCUME! PLATTED (MM/DD/YY) IF REQUESTING CONSIDERATION OF STATUTORY GRANDFATHE: NTATION OF THE DATE THE LOT WAS CREATED OR R PROVISIONS. PROPERTY INFORMATION PLATTED: AFTER 1972 jE, UNIT #23 LEGAL DESCRIPTION: EAST % OF TRAGHem PROPERTY ID #: 37744040001 I/M OR EQUIVALENT: [ ¥ /N] PROPERTY SIZE: 2.50 ACRES WATER SUPPLY: [X] PRIVATE PUBLIC [ ]<=2000GPD { ]>2000GPD IS SEWER AVAILABLE AS PER 381.0065, FS? [ ¥ 7/N] DISTANCE TO SEWER: N/A FT. PROPERTY ADDRESS: 13260 IMMOKALEE RD. DIRECTIONS TO PROPERTY: BUILDING INFORMATION DO { X ] COMMERCIAL Unit Type of No? Building Commercial/Institutional System Design No Establishment Bedrooms Area Sqft Table 1, Chapter 64H-6, FAC 1 STRIP MALL { 1]. Floor/Equipment Drains [ ] Other (Specify) RECEIVED SIGNATURE: Doel. Cette Qongq_ pare: Vai DH wi iti Environmental Health P 401L5, 10/97 (Previous Editions May Be Used) Soe eing age 1 PERMIT # STATE OF FLORIDA DEPARTMENT OF HEALTH ae . ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM EXISTING SYSTEM AND SYSTEM REPAIR EVALUATION . RECEIVED ' AppLrcaNr “We CA FEB 20 2009 Environmental Health CONTRACTOR / AGENT: Y } Engineering BLOCK: SUBDIV: LOT: TO BE COMPLETED BY FLORIDA REGISTERED ENGINEER, DEPARTMENT EMPLOYEE, SEPTIC TANK CONTRACTOR OR COMPLETE ALL APPLICABLE ITEMS. OTHER CERTIFIED PERSON. SIGN AND SEAL ALL SUBMITTED DOCUMENTS. COMPLETE TANK CERTIFICATION BELOW OR ATTACH LETTER FROM A PERMITTED SEPTAGE DISPOSAL SERVICE. Rocsoses= EXISTING TANK INFORMATION BAFFLED: [Y / N] BAFFLED: [Y / N] MATERIAL: { jSOC) GALLONS SEPTIC TANK/GPD ATU LEGEND: MATERIAL: : MATERIAL: & [2300) caLLONS SEPTIC TANK/GPD ATU LEGEND # PuMps:( Z 1 Feu ] GALLONS GREASE INTERCEPTOR LEGEND Uy ova 1 GALLONS DOSING TANK LEGEND MATERIAL: sauepecsssceeeeeees seeaseassesenesesesessene Dosseesgenecscaeerseceenessccsesssseseees I CERTIFY ABOVE NOTED TA WERE PUMPED ON /_(0/ (09, HAVE THE VOLUMES SPECIFIED, ARE UND, AND HAVE A &j “2 , / OUTLET FILTER: DEVICE ] Penge : wor SIGNATURE LICENSED CONTRACTOR BUSINESS NAME / DATE . ee eneesseseeeneascensessssesessseensessssss Soo ee ee ees SSSR SS SSS SSS SS posusnesseceseeseess== EXISTING DRAINFIELD INFORMATION J DIMENSIONS: x RIMARY DRAINFIELD SYSTEM NO. OF TRENCHES [ DIMENSIONS : x . ] SQUARE FEET che Guic (CU{_ sysrem No. oF TRENCHES t2b1 i Drét 222) square FEET TYPE OF SYSTEM: [ ] STANDARD [ ] FILLED [\] MOUND [ ] CONFIGURATION: [XN]. TRENCH { 1] BED [1 . DESIGN: [ ] HEADER { ] D-Box [ ] GRAVITY SYSTEM _[ Kj] DOSED SYSTEM ELEVATION OF BOTTOM OF DRAINFIELD IN RELATION TO EXISTING GRADE INCHES [ ABOVE / /BELOW] SYSTEM FAILURE AND REPAIR INFORMATION ] DOMESTIC { ] COMMERCIAL TYPE OF WASTE t 64E-6, FAC 4 [2002 |] SYSTEM INSTALLATION DATE if% Cart] GPD ESTIMATED SEWAGE FLOW BASED ON [ ] METERED WATER [ ] TABLE 1, [ ] DRAINAGE STRUCTURES [ ] POOL { 1] PATIO / DECK {4 PARKING SITE CONDITIONS: [ ] SLOPING PROPERTY {[ ] NATURE OF [ ] HYDRAULIC OVERLOAD (%] sors [ ) MAINTENANCE ( ] S¥STEM DAMAGE FAILURE: { ] DRAINAGE / RUN OFF ] ROOTS [ ] WATER TABLE { J FAILURE [ ] SEWAGE ON GROUND { ] TANK [ ] D BOX/HEADER ([\Q DRAINFIELD SYMPTOM: [ ]} PLUMBING BACKUP to] _ Corsage, Gus : REMARKS/ADDITIONAL CRITERIA TITLE /LICENSE Pie pare, Je 10-04 SUBMITTED BY: DH 4015, 10/96 (Previous Editions may ‘be used) Page 4 of 4 STATE OF FLORIDA DEPARTMENT OF HEALTH . ONSITE SEWAGE TREATMENT CONSTRUCTION INSPECTIO. APPLICANT: . . AND DISPOSAL SYSTEM N AND FINAL APPROVAL AGENT: . CENTRAX #: DATE PAID: __ : FEE PAID: _ OSTDSNBR :-- County # PROPERTY STREET ADDRESS: BLOCK: [ SUBDIVISION: —_——— Section/Township/Range /Parcel No.} LOT: . PROPERTY ID #: ‘ (OR TAX ID NUMBER] CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITH CHAPTER 64E~6, FLORIDA ADMINISTRATIVE CODE. TANK INSTALLATION : [01] TANK SIZE 1113300 [2] {S00 [02] TANK MATERIAL Conte 4? [03] OUTLET DEVICE sd .d# pchen [04] MULTI-CHAMBERS [05] LEGEND __&x\ \n : [06] WATERTIGHT [07] LEVEL Y [08] DEPTH OF, LID DRAINFIELD INSTALLATION f09] AREA [1] 2) 44 4?) SOFT DISPREBUTION - BOX/EADED 4. NUMBER OF DRAINLIN - DRAINLINE SEPARATION Teeth > DRAINLINE SLOPE O\ Rosta , mo eee oe ee od ww ee er rans [10] [11] [12] [13] ae roan ee 14] [15] [16] (17] [18] {19] [20] (21) uA: . FILL/EXCAVATION MATERIAL \2. [22] FILL AMOUNT a SYSTEM LOCATION DOSING PUMPS AGGREGATE SIZE AGGREGATE SOURCE AGGREGATE WASHED AGGREGATE DEPTH mas AAS wee - a ] ] (23) FILL TEXTURE } [24] EXCAVATION DEPTH } [25] EXCAVATION AREA ) [26] REPLACEMENT MATERIAL mae [ [ C [ [ [ [ [ [ [ [ [ DEPTH OF COVER system ELEVATION [7 Above/ Geigy BM B [ [ [ { [ { [ f [ . SETBACKS SURFACE WATER : pricnes_ &! PRIVATE WELLS LOOT PUBLIC WELLS ___. TRRIGATION WELLS POTABLE WATER LINES_32 BUILDING FOUNDATION_5 PROPERTY LINES 9.5 OTHER IZ } [27] j [28] } 29] }) [30] ] [34] } [32] } [33] ) [34] ). [35] FILLED/MOUND SYSTEM [36] DRAINFIELD COVER [37] SHOULDERS _ " [38] SLOPES__#, [39] STABILIZATION MATERIAL ADDITIONAL INFORMATION ) [40] UNOBSTRUCTED AREA ] [41] STORMWATER RUNOFF j [42] ALARMS 64 ] [43] MAINTENANCE AGREEMENT } [44] BUILDING AREA ] [45] PLUMBING FIXTURES a ] [46] .PINAL SITE G DING } [47] CONTRACTOR Dix ] [48] OTHER Quuk 46 ABANDONMENT ] [49] TANK PUMPED } [50] TANK CRUSHED AND FILLED XPLANATION OF VIOLATIONS: New p len w] charge tent Si2eS reg vied CHD Date: ala 3/04 Cy a eavad J A My Moo couse KEENE ENGINEERING CONSULTANTS, INC. ' PLANNING © SUBDIVISIONS * DRAINAGE ¢ UTILITIES February 21, 2009 Collier County Health Department : RE CEIVE, State of Florida Department of Health & Rehabilitative Services D Environmental Health and Engineering FER 23 20 2800 North Horseshoe Drive Environm 09 Naples, FL 34104 Engineer fealth ENGINEER’S CERTIFICATION OF INSTALLATION SEPTIC PERMIT NO. AP909666 13260 IMMOKALLEE RD. To Whom It May Concern: ~ This is to certify that we have inspected the septic drainfield site at the above referenced location and — our findings are that the constructed system has been installed in accordance with the approved plans and specifications. The installed system appears to meet the intent of FAC Chapter 64E-6. _ If you have any questions, please don’t hesitate to cail. Sincerely, | alates Beau Keene, P.E. ’ Florida Reg. No. 46831 Armando’s Market BAAR ee hee Aor a hlnulan El ZAIN « PRO-ANA-MPA OFFICE @ 239-403-9399 FAX \ ) oD RAQOOAND. 2 re ae fe SINGLE |” DUAL GReAse TANKSE =) XA. e BES.» . ” TRENCH. st ee PECTE! aa © ence OF PAVEMENT Bf (185) QUICK 4 EQ-36 CHAMBERS PER FIELD (TOTAL 370 REQUIRED) IN A MOUNDED TRENCH SYSTEM MINIMUM. 24: INCHES. SEPARATION EXISTING GREASE AND SEPTIC TANKS TO REMAIN. PUMP TANKS PRIOR TO CONNECTION TO NEW ORAINFIELD aa BUILDING LINE r ~1-W-, see INDICATES APPROXIMATE © Fine STATON Lu Bl SS ied tay eee J TO FINAL “GRADE @EXSTING 1,356-GAL. ® SEPTIC TANK 3 700 EXISTING 750° GAL, GREASE INTERCEPTOR i EXISTING STRIP MALL ‘ame TWvaNya EXISTING STORM SEWER WAXIMUM 3:1. SODDED PAIR CULATIONS 3/539 GALLONS PER DAY BASED ON PREVIOUSLY APPROVED PLAN AINFIELD SIZING CALCUI : D iT IONS: yr: ISTING PUMP STATION WILL RECEIVE A TOTAL FLOW OF 3,539 GPD, A DUPLEX PUMP ARRANGEMENT WIM ALTERNATING PUMPS EACH SERVING ONE-HALF THE ORANFIELD AREA IS REQUIRED, 8: PTL AREA i LOW PRESSURE DISTRIBU: ION: RUN 3” TRANSMISSION LINE TO 2" MANIFOLD, AT EACH TRENCH, TEE (OR 90° FOR END) 4171/2" LATERALS TO RUN ENTIRE LENGTH OF TRENCH. PROVIDE 3/16" DIAMETER HOLES AT 6~FEET ON CENTER STRAP 1~1/2" CATERALS TO TOP OF CHAMBERS WITH ‘SPRAY HOLES POINTING UP. PROVIDE A 90° SWEEP WITH A FEMALE TREADED CAP AT OISTAL END OF RUNS; SET CAP 'N VALVE BOX BROUGHT TO FINAL GRADE, gER3 bed oo.7 zw ZS, Baa - g28L ne ON m Q 25 7” g- od i a = AC OF COLLIER INC, 2" 0.S.D.S. REPAIR PL 48260 IMMOKALEE ROAD STATE OF FLORIDA PERMIT # DEPARTMENT OF HEALTH a . ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM EXISTING SYSTEM AND SYSTEM REPAIR EVALUATION . RECEIVED APPLICANT: “Ve Call FEB 20 2003 Environmental Health CONTRACTOR / AGENT: mek ; Engineering BLOCK: SUBDIV: LOT: TED BY FLORIDA REGISTERED ENGINEER, DEPARTMENT EMPLOYEE, SEPTIC TANK CONTRACTOR OR COMPLETE ALL APPLICABLE ITEMS. OTRER CERTIFIED PERSON. SIGN AND SEAL ALL SUBMITTED DOCUMENTS . COMPLETE TANK CERTIFICATION BELOW OR ATTACH LETTER FROM A PERMITTED SEPTAGE DISPOSAL SERVICE EXISTING TANK INFORMATION BAFFLED: [¥ / N] MATERIAL: 1&0) GALLONS SEPTIC TANK/GPD ATU LEGEND: [ J&OCy GALLONS SEPTIC TANK/GPD ATU LEGEND: MATERIAL: Ea BAFFLED: [Y / N] 2 “qv ] GALLONS GREASE INTERCEPTOR LEGEND: MATERIAL: a t Goro ] GALLONS DOSING TANK LEGEND: MATERIAL: # PUMPS: [ 2 } Se SspescsseSsS Sasa stesec= eee eee EEE RSS eee ESSE SE SSS SRE RES SS SSSR SRS ESSE = I CERTIFY ABOVE NOTED TA WERE PUMPED ON OF 64, HAVE THE VOLUMES SPECIFIED, ARE , AND HAVE A DERLECTION 3 / OUTLET FILTER DEVICE 1 es . STRU DATE . EXISTING DRAINFIELD INFORMATION {[ ] DIMENSIONS: ___* ] SQUARE FEET PRIMARY DRAINFIELD SYSTEM NO. OF TRENCHES SYSTEM NO. OF TRENCHES 120] DIMENSIONS : x [ UZT2E{) SQUARE FEET BS GQuic (CU ““cypz OF SYSTEM: [ ] STANDARD [ | FILLED [\] moUND [ ] CONFIGURATION: (%] TRENCH [ 1 BED t ] . DESIGN: [ ] HEADER L ] D-Box [ ] GRAVITY SYSTEM Vj DOSED SYSTEM ELEVATION OF BOTTOM OF DRAINFIELD IN RELATION TO EXISTING GRADE INCHES [ ABOVE /)JBELOW] SYSTEM FAILURE AND REPAIR INFORMATION ] DOMESTIC { ] COMMERCIAL TYPE OF WASTE if [ ] TABLE 1, 64E-6, FAC t [“72o02 ] SYSTEM INSTALLATION DATE [ ] METERED WATER Gs Ne Cart J GPD ESTIMATED SEWAGE FLOW BASED ON ] PATIO / DECK { YJ PARKING SITE {[ J] DRAINAGE STRUCTURES [ ] POOL if CONDITIONS: [ ] SLOPING PROPERTY [ ] NATURE OF [ ] HYDRAULIC OVERLOAD (&] sors { ] MAINTENANCE [ ] S¥STEM DAMAGE FAILURE: { ] DRAINAGE / RUN OFF ] ROOTS { ] WATER TABLE [ j D BOX/HEADER { Q DRAINFIELD FAILURE [ ] SEWAGE ON GROUND {.] TANK co] t 1 __ (Conapae, Zo 6 SYMPTOM: {[ ] PLUMBING BACKUP REMARKS/ADDITIONAL CRITERIA TITLE/LICENSE DURTIS NA pare: (0-04 SUBMITTED BY: DH 4015, 10/96 (Previous Editions may be used) Page 4 of 4 ATTACHMENT A-1 Charlie Crist Governor Ana M. Viamonte Ros, M.D., M.P.H. State Surgeon General Environmental Health & Engineering MEMORANDUM February 2, 2009 TO: Reliable Drainfield Design 3890 19" Ave SW Naples, FL 34117 FROM: Erin Kurbec Environmental Health and Engineering P.O. Box 429 ; Naples, FL 34106-0429 SUBJECT: Septic System, Additional Information Required. Building Permit — Application No.: AP 909666 For construction located at 13260 Immokalee Rd., cannot be approved by this office for lack of the following documents and/or information: . 1. The application must contain details to substantiate flow. Please include the business types, and flows for each. . 2. Form DH 4015 Repair evaluation is required to be completed in full, by a licensed septic tank contractor or a licensed plumber. All tanks must be pumped and certified as being structurally sound. Use two forms if needed. Please submit the foregoing to: Collier County Health Department, P.O. Box 429, Naples, FL 34106 or bring same to 3301 Tamiami Trail E Bldg. H-3, Naples, Florida. Please be aware that all rules and design criteria are taken from 64E-6 FAC. Questions regarding the above may be directed to this office at (239) 252-2499 Collier County Health Department 3301 Tamiami Trail E Joan Colfer, M.D., Mailing Address: Ver i Bidg. H-3 M.P.H., Director : Post Office Box 429 Department! Naples, Florida * 34112 : Naples, Florida * 34106-0429 Cirg..Comntted-Helying, Dedicated To the Wellness of ‘Our Communstty Telephone (239) 252-2499 ATTACHMENT B STATE OF FLORIDA » PERMIT # AP IB Ba DEPARTMENT OF HEALTH : ONSITE SEWAGE TREATHENT AND DISPOSAL SYSTEM RECEIVED . EXISTING SYSTEM AND SYSTEM REPAIR EVALUATION : I DEC 9 2 2008 | _ Chodkowski Residence a Te) Collier County Heaith Dept. APPLICANT: D0 AB HY Bt . uty is 4, a N TATE TELS RPE) & TASIESTING CONTRACTOR / AGENT: Dixie Drainfields, Inc. SUBDIV: N 180 TR.- 121 U.-6 GG Estates toa: 36867720005 LOT: swan BLOCK: oo ceue ee eeeeewenseceeucueedeecononees caged eeccemene seme er ess seammmass Poems SERS SS ETA ESE SES SSCS OSS TO BE COMPLETED BY FLORIDA REGISTERED ENGINEER, DEPARTMENT EMPLOYEE, ‘SEPTIC TANK CONTRACTOR OR OTHER CERTIFIED PERSON. SIGN AND SEAL ALL SUBMITTED DOCUMENTS. COMPLETE ALL APPLICABLE ITEMS. COMPLETE TANK CERTIFICATION BELOW OR ATTACH LETTER FROM A PERMITTED SEPTAGE DISPOSAL SERVICE. vewea uae pauusenengegae s Wee Rn REUScoeR CE sUS RRR S ESE RES SN eNER MNS SEES aS eR SESE ARES STES NSS SS SEER SLES BXISTING TANK INFORMATION MATERIAL: Concrete BAFFLED: [K / N} w—- MATERIAL: —- BAFFLED: [Y / N] ] GALLONS GREASE INTERCEPTOR LEGEND? ~~ MATERIAL: : ING TANK LEGEND: -—— MATERIAL: ——- # PUMPS: [--—-—] | i | [900 ] GALLONS SEPTIC TANK/GPD ATU LEGEND: None {[-—-— ] GALLONS SEPTIC TANK/GPD ATU LEGEND: — [ foe a ee too geoecemmneotercs sds eEsr SSeS eR eE SERS RES eansans éva NOTED TANKS WERE PUMPED on 9 /18/08, HAVE THE VOLUMES SPECIFIED, ARE AND HAVE A [ SOLIDS DEFLECTION DEVICE 7 XIPOLLEXESUT OR OSERLO J PASTALLEDS Dixie Dralnfields, Inc. f CONTRACTOR BUSINESS NAME DATE eumgegcecscscsmesonseseess So Sa en S SIGNATURE OF f BORG SReesesoM Es eee Sa EC REESE SS EXISTING DRAINFIELD INFORMATION [375 1] SQUARE FEET PRIMARY DRAINFIELD SYSTEM NO. OF TRENCHES [ ] prMENsrons: 15 25 SYSTEM NO. OF TRENCHES [ ] DIMENSIONS: x if ] SQUARE FEET TYPE OF SYSTEM: [ ] STANDARD [ ] FILLED [X] mounD [ ] | CONFIGURATION: [ ] TRENCH {X] BED {1 | DESIGN: {X ] HEADER { J] D-BOX [X] GRAVITY SYSTEM { ] DOSED SYSTEM t EXISTING GRADE 22 _—s INCHES [ XBOWIK / BELOW] ELEVATION OF BOTTOM OF DRAINFIELD IN RELATION TO SYSTEM FAILURE AND REPAIR INFORMATION TYPE OF WASTE [IX] DOMESTIC [ 1] COMMERCIAL 1982 ] SYSTEM INSTALLATION DATE 1300 ] @PD ESTIMATED SEWAGE FLOW BASED ON [ ] METERED WATER [X] TABLE 1, 64E-6, FAC | SITE { ] DRAINAGE STRUCTURES [ ] POOL { ] patzo / DECK { 1] PARKING CONDITIONS: [ ] SLOPING PROPERTY tl : NATURE OF [ |] HYDRAULIC OVERLOAD { ] sorns [X ] MAINTENANCE { ] SYSTEM DAMAGE FAILURE: I 1 DRAINAGE / RUN OFF { } Roors [ } WATER TABLE tol | FAILURE [ ] SEWAGE ON GROUND [ ] TANK { ] D BOX/HEADER [ ] DRAINPIRLD i SYMPTOM: [X] PLUMBING BACKUP tC] : REMARKS/ADDITIONAL CRITERIA. : SUBMITTED BY: TITLE/LICENSE Dyn pare: { Yo {s of DH 4015, 10/96 (Previous Editions may be used) Page 4 of 4 COMPOSITE ATTACHMENT C DIXIE DRAINFIELDS, Inc. Septage Hauling Log Date: 9/17/08 Address: Lely Resort Maintenance Residence: Business /Type Yes / Maintenance 4015 Evaluation Estimated Volume: Gal. Notes: a aU Date: 9/17/08 Address: 690 Wren Street Residence: Yes Business / Type fo 4015 Evaluation Estimated Volume: Gal. Notes: Se i 5400 21st Avenue SW Date: 9/18/08 Address: Residence: Yes Business /Type - f 4015 Evaluation Estimated Volume: Gal. Notes: a Date: 9/18/08 Address: Pena Surgury : Residence: Business / Type YES _/_DR Office 4015 Evaluation Estimated Volume: Gal. Notes: A Discharge Site: JC Drainfield or Other JCDrainfield Date of Discharge: 9/18/08 ; Time of Discharge 11 AM Attach all Discharge and other recelpts as required. Hauling Log WBM o:e/dixte/dixdocs DIXIE DRAINFIELDS, Inc. Septage Hauling Log Date: 9/18/08 Address: Naples Bay Club es Residence: Business / Type Yes / Restaruant 4015 Evaluation Estimated Volume: Gal. Notes: cee ee Date: 9/18/08 Address: Bone Fish Grill Residence: Business / Type Yes / Restarunt 4015 Evaluation Estimated Volume: Gal. Notes: ce a Date: 9/18/08 Address: Cottages Resiarunt Residence: Business / Type Yes / Restarunt 4015 Evaluation Estimated Volume: Gal. Notes: ee Date: Address: — Residence: Business / Type / 4015 Evaluation Estimated Volume: Gal. Notes: . TT ee Discharge Site: JC Drainfield or Other JC Drainfield Date of Discharge: _9/18/08 Time of Discharge 1PM Attach all Discharge and other receipts as required. Hauling Log WBM 64 o:cidixie/dixdocs DIXIE DRAINFIELDS, Inc. Septage Hauling Log Date: 9/18/08 Address: 3265 4th Street NE Residence: Yes Business / Type VA 4015 Evaluation Estimated Volume: Gal. Notes: I inn Date: 9/19/08 Address: 5012 29th Place SW Residence: Yes Business / Type /. 4015 Evaluation Estimated Volume: Gal. Notes: ; Date: 9/22/08 Address: 6310 Hunters Road Residence: Yes Business / Type LZ. 4015 Evaluation Estimated Volume: Gal. Notes: 1058 Trail Terrace Drive Date: 9/22/08 Address: Residence: Yes Business / Type L 4015 Evaluation Estimated Volume: Gal. Notes: Discharge Site: JC Drainfield or Other JC Drainfield Date of Discharge: _9/22/08 Time of Discharge 11AM Attach all Discharge and other receipts as required. Hauling Log WBM o:cidixie/dixdocs STATE OF FLORIDA PERMIT # AP Yotloo4 DEPARTMENT OF HEALTH a ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM EXISTING SYSTEM AND SYSTEM REPAIR EVALUATION (OF \/EP} DEC (6 20g appircant: _Brown Residence SRLS 167 Ave. ow . ° Cater tor rity Tea CEpt. Dixie Drainfields, Inc. Environmentel Health & Engineering CONTRACTOR / AGENT: W75 Ti1t & E75 7120 GG Ests. U-27 rp#: 3799060009 LOT: BLOCK: TW" SUBDIV: peumemeeeSUseeRRSRe ens Sees RSS ERe SERS RES SRS SEES EE Bnew cee tae Re ERE RSS REESE EERE TS SSO SS To BE COMPLETSD BY FLORIDA REGISTERED ENGINEER, DEPARTMENT EMPLOYEE, SEPTIC TANK CONTRACTOR OR OTHER CERTIFIED PERSON, SIGN AND SEAL ALL SUBMITTED DOCUMENTS. COMPLETE ALL APPLICABLE ITEMS. COMPLETE TANK CERTIFICATION BELOW OR ATTACE LETTER FROM A PERMITTED BEPTAGE DISPOSAL SERVICE. sa otsEnnased seas SSeS SST pees ERe TESS SESSA S snagenestese seer eseaeeenEs eases SEE EXISTING TANK INFORMATION [900 1 GALLONS SEPTIC TANK/GPD ATU LEGEND: None BATERIAL: Concrete BAFFLED: [K / XN} [———- ] GALLONS SEPTIC TANK/GFD ATU poo «= BAFFLED? [¥ / Wi ] GALLONS GREASE INTERCEPTOR LEGEND: nesteenncasRceEe ES eee SSSR TRESS Soccer mS ROVE NOTED TANKS WERE PUMPED oN 9 /18/08, HAVE THE VOLUMES SPECIFIED, ARE YEDOOEXH EEC RR SEMA ] INSTALLED. 27 4-8 AND HAVE A [ SOLIDS DEFLECTION DEVICE / sS Dixie Drainflelds. inc. SIGNATURE OF LICENSED CONTRACTOR BUSINESS NANE DATE REGSH SSR REESSSeRRES REESE ROSTERS ESTEE SRSA SE TS = EXISTING DRAINFIELD INFORMATION co Se USE OSoN RSE ER MSA ORE SESS SS SSS 1300 1 SQUARE FEET PRIMARY DRAINFIELD SYSTEM NO. OF TRENCHES [ ] DIMENSIONS: 45 x20 if ] SQUARE FEET SYSTEM NO, OF TRENCHES [ ] DIMENSIONS: TYPE OF SYSTEM: [X] STANDARD [ |] FILLED { ] MOUND { ———— CONFIGURATION: { ] TRENCH [X] BED {1 DESIGN: {X ] HBADER [ ] DeBox [X] Gravity system [ J DOSED SYSTEM INcHES [ XH / BELOW] ELEVATION OF BOTTOM OF DRAINFIELD IN RELATION TO EXISTING GRADE 22 SYSTEM FAILURE AND REPAIR INFORMATION 11979 ] SYSTEM INSTALLATION DATE ype OF WASTE [XJ] Domestic [ 1 COMMERCIAL 1300 ] GPD ESTIMATED SEWAGE FLOW BASED ON [ ] METERED WATER [X] TABLE 1, 64-6, FAC SITE | ] DRAINAGE STRUCTURES [ ] POOL { ] PATIO / DECK [ ] PARKING CONDITIONS: [ ] SLOPING PROPERTY - al SOILS [X ] MAINTENANCE ] SYSTEM DAMAGE NATURE OF [ ] HYDRAULIC OVERLOAD to} WATER TABLE Fa FAILURE: { ] DRAINAGE / RUN OFF { 1 Roots { J FAILURE [ ] SEWAGE ON GROUND IL J TANK [ ] D BOX/HEADER { ] DRAINFIELD SYHPTOM: {X] PLUMBING BACKUP fo) REMARKS/ADDITIONAL CRITERIA. SUBMITTED BY: DH 4015, 10/96 (Previous Editions may ‘be used) Page 4 of 4 COMPOSITE ATTACHMENT D TITLE/LICENSE Coed, DATE: (2-4. 08 DIXIE DRAINFIELDS, Inc. Septage Hauling Log Date: 9/17/08 Address: Lely Resort Maintenance Residence: Business / Type Yes Maintenance 4015 Evaluation Estimated Volume: Gal. Notes; Date: 9/17/08 Address: 690 Wren Street Residence: Yes Business / Type VA 4015 Evaluation Gal. Estimated Volume: Notes: ITO a Date: 9/18/08 Address: 5400 21st Avenue SW Residence: Yes Business / Type VA 4015 Evaluation Estimated Volume: Gal. Notes: iO Date: 9/4 8/08 Address: Pena Surgury Residence: Business / Type YES DR Office 4015 Evaluation Estimated Volume: Gal. Notes: Discharge Site: JC Drainfield or Other JC Drainfield Date of Discharge: _9/18/08 Time of Discharge 11 AM Attach all Discharge and other receipts as required. Hauling Log WBM 64 o:cidixiefdixdocs DIXIE DRAINFIELDS, Inc. Septage Hauling Log Date: 9/18/08 Address: Naples Bay Club Residence: Business / Type Yes / Restaruant_ 4015 Evaluation Estimated Volume: Gal. a Notes: a a Date: 9/18/08 Address: Bone Fish Grill Residence: Business / Type Yes Restarunt 4015 Evaluation Estimated Volume: Gal. —_ Notes: a a a Date: 9/18/08 Address: Cottages Restarunt Residence: Business / Type Yes Restarunt 4015 Evaluation Estimated Volume: Gal. Notes: Date: Address: —_ Residence: Business / Type A 4015 Evaluation Estimated Volume: Gal. Notes: . ___— Discharge Site: JC Drainfield or Other JC Drainfield Date of Discharge: _9/18/08 Time of Discharge 1PM Attach all Discharge and other recelpts as required. Haullng Log WBM 64 o:cidixieldixdocs DIXIE DRAINFIELDS, Ine. Septage Hauling Log Date: 9/18/08 Address: 3265 4th Street NE Residence: Yes Business / Type /. 4015 Evaluation Estimated Volume: Gal. Notes: . ce a Date: 9/19/08 ___Address: 5012 29th Place SW Residence: Yes Business / Type VA 4015 Evaluation Estimated Volume: Gal. Notes: nee i Date: 9/22/08 Address: 6310 Hunters Road Residence: Yes Business / Type Z. 4015 Evaluation Estimated Volume: Gal, Notes: i 4058 Trail Terrace Drive Date: 9/22/08 Address: Residence: Yes Business / Type lA 4015 Evaluation Estimated Volume: Gal. ee - Notes: cc Discharge Site: JC Drainfield or Other JC Drainfield : Date of Discharge: _9/22/08 Time of Discharge 11 AM _ Attach all Discharge and other receipts as required. Hauling Log WBM 64 o:cldixie/dixdocs STATE OF FLORIDA PERMIT # AP 40320) DEPARTMENT OF HEALTH ; RECEIVED ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM EXISTING SYSTEM AND SYSTEM REPAIR EVALUATION oy om NOV 25 2008 Environmental Health . appircant: Kahi Trust ~ “29 2) Friend Ship lanes Fnatneering CONTRACTOR / acENT: Dixie Drainfields, Inc. BLOCK: -eeee supprv: A portion 24/47/27 Ip#: 00100960008 LOT: > BESS Se RSS PRR SSR SS SRE S SNS RR ESE ERE PEERS A ERR ASSES SSS ETS ee Pee ereSsEaSssSS TO BE COMPLETED BY FLORIDA REGISTERED ENGINEER, DEPARTMENT EMPLOYEE, SEPTIC TANK CONTRACTOR OR OTHER CERTIFIED PERSON. SIGN AND SEAL ALL SUBMITTED DOCUMENTS. COMPLETE ALL APPLICABLE ITEMS, COMPLETE TANK CERTIFICATION BELOW OR ATTACH LETTER FROM A PERMITTED SEPTAGE DISPOSAL SERVICE. SRSESRATS ES ERAS Rese eee aS SEES SSE R RSNA EAR SRNR ASSES SSSA Ce ERA RN SSRI NII TASER ERE EXISTING TANK INFORMATION LEGEND: None ss MATERIAL: Concrete BAFFLED: [XK / N] NATERIAL: BAFFLED: [¥ / NJ MATERTAL: MATERIAL: {900 1 GALLONS SEPTIC TANK/GPD ATU [—~—~ ] GALLONS SEPTIC TANK/GPD ATU LEGEND: [—~-—1 GALLONS GREASE INTERCEPTOR LEGEND: ALows~ROSING TANK LEGEND: > noSe/ ABOVE NOTED TANKS WERE PUMPED ON 10 10/18 /08, HAVE THE VOLUMES SPECIFIED, ARE STRUCTURALLY ts D, AND HAVE A [ SOLIDS DEFLECTION DEVICE BE /: ] “NSD Dixie Drainfields, Inc. | RRP ever a SIGNATURE OF LICENSED CONTRACTOR BUSINESS NAME DATE . SECON SACS See ee EE SS SS RASS S SEE eS SEES SSS SS CMS EMER RS RASS REM EXISTING DRAINFIELD INFORMATION # PUMPS: [———-] (375 1 SQUARE FEET PRIMARY DRAINFIELD SYSTEM NO, OF TRENCHES [ ] DIMENSIONS: 16 x25 if ] SQUARE FEET SYSTEM NO. OF TRENCHES [ ] DIMENSIONS: x _ TYPE OF SYSTEM: [ ] STANDARD [ ] FILLED [X] MOUND [ ] CONFIGURATION: [ ] TRENCH {X] BED fo] DESIGN: [X } HEADER ( 1] D-Box [X] GRAVITY SYSTEM { 1] DOSED SYSTEM ELEVATION OF BOTTOM OF DRAINFIRLD IN RELATION TO EXISTING GRADE 22 INCHES [ XKOOE/ BELOW) SYSTEM FATLURE AND REPAIR INFORMATION (1988? } SYSTEM INSTALLATION DATE TYPE OF WASTE [X] DOMESTIC’ [ J] COMMERCIAL (300 ] GPD ESTIMATED SEWAGE FLOW BASED ON { ] METERED WATER [X] TABLE 1, 64E-6, FAC SITE { J] DRAINAGE STRUCTURES [ ] POOL I J] patro / DECR [ ] PARKING CONDITIONS: { ] SLOPING PROPERTY [ } NATURE OF [ ] HYDRAULIC OVERLOAD {[ } sorns {X] MAINTENANCE [ ] SYSTEM DAMAGE FAILURE: [ ] DRAINAGE / RUN OFF { ] Roors {[ ] WATER TABLE {1 FAILURE [ ] SEWAGE ON GROUND [ ] TANK [ } D BOX/HEADER [ ] DRAINFIELD _ SYMPTOM: [X] PLUMBING BACKUP [] REMARKS/ADDITIONAL CRITERIA SUBMITTED BY: TITLE/ LICENSE Dug DATE: hey DH 4015, 10/96 (Previous Editions may be used) Page 4 of 4 COMPOSITE i i i i i ATTACHMENT E DIXIE DRAINFIELDS, Inc. Septage Hauling Log Date: 10/15/08 Address: 130 7th Street NW Residence: Yes Business / Type A 4015 Evaluation Estimated Volume: Gal. Notes: Date: 10/15/08 Address: 438 Gordonia Residence: Yes Business / Type VA 4015 Evaluation Estimated Volume: Gal. Notes: $e PS Date: 10/15/08 Address: 1123 Cooper Drive Residence: Yes Business / Type YA 4015 Evaluation Estimated Volume: Gal. Notes: eS Date: Address: Residence: Business / Type YA 4015 Evaluation Estimated Volume: Gal. Notes: _—_—_—————————————— Discharge Site: JC Drainfield or Other JC Drainfield Date of Discharge: _ 10/16/08 Time of Discharge 7:30 AM Attach all Discharge and other receipts as required. 64 Hauling Log WBM o:c/dixie/dixdocs DIXIE DRAINFIELDS, Inc. Septage Hauling Log Date: 10/16/08 Address: 215 Cocohatchee Drive Residence: Yes Business / Type A 4015 Evaluation Estimated Volume: Gal. Notes: Date: 10/16/08 Address: 2806 South Horseshoe Drive Residence: Business / Type Yes / Office 4015 Evaluation Estimated Volume: Gal. Notes: Date: 10/16/08 Address: 2988 Santa Barbara Blvd Residence: Yes Business / Type YA 4015 Evaluation Estimated Volume: Gal. Notes: Date: Address: Residence: Business / Type / 4015 Evaluation Estimated Volume: Gal, Notes: i Discharge Site: JC Drainfield or Other JC Drainfield Date of Discharge: _10/16/08 Time of Discharge 1:30 PM Attach all Discharge and other receipts as required. Hauling Log WBM 64 o:c/dixie/dixdocs DIXIE DRAINFIELDS, Inc. Septage Hauling Log Date: 40/20/08 Address: 285 10th Avenue NE Residence: Yes Business / Type fo 4015 Evaluation Estimated Volume: Gal. Notes: ; I en Date: 10/21/08 Address: 5009 Oak Tree Drive Residence: Yes Business / Type f. 4015 Evaluation Estimated Volume: Gal. Notes: . oN eee ere A TS Date: 10/21/08 Address; 1121 29th Street SW Residence: Yes Business / Type lA 4015 Evaluation Estimated Volume: Gal. Notes: parent LL, Date: 10/23/08 Address: 1814 49th Street SW Residence: Yes Business / Type VA 4015 Evaluation Estimated Volume: Gal. Notes: SL Discharge Site: JC Drainfield or Other JC Drainfield Date of Discharge: _10/23/08 Time of Discharge 9AM Attach ail Discharge and other receipts as required. Hauling Log WBM 64 o:eldixieldixdocs DIXIE DRAINFIELDS, Inc. Septage Hauling Log Date: 10/23/08 Address; 1298 Winterberty Drive Residence: Yes Business / Type VA 4015 Evaluation Estimated Volume: Gal. , Notes: ~ I A Date: 10/23/08 Address: 1031 Pettit Ct Residence: Yes Business / Type Lo 4015 Evaluation : Estimated Volume: Gal. Notes: ee a Date: Address: - Residence: Business / Type L 4015 Evaluation Estimated Volume: Gal. Notes: a eae Date: Address: Residence: Business / Type / 4015 Evaluation Estimated Volume: Gal. Notes: en Discharge Site: JC Drainfield or Other JC Drainfield Date of Discharge: _10/23/08 Time of Discharge 1:30 PM Attach all Discharge and other receipts as required. Hauling Log WBM 84 oreidixie/dixdocs ” gTATE OF FLORIDA PERMIT # AF FOsIGA. | DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM : I EXISTING SYSTEM AND SYSTEM REPAIR EVALUBEPE VED , | ! ; . 25 2008 apprrcawr: Afmantrout Residence 2499 Sunset NOV: ¢ i conTRAcrOR / agent; Dixie Drainfields, inc. Blud. Engineerlng suspiv: A Portion $16 T50 R26 ty: 00423560004 / i LOT: BLOCK: He eee eee eee eee een Rae SRS SEN REE ERS See SRE S SES SSSR RSS SASS SSCS SS SSS TO BE COMPLETED BY FLORIDA REGISTERED ENGINEER, DEPARTMENT EMPLOYEE, SEPTIC TANK CONTRACTOR OR i OTHER CERTIFIED PERSON. SIGN AND SEAL ALL SUBMITTED DOCUMENTS. COMPLETE ALL APPLICABLE ITEMS. i COMPLETE TANK CERTIFICATION BELOW OR ATTACH LETTER FROM A PERMITTED SEPTAGE DISPOSAL SERVICE. © : sono nnemensecesessnseeeee sees nese eees se USERS SSS SOS ORR E RS ETE RSE SSSR ES SS OSS S TERRE BES | EXISTING TANK INFORMATION {900 ] GALLONS SEPTIC TANK/GPD ATU LEGEND: None MATERTAL; Concrete BAFFLED: [XK / N] | [-~-— 1] GALLONS SEPTIC TANK/GPD ATU LEGEND: MATERIAL: --————--—-_ BAFFLED: [¥ / §] | [-—~-~] GALLONS GREASE INTERCEPTOR LEGEND: MATERIAL: : . | MATERIAL: # PuMEs: [ 1 H {----~] GALLONS DOSING TANK LEGEND: So Se RS RAE EES ERE ERE SS ESSE ORS RSTOCKS AA I CERTIFY VE NOTED TANKS WERE PUMPED on 10 /21./08, HAVE THR VOLUMES SPECIFIED, ARE AND HAVE A [ SOLIDS DEFLECTION DEVICE / WOQDMXMKGGRODEKAR | irae BUSINESS NAME DATE SIGNATURE OF ED CONTRACTOR sane eos cate eceseeeRR ene coeec EEE SEES Re ees SSE ERE ARMS ROSS SAT ES ESS SSA SSSR [300 1 SQUARE FEET PRIMARY DRAINFIELD SYSTEM NO, OF TRENCHES [ 1 oDrmensrons: 15 x20 1 i | | j i EXISTING DRAINFIELD INFORMATION H i ] SQUARE FEET Cs «SYSTEM NO. OF TRENCHES [ ] DIMENSIONS: Ee TYPE OF SYSTEM: [ J] STANDARD [ ] FILLED [X] MOUND [ 1 - CONFIGURATION: [ ] TRENCH 1X] BED i] INCHES [ XBOAMK / BELOW] a : DESIGN: {[X ] HEADER { ] D-BOx (X] GRAVITY SYSTEM [ ] DOSED SYSTEM i ELEVATION OF BOTTOM OF DRAINFIELD IN RELATION TO EXISTING GRADE 22 { ; | i SYSTEM FAILURE AND REPAIR INFORMATION 11974 ] SYSTEM INSTALLATION DATE _TYP# OF WASTE [X1 DOMESTIC [ ] COMMERCIAL : 1300 ] GPD BSTIMATED SEWAGE FLOW BASED ON [ ] METERED WATER [X] TABLE 1, 648-6, PAC | SITE [ ] DRAINAGE STRUCTURES [ ] POOL { 1] PATIO / DECK [ ] PARKING CONDITIONS: [ ] SLOPING PROPERTY t J NATURE OF [ ] HYDRAULIC OVERLOAD [ ] sorzs [X] MAINTENANCE [ ] SYSTEM DAMAGE FAILURE: [ ] DRAINAGE / RUN OFF t } Rooms [ ] WATER TABLE £ ] FAILURE { ] SEWAGE ON GROUND [ ] TANK I ] D BOX/HEADER {[ ] DRAINFIELD SYMPTON: {X] PLUMBING BACKUP {1} REMARKS/ADDITIONAL CRITERIA. erme/urcense AUP pare:_({ 29-8 ! Page 4 of 4 SUBMITTED BY: DH 4015, 10/96 (Previous Editions may be used) COMPOSITE ATTACHMENT F DIXIE DRAINFIELDS, Inc. Septage Hauling Log " Date: 40/20/08 Address: 285 10th Avenue NE Residence: Yes Business / Type f 4015 Evaluation Estimated Volume: Gal. Notes: a inn Date: 40/21/08 Address: 5009 Oak Tree Drive Residence: Yes Business / Type / 4015 Evaluation Gal. Estimated Volume: Notes; ne LL 1124 29th Street SW Date: 10/21/08 Address: Residence: Yes Business / Type vA 4015 Evaluation Estimated Volume: Gal. Notes: i Date: 10/23/08 Address: 1814 49th Street SW Residence: Yes Business / Type vA 4015 Evaluation Estimated Volume: Gal. ——— Notes: A Discharge Site: JC Drainfield or Other JC Drainfield Date of Discharge: _10/23/08 Time of Discharge 9AM Attach all Discharge and other receipts as required. Hauling Log WBM 64 o:cidixleldixdocs DIXIE DRAINFIELDS, inc. Septage Hauling Log Date: 10/23/08 Address: 1298 Winterberry Drive Residence: Yes Business / Type A 4015 Evaluation Estimated Volume: Gal. Notes: cr OO Date: 10/23/08 Address: 1031 Petit Ct Residence: Yes Business / Type f 4015 Evaluation Gal. Estimated Volume: Notes: _ nnn aces a EEE Date: Address: Residence: Business / Type VA 4015 Evaluation Estimated Volume: Gal. Notes: a Date: Address: nee aoa Residence: Business / Type Aa 4015 Evaluation Estimated Volume: Gal. Notes: ee Discharge Site: JC Drainfield or Other JC Drainfield Date of Discharge: _10/23/08 Time of Discharge 1:30 PM Attach all Discharge and other receipts as required. Hauling Log WBM 64 o:cidixie/dixdocs PERMIT # AP 90320 STATS OF FLORIDA DEPARTMENT OF HEALTH ONSITE. SEWAGE TREATHENT AND preposarheeehay ED EXISTING SYSTEM AND SYSTEM REPAIR EVALUATION NOV 25 2008 Environmental Health aprurcant: Macek Residence rd/* tp) Ersineering CONTRACTOR / AGENT; Dixie Drainfields, Inc. Lot: 6 Brock: 208 supprv: Golden Gate Unit 6 Part 1 rp¥: 36374400009 pm aeesce none enecesscmeacecwedees eeeoneme cee eee se cee Se RRA SS RRS SSSR SESS SESS ES TO BE COMPLETED BY FLORIDA REGISTERED ENGINEER, DEPARTMENT EHPLOYEE, SEPTIC TANK CONTRACTOR. OR OTHER CERTIFIED PERSON. SIGN AND SEAL ALL SUBHITTED DOCUMENTS. COMPLETE ALL APPLICABLE ITEMS. COMPLETE TANE CERTIFICATION BELOW OR ATTACH LETTER FROM A PERMITTED SEPTAGE DISPOSAL SERVICE. Serene soe eee sense ROE ER eee ee CeO SRE RE ERE SEER HORSES RTS SSS SSSEESSS SSS EXISTING TANK INFORMATION MATERTAL: Fiberglass | BAFFLED: IK/N) [900 1 GALLONS SEPTIC TANK/GPD ATU LEGEND: None MATERTAL: ———-————----__ BAFFLED: [¥ / Nl [—--—- ] GALLONS SEPTIC TANK/GPD ATU LEGEND: [-———-] GALLONS GREASE INTERCEPTOR LEGEND: MATERIAL: NS MATERIAL: ———-——--——_ # PUMPS: [ J iS TANK LEGEND : awumnuneceessneanen sanca@edGSna sco eE Seen ees E eS RECS sen smesE ssa I CERTIFY re STRUCTORA SOUND, AND HAVE A [ SOLIDS DEFLECTION DEVICE f ] INSTALLED. Dixie Draintields, Inc. YO DATE BUSINESS NAME 0 Mak a ee a SIGNATURE OF LEGENBED CONTRACTOR Petr er ee EXISTING DRAINFIELD INFORMATION [300 1] SQUARE FEET PRIMARY DRAINFIELD SYSTEM NO. OF TRENCHES [ ] DIMENSIONS: 16 x20 SYSTEM NO. OF TRENCHES [ } DIMENSIONS: x [ ] SQUARE FEET TYPE OF SYSTEM: [ ] STANDARD [ |] FILLED [X] MouND [ J] _o CONFIGURATION: {[ ] TRENCH {X] BED | DESIGN: {X ] HRADER { ] B-BOX [X1 GRAVITY SYSTEM { 1] DOSED SYSTEM INCHES { XBOUK / BELOK] ELEVATION OF BOTTOM OF DRAINFIELD IN RELATION TO EXISTING GRADE 22 : SYSTEM FAILURE AND REPAIR INFORMATION TYPE OF WASTE {X] DOMESTIC [ ] COMMERCIAL 1 1985 ] SYSTEM INSTALLATION DATE . {300 ] GPD ESTIMATED SEWAGE FLOW BASED ON [ ] METERED WATER {X] TABLE 1, 64-6, FAC SITE { ] DRAINAGE STRUCTURES [ |] POOL I 1] PATIO / DECK £ ] PARKING CONDITIONS: [ ] SLOPING PROPERTY { j NATURE OF [ ] HYDRAULIC OVERLOAD { ] sorns {X] MAINTENANCE { |] SYSTEM DAMAGE FAILURE: E ] DRAINAGE / RUN OFF { ] ROOTS { ] WATER TABLE { ] DRAINFIELD FAILURE { 1] SEWAGE ON GROUND { ] TANK [ ] D BOX/HEADER a) SYMPTOM: {X] PLUMBING BACKUP fo] REMARKS/ADDITIONAL CRITERIA. TITLE/ LICENSE une DATE: [ % Page 4 of 4 SUBMITTED BY: pH 4015, 10/96 (Previous Editions may be used) COMPOSITE ATTACHMENT G i i DIXIE DRAINFIELDS, Inc. Septage Hauling Log Date: 10/20/08 Address: 285 10th Avenue NE Residence: Yes Business / Type VA 4015 Evaluation Estimated Volume: Gal. Notes: ‘ LEE Date: 10/21/08 Address: 5009 Oak Tree Drive Residence: Yes Business / Type Lf 4015 Evaluation Estimated Volume: Gal. Notes: —_—<—$< Ka ener eae A, Date: 10/21/08 Address: 1121 29th Street SW Residence: Yes Business / Type Z. 4015 Evatuation Estimated Volume: Gal, Notes: Date: 10/23/08 Address: 1814 49th Street SW Residence: Yes Business / Type / 4015 Evaluation Estimated Volume: Gal. Notes: Discharge Site: JC Drainfield or Other JC Drainfield Date of Discharge: _ 10/23/08 Time of Discharge 9AM Attach all Discharge and other receipts as required. Hauling Log WBM o:c/dixie/dixdocs DIXIE DRAINFIELDS, Inc. Septage Hauling Log Date: 10/23/08 Address: 1298 Winterberry Drive Residence: Yes Business / Type VA 4015 Evaluation Estimated Volume: Gal. Notes: ; ET i Date: 10/23/08 Address: 1031 Pettit Ct Residence: Yes Business / Type YA 4015 Evaluation Estimated Volume: Gal. Notes; ne rr Date: : Address: . Residence: Business / Type VA 4015 Evaluation Estimated Volume: Gal. Notes: A Date: Address: . Residence: Business / Type A 4015 Evaluation Estimated Volume: Gal. Notes: er Discharge Site: JC Drainfield or Other JC Drainfield Date of Discharge: _10/23/08 Time of Discharge 1:30 PM Attach all Discharge and other recelpts as required. Hauling Log WBM 64 o:c/dixie/dixdocs RECEIVED NOV 2.5 2008 STATE OF FLORIDA Environmental Health PERMIT # DEPARTMENT OF HEALTH Engineering BP 908 Glo ONSITE SEWAGE TREATHENT AND DISPOSAL SYSTEM EXISTING SYSTEM AND SYSTEM REPAIR EVALUATION apprrcanr: _Sorhegui Residence LAQE faa ham bra Cy cele East : CONTRACTOR / agent, Dixie Drainfields, Inc. suaprv: Naples Twin Lakes Part 1 Ip¥: 63453280003 LoT: 41 Biock: 11 SESE SSRI RRE RSME RARE SSE SSS SSeS ESSE SSeS TO BE COMPLETED BY FLORIDA REG. ARTMENT EMPLOYEE, SEPTIC TANK CONTRACTOR OR OTHER CERTIFIED PERSON. SIGN A DOCUMENTS. COMPLETE ALL APPLICABLE ITEMS. COMPLETE TANK CERTIFICATION BELOW OR ATTACH LETTER FROM A PERMITTED SEPTAGE DISPOSAL SERVICE. SeeaaeVon eames Sencemnesecsns sees eee ress = oe i — wow sceene cede reameseenomeoaas canoe REE eR eRe R ESR SSE BXISTING TANK INFORMATION : MATERIAL: Concrete BAFFLED: [(K / WN] t300 ] GALLONS SEPTIC TANK/GPD ATU LEGEND: None BAFFLED: [y / NR] I-——— ] GALLONS SEPTIC TANK/GPD ATU LEGEND: MATERIAL: C ] GALLONS GREASE INTERCEPTOR UEGEND; MATERIAL: . MATERIAL: # PUMPS: [ J is } SSeS CA RRMA R ASMA ARAN SRR SER OSING TANK LEGEND: Poa cwAe RES SRS RRS OVE NOTED TANKS WERE PUMPED oN 11/20/08, BAVE THE VOLUMES SPECIFIED, ARE AND HAVE A [ SOLIDS DEFLECTION DEVICE / X#ODDGOXKXMRRROCENAYM } INSTALL! gf ‘ Dixie Drainfieids, Inc, : SIGNATURE OF LT ED CONTRACTOR BUSINESS NAME DATE SESS SRE SSE REESE CO RESTA SER SSARAST ATTRA SS EXISTING DRAINFIELD INFORMATION {300 ] SQUARE FEET PRIMARY DRAINFIELD SYSTEM NO. OF TRENCHES [ 1 pimensrons: 15 x20 ___ SYSTEM NO. OF TRENCHES [ ] DIMENSIONS: x [ 1 SQUARE FEET TYPE OF SYSTEM: [ ] STANDARD [ ] FILLED [X] MOUND [ ] CONFIGURATION: [ 1] TRENCH EX] BED £1 DESIGN: {X ] BEADER { 1] p-Box {[X] GRAVITY SYSTEM [ ] DOSED SYSTEM INCHES [ XROVK / BELOW] ELEVATION OF BOTYOM.OF DRAINFIELD IN RELATION TO EXISTING GRADE 22 SYSTEN FAILURE AND REPAIR INFORMATION ROK WASTE [X] DOMESTIC [ J} COMMERCIAL METERED WATER [X] TABLE 1, 64H-6, FAC is ] SYSTEM INSTALLATION DATE £300 ] GPD ESTIMATED SEWAGE FLOW_E SITE [ ] DRAINAGE STRUCTURES ] PATIO / DECK [ ] PARKING © CONDITIONS: { ] SLOPING PROPERTY - td NATURE OF [ ] HYDRAULIC OVERLOAD [ ] sorns [X] MAINTENANCE [ ] SYSTEM DAMAGE FAILURE: { ] DRAINAGE / RUN OFF { ] RooTs { 1 WATER TABLE [ ] FAILURE {[ ] SEWAGE ON GROUND { ] TANR [ ] D BOX/HEADER { ] DRAINFIELD SYMPTOM: [X] PLUMBING BACKUP a) REMARKS/ADDITIONAL CRITERIA it TITLE/ LICENSE Pipl Z pare: [/7 UAB Page 4 of 4 SUBMITTED BY: DH 4015, 10/96 (Previous Editions may be used) COMPOSITE ATTACHMENT H DIXIE DRAINFIELDS, Inc. Septage Hauling Log Date: 41/18/08 Address: 1854 Woodbine Ct Residence: Yes Business / Type f 4015 Evaluation Estimated Volume: Gal. Notes: __ eel Date: 41/18/08 Address: 248 Dan River CT Residence: Yes Business / Type VA 4015 Evatuation Estimated Volume: Gal. Notes: a nc Date: 11/18/08 Address: 1854 Woodbine Ct Residence: Yes Business / Type VA 4015 Evaluation ‘Estimated Volume: Gal. Notes: a Date: 11/49/08 Address: 2641 44th Street SW Residence: Yes Business / Type / 4015 Evaluation Estimated Volume: Gal. Notes: . are A Discharge Site: JC Drainfield or Other Date of Discharge: Time of Discharge Attach all Discharge and other receipts as required. Hauling Log WBM 64 o:c/dixie/dixdocs DIXIE DRAINFIELDS, Inc. Septage Hauling Log Date: 41/21/08 Address: 1268 Balboa Ct Residence: Yes Business / Type f. 4015 Evaluation Estimated Volume: Gal. Notes: i i Date: 41/21/08 Address: 889 South Barfield Residence: Yes Business / Type VA 4015 Evaluation Estimated Volume: Gal. Notes: TT Pn Date: 11/21/08 Address: 395 Ridge Drive Residence: Yes Business /Type LZ 4015 Evaluation Estimated Volume: Gal. Notes: ra Date: 41/21/08 Address: 395 Ridge Drive Residence: Yes Business / Type ZL 4015 Evaluation Estimated Volume: Gal. Notes: en Discharge Site: JC Drainfield or Other JC Drainfield Date of Discharge: 11/21/08 Time of Discharge 4PM Attach all Discharge and other recelpts as required. Hauling Log WBM 64 oreldixle/dixdocs DIXIE DRAINFIELDS, Inc. Septage Hauling Log Date: 11/20/08 Address: 6 Derhenson Residence: Yes Business / Type VA 4015 Evaluation Estimated Volume: Gal. Notes: TL Date: 14/21/08 _ Address: 5406 27th Avenue SW Residence: Yes Business / Type f 4016 Evaluation Estimated Volume: Gal. Notes: fn TIE EEE Date: 11/21/08 Address: 5216 53rd Terrace SW Residence: Business / Type VA 4015 Evaluation Estimated Volume: Gal. Notes: a ee Date: Address: Residence: Business / Type VA 4015 Evaluation . Estimated Volume: Gal. Notes: $$$ i Discharge Site: JC Drainfield or Other JC Drainfield Date of Discharge: 11/21/08 Time of Discharge 9:30 AM Attach all Discharge and other receipts as required. Hauling Log WBM 64 o:cidixte/dixdocs STATE OF FLORIDA omar ¥ AP 405/28 DEPARTHENT OF HEALTH . zm TREATMENT SYSTEM SN eee MEYSOEM REPAIR EVALUATION RECEIVED DEC 1 § 2008 appircanr: _ Moore Residence alol ALS Tar. SL.) Envronmental Health Engineering Dixie Drainfields, Inc. CONTRACTOR / AGENT: rp#: 36240120002 not: 10 puock: 166 suspiy: Golden Gate Unit & ‘TO BE COMPLETED BY FLORIDA REGISTERED ENGINEER, DEPARTMENT EMPLOYEE, SEPTIC TANK CONTRACTOR OR OTHER CERTIFIED PERSON. SIGN AND SEAL ALL SUBMITTED DOCUMENTS. COMPLETE ALL APPLICABLE ITEMS. SEPTAGE DISPOSAL SERVICE. COMPLETE TANK CERTIFICATION BELOW OR ATTACH LETTER FROM A PERMITTED pooenoeces ana se ssn eRS Ss SS SSSSS Sele SRS PRREER EER RA ESS See SEES SATS SS RomescascotesesseS Sescomessecenesorenceee EXISTING TANK INFORMATION MATERIAL: Concrete BAFFLED; [K / #] tgo00 1 GALLONS SEPTIC TANK/GED ATU LEGEND; None oe BAFFLED: {¥ / Ni LEGEND: << MATERIAL: ——-—————— [—--- ] GALLONS SEPTIC TANK/GPD ATU [——~"-] GALLONS GREASE INTERCEPTOR LEGEND: ——————— Cs: MATERIAL? woreveree §«= MATERIAL? — # PUMPS: [—-——1 aa [—----] GALLONS DOSING TANK LEGEND: sondage DeOP SSCS RISER SMES RSS ASSES RASS SSS ET NOTED TANKS WERE PUMPED on 12 /12 /08, HAVE TRE VOLUMES SPECIFIED, ARE ] INSTALLED. - ) HAVE A [ SOLIDS DEFLECTION DEVICE / “ Dixie Drainfields, Inc. 12-15 -% DATE fused A ONTRACTOR BUSINESS NAME aumgucenaosas=aeepenees SRPSKA ROSS SASS SSE SASS Meee See esse Saecceseescsrsasesree oases EXISTING DRAINFIELD INFORMATION {375 ] SQUARE FEET PRIMARY DRAINFIRLD SYSTEM NO. OF TRENCHES [ ] DIMENSIONS: 15 x25 is ] SQUARE FEET SYSTEM NO. OF TRENCHES [ ] DIMENSIONS: x TYPE OF SYSTEM: [ ] STANDARD { 1 FILLED [X] MOUND [ ] CONFIGURATION: [ ] TRENCH [X] BED {to} DESIGN: LX ] HEADER { 1] D-Hox [XI GRAVITY sysTeM [ 1] DOSED SYSTEM STING GRADE 22 INCHES [ XBOX / BELOW] ELEVATION OF BOTTOM OF DRAINFIELD IN RELATION TO BAT. SYSTEM FAILURE AND REPAIR INFORMATION TYPE OF WASTE (X} DoMEsTIc = [ ] COMMERCIAL (1984 ] SYSTEM INSTALLATION DATE 1300 ] GPD ESTIMATED SEWAGE FLOW BASED ON [ ] METERED WATER [X] TABLE 1, 648-6, FAC SITE { ] DRAINAGE STRUCTURES 1X] Poon t ] PATIO / DECK [ ] PARKING CONDITIONS: [ ] SLOPING PROPERTY I] [X] MAINTENANCR [ ] SYSTEM DAMAGE NATURE OF [ ] HYDRAULIC OVERLOAD I ] sorns i } WATER TABLE [ J] _—___ FAILURE: c DRAINAGE / RUN OFF { ] Roots [ FAILURE { J] SEWAGE ON GROUND [ .] TANK { 1 D BOX/EEADER [ ] DRAINFLELD SYMPTOM: TX] PLUMBING BACKUP [1 REMARKS/ADDITIONAL CRITERIA TITLE/LICENSE ‘4 Ae DATE: liv IS: if iy Page 4 of 4 SUBMITTED: BY: DH 4015, 10/96 (Previow® Editions may be used} COMPOSITE ATTACHMENT I DIXIE DRAINFIELDS, Inc. Septage Hauling Log Date. 12/11/08 Address: 40 Weber Blvd North Residence: Yes Business / Type iA 40415 Evaluation Estimated Volume: Gal. Notes: Ne a Date: 42/11/08 Address: 112 Hickory Road Residence: Yes Business / Type vA 4015 Evaluation Gal. Estimated Volume: Notes: I ee Date: 12//1 1/08 Address; 140 West Street Residence: Yes Business / Type f. 4015 Evaluation Estimated Volume: Gal. Notes: Date: 42/12/08 Address: 720 23rd Street NW Residence: Yes Business / Type LZ. 4015 Evaluation _- Estimated Volume: Gal. Notes: a Discharge Site: JC Drainfield or Other JC Drainfield Date of Discharge: _12/12/08 Time of Discharge 9:30 AM Attach all Discharge and other rece/pts as required. Hauling Log WBM o:cidixie/dixdocs DIXIE DRAINFIELDS, Inc. Septage Hauling Log Date: 12/12/08 Address: 806 Caribbean Ct Residence: Yes Business / Type A 4015 Evaluation Estimated Volume: Gal. Notes: a SUS Date: 12/12/08 Address: 1559 South Barfield Residence: Yes Business / Type VA 4015 Evaluation Estimated Volume: Gal. Notes: i —_ nnn Date: 42/12/08 Address: 1929 Sunshine Blvd Residence: Yes Business / Type L 4015 Evaluation Estimated Volume: Gal. Notes: en Date: 42/12/08 Address; 321 20th Avenue NE Residence: Yes Business / Type YA 4015 Evaluation Estimated Volume: Gal, Notes: a Discharge Site: JC Drainfield or Other JC Drainfield Date of Discharge: _12/15/08 Time of Discharge 9 AM Attach all Discharge and other receipts as required. Hauling Log WBM 64 o:cidixie/dixdocs PERMIT # RP Golole 03 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM EXISTING SYSTEM AND SYSTEM REPAIR EVALUATION RECEIVED appricanr: Bruening Residence 34e1_\19% Av 29) AN 3 a Environmental Health CONTRACTOR / aGENT: Dixie Drainfields, Inc. — Lot: - —_ BLOC: sueprv: Golden Gate Estates Unit 27 qp#s 37983400004 eee ceeesrensconege sees een ree renee sce oe RON SS RESTA ER See EES SER SEAS SNES SS ERE Aaa TO BE COMPLETED BY FLORIDA REGISTERED ENGINEER, DEPARTMENT EMPLOYEE, SEPTIC TANK CONTRACTOR OR OTHER CERTIFIED PERSON. SIGN AND SEAL ALL SUBMITTED DOCUMENTS. COMPLETE ALL APPLICABLE ITEMS. COMPLETE TANK CERTIFICATION BELOW OR ATTACH LETTER FROM A PERMITTED SEPTAGE DISPOSAL SERVICE. Cea mee SONAR SSE SSS CRESS SSS EE Stes cece s SEARS Ree ROSE EXISTING TANK INFORMATION £900 1 GALLONS SEPTIC TANK/GPD ATU LEGEND: None MATERIAL: Concrete BAFFLED: (XK / N] [~~~ ] GALLONS SEPTIC TANK/GFD ATU LEGEND: MATERIAL: BAFFLED: [¥Y / N]} i [ ] GALLONS GREASH INTERCEPTOR LEGEND: MATERIAL? : ; - MATERIAL: ~ # puMPs: [-———~] i -] GALLONS DOSING TANK LEGEND: Bf PERO SEE ORS OE SESS RE SS EES SST Se SAMS SES SES EES > ABOVE NOTED TANKS WERE PUMPED oN 12 729/08, HAVE THE VOLUMES SPECIFIED, ARE i AND HAVE A [ SOLIDS DEFLECTION DEVICE RECOLOR COLA | INSTALLED. Dixie Drainfields, Inc. “3 ii | DATE i SIGNATURE OF ENSED CONTRACTOR BUSINESS NAME Sam sme eeecnoercer see ntactenn noes Rese Se SSE SORE See EERE RE PRES E CAREER SSRN AS SSS SSSR RSET BRISTING DRAINFIELD INFORMATION Dimensions: 15 x25 [37H ] SQUARE FEET PRIMARY DRAINFIELD SYSTEM NO. OF TRENCHES C ] x SYSTEM NO. OF TRENCHES [| ] DIMENSIONS: ] SQUARE. FERT TYPE OF SYSTEM: [ ] STANDARD [ ] Frzmeb (X] MouwD £ } CONFIGURATION: { J]. TRENCH (X%] BED [ I DESIGN: {X ] HEADER { 1 D-BOX [XJ] GRAVITY sysT=M [1 DOSED SYSTEM incuEs [ XROWNK / BELOW) ELEVATION OF BOTTOM OF DRAINFIRLD IN RELATION TO EXISTING GRADE 22 SYSTEM FAILURE AND REPAIR INFORMATION 11978 } SYSTEM INSTALLATION DATE TYPE OF WASTE [X] DOMESTIC [ ] COMMERCIAL | £300 ] GPD ESTIMATED SEWAGE FLOW BASED ON { }] METERED WATER [X] TABLE 1, 64E-6, FAC | SITE { ] DRAINAGE STRUCTURES [ ] POOL I ] PATIO / DECK { ] PARKING : ca _ CONDITIONS: [ ] SLOPING PROPERTY NATURE OF [{ ] HYDRAULIC OVERLOAD { ] sorus [X ] MAINTENANCE {[ ] SYSTEM DAMAGE FAILURE: [ ] DRAINAGE / RUN OFF £ J] RooTS { 1] WATER TABLE { J : i FAILURE {( ] SEWAGE ON GROUND [ ] TANK { ] D BOX/SEADER { J] DRAINFIELD i SYMPTOM: {X] PLUMBING BACKUP {] RENARKS/ADDITIONAL CRITERIA. ” i> SUBMITTED BY: fe TITLE/LICENSE | XM eh) DATE: 13-7 : DH 4015, 10/96 (Previous Editions may be used) Page 4 of 4 COMPOSITE ATTACHMENT J DIXIE DRAINFIELDS, Inc. Septage Hauling Log Date: 42/24/08 Address: 2415 47th Avenue NE Residence: Yes Business / Type VA 4015 Evaluation Estimated Volume: Gal. Notes: Ic i Date: 12/24/08 Address: 149 South Seas Ct. Residence: Yes Business / Type VA 4015 Evaluation Estimated Volume: Gal. Notes: Too i 41361 31st Street SW Date: 42/24/08 Address: Residence: Yes Business / Type / 4015 Evaluation Estimated Volume: Gal. Notes: i Date: 12/26/08 Address: 2260 23rd Street SW Residence: Yes Business / Type LZ. 4015 Evaluation Estimated Volume: Gal. Notes: en Discharge Site: JC Drainfield or Other a Date of Discharge: Time of Discharge . Attach all Discharge and other receipts as required. Hauling Log WEM 64 o:e/dixieldixdocs DIXIE DRAINFIELDS, Inc. Septage Hauling Log Date: 12/29/08 Address: 411 27th Street NW Residence: Yes Business / Type /. 4015 Evaluation Estimated Volume: Gal. Notes: aa nS Date: 12/29/08 Address: 3265 72nd Avenue NE Residence: Yes Business / Type A 4015 Evaluation Estimated Volume: Gal. Notes: ; a pn Date: 12/29/08 Address: 4835 20th Street NE Residence: Yes Business / Type YA 4015 Evaluation Estimated Volume: Gal. Notes: I Date: Address: Residence: Business / Type Lf 4015 Evaluation Estimated Volume: Gal. Notes: nn ee Discharge Site: JC Drainfield or Other JC Drainfield Date of Discharge: _12/29/08 Time of Discharge 2PM Attach all Discharge and other receipts as required. Hautlng Log WBM 64 o:cidixieldixdoes DIXIE DRAINFIELDS, Inc. Septage Hauling Log Date: 12/29/08 Address; 2910 8th Avenue SE Residence: Yes Business / Type Z. 4015 Evaluation Estimated Volume: Gal, Notes: I i Date: Address: Residence: Business / Type L 4015 Evaluation Estimated Volume: Gal. Notes: ES i Date: Address: Residence: Business / Type / 4015 Evaluation Estimated Volume: Gal. Notes: nee Date: Address: Residence: Business / Type lA 4015 Evaluation Estimated Volume: Gal. EE Notes: a Discharge Site: JC Drainfield or Other JC Drainfield Date of Discharge: _12/29/08 Time of Discharge 10 AM Attach all Discharge and other receipts as required. Hauling Log WBM 64 o:c/dixtefdixdocs DIXIE DRAINFIELDS, Inc. Septage Hauling Log Date: 12/29/08 Address; 506 Gordonia Residence: Yes Business / Type /. 4015 Evaluation Estimated Volume: Gal. Notes: aa nn Date: 12/29/08 Address: 1010 Dill Court Residence: Yes Business / Type A 4015 Evaluation Gal. Estimated Volume: Notes: aaa nnn Date: 12/29/08 Address: 3370 27th Avenue SW Residence: Yes Business / Type VA 4015 Evaluation Estimated Volume: Gal. Notes: eee Date: 42/29/08 Address: 2757 53rd Terrace SW Residence: Yes Business / Type L 4015 Evaluation Estimated Volume: Gal. Notes: a Discharge Site: JC Drainfield or Other JC Drainfield Date of Discharge: _12/30/08 Time of Discharge 9AM Attach all Discharge and other receipts as required. Hauling Log WBM 64 oreldixie/dixdocs DIXIE DRAINFIELDS, Inc. Septage Hauling Log Date: 12/30/08 Address: 379 Edgewater Ct Residence. Yes Business / Type A 4015 Evaluation Estimated Volume: Gal. Notes: a Date: 12/30/08 Address: 195 Rose Apple Lane Residence: Yes Business / Type VA 4015 Evaluation Estimated Volume: Gal. Notes: a nC Date: 12/30/08 Address: Naples Bay Club Residence: Business / Type Yes _/Restaurant 4015 Evaluation Estimated Volume: Gal. Notes: a Date: Address: Residence: Business / Type VA 4015 Evaluation Estimated Volume: Gal. Notes: i Discharge Site: JC Drainfield or Other JC Drainfield Date of Discharge: 12/30/08 Time of Discharge 2:30 PM Attach all Discharge and other receipts as required. Hauling Log WBM 64 o:c/dixte/dixdocs STATE OF FLORIDA DEPARTHENT OF HEALTH PERMIT # he GOB44g ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM EXISTING SYSTEM AND SYSTEM REPAIR EVALUATION RECEIVED JAN 2 1 2009 APPLICANT: Grant Residence Enviranmentat Health — ———_____ 2 Engineering 1 CONTRACTOR / acENnT: Dixie Drainfields, inc. 152 Hel | Ce. | q i - xpi 57927680006 Lot: 12 BLOCK: 387 suppiv: Marco Beach Unit 11 senace puauaeecoeensocsccnmmemenecosemesmentescesss Se eesumnneneesessonenscsss sess sees ees SSeeeee: TO BE COMPLETED BY FLORIDA REGISTERED ENGINEER, DEPARTMENT EMPLOYEE, SEPTIC TANK CONTRACTOR OR OTHER CERTIFIED PERSON. SIGN AND SEAL ALL SUBMITTED DOCUMENTS. COMPLETE ALL APPLICABLE ITEMS. COMPLETE TANK CERTIFICATION BELOW OR ATTACH LETTER FROM A PERMITTED SEPTAGE DISPOSAL SERVICE. Senne mses se Saas SSeS SSeS SSSSOSsS SS ees eee RS Re eS SSS SESS SSS SSE Sees SSS SSS EXISTING TANK INFORMATION MATERIAL: Concrete BAYFLED: [XK / N] MATERIAL: ——-- BAFFLED: [Y / N] MATERIAL: MATERIAL: ————-——-__ # PUMPS: IT J Go dg Gao nen Se Snocee dae eRe S RES eS ‘ABOVE NOTED TANKS WERE pumpeD on 7 /5 /08, HAVE THE weve shone ARE BND HAVE A [ SOLIDS DEFLECTION DEVICE /? ice 11050 ] GALLONS SEPTIC TANK/GPD ATU LEGEND: None [-—-— ] GALLONS SEPTIC TANK/GPD ATU LEGEND: ] GALLONS GREASE INTERCEPTOR ] GALLONS DOSING TANK ELEVATION OF BOTTOM OF DRAINFIELD IN RELATION TO EXISTING GRADE SYSTEM FAILURE AND REPAIR INFORMATION STRUI Dixie Drainfields, inc. SIGNATURE OF LICENSED CONTRACTOR BUSINESS NAME DATE . Segre rae See Oe Ree ee ee Re RR ee Se Seem MRE SES SEE ER ARSE SASS SSR ERSTE SEES SSS EXISTING DRAINFIELD INFORMATION C ] SQUARE FEET PRIMARY DRAINFIELD SYSTEM NO. OF TRENCHES [ | DIMENSIONS: _ xX ! c ] SQUARE FEET SYSTEM NO. OF TRENCHES [ ] DIMENSIONS: x | TYPE OF SYSTEM: | }S3ANDARD TT Piunep { ] MOUND [ 1] _———— i CONFIGURATION: [ ] TRENCH { ] BED ti i DESIGN: [ ] HEADER [ ] D-Box [ ] GRAVITY SYSTEM [ ] DOSED SYSTEM : / t INCHES [ ABOVE / BELOW] i | TYPE OF WASTE (X] DOMESTIC [ ] COMMERCIAL [ ] SYSTEM INSTALLATION DATE: : C ] GPD ESTIMATED SEWAGE FLOW BASED ON L ] MEYERED WATER [X] TABLE 1, 64E-6, FAC i SITE {[ 1] DRAXNAGE STRUCTURES. [ ] POOL [ ] PATIO / DECK [ J PARKING | CONDITIONS: [ ] SLOPING PROPERTY {-.] ] HYDRAULIC OVERLOAD { 1] SOILS [X] MAINTENANCE. { 1] SYSTEM DAMAGE NATURE. OF [ ] WATER TABLE [] FAILURE: { ] DRAINAGE / RUN OFF [ 1] Roors C FAILURE { ] SEWAGE ON GROUND [ ] TANK | [ ] D BOX/HEADER [ ] DRAINFIELD / SYNPTOM: [X] PLUMBING BACKUP [i - : REMARKS/ADDITIONAL CRITERIA, TITLE /LICENSE Die L- ___PATE: bE GF UF Page 4 of 4 SUBMITTED BY: DH 4015, 10/96 (Previous Editions may be used) COMPOSITE ATTACHMENT K “Estimated Volume: Gals DIXIE DRAINFIELDS, Inc. Septage Hauling Log Date: 4/2109 Address: 169 Richmond Ct Residence: Yes Business / Type VA 4015 Evaluation Estimated Volume: Gal. Notes: : TL Date: 1/5/09 Address: 2348 55th Terrace SW Residence: Yes Business / Type VA 4015 Evaluation Estimated Volume: Gal. Notes: A I Date: 41/5/09 Address; 5401 24th Avenue SW Residence: Yes Business / Type LZ. 4015 Evaluation Notes: Date: Address: Residence: Business / Type Z 4015 Evaluation Estimated Volume: Gal. Notes: Discharge Site: JC Drainfield or Other JC Drainfield Date of Discharge: _1/5/09 Time of Discharge 10:30 AM Attach all Discharge and other receipts as required. Hauling Log WBM 64 orcldixle/dixdoces DIXIE DRAINFIELDS, Inc. Septage Hauling Log Date: 1/5/08 Address: 1216 Cypress Woods Drive Residence: Yes Business / Type f 4015 Evaluation Estimated Volume: Gal. Notes: Date: 1/5/09 Address: 801 Laural Oak Drive Residence: Yes Business / Type lA 4015 Evaluation Estimated Volume: Gal. Notes: Date: 41/5/09 Address: 840 Lakeland Avenue Residence: Yes Business / Type VA 4015 Evaluation Estimated Volume: Gal. Notes: Date: 1/6/09 Address: 3401 11th Avenue SW Residence: Yes Business / Type f 4015 Evaluation Estimated Volume: Gal. Notes: Discharge Site: JC Drainfield or Other JC Drainfield Date of Discharge: _1/6/09 Time of Discharge 9AM Attach alf Discharge and other receipts as required. Hauling Log WBM 64 o:cldixie/dixdocs JeN-28-2003 19:@2 From: McQi RECEIVED STATE OF FLORIDA JAN 28 amy PERMIT # HP 10, i : be DEPARTMENT OF HEALTH Environmental Health i ONSITE SEWAGE TREATMENT AND pispoqmisipesiaas : ia EXISTING SYSTEM AND SYSTEM REPAIR EVALUATION apphicawr: Richards Residence’ AtOF ; 530/ Tove. Su) _ Conrracton / adarr: Dixla Drainfialds, Inc, oo. a LoT: 8 BLOCK; 207 susprv: Golden Gate Unit § Part 1 roe: 36374000001 0 TO BE COMPLETED HY FLORIDA REGISTERED ENGINEER, DEPARIMENT EMPLOYEE, SEPTIC TAMK CONTRACTOR OR . OTHER CERTIFIED PERSON. SIGN AND SEAL ALY, SUBMITTED DOCUMENTS. COMPLETE AL. APPLICABLE ITEMS. : COMPLETE TANK CHRTIFICATION BELOW OR ATTACH LETTER FROM A PERMITTED SEPTAGH DISPOSAL SERVICE, A a a A a EXISTING TANK INFORMATION (900 3 GALLONS SEPTIC TANK/GFD ATU LEGEND: None MATERTAL: Concrete BAFFLED: [(K / MI] . [~~ ] GALLONS SEPTIC TANE/GPD ATU LEGEND: MATERTAL: BAFFLED: (¥ / WJ [————"1] GALLONS GREASE INTERCEPTOR LEGEND: MATERIAL 1 = # PUMPS: [ J J GALLONG DOSING TANK LEGEND : ——— HATERIAL a A A SS Sig NOTED TANKS WERE rouMpep on 1/23/08, HAVE THE VOLUMES SPECIFIED, ARE i CERT IEY pa EL SEIOVE SOS. AND HAVE A [ SOLIDS DEFLECTION DEVICE /OORRWRGRROUOKYK ] PNBTALLED, Dixie Drainfields, Inc. bal — sugthESd MAME DATE CONTRACTOR BUSINESS MAKE LL A a a ae a a EXISTING DRAINFIELD INFORMATION i i (375 3} SQUARE FEET YEIMARY DRATNVIELD SYSTEM NO. OF TRENCHES { |] t } SQUARE FEET ..... SYSTEM RO. OF TRENCHES [ ] DIMENSIONS TZPE OF 6X8TEM; [ ] STANDARD [ ] FinmeD [X] MOUND [ 1] _. i CONFXGURATION: [ ] TRENCH {X%] BED ry rrr, | DESIGN: [X ] READER [ ]. D-BOox [X] GRAVITY sysTeM [ ] hosezD SYSTEM i ELEVATION OF HOTTOM OF DRAINFIZLD IW RELATION TO EX{STING GRADE 22 SYSTEN FATLUKE AND REPAIR INFORMATION £1990 ) SYSTEM INSTALLATION DATE TYRE OF WASTH = [X] DOKHSTIG [| J COMMERCTAL 1300 1 GPD ESTIMATED SEWAGE FLOW BASED ON { 1 METERED WATER {X] TABLE 1, 648-6, PAC ; SITs [ ] DRAINAGE STRUCTURES [ 1 P00L [ ] PATIO / DECK [ ] PARKING ; COMDITIONS: [| ] SLOPING PROPERTY to : a i NATORE OF [ ] HYDRAULIC OVERLOAD [ | sOrLs [X] MAINTENANCE [ ] GYSTEN DAMAGE PALTLORE: ( ) oeatmace / RUW OFF { ] Roors [ ] WATER TABLE C 2 : FAILURE [ ] SEWAGE ON GROUND { J TANK [ ] D ROS/HRADER [ } DRAINPIELD : SYEPTOM: [X] PLUMBING BACKUP ti REMARKS/ADDITIONAL CRITERIA en nrme/ircense___(Hvef— razz: _{* 2608 Page 4 of 4 ' DE 4015, 10/86 (Previous Editions may be used) COMPOSITE ATTACHMENT L DIXIE DRAINFIELDS, Inc. Septage Hauling Log Date: 4/22/08 Address: 3636 Everglades Boulevard Residence: Yes Business / Type YA 4015 Evaluation Estimated Volume: Gal. Notes: a Date: 1/22/08 Address: 630 31st Street SW Residence: Yes Business / Type vA 4015 Evaluation Estimated Volume: Gal. Notes: EEE etna eae Date: 4/22/08 Address: 2498 55th Street SW Residence: Yes Business / Type a : 4015 Evaluation Estimated Volume: Gal. Notes: Date: Address: Residence: Business / Type VA 4015 Evaluation Estimated Volume: Gal. Notes: Discharge Site: JC Drainfield or Other JC Drainfield Date of Discharge: _1/23/08 Time of Discharge 12:30 PM Attach all Discharge and other receipts as required. Hauling Log WBM 64 o:c/dixie/dixdocs DIXIE DRAINFIELDS, Inc. Septage Hauling Log Date: 1/23/09 Address; 1400GoodietteRoad Residence: Business/Type Yes /_DR, Office 4015 Evaluation Estimated Volume: Gal. Notes: _ __—_——__— SS cceaa a Date: 1/23/09 Address: 3550 17th Avenue SW Residence: Yes Business / Type f 4015 Evaluation Estimated Volume: Gal. Notes: no ee Date: 4/23/09 Address: 128 Shorecrest Residence: Yes Business / Type LZ. 4015 Evaluation Estimated Volume: Gal. Notes: a Date: 1/23/08 Address: 975 Caxambas Drive Residence: Yes Business / Type / 4015 Evaluation Estimated Volume: Gal. Notes: a Discharge Site: JC Drainfield or Other JC Drainfield Date of Discharge: 1/23/09 Time of Discharge 3:30 PM Attach all Discharge and other receipts as required. Hauling Log WBM 64 o:c/dixieldixdocs ,-@3-2889 14:19 From:Medi STATE OF FLORIDA FERMIT # AP $94.3) DEVARTHENT OF HEALTH Dearne SEPT ne Eee eee RECEIVE egg 03 018 Dh a A lk 2 ft TO BR COMPLETED BY FLORIDA REGISTERED ENGINEER, DEPARTMEWT FMPLOYER, SEPTIC TANK CONTRACTOR On OTHER CERTIFIED PERGOH. SIGH ARD BAL ALY BUBMITTED DOCUMENTS. COMPLETE ALL APPLICABLE TEKS. COMPLETE TANK CERTIFICATION BELOW OR ATTACH LETTER FROM A PERMITTED SEPTAGE DISFOUAL SERVICE. SA nm LEE SE hk MS fo al NIA DH EXISTING TANK INFORMATION [ (OSO 1 GALLONS SEPTIC TANK/GED ATU LEGEND: Ns warmrats (Yn. BAPY! y] ] GALLONS BEPTIG TANE/GPD ATU JAEGEND: MATERIALS BAFFLEDTTZ’ / Ny] : LEGEND I MATERIAL: # POMPSif J | ES eS eh ta ES SS 8 eps Thee HOTED ‘ants wuee ruuren on ?@. / | C1, SAVE THE VOLUMES SPECIFIED, azz HAVE A [ souIns agit 7 OUTLET PILERR DEVICE } THBPADLED, 5 a PE 8 A Sa Ma PO EXISTING DRAINVIELD INFORMATION if 1 SQUARE PRET PRIMARY DRATNVIELD SYSTEM WO. OF TRENCHES [ 1 PIMENSKONS: | x E 1] SQUARE FEET SYSTEM WO. OW TRENCHES [ 1] DYHSWETOMS: 0 XO TYPE OF SYSTEM: [ ]} STANDARD f } mom © J pe q td . eennneven DESIGN: t 1 SBADER Denoxk { J] GRAVETY ByaTam { ] ROSED sysTEM ELEVATION OF BOTTOM OF URRINFIELD IM RELATION TO EXISTING GRADY SYSTEM FAXLORG AND REPAIR ONFORWATION- { ] SYSTEM rMsTaLiarrom nary @¥PS OF WASTE [ ] DoMESTrC o£ 1] COMMEECIAL { J GPD ESTIMATED SEWAGE FLOW BASED ON { ] mererep WATER [ } TABLE 1, 642-6, Fac SIIE { 1 DRamnGs sTeucromes [ ] POOL {J parre / raex [ J PARKING Conpi7ions: [ ] SLOPING PROPERTY tI ] MAINTENANCE t 1 S¥STEM DAMAGE 1 WATER TABLE toi ce ee ee NATURE OF [ ] HYDRANLIC ovEeRtoOan C PAXLURB: [ ] DRATNAGE / RUM O¥Y i FAILURE I 1] SEWAGE ON GROURD [ SYMPTOM: { ] PLUMBING BACKUP [ TITLE/ LICENSE Oe DATE: z- of DH 40215, 10/96 (Previous Editions may be used) Page 4 of 4 : COMPOSITE ATTACHMENT M DIXIE DRAINFIELDS, Inc. Septage Hauling Log Date: 4/31/09 Address; 578 Coconut Avenue Residence: Yes Business / Type / 4015 Evaluation Estimated Volume: Gal. Notes: Ia a Date: 1/31/09 Address: 1527 Galleon Residence: Yes Business / Type vA 4015 Evaluation Gal. Estimated Volume: Notes: a a Date: 2/2/09 Address: 770 21st Street NW Residence: Yes Business / Type VA 4015 Evaluation Estimated Volume: Gal. : Notes: a Date: Address: Residence: Business / Type /. 4015 Evaluation Estimated Volume: Gal, Notes: ee Discharge Site: JC Drainfield or Other JC Drainfield Date of Discharge: _2/2/09 Time of Discharge 10:30 AM Attach all Discharge and other receipts as required. Hauling Log WBM 64 o:cidixie/dixdocs DIXIE DRAINFIELDS, Inc. Septage Hauling Log Date: 2/3/08 Address: 3448 Matanzas Road Residence: Yes Business / Type f 4015 Evaluation Estimated Volume: Gal. Notes: a TSS Date: Address: Residence: Business / Type ZL 4015 Evaiuation Estimated Volume: Gal. Notes: $$ $e a ee Date: Address: —______- Residence: Business / Type ZL 4015 Evaluation Estimated Volume: Gal. Notes: i Date: Address: Residence: Business / Type LZ. 4015 Evaluation Estimated Volume: Gal. . Notes: EE Discharge Site: JC Drainfield or Other JC Drainfield Date of Discharge: _2/3/09 Time of Discharge 3:30 PM Attach all Discharge and other receipts as required. Hauling Log WBM 64 o:c/dixieldixdocs DIXIE DRAINFIELDS, Inc. Septage Hauling Log Date: 2/3/09 Address: 5681 Dogwood Way Residence: Yes Business / Type VA 4015 Evaluation Estimated Volume: Gal. Notes: eterna Date: Address: Residence: Business / Type / 4015 Evaluation Estimated Volume: Gal. Notes: NN UU EE EEN nnn Date: Address: Residence: Business / Type L. 4015 Evaluation Estimated Volume: Gal. Notes: LE LS Date: Address: Residence: Business / Type Lo 4015 Evaluation Estimated Volume: Gal. Notes: a EAE Discharge Site: JC Drainfield or Other JC Drainfield Date of Discharge: _2/3/09 Time of Discharge 10 AM Attach all Discharge and other receipts as required. Hauling Log WBM o;cidixisidixdocs a ee ee he REC LELLELLEUC GCI « Friday Ab 0g 2-¥ °249 6 | Puen te/euillarme fie 16" hues 7 89-B ep | Sch Moore 324/ Desow Col § 9-9 Tank Boley Ohl Bod: Doll lesen ee 10-1130 SunTrust. So! Laurel Ak Or 116 -—Afo Wil£rgle Teaghas 4527 Dorgadg Pr ~%0-3 70 550 flared, CT $70 630 Aaloay GIS Laxambes Dr b fo - Z Nhenday 27 oF 7-7 58IYS 2 Humberto Sasceaz CUO Rast 740-20 Deas Kyle 7225 177° hee Sue 870-920 witky — Y9hl QU" sr ur Vo-/ EI? Sian fr WM -f¥0 F- K Nhe Laban Q~ lf -Z Prntado Y-SF | dal Ave NE 5-9 _ : uescley 21007 7-5 BME 14 | D Susan Marzucte 3057 UP tery Ww 970-990 Lhe Fell 5089 28° Win Fi0-b fe ey Villoge Falls $08? Famiami Tradl 1f-¥ bofizie Tp yy) OSANVS SIN Wedae selay Lif 07 7-J30 U-i%e Terry keel Sto 2 Srsu SEH Sim Kasff YUP 1a" Srpw $B )0-9 bothe Eyerlen WIS Lerrane be 9-7 sonra 7 oie: SB2PP 12. . Vilkge. Falls 3099 Tominy T> 11 -/ See Trufane Hel IS" hes /-A a Jester V2p Wwiloy Wd dP ta -Y . Ed lewis [20 fan (orto 6-870 - Doth FBS _ I hig! 7-130 Th ylsdley 24209 %7-Sie . SEV2F 72 yan = beofirey Bell 2960 18 87 8w 730-17 E pert Kes Ht Cor bIY0 hathsnake bammak 10-/f Vill é falls S079 Tamang I= VIO : Pricey 2 1307 7-4 5a92 12 “ Uitlege Feb Ge IR av Seey Borcre 1400 bette fol | /Naloney 198 Cara mbas Db /-270 A 125 eakes Bled 290 ~?70 | i> . Sunday Alser 6~830. “ Efe Tineo $0 pst $e qy/ fe. So madera CT FF Yag Boricher 6524 Tet) Phof YK VSSSSEEEEEELLELLEUE Arley Ab 0? 7-62 2ES9Y =e hey Tem Lhiistran TAS Nautites CT $39 -W2p fue boot bet Oyyfress how ay 129 -/ ME SH? Dosenalnasy /~2 ) : mgs Kr /9¢ Cul streamn ST 270 ~Y?0 Elbe nee YO 1ST orp 99-5 3p [aco 799 57h ST Sw SPo-kID Tuttdey 21709 2-9 | SHT2Z5 2/ brundes ° 2-3 | es Valonre Smith 599 wesrhrr ly 7-Y ab Sohasen 623 helm fee ~ 20-F9p Lar! Beondin Y77 § bachre bl Fi -b lowis Bonito WTI Galleon CT bep-—b p20 —Lalt 453 they gw b Je 740 Weenesdey 21809 9 ~£70 Sflee py Brmoades P—/? , Tim Chresman 125 Wout tut OF if te- 12p2 Sunser Ely Dég Edgewater C7 12 70-ol I np 2g laxemhes CT eH 2-9 Te W3I Morclersen CT PV Dew Bricher S70 Tl Bol Vb ~ Re. Thatsday Algey 9b SOSS@ 7g : Frensids 2-Y Lats Yop Scodene fof 74~¢ Frey Qo Fy , SBME 2 brnsadey 9-9 72 Mary fadgers 10? Seq Sung 970 ~lozp Sue Pol 2) Merkcian C7 1070. )/ Link 316 be Seectrell 7 — //~ 1230 Yous Y92E 297% Sue Armecdes BE 150-6 12f9~)Fo LIY Kapwore ff ea 2661 1b he NE 8-7 Sterley 22) 9h 7-5 7-2 Vittthy 22)07 9. van nad 0 - F0 ws kev weit 96 Copeland Lr F26-/29 bed-2 : Bohad DYE ha hivern oF W2b~ | 230 gil YP isthe gay CT j23p 1 fo Garming 3975 397 hee we S204 29 Tuesday 2207 2-Y Salle 18 hesse/ *Jucly 122 Deguevet Ur 790-2? Tames Groves ih) Tain nk tr Fe ~loilil ML27 Ato sy (1T- far (0-2 BS Late llo $221 Guilford cr 12-/ “AR INGS barry Wenten 1036 bollen Rel Ax 130 -B20 hediesolay AA OF 7-5 Brmorcles 2-5 Thareday 2 2607 7-5 Brnvncles QE - GIO Wi/lams 1900 Cutlea (7 8 ?7o-I/ee V Hors IM-/ fox YI he VE Shoal 3-5 Friday 2 2701 2-5 ark s Dap inprl2 YY 20 YW sr NE 19-1070 VWist_ Garolens 6295 techers fhnmack Rl 12-1222 . Soh Balto So, and AF Sir 1230 -/? 0 Gress P5b/ Isr fig Wee pp -2 1. V oats J~S Saterelay 22804 Feu5;//p 210 197 sp we FH DIXIE DRAINFIELDS, Inc. Septage Hauling Log Date: 2/6/09 Address: 310 16th Avenue SW Residence: Yes Business / Type Ae 4015 Evaluation Estimated Volume: Gal. Notes: Date: 2/6/09 Address: 3241 Desoto Blvd So. Residence: Yes Business / Type ZL 4015 Evaluation Estimated Volume: Gal. Notes: Date: Address: Residence: Business / Type le 4015 Evaluation Estimated Volume: Gal. Notes: Date: Address: Residence: Business / Type / 4015 Evaluation Estimated Volume: Gal. Notes: Discharge Site: JC Drainfield or Other JC Drainfield Date of Discharge: 2/6/09 Time of Discharge 9AM Attach all Discharge and other receipts as required. Hauling Log WBM 64 o:c/dixie/dixdocs ATTACHMENT O DIXIE DRAINFIELDS, Inc. Septage Hauling Log Date: 2/6/09 Address: 20460 Logan Avenue Residence: Yes Business / Type /. 4015 Evaluation Estimated Volume: Gal. Notes: Date: 2/6/09 Address: 801 Laurel Oak Drive Residence: Yes Business / Type A 4015 Evaluation Estimated Volume: Gal. Notes: Date: 2/6/09 Address: 4527 Dorando Drive Residence: Yes Business / Type / 4015 Evaluation Estimated Volume: Gal. Notes: Date: Address: Residence: Business / Type / 4015 Evaluation Estimated Volume: Gal. Notes: Discharge Site: JC Drainfield or Other JC Drainfield Date of Discharge: _2/6/09 Time of Discharge 3:30 PM Attach all Discharge and other receipts as required. Hauling Log WBM 64 o:c/dixie/dixdocs DIXIE DRAINFIELDS, Inc. Septage Hauling Log Date: 2-9-09 Address: 640 3rd Street NW Residence: Yes Business / Type / 4015 Evaluation Estimated Volume: Gal. Notes: Date: 2/9/09 : Address: 3325 13th Avenue SW Residence: Yes Business / Type YA 4015 Evaluation Estimated Volume: Gal, Notes: Date: 2/9/09 Address: 4961 21st Street SW Residence: Yes Business / Type A 4015 Evaluation Estimated Volume: Gal. Notes: Date: Address: Residence: Business / Type VA 4015 Evaluation Estimated Volume: Gal. Notes: Discharge Site: JC Drainfield or Other JC Drainfield Date of Discharge: 2/9/09 Time of Discharge 2PM Attach all Discharge and other receipts as required. Hauling Log WBM 64 o:cidixle/dixdocs DIXIE DRAINFIELDS, Inc. Septage Hauling Log Date: 2/10/09 Address: 3053 41st Terrace Residence: Yes Business / Type YA 4015 Evaluation Estimated Volume: Gal. Notes: Date: 5289 28th Place Sw Address: Residence: Business / Type YA 4015 Evaluation Estimated Volume: Gal. Notes: Date: Address: Residence: Business / Type YA 4015 Evaluation Estimated Volume: Gal. Notes: Date: Address: Residence: Business / Type J 4015 Evaluation Estimated Volume: Gal. Notes: Discharge Site: JC Drainfield or Other JC Drainfield Date of Discharge: 2/10/09 Time of Discharge 10 AM Attach all Discharge and other receipts as required. Hauling Log WBM 64 o:c/dixie/dixdocs DIXIE DRAINFIELDS, Inc. Septage Hauling Log Date: 2/11/09 Address: 510 29th Street SW Residence: Yes Business / Type J 4015 Evaluation Estimated Volume: Gal, Notes: Date: 2/14/09 Address: 410 19th Street NW Residence: Yes Business / Type YA 4015 Evaluation Estimated Voiume: Gal. Notes: Date: 2/11/09 Address: 4215 Lorraine Avenue Residence: Yes Business / Type VA 4015 Evaluation Estimated Volume: Gal. Date: Address: Residence: Business / Type J 4015 Evaluation Estimated Volume: Gal. Notes: Discharge Site: JC Drainfield or Other JC Drainfield Date of Discharge: 2/11/09 Time of Discharge 9:30 AM Attach all Discharge and other receipts as required. Hauling Log WBM 64 o:cidixie/dixdocs DIXIE DRAINFIELDS, Inc. Septage Hauling Log Date: 2/11/09 Address: 5401 25th Avenue SW Residence: Yes Business / Type VA ~ 4015 Evaluation Estimated Volume: Gal. . Notes: Date: 2/41/09 Address: 4220 Wilson Blvd North Residence: Yes Business / Type YA 4015 Evaluation Estimated Volume: Gal. Notes: Date: 2/11/09 Address: 1130 San Marco Rd Residence: Yes Business / Type YA 4015 Evaluation Estimated Volume: Gal. Notes: Date: 2/11/09 Address: 3895 31st Avenue SW Residence: Yes Business / Type / 4015 Evaluation Estimated Volume: Gal. Notes: Discharge Site: JC Drainfield or Other JC Drainfield Date of Discharge: 2/12/09 Time of Discharge 8AM Attach all Discharge and other receipts as required. : Hauling Log WBM 64 o:c/dixie/dixdocs DIXIE DRAINFIELDS, Inc. Septage Hauling Log Date: 2/16/09 Address: 1400 Goodlette Road Residence: Yes Business / Type fo 4015 Evaluation Estimated Volume: Gal. Notes: Date: 2/13/09 Address: 975 Caxambas Drive Residence: Yes Business / Type lA 4015 Evaluation Estimated Volume: Gal. Notes: Date: 2/13/09 Address: 1325 Oaks Blvd Residence: Yes Business / Type VA 4015 Evaluation Estimated Volume: Gal. Notes: Date: 2/5/09 Address: 480 15th Street NW Residence: Yes Business / Type YA 4015 Evaluation Estimated Volume: Gal. Notes: Discharge Site: JC Drainfield or Other JC Drainfield Date of Discharge: 2/16/09 Time of Discharge 8:30 AM Attach all Discharge and other receipts as required. Hauting Log WBM 64 o:c/dixie/dixdocs DIXIE DRAINFIELDS, Inc. Septage Hauling Log Date: 2/16/09 Address: 725 Nautilus Ct Residence: Yes Business / Type / 4015 Evaluation Estimated Volume: Gal. Notes: Date: 2/16/09 Address: 6000 Cypress Hollow Way Residence: Yes Business / Type YA - 4015 Evaluation Estimated Volume: Gal. Notes: Date: 2/16/09 Address: 5710 Dogwood Way Residence: Yes Business / Type / 4015 Evaluation Estimated Volume: Gal. Notes: Date: Address: Residence: Business / Type A 4015 Evaluation Estimated Volume: Gal. Notes: Discharge Site: JC Drainfield or Other JC Drainfield Date of Discharge: 2/16/09 Time of Discharge 2:PM Attach all Discharge and other receipts as required. Hauling Log WBM 64 o:c/dixie/dixdocs DIXIE DRAINFIELDS, Inc. Septage Hauling Log Date: 2/16/09 Address: 189 Gulfstream Street Residence: Yes Business / Type YA 4015 Evaluation Estimated Volume: Gal. Notes: Date: 2/16/09 Address: 480 15th Street NW Residence: Yes Business / Type VA 4015 Evaluation Estimated Volume: Gal. Notes: Date: 2/16/09 Address: 790 5th Street SW Residence: Yes Business / Type VA 4015 Evaluation Estimated Volume: Gal. Notes: Date: Address: Residence: Business / Type fo 4015 Evaluation Estimated Volume: Gal. Notes: Discharge Site: JC Drainfield or Other JC Drainfield Date of Discharge: 2/16/09 Time of Discharge 6:30 PM Attach all Discharge and other receipts as required. Hauling Log WBM 64 o:c/dixie/dixdocs DIXIE DRAINFIELDS, Inc. Septage Hauling Log Date: 2/16/09 Address: Armondos Immokalee Road Residence: Business/Type Yes /_ Strip Mall 4015 Evaluation Estimated Volume: Gal. Notes: Date: Address: Residence: Business / Type Lf 4015 Evaluation Estimated Volume: Gal. Notes: Date: Address: Residence: Business / Type YA 4015 Evaluation Estimated Volume: Gal. Notes: Date: Address: Residence: Business / Type VA 4015 Evaluation Estimated Volume: Gal. Notes: Discharge Site: JC Drainfield or Other JC Drainfield Date of Discharge: 2/16/09 Time of Discharge 11 AM Attach all Discharge and other receipts as required. Hauling Log WBM 64 o:e/dixie/dixdocs DIXIE DRAINFIELDS, Inc. Septage Hauling Log Date: 2/16/09 Address: Armondos Residence: Business / Type Yes /_Strip Mall 4015 Evaluation Estimated Volume: Gal. Notes: Date: Address: Residence: Business / Type / 4015 Evaluation Estimated Volume: Gal. Notes: Date: Address: Residence: Business / Type / 4015 Evaluation Estimated Volume: Gal. Notes: Date: Address: Residence: Business / Type f 4015 Evaluation Estimated Volume: Gal. Notes: Discharge Site: JC Drainfield or Other JC Drainfield Date of Discharge: 2/16/09 Time of Discharge 1:30 PM Attach all Discharge and other receipts as required. Hauling Log WBM 84 o:c/dixle/dixdocs DIXIE DRAINFIELDS, Inc. Septage Hauling Log Date: 2/16/09 Address: 189 Gulfstream Street Residence: Yes Business / Type fo 4015 Evaluation Estimated Volume: Gal. Notes: Date: 2/16/09 Address: 480 15th Street NW Residence: Yes Business / Type VA 4075 Evaluation Estimated Volume: Gal. Notes: Date: 2/16/09 Address: 790 5th Street SW Residence: Yes Business / Type / 4015 Evaluation Estimated Volume: Gal. Notes: Date: 2/17/09 Address: 5740 Westport Lane Residence: Yes Business / Type / 4015 Evaluation Estimated Volume: Gal. Notes: Discharge Site: JC Drainfield or Other JC Drainfield Date of Discharge: 2/16/09 Time of Discharge 6:30 PM Attach all Discharge and other receipts as required. Hauling Log WBM 64 o:c/dixie/dixdocs DIXIE DRAINFIELDS, Inc. Septage Hauling Log Date: 2/18/09 Address: Armondos Residence: Business / Type Yes / Strip Mall 4015 Evaluation Estimated Volume: Gal. Notes: Date: Address: Residence: Business / Type / 4015 Evaluation Estimated Volume: Gal. Notes: Date: Address: Residence: Business / Type YA 4015 Evaluation Estimated Volume: Gal. Notes: Date: Address: Residence: Business / Type / 4015 Evaiuation Estimated Volume: Gal. Notes: Discharge Site: JC Drainfield or Other JC Drainfield Date of Discharge: 2/18/09 Time of Discharge 10 AM Attach all Discharge and other receipts as required. Hauling Log WBM 84 o:c/dixie/dixdocs DIXIE DRAINFIELDS, Inc. Septage Hauling Log Date: 2-20-09 Address: Armondos Residence: Business/Type Yes Z_Strip Mall 4015 Evaluation Estimated Volume: Gal. Notes: Date: Address: Residence: Business / Type A 4015 Evaluation Estimated Volume: Gal. Notes: Date: Address: Residence: Business / Type A 4015 Evaluation Estimated Volume: Gal. Notes: Date: Address: Residence: Business / Type Z 4015 Evaluation Estimated Volume: Gal. Notes: Discharge Site: JC Drainfield or Other JC Drainfietd Date of Discharge: 2/20/09 Time of Discharge 6PM Attach all Discharge and other receipts as required. Hauling Log WBM 64 o:c/dixie/dixdocs DIXIE DRAINFIELDS, Inc. Septage Hauling Log Date: 2/21/09 Address: Armondos Residence: Business/Type Yes /_ Strip Mall 4015 Evaluation Estimated Volume: Gal. Notes: SG Date: Address: Residence: Business / Type A 4015 Evaluation Estimated Volume: Gal. Notes: i Date: Address: Residence: Business / Type YA 4015 Evaluation Estimated Volume: Gal. Notes: Sh Date: Address: Residence: Business / Type YA ; 4015 Evaluation Estimated Volume: Gal. Notes: eee —_———————— Discharge Site: JC Drainfield or Other JC Drainfield Date of Discharge: 2/21/09 Time of Discharge 4PM Attach ail Discharge and other receipts as required. Hauling Log WBM 64 o:cidixle/dixdocs DIXIE DRAINFIELDS, Inc. Septage Hauling Log Date: 2/22/09 Address: Armondos Residence: Business / Type Yes / Strip Mall 4015 Evaluation Estimated Voiume: Gal. Notes: Date: Address: Residence: Business / Type VA 4015 Evaluation Estimated Volume: Gal. Notes: Date: Address: Residence: Business / Type fo 4015 Evaluation Estimated Volume: Gal. Notes: Date: Address: Residence: Business / Type YA 4015 Evaluation Estimated Volume: Gal. Notes: Discharge Site: JC Drainfield or Other JC Drainfield Date of Discharge: 2/22/09 Time of Discharge 10AM Attach all Discharge and other receipts as required. Hauling Log WBM 64 o:c/dixie/dixdocs DIXIE DRAINFIELDS, Inc. Septage Hauling Log Date: 2/23/09 Address: Armondos Residence: Business / Type Yes / Strip Mall 4015 Evaluation Estimated Volume: Gal. Notes: a Date: Address: Residence: Business / Type YA 4015 Evaluation Estimated Volume: Gal. Notes: KL Date: Address: Residence: Business / Type Lo 4015 Evaluation Estimated Volume: Gal. Notes: pe Date: Address: Residence: Business / Type fo 4015 Evaluation Estimated Volume: Gal. Notes: re Discharge Site: JC Drainfietd or Other JC Drainfield Date of Discharge: 2/23/09 Time of Discharge 8:30 AM Attach ail Discharge and other receipts as required. Hauling Log WBM 84 o:c/dixle/dixdocs DIXIE DRAINFIELDS, Inc. Septage Hauling Log Date: 2/23/09 Address: 3735 37th Avenue NE Residence: Yes Business / Type / 4015 Evaluation Estimated Volume: Gal, Notes: ee Date: 2/24/09 Address: 1722 Dogwood Drive Residence: Yes Business / Type YA 4015 Evaluation Estimated Volume: Gal. Notes: eee ec Date: 2/24/09 Address: 1161 Twin Oak Court Residence: Yes Business / Type / 4015 Evaluation Estimated Volume: Gal. Notes: ee Date: Address: Residence: Business / Type YA 4015 Evatuation Estimated Volume: Gal. Notes: eee ne Discharge Site: JC Drainfield or Other JC Drainfield Date of Discharge: 2/24/09 Time of Discharge 10 AM Attach all Discharge and other receipts as required. Hauling Log WBM 64 o:c/dixie/dixdocs DIXIE DRAINFIELDS, Inc. Septage Hauling Log Date: 2/24/09 Address: 3321 Guilford Ct Residence: Yes Business / Type / 4015 Evaluation Estimated Volume: Gal. Notes: See Date: 2/24/09 Address: 1036 Goldenrod Avenue Residence: Yes Business / Type YA 4015 Evaluation Estimated Volume: Gal. Notes: - SS Date: 2/27/09 Address: 4420 40th Street NE Residence: Yes Business / Type YA 4015 Evaluation Estimated Volume: Gal. Notes: —————— Date: Address: Residence: Business / Type VA 4015 Evaluation Estimated Volume: Gal. Notes: SS St Discharge Site: JC Drainfield or Other JC Drainfield Date of Discharge: 2/27/09 Time of Discharge 10:30 AM Attach all Discharge and other receipts as required. Hauling Log WBM 64 o:c/dixie/dixdocs DIXIE DRAINFIELDS, Inc. Septage Hauling Log Date: 2/27/09 Address: 3071 42nd Street SW Residence: Yes Business / Type YA 4015 Evaluation Estimated Volume: Gal. Notes: Date: 2127109 Address: 3561 1st Avenue NW Residence: Yes Business / Type A 4015 Evaluation Estimated Volume: Gal. Notes: Date: 2/28/09 Address: 270 14th Street NE Residence: Yes Business / Type fo 4015 Evaluation Estimated Volume: Gai. Notes: Date: Address: Residence: Business / Type YA 4015 Evaluation Estimated Volume: Gal. Notes: Discharge Site: JC Drainfield or Other JC Drainfield Date of Discharge: 3/1/09 . Time of Discharge 2:30 PM Attach all Discharge and other receipts as required. Hauling Log WBM 64 ; ore/dixie/dixdocs a PRES IN THE CIRCUIT COURT OF THE TWENTIETH JUDICIAL CIRCUIT IN AND FOR COLLIER COUNTY, FLORIDA STATE OF FLORIDA DEPARTMENT OF ENVIRONMENTAL REGULATION, Plaintiff, vs. TIMOTHY BEEBE and AMERICAN . SANITATION & REPAIR, INC., CASE NO. 93-00959-CA Defendants. This cause came on to be heard on November . 1994, upon the Plaintiff’s Motion for Contempt dated Ap acting pro se. = sie B - 3 8 vy ad The Defendants were represented by. Timothy Beebe Having considered the evidence at hearing and 1. being otherwise fully advised in the premises, this Court makes the following findings: On May 12, 1992, the parties entered a Consent Order to resolve violations for the illegal dumping of 2. septage sludge into a private utility’s wastewater collection Order, and the Plaintiff filed the present action. On April system. The Defendants failed to comply with the Consent 24, 1993, the parties Stipulation and Consent Final Judgment. entered a The required the Defendants to submit a training manual and Judgment operations protocol by May 24, 1993, to ensure compliance with environsental requirements for septic sludge disposal. The Judgment also required the payment of $5,000.00 in civil ATTACHMENT P penalties, the first of two installments of which was due on June 8, 1993. 3. The Defendants have failed to pay any civil penalties required by the Judgment. 4. On October 21, 1993, the Defendants’ employees were again caught illegally dumping septage sludge into a collection systen. Collier County Utilities Department ‘suffered $2,417.25 in expenses for fixing and cleaning wastewater lines and a lift station, and in investigating the dumping. At hearing, Defendant Tim Beebe stipulated to the awarding of such costs to the County. 5. The Defendants have not engaged in the septage or Sludge hauling business since February of 1994 when their license was revoked by the Department of Health and Rehabilitative Services. Defendant Tim Beebe represented to the Court at hearing that the Defendants will no longer engage in such business. ; ; 6. At hearing, Defendant Tim Beebe represented to the Court that he had the ability to pay $100.00 per month toward satisfaction of the $5,000.00 in civil penalties. WHEREFORE, it is ORDERED, ADJUDGED, AND DECREED that A. The Defendants are in indirect civil contempt of this Court’s authority for their disregard of the Consent Final Judgment. ; B. Defendant Tim Beébe shall be incarcerated in the Collier County Jail for up to 180 days, unless he purges: his contempt by paying $100.00 per month to the Plaintiff on the 20th of each month beginning December 20, 1994, until the $5,000.00 in civil penalties is paid in-full. This Court may increase. _ oF decrease the . monthly... payment amount upon : denonstration of ‘a "chang th Defendant “Beebe’s financial condition . c. ._ Expens es of $2, 417.25 shall ba: vawarded to Collier county ‘Utilities Department and against the Defendants, for ° which’ let execution Aasue. Deo ‘The - Defendants shall> no tonger engage in the septage or sludge hauling business. - a “> EX The Dézendants shall keep this Court and the ..:Plaintiff£’s counsel informed of any change in the Defendants’ “ current mailing’ Paddress of Post oftice Box 8232, Naples, Florida 33964. . DONE AND ORDERED in Chambers on this [Z— day of DEC, 1994, TED H. BROUSSEAU Circuit Court Judge Clerk of Courts in and for Collier County, he tal above instrumentisatrueand Z hereb: ext donor certify thatthe true con oof tae fore bE: So copy of re orga which cn le in my office inthe was furnished by U. 5. vail courthouse in Naples, Collier County, aA = ee 136 te winexsucemynarcenssatie re L Lik mea David C. Schwartz, Esq. Dwight E. Timothy Beebe Deputy Clerk By: pry vie CLERK / JUDICIAL ASSISTANT / SECRETARY

Docket for Case No: 09-003973PL

Issue Date	Proceedings
Sep. 22, 2009	Order Closing Files. CASE CLOSED.
Sep. 21, 2009	Motion to Relinquish Jurisdiction filed.
Sep. 18, 2009	Notice of Cancellation of Taking Deposition filed.
Sep. 08, 2009	Beebe's Response to Amended Motion to Compel Answers to Request for Admissions filed.
Sep. 02, 2009	Petitioner's Notice of Filing Affidavit of Service of Subpoena Duces Tecum filed.
Sep. 01, 2009	Notice of Taking Deposition filed.
Sep. 01, 2009	Amended Motion to Compel Answers to Request for Admissions filed.
Aug. 31, 2009	Beebe's Answers to Interrogatories filed.
Aug. 31, 2009	Notice of Filing Beebe's Answers to Interrogatories filed.
Aug. 31, 2009	Beebe's August 31, 2009 Response to Department's Request to Produce filed.
Aug. 26, 2009	Order Granting Motion for Protective Order.
Aug. 21, 2009	Respondent's Request for Copies filed.
Aug. 19, 2009	The Department of Health's Notice Pursuant to Section 120.57(1)(d) Florida Statutes filed.
Aug. 19, 2009	Petitioner's Supplemental Response to Respondent's Motion for Extension of Time and Motion for a Protective Order filed.
Aug. 18, 2009	Notice of Filing Affidavit of Service of Subpoena Duces Tecum (J.C. Drainfield) filed.
Aug. 18, 2009	Notice of Filing Affidavit of Service of Subpoena Duces Tecum (E&F Septic) filed.
Aug. 17, 2009	Motion to Compel Answers to Request For Admissions filed.
Aug. 17, 2009	Notice of Filing Respondent's Request for Production from Petitioner filed.
Aug. 17, 2009	Stipulated Statement of Facts Regarding Timothy M. Beebe's Request for Protective Order filed.
Aug. 14, 2009	Order of Consolidation (DOAH Case Nos. 09-3973PL and 09-4283).
Aug. 12, 2009	Petitioner's Notice of Production from Non-party filed.
Aug. 12, 2009	Respondent, Timothy M. Beebe's First Production of Documents filed.
Aug. 11, 2009	Order on Motion for Extension of Time and Protective Order.
Aug. 11, 2009	Petitioner's Response to the Respondents Request for Production of Documents filed.
Aug. 11, 2009	CASE STATUS: Motion Hearing Held.
Aug. 06, 2009	Order of Pre-hearing Instructions.
Aug. 06, 2009	Notice of Hearing (hearing set for October 1 and 2, 2009; 9:00 a.m.; Naples, FL).
Aug. 04, 2009	Petitioner's Response Memorandum to Respondent's Request for a Protective Order filed.
Aug. 04, 2009	Respondent's Request for Copies (to J.C. Drainfield) filed.
Aug. 04, 2009	Respondent's Request for Copies (to E&F Septic Tank, Inc.) filed.
Aug. 04, 2009	Respondent, Timothy M. Beebe's, Memorandum of Law in Support of Motion for Protective Order filed.
Aug. 03, 2009	Respondent, Timothy M. Beebe's, Compliance with Initial Order filed.
Jul. 30, 2009	Joint Response to Initial Order filed.
Jul. 30, 2009	Petitioner's Notice of Filing Petitioner's Request for Admissions filed.
Jul. 30, 2009	Petitioner's Notice of Filing Petitioner's Request for Production of Documents filed.
Jul. 30, 2009	Petitioner's Certificate of Serving Interrogatories filed.
Jul. 28, 2009	Petitioner's Notice of Production from Non-party (J. Craft) filed.
Jul. 28, 2009	Petitioner's Notice of Production from Non-party (E&F Septic Tank Inc.) filed.
Jul. 28, 2009	Petitioner's Response to Respondent's Motion for Extension of Time and Motion for a Protective Order filed.
Jul. 27, 2009	Respondent's Response to Request for Admissions filed.
Jul. 27, 2009	Motion for Extension of Time and Protective Order With Regard to Petitioner's Request for Production of Documents filed.
Jul. 27, 2009	Initial Order.
Jul. 27, 2009	Administrative Complaint filed.
Jul. 27, 2009	Request for Administrative Hearing and Response to the Administrative Complaint filed.
Jul. 27, 2009	Notice (of Agency referral) filed.