Shalom 2000 AdditionMEMORANDUM
DATE:
TO:
FROM:
RE:
April 6, 2001
Maureen Kenyon, Supervisor, Clerk to Board
Shirley Nix, Engineering Technician IIt~
Project Plan Review
Shalom 2000 Addition
Water and/or Sewer Facilities Acceptance
· ~'~ , 200~The Board of County Commissioners
granted final acceptance of The water and/or sewer facilities
within the above-referenced project.
Attached, please find the following recorded documents, in order:
1. Utility Easement
2. Utilities Facilities Warranty Deed & Bill of Sale
Also, please find attached the following documents for your
files.
o
o
10.
11.
Owner's Affidavit
Attorney's Affidavit
Copy of preliminary approval letter from Engineering
Review
Copy of cashier's check & receipt for maintenance bond
Engineer's final payment confirmation
Certification of pressure testing of water lines by
Engineer of Record
Bacteriological clearances (DER certification) for
water facilities
Contractor's Final Release of Lien
Lab results on bacteriological test for water lines
Memorandum to Maureen Kenyon, Supervisor, Clerk to Board
April 6, 2001
Page Two
12.
Verification of final cost (Detailed: quantities,
sizes, unit cost, total cost, etc.)
13.
Letter by Engineer certifying that all water and/or
sewer facilities are located within the public
right-of-way or dedicated easements
14.
Contractual Guarantee for material and workmanship for
a period of at least one year after the Board of County
Commissioners' acceptance for both water and sewer
facilities
15.
Payment of water usage, laboratory and administrative
charges for filling, flushing and bacteriologically
certifying water lines from invoice prepared by the
Utilities Division
16. Copy of backflow prevention assembly test report
17.
Letter from Compliance Services section certifying that
the final inspection reveals that the Utility
facilities have been constructed in accordance with
County ordinances and regulations
18. One copy of utility easement
If you have any questions, please call and advise accordingly.
attachments
doc:2094-2
Dwight E. Brock
Clerk
County of Collier
CLERK OF THE CIRCUIT COURT
COLLIER COUNTY COURTHOUSE
3301 TAMIAMI TRAIL EAST
P.O. BOX 4413044
NAPLES, FLORIDA 34101-3044
ORIGINAL
OFFICIAL RECEIPT
When Validated
BY: DALE
DEPUTY CLERK
RECEIPT: 3404071
NAME :
PAYOR:
REFNC:
ENGINEERING REVIEW/ S NI
BCC 113 138312 63 649030
DC: 2 DOCUMENTS
DOC TYP FILE ID BOOK PAGE
ESMT 2772180 2799 3340
DEED 2772181 2799 3342
DESCRIPTION
RECORDING OF LEGAL INSTRUMENT
P.R.M.T.F. RECORDING FEE
INDEXING
DOCUMENTARY STAMPS - 70
DOCUMENTARY STAMPS - 35
INTANGIBLE TAX SALES
COPIES
MISCELLANEOUS FEES
INTANGIBLE PENALTY
INTANGIBLE INTEREST
RECORDING DEPOSITS
REFUNDS
AMOUNT
18.00
3.00
1.40
DEPT: RECORDING
TOTAL DUE:
22 .40
Page 01 of 01
2772180 OR: 2799 PG: 3340
R~CORDED in OFFICIAL RECORDS of COLLHR COUNTY, FL
04/03/2001 at 08:251M DWIGHT E. BROCK, CLRRK
R~C F~ 10,50
Retn: D0C-.?0 .?0
UTILITY EASEMENT
THIS EASEMENT, granted this'~'"~ay of ~ , 2000, by TEMPLE
SHALOM, INC., a Florida not-for-Profit corporation as Grantor, to the BOARD OF COUNTY
COMMISSIONERS OF COLLIER COUNTY, FLORIDA, AS THE GOVERNING BODY OF COLLIER
COUNTY AND AS EX-OFFICIO THE GOVERNING BOARD OF THE COLLIER COUNTY
WATER-SEWER DISTRICT, its successors and assigns, as Grantee.
WITNESSETH: That the Grantor for and in consideration of the sum of ten dollars ($10.00) and other
valuable consideration paid by the Grantee, receipt of which is hereby acknowledged, hereby conveys, grants,
bargains and sells unto the Grantee, its successors and assigns, a perpetual, non-exclusive easement, license, and
privilege to enter upon and to install and maintain utility facilities, in, on, over and under the following
described lands being located in Collier County, Florida, to wit:
See attached Exhibit "A," which is incorporated herein by reference.
TO HAVE AND TO HOLD the same unto the Grantee and its assigns, together with the right to enter
upon said land, excavate, and take materials for the purpose of constructing, operating, and maintaining utility
facilities thereon. Grantor and Grantee are used for singular or plural, as the context requires.
IN WITNESS WHEREOF, the Grantor has caused these presents to be executed the date and year first
Withe s s/# 1' 'S/gnature
Wtftness #2 Signature
[,James H. Perman
Witness #2 Name
STATE OF FLORiDA
COUNTY OF COLLIER
GRANTOR:
TEMPLE SHALOM, a Florida not-for-profit
corporation
e Mans' 'r
Its: President
The foregoing Utility Easement was acknowledged before me this '~'~/~ay of 0~, ,
2000 by Connie Mansfield, President of TEMPLE SHALOM, INC. a Florida not-for-profit corporation, on
behalf of the corporation. Personally known~'~or produ96~dentification . Type of identification produced:
N .c~/~2'3ff Pub. lic ,.:,
My Commission Expires: . :.': . . ~
Prepared by:
Christopher J. Thornton, Esq.
Treiser, Kobza, & Lieberfarb, Chtd.
4001 Tamiami Trail North, Suite 330
Naples, Florida 34103
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Prepared by:
Christopher J. Thornton, Esq.
Treiser, Kobza, & Lieberfarb, Chtd.
4001 Tamiami Trail North, Suite 330
Naples, Florida 34103
2772181 OR: 2799 PG: 3342
RSCOItDgD in OFFICIAL Rg¢ORD8 of COLLIER
04/03/2001 at 08:25AM DWIGHT g.
Retn:
SHIRLB¥ MIX/BNGIN~BRING RBVIBW
HORSBSH0] DRIV{
5586
10.50
DOC-.70 ,70
UTILITY FACILITIES
WARRANTY DEED AND BILL OF SALE
THIS INDENTURE made th day of ! , 2000, between TEMPLE
SHALOM, INC., a Florida not-for-profit corporation, (hereinafter referred to as "Grantor"), and the BOARD
OF COUNTY COMMISSIONERS OF COLLIER COUNTY, FLORIDA, AS THE GOVERNING BODY OF
COLLIER COUNTY AND AS EX-OFFICIO THE GOVERNING BOARD OF THE COLLIER COUNTY
WATER-SEWER DISTRICT, its successors and assigns, (hereinafter referred to as "Grantee").
WITNESSETH:
That said Grantor, for and in consideration of the sum of Ten Dollars ($10.00) and other good and
valuable consideration to said Grantor in hand paid by said Grantee, the receipt whereof is hereby
acknowledged, has granted, bargained and sold to the said Grantee, and Grantee's heirs, successors and assigns
forever, all water utility facilities lying within the following described land, together with appurtenant easement
rights for the operation, relocation, installation and maintenance of said facilities, situated, lying and being in
Collier County, Florida, to wit:
(See Exhibit "A" attached hereto and incorporated by reference herein.)
and said Grantor does hereby fully warrant the title to said utility facilities, be they realty, personalty, or mixed,
and will defend the same against the lawful claims of all persons whomsoever. For the purposes of this
conveyance, the utility facilities conveyed herein shall not be deemed to convey any of the lands described in
Exhibit "A". Grantor and Grantee are used for singular or plural, as context requires.
TO HAVE AND TO HOLD the same unto the Grantee and its assigns, together with the right to enter
upon said land, excavate, relocate and/or take materials for the purpose of constructing, relocating, operating,
and maintaining utility facilities thereon. Grantor and Grantee are used for singular or plural, as the context
requires.
IN WITNESS WHEREOF, Grantor has caused these presents to be executed the date and year first
above writteN.
Witnesk # 1 6;ignature
Spintman
~itnJ~ ~5 ~ignhture
[James H. Perman
Witness #2 Name
GRANTOR:
TEMPLE SHALOM, a Florida not-tbr-profit
corporation
By.?-'-Cbnni~ Ma'h~field
Its: President
STATE OF FLORIDA
COUNTY OF COLLIER
The,,~g, oi{ll~ Utility Facilities Warranty Deed and Bill of Sale was acknoWledged before me this ~
day of ( ~ ~ ,2000 by Connie Mansfield, President of ]'EMPLE SHALOM, INC. a Florid~
for-profit co'--~oratioUn, ~)n behalf of the corporation. Persong,llly known~'~ produced identification . Type
of identification produced: //,/ k
N~ltary Public {[~i" ~ '~4 MY COMMIS,.~'gON # CG 80~181 1[
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OWNER'S AFFIDAVIT
STATE OF FLORIDA
COUNTY OF COLLIER
BEFORE ME, the undersigned authority, personally appeared CONNIE MANSFIELD, who to me is
well known, and having been duly sworn and under oath, deposes and states:
1. My name is CONNIE MANSFIELD, I am over the age of twenty-one (21) years, am suijuris,
and have personal knowledge of the facts contained herein.
2. TEMPLE SHALOM, INC., a Florida not-for-profit corporation, is the owner of the real property
legally described in Exhibit "A" attached hereto. ! am President of TEMPLE SHALOM, INC., and am
authorized to execute instruments on its behalf.
3. All persons, firms, and corporations, including the general contractor and all subcontractors, who
have furnished services, labor or materials according to plans and specifications, or extra items, used in the
construction or repair of water utility facilities on the real estate hereinafter described, have been paid in full
and that such work has been fully completed and accepted by the owner.
4. No claims have been made to the Owner by, nor is any suit now pending on behalf of, any
contractor, subcontractor, laborer or materialman, and further no chattel mortgages or conditional bills of sale
have been given or are now outstanding as to the subject utility facilities placed upon or installed in the
aforesaid premises.
5. The utility facilities described herein are not included in, encumbered by, or subject to any real
property mortgage, chattel mortgage, security agreement, Uniform Commercial Code financing statement, or
any other encumbrance.
6. As and on behalf of the Owner of the subject utility facilities, TEMPLE SHALOM, INC., a
Florida not-for-profit corporation, does for valuable consideration hereby agree and guarantee, to hold the
Board of County Commissioners of Collier County, Florida, as the governing body of Collier County and as
Ex-Officio the Governing Board of the Collier County Water-Sewer District, harmless against any lien, claim or
suit by any general contractor, subcontractor, mechanic or materialman, and against chattel mortgages, security
interests or repair of the subject utility facilities. Affiant is used as singular or plural, as the context requires.
The utility facilities referred to herein are located within the real property described in the attached
Exhibit "A."
FURTHER AFFIANT SAYETH NAUGHT.
DATED this '~-~~y of ~ ,2000
Affianf Signat'ur~'~'-~
Connie Mansfield
Printed Name
STATE OF FLORIDA
COUNTY OF COLLIER
The foregoing Owner's Affidavit was sworn to and subscribed before me thi day of .
2000, by CONNIE MANSFIELD, in her authorized representative~:apac~jly as President of TEMPLE SHALOM,
INC., a Florida not-for-profit corporation. Personally known/t/$ ~ or produced identi~cation .
Type of identification produced: /// ' '-'-'-~ ~ I / ~
,'
M~ Commission Expires:
Prepared by:
Christopher J. Thornton, Esq.
Treiser, Kobza, & Lieberfarb, Chtd.
4001 Tamiami Trail North, Suite 330
Naples, Florida 34103
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ATTORNEY'S AFFIDAVIT
STATE OF FLORIDA
COUNTY OF COLLIER
BEFORE ME, the undersigned authority, personally on this 30 day of Oc.~o~r- , 2000, appeared
STANLEY J. LIEBERFARB, who to me is well known, and having been sworn and under oath, deposes and
states:
1. My name is STANLEY J. LIEBERFARB. I am over the age of twenty-one (21) years, am
otherwise suijuris, and have personal knowledge of the facts contained herein.
2. I am a licensed attorney, Florida Bar Number 174560, authorized to practice law and am practicing
law in the State of Florida. My business telephone number is (941)649-4900. My business mailing address is
4001 Tamiami Trail North, Suite 330, Naples, FL 34103.
3. This Affidavit is given as an inducement to the Board of County Commissioners of Collier County,
Florida, as the Governing Body of Collier County and as Ex-Officio the Governing Board of the Collier County
Water-Sewer District to accept the dedication or conveyance of water utility facilities located within or upon the
real property described in the attached Exhibit "A," which is incorporated herein by reference, said land being
located in Collier County, Florida.
4. The Affiant has examined record title information to both the real and personal property referenced
in this affidavit, including but not limited to information requested from the Florida Secretary of State relative to
any Uniform Commercial Code financing statements.
5. The record owner of the real and personal property described herein is Temple Shalom, Inc., a
Florida not-for-profit corporation (hereinafter referred to as "Owner"). The Owner acquired record title to the
subject real property by Warranty Deed recorded at Official Record Book 1529, Page 1519, of the Public Records
of Collier County, Florida and by Quit Claim Deed recorded at Official Record Book 1578, Page 1080, of the
Public Records of Collier County, Florida. Copies of the above-referenced instruments are attached hereto as
Exhibit "B" and incorporated by reference herein.
6. The Affiant has examined corporate information obtained from the Florida Secretary of State and
states that Temple Shalom, Inc., a Florida not-for-profit corporation, is current and active within the State of
Florida, and is currently authorized to do business in the State of Florida. Connie Mansfield, as President of
Temple Shalom, Inc., is authorized to execute instrmnents on behalf of the Corporation in conjunction with the
conveyance of the subject real and personal property.
7. The subject real property is encumbered by the following items of record:
a. Bill of Sale in favor of Board of County Commissioners of Collier County, Florida
recorded July 10, 1997 in Official Records Book 2330, Page 610 of the Public Records of Collier
County, Florida (a copy of said Bill of Sale is attached hereto as Exhibit "C" and incorporated by
reference herein);
b. Utility Facilities Warranty Deed in favor of Board of County Commissioners of Collier
County, Florida recorded July 10, 1997 in Official Records Book 2330, Page 612 of the Public
Records of Collier County, Florida (a copy of said Utility Facilities Warranty Deed is attached
hereto as Exhibit "D" and incorporated by reference herein);
c. Utility Easement in favor of Board of County Commissioners of Collier County, Florida
recorded July 10, 1997 in Official Records Book 2330, Page 614 of the Public Records of Collier
County, Florida (a copy of said Utility Easement is attached hereto as Exhibit "E" and incorporated
by reference herein);
d. Easement in favor of Florida Power and Light Company recorded March 26, 1998 in
Official Records Book 2398, Page 2610 of the Public Records of Collier County, Florida (a copy
of said Easement is attached hereto as Exhibit "F" and incorporated by reference herein);
8. Affiant further states that the information contained in this Affidavit is true, correct and current
as of the date this Affidavit is given.
FURTHER AFFIANT SAYETH NAUGHT.
r:,~t~d thi~ ,3~ ~ day o~ ~¢~
Affiarit Prin~l~
STATE OF FLORIDA
COUNTY OF COLLIER
The foregoing instrument was swom to and subscribed before me this~ff) day of~/--~do~~
2000, by STANLEY J. LIEBERFARB, who is personally known ~ or produced
identification.
Notary Public
My Commission Expires:
Prepared by:
Treiser, Kobza & Lieberfarb, Chtd.
4001 Tamiami Trail North, Suite 330
Naples, Florida 34103
Diana M Adams
;~1~; My Commission CC700676
Expires December 7 2001
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' OR BOOK ' PAGE'
~Y DEED
REC ~ THIS INDE~TuKE, made this ~ day of
F~,, -~,~ LAND ~ L~TED P~~ZP, a Florida L~m~ted
~(-~' Pa~nershtp, by B~ce S. .She~, ~neral Par~er, whose
T ~ ~den~i~cation n~er ~s ~-7 ~//~ , hereinafter
,,,0 .... referred to as Gr~tor, and T~ S~, INC., a Florida
profit corporation, whose ~dent~fication number
~s 59-2546855 , whose poa~ off~ce ad,ess Ls 1575 Pine
R~dg~ Road, Naples, Florida 33940, here~flafter referred
Grant~.
WITNESSETH, that said grantor, for and in consideration of the
sum of Ten Dollars ($10.05) and other good and valuable
consideration to said grantor in hand paid by said grantee, ~he
receiptwhereof is hereby acknowledged, has granted, bargained and
sold tot he said grantee, and grantee's heir and assigns forever,
the following described land, situate, lying and being in Collier
County, Florida, to-wit:
Trac~ 64, less and except the South 45 feet of the No=th 75 fe~t.
thereofl
Tract 65, less the North 75 feet thereof;
Tract 68, less the North 75 feet thereof,
all in Unit 26, GOLDE~ GATE ESTATES, in accordance with and subject
to the plat recorded in Plat Book 7, Pages 15 and 16, ~ublic
Records of Collier County, Florida.
Tax Fo3io Numbers: Tract 64 - 37926120C~8, Tract 65 - 37926160000,
Tract 68 - 37926440005.
NOTE: THIS IS NOT THE HG~-~STEAD PROPERTY OF THE GRANTOR AND THE
GRANT~R DOES IN FACT RLSl£.~ AT 695 Fountainhead Way, Naples,
Florida 33940.
NOTE: THIS CONVEYANCE IS A DONATION TO A NOT-FOR-PROFITRELIGIOUS
ORGANIZATION.
If Grantee fails to commence construction of s ~tructure for the
purpose of housing religious activitie~ or worship within five (5)
years from the~ate hereof, title ~o said property shall revert to
Grantor or its successors and/or assigns. Issuance of a building
permit and filing of a Notice of Commencement, or actual and
obvious physical evidence of construction (including but not
limited to pouring of slab) shall be deemed conclusive evidence of
commencement of construction.
Grantor does hereby fully warrant the title to said land, and will
defend the same against the lawful claims of all persons
whomsoever.
SUBJECT TO: restrictions, reservations and easements of record and
tax~s for the year 1990 and sttbsequent years.
"Grantor" and "gran~ee" ar~ used for singular or plural as
context requires.
IN WITNESS WHEREOF, grantor has hereunto set grantor's hand
and seal the day and year first above written.
Signed, sealed and delivered
in our presence
LAND PROCUREMENT LIMITED
PARTNERSHIP, a Florida limited
~ Partnership
WITNESS
Bruce S. Sherman, General
Partner
- 91] i$Z9 ,..00 L, 520
OR BOOK PAGE
STAT~OF Florida
COUN'~ OF CoOl,er
I HERE~Y C~RTIFY that on th£s day before me, an officer duZy
qualified to take acknowledgements, personally appeared Bt=ce S.
Sherman, General Partner of Land Procurement Limited Pa~ership,
to me known to be the person described In a~d who executed the
forego/rig instrument and acknowledged before me that he executed
the same.
WITNESS my h.a~d ~hnd official seaZ in the county 4nd State Zest
al°re'aid this ~/Y~%day °f MaY' 1990'
(S~L} N~y ~C -.; · ~
This Instrument Prepared By and
Return To:
Holly A. Harmon
LIEBE~FARB, TREISER, KOBZA & LEIGH, CHTD.
801 12th Avenue South
Naples, Flor/da 33940
EXP.
COcu.,.~ COuN ry. rco~m~
i,~.s C GIL£5. CL£R~
COLLIER COUNTY GOVERNMENT
COMMUNITY DEVELOPMENT AND ENVIRONMENTAL SERVICES DIVISION
ENGINEERING REVIEW SECTION
February 22, 2001
PLANNING SERVICES DEPARTMENT
2800 NORTH HORSESHOE DRIVE
NAPLES, FL 34104
Brett Rosenblum
Wilson, Miller, Barton & Peek, Inc.
3200 Bailey Lane, #200
Naples, FL 34105
Re: Shalom 2000 Building Addition
Dear Mr. Rosenblum:
This is to inform you that the above referenced project has been granted preliminary approval by
Engineering Review in compliance with Collier County Land Development Code, Section 3.
All water and/or sewer facilities approved, accepted and required to be maintained by Collier
County shall be conveyed to the County pursuant to the provisions set forth in Collier County
Ordinance No. 97-17, as amended.
You are reminded that it is your responsibility to petition the Development Services Director for
final approval of the improvements upon the expiration of the minimum one (1) year
maintenance period. After satisfactory completion of all final inspections., the Board of County
Commissioners shall grant final approval of the required improvements establishing County
responsibility for maintenance of the required improvements if it is the Board's desire to accept
and maintain the facilities.
If you should have any questions or if we may be of assistance, please advise.
Very truly yours,
Shirley~
Engineering Technician II
CC;
Paul Mattausch, Water Director
Lisa Taylor, Public Works
PHONE 1941) 403-2400 FAX (941) 643-6968 www. co.collier, fl.us
.PAY
'offiCial check..
Payable at SunTruSt::Banl~
Date:;.. , Initials:
.i: ;: '~': i;~:[ ;~).i! (type)
****'$1 :'74:0 00'*** ~:
· :,. : :. ; :;:',: :,::.: .: $ 1, ?e0.
; ; : .... ... ::.,: '.:. ::[?. ::
Official Receipt - Collier County Board of County Commissioners
CDPR1103 ~ Official Receipt
231600 11/03/2000 2:38:49 PM i 11/03/2000 MS 78083
TEMPLE SHALOM, INC.
SHALOM 2000 BUILDING ADDITION
Payor · TEMPLE SHALOM
Fee Information
Fee Code i Description IGL Account
i 12~.0ND _ I DEPOSlTS-COMM DEV (CASH BOND 67000000022011300000
Total
Amount ~A~a i.~e~
$1740.00
$1740.00
P~yment C0d~ IAccount/Check Number
CH~I~ !4701647583
Payments
Memo:
Total Cash
Total Non-Cash
Total Paid
/- ~740~0j
Cashier/location: FROLOFF E / 1
User: NIX S
Collier County Board of County Commissioners
CD-Plus for Windows 95/NT
Printed: 11/03/2000 2:39:22 PM
WilsOnMiller
New Directions In Planning, Design & Engineering
December 1, 2000
Mr. Thomas Kuck, PE
Engineering Review Manager
Collier County Engineering Review Services
2800 North Horseshoe Drive
Naples, FL 34104
Subject:
Shalom 2000 Building Addition
Utility Dedication
Engineer's Final Payment Confirmation
Collier County Conveyance Document Checklist, Legal Documents Item 16
Dear Mr. Kuck:
WilsonMiller confirms receiving payment for our services to date on the subject project. As of
this date, no monies are outstanding from the owner (client).
Sincerely,
WilsonMiller, Inc.
dolfo A. Gonzalez,;~
Project Manager
CCZ
Steve Aronson, Temple Shalom, w/enclosures
Mike Richardson, D. Garrett Construction, w/o enclosures
Naples Fort Myers Sarasota Bradenton Tampa
3200 Bailey Lane, Suite 200 Nap/es, F/or/da 34105-8507 941-649-4040 ~ 941-643-5716
www. wilsonmiller, corn
WilsonMdler, lnc. -- FL Lic.# LC-CO00170
WilsdnMiller
New Directions In Planning, Design & Engineering
November 2, 2000
Mr. Thomas Kuck, P.E.
County Engineer
Collier County Engineering Review Services
2800 North Horseshoe Drive
Naples, FL 34104
SUBJECT:
Shalom 2000 Building Addition - SDP #90-128(E)
Utility Testing Results
Dear Mr. Kuck:
The following attached test for the subject project is in our professional judgment and to the best
of our knowledge and belief representative of actual field conditions on the date performed:
1. Watermain pressure test, dated August 4, 2000
Enclosed, please also find the FDEP Certification form. If you should have any questions, please
do not hesitate to contact Brett Rosenblum or myself at our office.
Sincerely,
WilsonMiller, /nc.
~ :~ lef ~ t AM aGn°angZearl e z' Py -
Encls.
CC:
Steve Aronson, Temple Shalom, w/enclosures
Mike Richardson, D. Garrett Construction, w/o enclosures
PE/No. 42577
03061 -d01-001 -EDED-249q0
Naples Fort I~fyors Sarasota Bradenton Tampa
3200 Bailey Lane, Suite 200 Nap/es, F/or/da 34105-8507 941-649-4040 ~ 941-643-5716
www. wilsonmiller, corn
L
Project:
Type of Main:
PIN' 0:~ 'i~ q",
Plan File:
Supt.:
Date of Test:
The computed allowable leakage for the test section is (calculations attached)
C~. O1~C' Gal. Hr.
The maintained test pressure for the test duration was
psi.
The measured leakage during the test was
gallons.
The duration of the test was
i
The measured leaka§e was
gallons per hour.
The method of measurement was:
Meter:
Calibrated Drum:
The hydrostatic test for this section meets
allowable leakage.
I/~ioes not meet
the
WilsonMiller, [nc.
..--:>//
Field Representative
Date:
Jeb Bush
Governor
Department of
Environmental erotectiOff
South District
P.O. Box 2549
Fort Myers, Florida 33902-2549
David B, Struhs
Secretary
Connie Mansfield, President
Temple Shalom, Inc.
4630 Pine Ridge Road
Naples, FL 34119
Re'
December 18, 2000
Collier County - PW
Shalom 2000 Building Addition
(Collier County Regional WTP)
167095-001 -DSGP
Southwest Coast EMA
Dear Ms. Mansfield:
This acknowledges receipt of certification that the subject water distribution system extension has
been completed in accordance with the plans and related materials permitted by this agency under
Permit Number 167095-001-DSGP dated March 21, 2000.
Based on this certification and satisfactory bacteriological results, we are approving these
facilities for service. Your continued cooperation in our water supply program is appreciated.
Sincerely,
O. James Oni
Professional Engineer
Water Facilities
OJO/MFJ/klm
cc: Adolfo A. Gonzalez, P.E.
Thomas E. Kuck, P.E. L/
"More Protection, Less Process"
Printed on recycled poper.
WAIVER AND RELEASE OF LIEN
UPON FINAL PAYMENT
The undersigned lienor, in consideration of the Final payment in the amount of:
Seventeen Thousand and Four Hundred Dollars and 00/100
($17,400.00)
hereby waives and releases its lien and right to claim a lien for labor, services or materials furnished to:
D. Garrett Construction
on the job of: Temple Shalom
to the following described property:
"Temple Shalom" 4630 Pine Ridge Road, Collier County, Florida, Section 15, Township 49,
Range 28, Subdivision 714, Unit 26, Block 64, Lot 0, Zone: X, Recorded in OR Book 2667, Page 1476 of
the Public Records of Collier County, Florida.
Dated on July 5, 2000
JENS~.~~UTILITIES, INC.
Prifft~: Ke~ja~sen
Title:4~esident
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was acknowledged before me on __July 5 ,2000 by __Kevin
Jensen__ as _President of Jensen Underground Utilities, Inc., a Florida Corporation,
on behalf of the corporation. He is personally known to me and did take an oath.
Notary Public:
Print: Donna L. Lundgren
State of Florida at Large (Seal)
My Commission Expires:
NOTE:
This is a statutory form prescribed by Section 713.20, Florida Statutes (1996).
Effective October 1, 1996, a person may not require a lienor to furnish a waiver or release of lien
that is different from the statutory form.
State of Florida
Oel~rt~nt of Health
Office of Lal~ratory Services
Jacksonville, Niami, Pensacola
Tampa, West Palm Beach
DRINKING WATER
BACTERIOLOGICAL ANALYSIS
· ':FOR LAB USE ONLY
Press hard, (5) copies
SYSTEM I.D. NO:
:~ · ~ : ,, i . COUNTY:
SYSTEM PHONE #:
DISTRICT:
SYSTEM NAME:
ADDRESS:
COLLECTOR: ~ 'iD, i~L~
SAMPLE SITE (Locality or Subdivision):
COLLECTOR PHONE #:
DATE AND TIME COLLECTED: ,.=.~,.,~,,,:..,, !~: it ] :~'r
TYPE OF SUPPLY(Circle one): C~ommunity water s%st~Noncommunity water system Nontransient - noncommunity water system
Private well SwiK~ing pool Bottled water Limited Use system
TYPE OF SAMPLE(Circle one): Compliance Repeat Replacement r Main cleara~ Well survey Other
(Check Box)
[ ] Distribution [ ] Check here if payment made
[ ] Raw to county public health uni
TO BE COMPLETED BY COLLECTOR OF SAMPLE TO.~BE COMPLETED BY LAB
COLL. SAMPIrE POINT CE NON O--T~I RM CONFIRM
NO. I (Specific Address) pH COLIFORM *T TOTAL FECAL E: COLI SAMPLE NUMBER
i
I
* Results in this column are presumptive.
P - CoLiforms are present
A - Coliforms are absent
Total coliform and fecal coliform or E. coli confirmation will follow in 24-48 hours.
C - Confluent growth TA - Turbid, Absence of gas or acid
TNTC - Too numerous to count
INVOICE ADDRESS (if different than address below):
INTERPRETATIONS-REMARKS BY. PROGRAM REVIEWER
NAME AND MAILING ADDRESS OF PERSON/FIRM TO RECEIVE REPORT
REVIEWING OFFICIAL:
TITLE:
( )
( ) SATISFACTORY
( ) INCOMPLETE COLLECTION INFORMATION
( ) REPEAT SAMPLES
( ) REPLACEMENT SAMPLES
State of FLorida
Department of HeaLth
Office of Laboratory Services
JacksonviLLe, Niami, PensacoLa
Tampa, West PaLm Beach
DRINKING WATER
BACTERIOLOGICAL ANALYSIS
LAB USE ONLY
Press hard, (5) copies
SYSTEM NAME: SYSTEM I.D. NO: SYSTEM PHONE #:
ADDRESS: COUNTY: D ! STR I CT:
COLLECTOR: COLLECTOR PHONE #:
SAMPLE SITE (Locality or Subdivision):
DATE AND TIME COLLECTED:
TYPE OF SUPPLY(Circle one): C~_~mmunity water syste~. Noncommunity water system Nontransient - nonconmlunity water system
Private well Sw]n~lng pool Bottled water Limited Use system
TYPE OF SAMPLE(Circle one): Compliance Repeat Replacement ~a~n clea~ Well
survey
Other
(Check Box)
[ ] Distribution [ ] Check here if payment made
[ ] Raw to county public health unit
TO BE COMPLETED BY COLLECTOR_OF SAMPLE _ TO_BE COMPLETED BY LAB
__ANALYSIS METHOD: /~'~F~ MTF MMO-MUG PA
COLL. SAMPLE POINT CL NON~7J3N~FI RM CONFIRM
NO. (Specific Address) RES'D pH COLIFORM *TOTAL TOTAL FECAL E. COLI SAMPLE NUMBER
Results in this column are presumptive. Total coliform and fecal coliform or E. coLi confirmation will follow i 24-48 hours.
P - CoLiforms are present
A - CoLiforms are absent
C - Confluent growth TA - Turbid, Absence of gas or acid
TNTC - Too numerous to count
INVOICE ADDRESS (if different than address below):
INTERPRETATIONS-REMARKS BY. PROGRAM REVIEWER
NAME AND MAILING ADDRESS OF PERSON/FIRM TO RECEIVE REPORT
REVIEWING OFFICIAL:
TITLE:
SATISFACTORY
INCOMPLETE COLLECTION INFORMATION
REPEAT SAMPLES
REPLACEMENT SAMPLES
State of Florida
Department of #ea[th
Office of Laboratory Services
JacksonviLLe, #ia~t, PensacoLa
TAmpa, West Palm Beach
DRINKING WA TER
BACTERIOLOGICAL ANALYSIS
I"-; I~OH:fH~,.~,5'?SI~PR LAB USE ONLY
TESTED
Date: 1i-2~-00 L~y:L~JL~
Time: 14:30 TO 15:00
CONF I RMED
SYSTEM NAME:
ADDRESS:
Press hard, (5) copies
Collier County Water Dept ~11~06~
SYSTEM I.D. NO: SYSTEM PHONE #:
~01 iaml~mi "l-~i 11 ~pie~l FL COUNTY: ~0i ~i~r DISTRICT:
COLLECTOR:
G~ G~~ COLLECTOR PHONE #:
SAMPLE SITE (LocaLity or Subdivision): ii::i~Fq.i:~ '?~!~*~LJ,J?ib
DATE AND TIME COLLECTED:
],I
-
TYPE OF SUPPLY(CircLe one):'~nity water syste Noncon~unity water system Nontransient - nonconrmanity water system
Private weLL ~wlmm~ng pool BottLed water Lfmited Use system
TYPE OF SAHPLE(CircLe one): CompLiance Repeat Rep[acenmnt ~ ctearanc~ WeLL survey Other
(Check Box)
[ ] Distribution [ ] Check here if payment made
[ ] Raw to county pt~oLic health uni
TO BE COMPLETED BY COLLECTOR OF SAMPLE
E COMPLETED BY LAB
ANALYS I S METHO0: MTF HMO-MUG PA
COLL. SAMPLE POINT Ct NON CONFIRM CONFIRM
NO. (Specific Address) RES'D pH COLIFORM *TOTAL TOTAL FECAL E. COLI SAMPLE NUMBER
4 tZ~q+~tJ JUMk'EN J. 5 8. ~( /q OiZ~l 1-~
5 00+55 METER 3.5 8.4(, ~ 001
* ResuLts in this column are presun~tive. Total coliform and fecal coliform or E. coti confirmation wiLL foLLow in 24-48 hours.
P - CoLiforms are present C - ConfLuent growth TA - Turbid, Absence of gas or acid
A - Co[iforms are absent TNTC - Too numerous to count
INVOICE ADDRESS (if different than address below):
REMARKS: DAY ONE
NAME AND MAILING ADDRESS OF PERSON/FIRM TO RECEIVE REPORT
REVIEWING OFFICIAL:
TITLE:
INTERPRETATIONS-REMARKS BY. PROGRAM REVIEWER
( )
( ) SATISFACTORY
( ) INCOMPLETE COLLECTION INFORI"LRTION
( ) REPEAT S/U4PLES
( ) REPLACEMENT SAMPLES
State of FLorida
Department of Neaith
Office of Laboratory Servicea
Jacksonville, Mi~u.i, Pensacola
Tm, Writ PaLm Beach
DRINKING WATER
BACTERIOLOGICAL ANALYSIS
~ DUI~_~/~3~R LAB USE ONLY
Necv c~ .i. i: 1~ I
Press hard. (5) copies
Co I l i e r Co un~ y Wa~ e r De p~ ~5114069 73~'.-PJ5~8
SYSTEM N~E: SYSTEM I.D. NO: SYSTEM PH~E
ADDRESS: 3301 Tamiami T~-ai
COLLECTOR: GJ ~RA~ER COLLECTOR PHONE ~: 352--'70~
S~PLE SITE (L~ality or Su~ivision):
DATE AND TIME COLLECTED:
TYPE OF SUPPLY(Circle o~ee):~ity~ Noncommunity eater system Nontransient - noncommunity uater system
-1~ S~im~ing pool Bottled water Limited Use system
TYPE OF SAMPLECCirc[e one): Compliance Repeat Replacement ~earan~ Well survey Other
(Check Box)
[ ] Dfstribution [ ] Check here if payment made
[ ] Raw to county pubtic health unit
TO BE COMPLETED BY COLLECTOR OF S/U4PLE ,.IQ-BE. COMPLETED BY LAB
ANALYSIS METHO0: ~ ~ MTF MMO-MUG PA
COLL. SAMPLE POINT CL NON '":OR'r~RM CONFIRM
NO. (Specific Address) RES*D pH COLIFORM *TOTAL TOTAL FECAL E. COLI SAMPLE NUMBER
4 0~+00 J'UMPEH 3.5 8. b~ A e~l
* Results in this column are presumptive. Total coliform and fecal coliform or E__:. coLi confirmation ~iLL follow in 2&-~8 hours.
P - CoLiforms are present
A - Coliforms are absent
C - Confluent grouth TA - Turbid, Absence of gas or acid
TNTC - Too numerous to count
INVOICE ADDRESS (if different than address below):
NAME AND MAILING ADDRESS OF PERSON/FIRM TO RECEIVE REPORT
REVIEWING OFFICIAL:
TITLE:
INTERPRETATIONS-REMARKS BY. PROGRAM REVIEWER
( )
( ) SATISFACTORY
( ) INCOMPLETE COLLECTION INFORMATION
( ) REPEAT SAMPLES
( ) REPLACEMENT SAMPLES
5585 TAYLOR ROAD · NAPLES, FLORIDA 34109 · (941) 597-0060 ° FAX (941) 597-0061
VERIFICATION OF FINAL COST FOR WATRE FACILITIES ACCEPTANCE
Temple Shalom
4630 Pine Ridge Road
Naples, FL
Wilson Miller Barton & Peek
GENERAL CONTRACTOR
D. Garrett Construction
4933 N. Tamiami Trail, Suite 300
Naples, FL
1 Ea. 6" x 4"
20 L.F. 4"
1 Ea. 4"
1 Ea. 4" x 3"
1 Ea. 3"
Tapping Sleeve & Valve 2,800.00 2,800.00
C-900 CL 150 10.00 200.00
90° Bend 200.00 200.00
Reducer (LEMJ) 200.00 200.00
Domestic Assembly 14,000.00 14,000.00
WATER TOTAL
17,400.00
CERTIFIED UNDERGROUND UTILITY: CU CO44996 · FIRE SPRINKLER CONTRACTOR V: 117961000192
WilsOnMiller
New Directions In Planning, Design & Engineering
November 2, 2000
Mr. Thomas Kuck, PE
Engineering Review Manager
Collier County Engineering Review Services
2800 North Horseshoe Drive
Naples, FL 34104
SUBJECT:
Shalom 2000 Building Addition
Utility Dedication Engineer's Certification
Dear Mr. Kuck:
On October 31, 2000, WilsonMiller conducted an on-site inspection of the site infrastructure and
to the best of our knowledge and belief the potable water distribution system for the Shalom 2000
Building Addition have been completed in substantial accordance with the enclosed plans,
WilsonMiller, Inc. Drawing File No. D-3061-03, revision 5, and specifications approved by Collier
County Engineering Review Services.
Furthermore, to the best of our knowledge and belief the subject water facilities have been
constructed by the contractor within the public right-of-way and/or proposed dedicated easements.
Please contact Brett Rosenblum at this office should you have any questions regarding this
matter.
Sincerely,
WilsonMiller, /nc.
~rojlefct Manager
Enclosures
CC:
Steve Aronson, Temple Shalom, w/enclosures
Mike Richardson, D. Garrett Construction, w/o enclosures
Ado~"~'A.
PE ~o. 42§77
Naples Fart Myers Sarasota Bradenton Tampa
3200 Bailey Lane, Suite 200 Nap/es, F/or/da 34105-8507 941-649-4040 ~ 941-643-5716
www. wilsonrniller, corn
WilsonMH/er, lnc FL L/c# LC-CO00170 CA 43
5585 TAYLOR ROAD · NAPLES, FLORIDA 34109 ° (941) 597-0060 ° FAX (941) 597-0061
July 5, 2000
Wilson Miller Barton & Peek
3200 Baily Lane, Suite 200
Naples, FL 34109
RE: One Year Warranty - Temple Shalom
The undersigned warrants all its work performed, and all the materials and equipment furnished,
in connection with the above referenced project to be free from all defects in material
workmanship for a period of one (1) year from the date of acceptance by the Jurisdicting
Authority. Additionally, the undersigned agrees to remedy all defects arising within that period
at its expense.
The term "defects" shall not be construed as embracing damage arising from misuse, negligence,
acts of God, normal wear and tear or failure to follow operating instructions.
BY:
TITLE:
CERTIFIED UNDERGROUND UTILITY: GU CO44996 · FIRE SPRINKLER CONTRACTOR V: 117961000192
Official Receipt - Collier County Board of County Commissioners
CDPR1103 - Official Receipt
tTrans Number Date Post Date Payment Slip Nbr _
243916 01/24/2001 1:23:11 PM 01/24/2001 UT 80974
JENSEN UNDERGROUND UTILITIES, INC
4630 PINE RIDGE RD/TEMPLE SHALOM
Payor · JENSEN UNDERGROUND UTILITES
Fee Information
Fee Code Description GL Account Amount Waived
42CYIN COUNTY INVOICES 40800000011510000000 $131.10
Total
$131.10
Payments
Payment Code Account/Check Number Amount
CHECK 18013 $131,10
Total Cash
Total Non-Cash
Total Paid
$0.00 t
$131.10
$131.10I
Memo:
DOR1249, W/O #034208/032562, RE-CHECK + BACT
Cashier/location: SORIANO V / 3
User: AVILES L
Collier County Board of County Commissioners
CD-Plus for Windows 95/NT
Printed:02/22/2001 11:59:02 AM
CUSTOMER: \~¢~'
STREET ADDRESS:
TEST AND MAINTENANCE REPORT
MAILING ADDRESS:
LOCATION OF ASSEMBLY: ~'o~J~' ~
TYPE OF ASSEMBLY: RP I~ DC [] PVB
MANUFACTURER: ~7'P---~ C-.C~ MODEL:
[] AVB [] SIZE: ,. ~~1/~
SERIAL NO: ~00°'~03 I(~ ~ I
TEST GAUGE MANUF. ~'~x.~e-~-- GAUGE SERIAL NO: ~.~0 ~'~)~
Check Valve #1 Relief Valve Check Valve #2 Pressure Vacuum Breaker
[] leaked [] leaked Air Inlet: did not open []
,~ closed fight opened at: ~ psi ~ closed tight opened at __ psi
gauge pressure across did not open [] gauge pressure across Check Valve: leaked []
check valve ~ psi check valve I, L~ psi held at ~ psi
[] cleaned only [] cleaned only [] cleaned only ,[-] cleaned only
Replaced: Replaced: Replaced: Replaced:
rubber kit [] rubber kit [] rubber kit [] rubber kit []
CV assembly [] RV assembly [] CV assembly [] CV assembly []
or or or disc, air inlet []
disc [] disc [] disc [] disk, CV []
O-dngs [] diaphragm (s) [] O-rings [] seat, CV []
seat [] seat [] seat [] spdng, air inlet []
spring [] spring [] spring [] spdng, CV []
stern/guide [] guide [] stem/guide [] retainer []
retainer [] O-rings [] retainer [] guide []
lock nuts [] Other [] lock nuts [] O-rings []
Other [] Other [] Other []
Gauge pressure across Relief valve opened at Gauge pressure across air inlet __ psi
check valve psi ~ psi check valve __ psi check valve psi
NOTE: All repairs shall be completed within five (5) working days.
REMARKS:
I hereby certify that this data is accurate and reflects the proper operation and maintenance of the assembly.
TESTER: ~----~' ~ ~--~'~/d~r~O/ CERT. No: ~I~O0~5~V DATE:
TIME: ~ o
CUSTOMER:
STREET ADDRESS:
TEST AND MAINTENANCE REPORT
MAILING ADDRESS:
LOCATION OF ASSEMBLY:
TYPE OF ASSEMBLY: RP
MANUFACTURER:
TEST GAUGE MANUF.
DC [] PVB r-I AVE [] SIZE:.
MODEL: <~ (-CN~ SERIAL NO: (~
GAUGE SERIAL NO:
Check Valve #1 Relief Valve Check Valve #2 Pressure Vacuum Breaker
[] leaked [] leaked Air Inlet: did not open []
'~ closed tight opened at: ~,~ psi ~ closed tight opened at ~ psi
gauge pressure across did not open [] gauge pressure across Check Valve: leaked []
check valve ~', ~' psi check valve } .O~ psi held at psi
[] cleaned only [] cleaned only [] cleaned only [] cleaned only
Replaced: Replaced: 'Replaced: Replaced:
rubber kit [] rubber kit [] rubber kit [] rubber kit []
CV assembly [] RV assembly [] CV assembly [] CV assembly []
or or or disc, air inlet []
disc [] disc [] disc [] disk, CV []
O-rings [] diaphragm (s) [] O-rings [] seat, CV []
seat [] seat [] seat [] spring, air inlet []
spring [] spring [] spdng [] spring, CV []
stem/guide [] guide [] stem/guide [] retainer []
retainer [] O-rings [] retainer [] guide []
lock nuts [] Other [] lock nuts [] O-rings []
Other [] Other [] Other []
Gauge pressure across Relief valve opened at Gauge pressure across air inlet ~ psi
check valve., psi psi check valve ~ psi check valve ~ psi
NOTE: Ali repairs shall be completed within five (5) working days.
REMARKS:
I hereby certify that this data is accurate and reflects the proper operation and maintenance of the assembly.
CERT. No: ~ O-IC~---~¢DATE: [I /)(-)l OO
TIME:
I Lylr.. +LI
COLLIER COUNTY GOVERNMENT
COMMUNITY DEVELOPMENT AND ENVIRONMENTAL SERVICES DIVISION
ENGINEERING REVIEW SECTION
February 20, 2001
PLANNING SERVICES DEPARTMENT
2800 NORTH HORSESHOE DRIVE
NAPLES, FL 34104
Mr. Gary Butler
Butler Engineering, Inc.
2223 Trade Center Way
Naples, FL 34109
RE: Temple Shalom, Water
Dear Mr. Butler:
A preliminary inspection of the referenced project was conducted by Randy Casey of
the Engineering Review Section of the Planning Services Department on February 20,
2001. Conditions were found to be acceptable, and appear to meet County standards.
If you should have any questions, please do not hesitate to call Randy Casey at (941)
403-2418.
Engineering Inspector
DN~ts/f:'anspection form
cc;
Lisa Taylor, Engineering Technician, Public Works
Joe Cheatham, Wastewater Director, Utilities
Paul Mattausch, Water Director, Utilities
Diane Deoss, D.O.R. Billing Supervisor
Don Nobles, Engineering Inspections Supervisor
Randy Casey, Engineering Inspector
Shidey Nix, Engineering Tech. II, Engineering Review Section
File
PHONE (941) 403-2400 FAX (941) 643-6968 www. co.collier, fl.us