PL-16-2396 RECEIVED
AUG 2 6
2016
Miami Shores Villagell�
y- _�
Building Department
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)7S6-8972
INSPECTION LINE PHONE NUMBER*1305)762.4949 ��u
FBC 20 (L4
BUILDING Master Permit No. I Ksa—2,356
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ELECTRIC ❑ ROOFING ❑REVISION ❑EXTENSION ❑RENEWAL
®PLUMBING MECHANICAL PUBLIC WORKS CHANGE OF CANCELLATION 0 SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 1173 NE 103 ST
City Miami Shores County Miami Dade Zio
Folio/Parcel#*11-2232-031-0070 H the Building Historically Designated:Yes NO X
Occupancy Type: SFR Load: Construction Type: SFR fkwd Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder):JAIME DEROSA Phone#:561-699-2428
Address:1173 NE 103 ST
City: MIAMI SHORES State: FL Ztp: 33138
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: SOUTHERN SEPTICP neo, 305 598-8266
Address: 21051 SW 234 ST
City: HOMESTEAD Sta 2iP: 33031
Qualifier Name: ROBERTO RODRIGU phone#: 305 598-8266
State Certification or Registratio 002142 Ce a of Competency#:
DESIGNER:Architect/Engineer: \ZjPhone#:
Address: City: State Zip:
Value of Work for this Permit:$ , ' Square/Llnear footage of Work:—2300
Type of Work: ❑ Addition ❑ Alteration ❑ New Q Repair/Replace ❑Demolition
Description of work: DRAIN FIELD REPLACEMENT
Specify color
rooff�color thru tile:
Submittal Fee$ —"r Permit Fee$ v CCF$ CO/CC S
Scanning Fee$ W Radon Fee DBPR$ Z. Notary$s
Technology Fee$ Training/Education Fee$ 4Double Fee$
Structural Reviews$ _ Bond$ �3
TOTAL FEE NOW DUE$
tae�edozn.no�ai
x,21 ` 0
T 2�
Bonding Company's Name(if applicable) WA
Bonding Company's Address
City State Zap
Mortgage Lender's Name(if applicable) NIA
Mortgage Lender's Address
city State Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. 1 certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this Jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES,BOILERS,HEATERS,TANKS,AiR CONDITIONERS,ETC.....
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING
YOUR NOTICE OF COMMENCEMENT."
Notice to Applicant: As o condition to the issuance of o building permit with an estimated value exceeding S250d,the applicant must
promise In good faith that o copy of the notice of commencement and construction lien low brochure will be delivered to the person
whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the fob site
for the first inspection which occurs seven (7)days after the building perm' ued. in the absence of such posted notice, the
Inspection will notbe ed and a reinspection fee wil a charged.
SignaturS
ignature
ONTRACTORWNERorAGENT
.r
The forego! iza
ment was acknowledged before me this The foregoing instrument ac re me this
ay 20 I�D by 7iy day of �c� 20by
: (jGMe Q-'rQS01 .who is personally known to b �i>fols ersonally known to
me or who has produced ,• as me or who has produced
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: -�� NOTARY PUBLIC
Sign: Sign:
Print• Print:
), ., r P IUiC State of Florida
Seal: t MY COMMISSION#FF171659 s e
Seal: °
EXPIRES October 26.2018f� q lAy Gomrrissior.FF 156750
* laoa` 00/03/2018
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APPROVED 8Y / f Plans Examiner Zoning
Structural Review Clerk
(RrAmd02/2412024)
PERMIT #:13-SC-1699282
STATE OF FLORIDA APPLICATION #:AP1250665
DEPARTMENT OF HEALTH DATE PAID:
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID:
CONSTRUCTION PERMIT
A� RECEIPT #:
DOCUMENT #:PR1028180
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Jaime Derosa
PROPERTY ADDRESS: 1173 NE 103 St Miami,FL 33138
LOT: 3 BLOCK: 2 SUBDIVISION:
PROPERTY ID #: 11-2232-031-0070 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
[OR TAX ID NUMBER]
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION
381.0065, F.S., AND CHAPTER 64E-6, E.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE
SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS,
WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE
PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID.
ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL,
STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY.
SYSTEM DESIGN AND SPECIFICATIONS
T [ 900 1 GALLONS / GPD `<edtpptiooa�l�ON
EXISTING Septic TO REMAIN CAPACITY (tpJ cava oz ire
A [ 0 1 GALLONS / GPD CAPACITY oeel(s(pt(etd ppp(OG(�pa(e
N [ 0 1 GALLONS GREASE
INTEROCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1�2p5�(( A �o FbQap���0 0((S pp`
K t [ ]GALLONS @[ ]DOSES
D °
[ 300 1 SQUARE FEET DF IN BED CONFIGURAT SYSTEM `so(\ o(tCAa(o\�Mea�s�eesessp(e��e
R [ 0 1 SQUARE FEET SYSTEM t(m6�c�o(sreo�(9.eontw�ao�ed0(o
A TYPE SYSTEM: [x] STANDARD I ] FILLED [ 7 MOUND [ ] (pS�SJ,�s�p�1(Op
I CONFIGURATION: [ ] TRENCH [x] BED
N
F LOCATION OF BENCHMARK: CL OF NE 103 ST.......10.94'NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 3.60 1[ INCHES FT ](ABOVE BELOW BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 45.60][ INCHES FT ][ABOVE Fi—ELOW-1 BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: [ 54.001 INCHES
1.-EXISTING 900 gal.septic tank with and approved filter TO REMAIN.
0 2.- Install 300 sf.of drainfield in bed configuration.
T 3.-Install 12"of slightly limited soil at the bottom of the drainfield.
H 4.-Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption r
(Comments Continued on Page 2.)
E
R
SPECIFICATIONS BY: Gaag L Philizaire TITLE: Engineering Specialist II
APPROVED BY: TITLE: Engineer Supervisor III Dade CHO
AEtSid V Ed�aLtle
DATE ISSUED: 08/04/2016 EXPIRATION DATE: 11/02/2016
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC Page 1 of 3
v 1.1.4 AP1250665 EE1004030
STATE OF FLORIDA APPLICATION # AP1250665
DEPARTMENT OF HEALTH PERMT # 13-SC-1699282
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM DOCUMENT # SE1004030
SITE EVALUATION AND SYSTEM SPECIFICATION
APPLICAT: Jaime Derosa
CONTRACTOR / AGENT: Southem Septic
LOT: 3 BLOCK: 2
SUBDIVISION: ID#: 11-2232-031-0070
TO BE COMPLETED BY ENGINEER, HEALTH DEPARTMENT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEERS MUST
PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. C014PLETE ALL ITEMS.
PROPERTY SIZE CONFORMS TO SITE PLAN: [X]YES [ ]NO NET USABLE AREA AVAILABLE: 0,21 ACRES
TOTAL ESTIMATED SEWAGE FLOW: 400 GALLONS PER DAY ( RESIDENCES-TABLET / OTHER-TABLE 2 J
AUTHORIZED SEWAGE FLOW: 525.02 GALLONS PER DAY [ 1500 GPD/ACRE OR L2500 GPD/ACRE ]
UNOBSTRUCTED AREA AVAILABLE: 450.00 SQFT UNOBSTRUCTED AREA REQUIRED: 450.00 SOFT
BENCHMARK/REFERENCE POINT LOCATION: CL OF NE 103 ST........10.94'NGVD
ELEVATION OF PROPOSED SYSTEM SITE 3.60 [ INCHES / FT ] [ ABOVE / BELOW] BENcHmARR/REFERENcE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES
SURFACE WATER: N/A FT DITCHES/SWALES: N/A FT NORMALLY WET: [ ]YES [X]NO
WELLS: PUBLIC: N/A FT LIMITED USE: N/A FT PRIVATE: N/A FT NON-POTABLE: N/A FT
BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: 5 FT POTABLE WATER LINES: 60 FT
SITE SUBJECT TO FREQUENT FLOODING? [ ]YES [X]NO 10 YEAR FLOODING? [ ]YES [X]NO)
10 YEAR FLOOD ELEVATION FOR SITE: FT[ MSL / NGVD ] SITE ELEVATION: 10.60 FT [ MSL / NGVD
SOIL PROFILE INFORMATION SITE 1 SOIL PROFILE INFORMATION SITE 2
USDA SOIL SERIES: Urban land USDA SOIL SERIES: Urban land
Munsell#/Color Texture Depth Munsell#/Color Texture Depth
1 OYR 4/1 Loamy Sand 0 To 15 1 OYR 4/1 Loamy Sand 0 To 15
1 OYR 8/3 Oolitic Limestone 15 To 15 10YR 8/3 Oolitic Limestone 15 To 15
OBSERVED WATER TABLE: 72,00 INCHES [ ABOVE / BELOW ] EXISTING GRADE TYPE: [ PERCHED / APPARENT 7
ESTIMATED WET SEASON WATER TABLE ELEVATION: 92 INCHES [ ABOVE / BELOW] EXISTING GRADE
HIGH WATER TABLE VEGETATION: [ ]YES [X NO MOTTLING: [ ]YES [X]NO DEPTH: INCHES
SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: Replacement 4-FS/0.60 DEPTH OF EXCAVATION: 54 INCHES
DRAINFIELD CONFIGURATION: [ ] TRENCH [X] BED [ ] OTHER (SPECIFY)
REMARKS/ADDITIONAL CRITERIA
SITE EVALUATED BY: DATE: 08/02/2016
Roddgue2,Roberto(Title:)(Southern Septic Contractors,Inc.)
DH 4015, 08/09 (Obsolete.Prwiou. edition. which say not be used) Incorporated: 64E-6.001, FAC Page 3 of 4
AP1250665 E101699282 w 1.0.2
APPLICATION M AP1250665 fV
STATE OF FLORIDA ro
PERMIT # 13-SC-1699282
DEPARTMENT OF HEALTH 0)
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM DOC # RE378291 CO
EXISTING SYSTEM AND SYSTEM REPAIR EVALUATION Cj
APPLICANT: Jaime Dero88
CONTRACTOR / AGENT: Southern Septic
LOT: 3 BLOCK: 2 SUBDIVISION: ID#: 11-2232-031-0070
TO BE COMPLETED BY A FLORIDA REGISTERED ENGINEER, DEPARTMENT EMPLOYEE, SEPTIC TANK CONTRACTOR OR OTHEF
CERTIFIED PERSON. SIGN AND SEAL ALL SUBMITTED DOCUMENTS. COMPLETE ALL APPLICABLE ITEMS. COMPLETE TAM
CERTIFICATION BELOW OR NOTE IN REMARKS WHY THE TANKS CANNOT BE CERTIFIED.
EXISTING TANK INFORMATION 7
[ 900 ] GALLONS Septic Tank LEGEND: MATERIAL:Concrete BAFFLED: [ Y N L
[ ] GALLONS LEGEND: MATERIAL: BAFFLED: [ Y / N ]
[ ] GALLONS GREASE INTERCEPTOR LEGEND: MATERIAL:
L ] GALLONS DOSING TANK LEGEND: MATERIAL: # PUMPS:[ ]
I CERTIFY THAT THE ABOVE NOTED TANKS WERE PUMPED ON 08/02/2016 BY Southern Septic HAVE
THE VOLUMES SPECIFIED AS DETERMINED BY DIMENSIONS FILLING / LEGEND ], ARE FREE OF OBSERVABLE
DEFECTS OR LEAKS AND HAVE A [ SOLIDS DEFLECTION DEVICE / OUTLET FILTER DEVICE ] INSTALLED.
Roberto Rodriguez(Southern Septic Contractors,In 08/02/2016
SIGNATURE OF LICENSED CONTRACTOR BUSINESS NAME DATE
EXISTING DRAINFIELD INFORMATION
L 300 ] SQUARE FEET PRIMARY DRAINFIELD SYSTEM NO. OF TRENCHES [ ] DIMENSIONS: 15.00 y 20.00
[ ] SQUARE FEET SYSTEM NO. OF TRENCHES [ ) DIMENSIONS: X
TYPE OF SYSTEM: [X] STANDARD [ ] FILLED ( ] MOUND [ ]
CONFIGURATION: [ ] TRENCH [X] BED [ ]
DESIGN: [X] HEADER [ ] D-BOX [Xj GRAVITY SYSTEM [ ] DOSED SYSTEM
ELEVATION OF BOTTOM OF DRAINFIELD IN RELATION TO EXISTING GRADE 42.00 INCHES [ ABOVE
SYSTEM FAILURE AND REPAIR INFORMATION
[ 01/01/1948 1 SYSTEM INSTALLATION DATE TYPE OF WASTE [X] DOMESTIC L 7 COMMERCIAL
[ 300 1 GPD ESTIMATED SEWAGE FLOW EASED ON [ ] METERED WATER
[X] TABLE 3, 64E-6, FAC
SITE [ ] DRAINAGE STRUCTURES [ ] POOL [ ] PATIO / DECK
[ ] PARKING
CONDITIONS: [ ] SLOPING PROPERTY [ ]
NATURE OF [ ] HYDRAULIC OVERLOAD [ ] SOILS [ ] MAINTENANCE
[X] SYSTEM DAMAGE
FAILURE: [ ] DRAINAGE / RUN OFF [X] ROOTS [ ] WATER TABLE [ ]
FAILURE [ ] SEWAGE ON GROUND [ ] TANK [ ] D-BOX / HEADER [Xj DRAINFIELD
SYMPTOM: [ ] PLUMBING BACKUP [ )
SUBMITTED BY: TITLE/LICENSE DATE:06/02/2016
Roberto Rodriguez(Southern Septic
DH 4015, 08/09 (Obsoletes previous editions which may not be used)
Incorporated 64E-6.001, FAC Page 4 of 4
v 1.0.0 AP1250665 EID1699282
7
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTIOIN P MIT
Permit Application Number on
o UrA
-------------------------r-PART II-SITEPLAN---------------------------
Scale: Each block represents-1 0feet and 1 inch=40 feet. 0 0 '
128 v
Q o0
0
I
` o �
o
Notes. THERE ARE NO PERTINENT FEATURES ON ADJACENT PROPERTIES AND OR ACROSS
THE STREET THAT MAY AFFECT THE NEW SYSTEM INSTALLATION.
Site Plan submitted by: 2
Plan Approvedproved Date
By I
County Health Department
ALL CHANGE MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
DH 4015,10/96(Replaces HRS-H Form 4016 which may be used) Page 2 of 4
(Stock Number. 5744-002-4015-6)