Loading...
PL-17-1551 �. P Nc 'P -6��' _15��1 Miami Shores Village � # Fu� -4 e (" 10050 N.E.2nd Avenue NE Wotkff sstfitfi*SOW_ •"' Miami Shores,FL 33138-0000 p e r hv ® Phone: (305)795-2204 ermrtStett�s: FL�ORt1)A iue �017 Expiration: 12J1 112017 Project Address Parcel Number Applicant 570 NE 106 Street 1122310140180 DING DETRICK Miami Shores, FL 33138-2046 Block: Lot: Owner Information Address Phone Cell DINO DETRICK 570 NE 106 ST MIAMI SHORES FL 33138-2046 Contractor(s) Phone Cell Phone Valuation: $ 7,000.00 PULLES PLUMBING COMPANY (786)251-1234 Total Sq Feet: 0 Type of Work:INSTALL SEPTIC TANK&DRAINFIELD SA Available Inspections: Type of Piping: Inspection Type: Additional Info:INSTALL SEPTIC TANK&DRAINFIELD SA HRS Approval Bond Return: Final Classification:Residential Scanning:3 Review Plumbing Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Bond Type-Contractors Bond $500.00 Invoice# PL-6-17-64282 CCF $4'20 06/14/2017 Credit Card $279.20 $50.00 DBPR Fee $4.50 DCA Fee $4.50 06/09/2017 Check#:18863 $50.00 $0.00 Education Surcharge $1.40 Bond#:3432 Permit Fee $300.00 Invoice# PL-6-17-64317 Scanning Fee $9.00 06/14/2017 Credit Card $500.00 $0.00 Technology Fee $5.60 Total: $829.20 Bond#:3432 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: Ice " hat al �egoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zonin I authorize the above-named contractor to do the work stated. June 14, 2017 Au rizo Signa re:Owner / Applicant / Contractor / Agent Date Building Department Copy June 14,2017 1 Miami Shores Village 2017 s 'UN Building Department - 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 �e Tel:(305)795-2204 Fax:(305)756-8972 L�� INSPECTION LINE PHONE NUMBER:(305)762-4949 ST'1 FBC 201 BUILDING Master Permit No. PL 1-7— 1 E5I PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL E PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP `� CONTRACTOR DRAWINGS JOB ADDRESS: `� City: Miami Shores �/ County: Miami Dade Zip: Folio/Parcel#: �l — 2-2"3I' ®�7' elew Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): ! `AJO )ae Phone?.0 775-g'S 3 Address: v Z D N E 10 (o S-�rr,e Z City: "'Lhw'► S r-" State: F L Zip: 3 -11 3 Tenant/Lessee Name: Phone#: Email: at V)a�c�t-i t <e q M cit • C owl CONTRACTOR:Company Name: l� f �!�/te1 �/v Phone#: _ �� Address:A � City: v state:^G/ `� Zip: Qualifier Name: � d� ✓�-�r' Phone#: State Certification or Registration#:�'F G 0,,-rZ w '?3 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: o Value of Work for this Permit:$ */1y,z)Q'0 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: ��S' � i�3�'c '7 � �a2 �'�� ��dr�t� v✓ �rrJ Specify color of color thru tile: Submittal Fee$ ;:t Permit Fee$ t3 CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee Structural Reviews$ Bond$ ` TOTAL FEE NOW DUE$ 2�9® 20 (Revised02/24/2014) Bonding Company's Name(if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES,BOILERS, HEATERS,TANKS,AIR CONDITIONERS,ETC..... OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachme . Iso,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection is occur, sev n (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be pprov d an rein pection fee will be charged. Signature Signature . OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this _day of 20 6 by q�h day of VIW 20 I ,by 1"e c, who is personally known to Ca rko& 1 0 Qgwho is personally known to me or who has produced E5®I-C --\o �AA�eA° as me or who has produced Irl Y CoQ�`�has identification and who di ake an oath. identification and who did NOTARY PUBL : O r NOTARY PUBL C: Sign: i Sign: n Z N e Print: 0,T- �� I�oQ V� Print: eal: vo' Seal: PA"f" Y YP IETO = u ?��►+! G"Lo-, p•�r�� A l:h� HOUN ;• YCOMMIS #FF214031 d Z N My�t dS' FF041210 P4 EXPIRES:March 25,2019 �a< h'„ ,qy. Bonded Thru Notary Public Umlenrlters a N a m "'•. moo?.• F'' Snnt• t 1.2017 ** Q a T- APPROVED BY Plans Examiner Zoning � � w Structural Review Clerk .rop`• vi 2/24/2014) STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 PULLES, CARLOS HUBERTO PULLES PLUMBING COMPANY 8541 SW 133RD PL MIAMI FL 33183 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and STATE OF FLORIDA Professional Regulation. Our professionals and businesses range ,. from architects to yacht brokers,from boxers to barbeque DEPARTMENT OF BUSINESS AND restaurants,and they keep Florida's economy strong. . PROFESSIONAL REGULATION Every day we work to improve the way we do business in order CFC056693 ISSUED: 06/22/2016 to serve you better. For Information about our services, please to onto www.myflorldalicense.com. There you can find more CERTIFIED PLUMBING CONTRACTOR information about our divisions and the regulations that impact PULLES, CARLOS HUBERTO you,subscribe to department newsletters and learn more about PULLES PLUMBING COMPANY the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly.We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, IS CERTIFIED under the provisions of Ch.489 FS. and congratulations on your new license! Expiration date:AUG 31,2018 L1606220000816 DETACH HERE RICK SCOTT, GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD CFC056693 The PLUMBING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. ' Expiration date: AUG 31, 2018 PULLES, CARLOS HUBERTO Q-161 PULLES PLUMBING COMPANY 8541 SW 133RD PLMIAMI FL 33183 ISSUED: 06/22/2016 DISPLAY AS REQUIRED BY LAW SEQ# L1606220000816 Local Busi ness Tax Fbcei pt Miami-Dade County, State of Florida -THIS ISNOT ABILL-DO NOT PAY BT 3252384ij BUSINESS NAM E/LOCATION RECEIPT NO. EXPIRES PULLES PLUMBING COMPANY RENEWAL SEPTEMBER 30, 2017 8541 SW 133 PL 3388139 MIAMI, FL 33183 Must be displayed at place of business Pursuant to County Code Chapter 8A-Art.0& 10 OWNER SEC.TYPE OF BUSINESS PAYM ENT RECEIVED PULLES PLUMBING COMPANY 196 PLUMBING BY TAX COLLECTOR C/O CARLOS H PULLES PRES CONTRACTOR 75.00 09!09/2016 Worker(s) 2 CFC056693 0224-16-005709 This Local Business Tax la cel pt only con"rms payment of the Local Business Tax.The Receipt is not a license, permit,or a oerti"cation of the holder's qua]i"cations,to do business.Holder must comply with any governmental ornongovernrnental regulatory laws and requirementswhichapply tothe business. Mt The FEMPT NQ above mist be displayed on all commercial vehicles-Miami-Dade Oode Sec Ba-2/8. Aw For more information,vi sit www.rriamidade.aovitaxcdlector ACO® DATE(MWDDIYYYY) `� CERTIFICATE OF LIABILITY INSURANCE 06/13/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terns and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Xamet Barreras Temax Insurance Inc PHONE , (786)539-5989 FpAjC No): (305)356-1235 9370 SW 72 Street ADDRESS: xamet@temaxinsurance.com A214 INSURERS AFFORDING COVERAGE NAIC# Miami FL 33173 INSURER A: LLOYDS OF LONDON INSURED INSURER B: PROGRESSIVE EXPRESS INSURANCE COMPAN- 10193 Pulles Plumbing INSURER C: 8541 SW 133 PI uNlsURERD: INSURER E: Miami FL 33183 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.ADOL INSR TYPE OF INSURANCE I=vim SUER POLICY NUMBER MM/DDY EFF MWDD EXP LIMITS LTR XRENTED COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DA AGE ToCLAIMS-MADE X OCCUR PREM SES E.occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 A UDC-1943804-CGL-17 04/03/2017 04/03/2018 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY1:1 PE O LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accidence_ ANY AUTO BODILY INJURY(Per person) $ 109000 B OWNED XJLET] AUTOS ONLY AUTOS 03226588-2 07/29/2016 07/29/2017 BODILY INJURY(Per accident) $ 20,000 AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ 10,000 AUTOS ONLY AUTOS ONLY (Par accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE F--1 N_LA E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) State Plumbing Contractor CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village ACCORDANCE WITH THE POLICY PROVISIONS. Building Deparment AUTHORIZED REPRESENTATIVE 10050 NE 2 Ave Miami Shores FL 33138 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD PULLES PLUMBING CO. 8541 S.W 133 PL. MIAMI, FLORIDA 33183 PH: (305)-558-0410 FAX: (305) 382-8914 CFC056693 Date: STATE OF FLORIDA COUNTY OF DADE BEFORE ME THIS DAY PERSONALLY APPEARED CARLOS PULLES WHO, BEING DULY SWORN, DEPOSES AND SAYS: THAT HE OR SHE WILL BE THE ONLY PERSON WORKING ON THE PROJECT LOCATED AT: 570 N.E 106 ST MIAMI SHORES, FLORIDA 33138 CONT R,S1PaTU RE `S 0P, TO (OR AFFIRMED) AND SUBSCRIBED BEFORE ME THIS(yt�DAY OF na. . 20 11 - ABY 00,40-> Personally Know OR Produced Ide tification FkJ,�h �d�' 154f Gr`ce�sP Type of Identificatio Produced Ramses Garda Notary Public State o4 Florida 'y, Ny Commission Expit Aja 04.19-2020 Print,Type or Stamp Name of Notary Commission No.FFOMI3 `g8oR Miamishores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305)795.2204 Fax: (305)756.8972 Notice to Owner — Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation%insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers'Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees,including the owner,must obtain workers'compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if: 1. The officer owns at least 10 percent of the stock of the corporation,or in the case of an LLC,a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State,Division of Corporations;and 3. The corporation is registered and listed as active with the Florida Department of State,Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers'compensation exemption and has acknowledge that he or she will not use day labor,part-time employees or subcontractors for your project.The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project.In these circumstances,Miami Shores Village does not require verification of workers'compensation insurance coverage from the contractor's company for day labor,part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. / Signature a. Lam. Owner State of Florida County of Miami-Dade The foregoing was acknowledge before me this ( � day of �U�� 20 17. By &,,J rg M C A er1'L/e—Ur i et who is personally known tome or has produced flSv.3 I v Q_ dentification. Notary: "° MARIA A CALHOUN =` MY COMMISSION#FF041210 SEAL: -' OF. EXPIRES September 10,2017 (407)'3 0153 FloridallotaryService.com e go PERMIT #: 13-SC-1766353 STATE OF FLORIDAAPPLICATION #:AP1292703 DEPARTMENT OF HEALTH DATE PAID: ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID: SYSTEM RECEIPT #: DOCUMENT #:PR1063905 CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: Dino Detrick PROPERTY ADDRESS: 570 NE 106 St Miami, FL 33138 LOT: 3 4 BLOCK: 110 SUBDIVISION: PROPERTY ID #: 11-2231-014-0180 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] [OR TAX ID NUMBER] SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION 381.0065, F.S., AND CHAPTER 64E-6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS, WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL, STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY. SYSTEM DESIGN AND SPECIFICATIONS T [ 1,050 ] GALLONS / GPD NEW SeDfic TANK CAPACITY A [ 0 ] GALLONS / GPD CAPACITY N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS a .`S e'd e�p1o°a,i p�N des+QUO 1 �n<<e,1d pS0v2, ale cte D [ 300 ] SQUARE FEET NEW DF IN BED CONFIG SYSTEM trac�o�t°� �t°tn''d %°F\°a� R [ 0 ] SQUARE FEET SYSTEM A TYPE SYSTEM: [X] STANDARD [ ] FILLED [ ] MOUND I CONFIGURATION: [ ] TRENCH [x] BED [ ] SaQC�O �e°'i a\lheas odZ�C�ti� N teS� 51 10dr'� F LOCATION OF BENCHMARK: CL OF NE106 ST 13.05'NGVD ce�nspeobs<<e atth I ELEVATION OF PROPOSED SYSTEM SITE [ 7.32 ] [ INCHES FT ] [ABOVE BELOW BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 49.32 ] [ INCHES FT ] [ABOVE BELOW BENCHMARK/REFERENCE POINT L D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: [ 54.00 ] INCHES wam 1.-Install a 1050 gal.septic tank with an approved filter ° 2.-The licensed contractor installing the system is responsible for installing the minimum catego ot T with s.64E-6.013(3)(f)FAC. H 3.-Install 300 sf.of drainfield in ...BED....configuration. 4.-Install 12"of slightly limited soil at the bottom of the drainfield. E 5.-Perimeter of excavation area shall be at least 2 It wider and longer than the proposed absorption bed or trench. R (Comments Continued on Page 2.) 01 SPECIFICATIONS BY: i X Gonzale TITLE' Engineering Specialist II APPROVED BY: TITLE: Engineer Supervisor III Dade CHD Astrid V Edwards DATE ISSUED: 06/01/2017 EXPIRATION DATE: 08/30/2017 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 AP1292703 SE1036138 STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR CONSTRUCTION PERMIT PPIQ9�73 Permit Application Number, ---------- -- -- - - - - - -- ------ PART II -SITEPLAN - ---- -- - --- ------ - -- ------- Scale: Each block re resents 10 feet and 1 inch =40 feet. C � 4e M � i f A Q � I` f� t n6. V, 4414 e SZ b, 14 MR -rr qtY 14 �) xf is Notes: ,5.A?,4 Aga NG 153;,fr/4 v417` Site Plan submitte by: Gp� �- � rel C !v s (� (s� C'��dyG 6 1-3 Plan Approved Not Approved Date By County Health Department ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT DH 4015,08/09(obsoletes previous editions which may not be used) Incorporated: 64E-6.001,FAC Page 2 of 4 (Stock Number: 5744-002-4015-6) DOCUMENT #: PR1063905 (Comments continued on Page 2) 6:Invert elevation of drainfield to be no less than 9.44' NGVD 7:Bottom of drainfield elevation to be no less than 8.94'NGVD 8.-This permit includes the abandonment of the existing septic tank. THIS PERMIT IS NOT FOR ANY ADDITIONS. The system is sized for 3 bedrooms with a maximum occupancy of 6 persons(2 per bedroom),for a total estimated flow of 300 gpd. Required drainfield area based on rule 64E-6.015(6)(c)2. Install a new drainfield to achieve Drainfield size requirement. The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance with s. 64E-6.013(3)(0, FAC. STATE OF FLORIDA APPLICATION # AP1292703 DEPARTMENT OF HEALTH PERMIT # 13-SC-1766353 ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM DOCUMENT # SE1036138 s SITE EVALUATION AND SYSTEM SPECIFICATION y WIL APPLICANT: Dino Detrick CONTRACTOR / AGENT: Pulles Plumbing LOT: 3 4 BLOCK: 110 SUBDIVISION: ID#: 11-2231-014-0180 TO BE COMPLETED BY ENGINEER, HEALTH DEPARTMENT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEERS MUST PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS. PROPERTY SIZE CONFORMS TO SITE PLAN: [X ]YES [ ]NO NET USABLE AREA AVAILABLE: 0.28 ACRES TOTAL ESTIMATED SEWAGE FLOW: 300 GALLONS PER DAY [ RESIDENCES-TABLET / OTHER-TABLE 2 ] AUTHORIZED SEWAGE FLOW: 700.01 GALLONS PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE ] UNOBSTRUCTED AREA AVAILABLE: 450.00 SQFT UNOBSTRUCTED AREA REQUIRED: 450.00 SQFT BENCHMARK/REFERENCE POINT LOCATION: CL OF NE106 ST 13.05'NGVD ELEVATION OF PROPOSED SYSTEM SITE 7.32 [ INCHES / FT ] [ ABOVE / BELOW ] BENCHMARK/REFERENCE POINT THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES SURFACE WATER: 0 FT DITCHES/SWALES: 0 FT NORMALLY WET: [ ]YES [XINO WELLS: PUBLIC: 0 FT LIMITED USE: 0 FT PRIVATE: 0 FT NON-POTABLE: 0 FT BUILDING FOUNDATIONS: 6 FT PROPERTY LINES: 5 FT POTABLE WATER LINES: 50 FT SITE SUBJECT TO FREQUENT FLOODING? [ ]YES [X]NO 10 YEAR FLOODING? [ ]YES [XINO] 10 YEAR FLOOD ELEVATION FOR SITE: 4.00 FT [ MSL / NGVD ] SITE ELEVATION: 12.40 FT [ MSL / NGVD SOIL PROFILE INFORMATION SITE 1 SOIL PROFILE INFORMATION SITE 2 USDA SOIL SERIES: Urban land USDA SOIL SERIES: Urban land Munsell#/Color Texture Depth Munsell#/Color Texture Depth 10YR 6/3 Sand 0 To 72 1 OYR 6/3 Sand 0 To 72 OBSERVED WATER TABLE: INCHES [ ABOVE / BELOW ] EXISTING GRADE TYPE: [ PERCHED / APPARENT ] ESTIMATED WET SEASON WATER TABLE ELEVATION: 101 INCHES [ ABOVE / BELOW ] EXISTING GRADE HIGH WATER TABLE VEGETATION: [ ]YES EX]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: 05/26/2017 Pulles,Carlos(Title:)(Pulles Plumbing Company) DH 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated: 64E-6.001, FAC Page 3 of 4 AP1292703 EID1766353 v 1.0.2 APPLICATION # AP1292703 M STATE OF FLORIDA Un "^ $� PERMIT # 13-SC-1766353 � DEPARTMENT OF HEALTH CO ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM DOC # RE395931 ti EXISTING SYSTEM AND SYSTEM REPAIR U fy EVALUATION M APPLICANT: Dino Detrick CONTRACTOR / AGENT: Pulles Plumbing LOT: 3 4 BLOCK: 110 SUBDIVISION: ID#: 11-2231-014-0180 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 TANP CERTIFICATION BELOW OR NOTE IN REMARKS WHY THE TANKS CANNOT BE CERTIFIED. EXISTING TANK INFORMATION [ 1050 ] GALLONS Septic Tank LEGEND:Unknown MATERIAL:Concrete BAFFLED: N l I l GALLONS LEGEND: MATERIAL: BAFFLED: [ Y / N l [ ] GALLONS GREASE INTERCEPTOR LEGEND: MATERIAL: [ ] GALLONS DOSING TANK LEGEND: MATERIAL: # PUMPS: [ ] I CERTIFY THAT THE ABOVE NOTED TANKS WERE PUMPED ON 05/09/2017 BY Pulles Plumbing Company , 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. Carlos H Pulles(Pulles Plumbing Company) 06/13/2017 SIGNATURE OF LICENSED CONTRACTOR BUSINESS NAME DATE EXISTING DRAINFIELD INFORMATION [ 300 l SQUARE FEET PRIMARY DRAINFIELD SYSTEM NO. OF TRENCHES [ ] DIMENSIONS: 10.00 X 30.00 [ ] SQUARE FEET SYSTEM NO. OF TRENCHES [ ] DIMENSIONS: X TYPE OF SYSTEM: [X] STANDARD [ ] FILLED [ ] MOUND [ ] CONFIGURATION: [ ] TRENCH [X ] BED [ ] DESIGN: [X] HEADER [ ] D-BOX [X] GRAVITY SYSTEM [ ] DOSED SYSTEM ELEVATION OF BOTTOM OF DRAINFIELD IN RELATION TO EXISTING GRADE 42,00 INCHES [ ABOVE SYSTEM FAILURE AND REPAIR INFORMATION [ 01/01/1947 ] 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 [X ] DRAINAGE STRUCTURES [ ] POOL [ ] PATIO / DECK [ ] PARKING CONDITIONS: [X] SLOPING PROPERTY [ ] NATURE OF [ ] HYDRAULIC OVERLOAD [ ] SOILS [ ] MAINTENANCE [X] SYSTEM DAMAGE FAILURE: [ ] DRAINAGE / RUN OFF [ ] ROOTS [ ] WATER TABLE [ ] FAILURE [ ] SEWAGE ON GROUND [X ] TANK [ ] D-BOX / HEADER [X] DRAINFIELD SYMPTOM: [X ] PLUMBING BACKUP [ ] SUBMITTED BY: TITLE/LICENSE DATE:05/13/2017 Carlos H Pulles(Pulles Plumbing Com 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 AP1292703 EID1766363 - . � 0UNDAR It SURVEY SCALE: 1" = 20' /,L-L E-1 Ep � O E� rip - a v Iryi r,r � E"�mpy91 FY I s A � i:• a �M.= � I ' t - e'- F�—Eli=Can N _ ) r o 7 I{ N 2d o G.G {e 13 do. --70 6c 0 i FOIJI-l��' "•"` � I. F.I P. C�rne� r' • Y NOTES: — BEARINGS WHEN SHOWN ARE REFERRED TO AN ASSUMED VALUE / — ELEVATIONS WHEN SHOWN ARE REFERRED TO �L PROPERTY ADDRESS "270 LI r 641 6rA i V. LEGAL DESCRIPTION LOT 41 11 [ I I n BLOCK 110 3LIBDMSION fvi AMf=FJDEi PIAT of ta1=_G ied l,Io• I ACCORDING TO THE PLAT THEREOF AS RECORDED IN PLAT BOOK to AT PAGE 47 d OF THE PUBLIC RECORDS OF COUNTY, FLORIDA ► 0 1 e n A Itltl Z W ausj> �.F. ►oma` -,� r w s .9 ► Q TN 'i z �'� �� �� iCc 17 lP� 19 LO 21 cZ L'. z4- UI ► � e l n aqqn eyyl��op} c 0 ooda�aa M a LOCATION SKETCHI- scALE. ce THE NATIONAL FLOOD W_.URANi;E RATE AWDATED u p-o,2 18`11+ WBidStiED BY TFI'f FFDFTiAL i:WERWFLt' tWkAG&]iENT AGiTCf DEL1FlEaTES M u o 0 o n o o a o THE HEREIN DESCRIBED LAND TO BE SITUATED WITHIN ZONE X 2oC �2 pANEI �l' SUFFI> �• W,f 3 � 25 COM►IUFUTI NO I HEREBY CERTIFY: That the BOUNDARY SURVEY of the above described property is true and correct to the best of my knowledge and belief as recently surveyed under my direction, also that there are no above ground encroachments unless shorn. g This survey meets the min k u rn teehniead standards set forth by the Florida Board of Professional Surveyors and Mappers, in Chapter 61G17-6, Florida Administrative Code, pursuant to section 472.027 Florida Stotutes. Examination of the abstract of title wig have to be rrxde to deterrrdrro recorded Instruments. R any. affecting the property. Location and identification of utilities adjocent c to the property were not secured as such information was not requested, Ownership is subject to opinion of title. This survey is W not intended for design nor construction purposes. For those purposes a Topographic Survey is required. 3 CERTIFIED "f0: J'_� DINO DETRICK AND SANDRA MCKENZIE DETRICK, husband�'N �. BONF,u`=L'_ ��� C, and wife PRROFEESO1INSIF �AlO�QS}4RVEYOR AND PER N0. 3179 STATU U W 4 4 ONESTOP MORTGAGE, INC. , its successors and/or DATE: o-i-�c- assigns as their interest may appear OLD REPUBLIC NATIONAL TITLE INSURANCE COMPANY NOT VALID WITHOUT THE ORIGINAL RAISED SEAL AND SIGNATURE OF A FLORIDA s NOUVELLE TITLE SERVICES, INC. LICENSED SURVEYOR AND MAPPER. B i g �o &&ilfi &— A -'iatel� IID-lC-.— LB No.3398 REVLON: SIO"` $� • Registered Surveyor and Mapper, State of FlordaIIIIIIp O p 9360 S.W. 72nd STREET, Sulfe 265 CUEW: Miami, Florida 33173 (305) 598-8383 FAX: 598-0023 ORDER NO. - ��2 t t 9 BOUNDARY SURVEY S('ALF: ti ,Ns gnpRO\170 BY ` Dn,7F f(,ry nn_�lAir ( En t _..777T—� —CT TO C(ir?pLIA^JL-1- F- �_ E III,. r 1 Af r f a, h ' r NOTES: PKARING'S WHEN SHOWN ARE REFERRED TO AN ASSUMED VALUE / - ELEVATION'S WHEN SH0WN ARE REFERRED TO PROPERTY ADDRESS �- 7, , = I,.,. 9-.���_--___-��- _—. ,._-_. __-_-.__� � ! _m��,.- , ..41 LEGAL DESCRIPTION LOT131�O'CK SUBDMSION t I ACCORDING TO THE PLAT THEREOF AS RECORDED IN PLAT BOOK AT ME– OF THE PUBLIC RECORDS OF COUNTY, FLORIDA 1i j T- p I 5..,, 1 y S� 1 n B B �. LOCATION SKETCH SCALE: qpCt v Fl TF ME NATIOPal. FL= IWWW+X RATE MAP DATEL)— is F-UsUSNED Hy T,;E F.D0,64 EkemGiNCY Cy it -,'E HEREIN DESCRIBED LAND TO BE SITUATED WITHIN ZONE FANF i- Commulmy No.. Ix— 0 I HEREBY CERTIFY: That the BOUNDARY SURVEY of the above described property is true and correct to the best 0! my k Q noviledge and belief as recently surveyed under my direction, also that them are no above ground enc=ochrnorts ut�lesq shoran. This survey meets the minimum technical standards set forth by the Florida Board of Professional Surveyors one Mvppovn, in Chapter 6IG17-6, Florida Administrative Code, pursuant to section 472.027 Florida Statutes. Examination of the abstract of title vil! have tobe mode to determine recorded instruments. if any, affecting the properly, Location and identification a' utilibc,: to the property were not secured as such information was not requested. Ownership is subject to opinion of title ThissurveyI!. II not intended for design rv>r construction purposes. For those purposes a Topographic Survey is requires II -ER71FIED `0: 12";L` DINO D M-- 'RMAND SANDRA MCKENZIE DEPRICKJ- BONFILI ,,;[SSlONAL SURVEYOR X14L MW .-�4 IPEP NO. 31 and wife , J,;<e OF FLOR;01, ONESTOP MORTGAGE, INC. , its successors and/or ( assigns as their interest may appear NOT VALID WPF0'2T 'Mk� DRIGINRX'S)ED OLD REPUBLIC NATIONAL TITLE INSURANCE COMPANY AND SIGNAIURF OF A Fi.0RIDA Q NOWELLE TITLE SERVICES, INC. J5 L B No. 3398 I REMSION 8 J &, Registered Surveyor and Mapper, State of Florida C A JEW: 9360 SAY. "2nd STREET, Suite 265 Mimi, Florida 33173 (305) 598-8383 FAX: 598-0023 ORDER Na DIVISION Of �.+ i .rr Environmental Heatth P I " 42 Dat i u ry � 1 $ .Y w. �