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PL-12-2963 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone:(305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-294078 Permit Number: PL-12-17-2963 Scheduled Inspection Date: May 10,2018 Permit Type: Plumbing - Residential Inspector: Hernandez,Rafael Inspection Type: Final Owner: HOBSON,HOYT _ Work Classification: Drainfield Job Address:1270 NE 102 Street Miami Shores,FL Phone Number Parcel Number 1132050250031 Project <NONE> Contractor: SOUTHERN SEPTIC CONTRACTORS INC Phone: (305)598-8266 Building Department Comments DRAINFIELD REPLACEMENT Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed HRS ON FILE Failed Correction Needed ❑ Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid May 09,2018 For Inspections please call:(305)762-4949 Page 6 of 39, +DIVISION_OF Environmental Health y t +y'z^• Florida Health Miami,-Dade County F Q� ,,OSTDS/Well Division 11805 SW 2 th�Sireet•;Miami,FL 33175 �, f ' Inspector': ' !�C i Date Address 12'?d1`��Y Y�.SZ.:a �OSTDS#*T Comments: y g `Signature', J � r, FFe 16 201V_, a Permit No.;PL4 2-17-2963 Miami Shores Village Y tPermit Type: Plumbing-Residential a .. 10050 N.E.2nd Avenue NE WorkCiassifCalion:DraII fieId Miami Shores,FL 33138-0000P rm Permit Status:APPROVED Phone: (305)795-2204 X20 RiD� i issue Date:1/1812018 Expiration: 07/1712018 Project Address Parcel Number Applicant f 1270 NE 102 Street 1132050250031 Miami Shores, FL Block: Lot: EDWIN CINTRON Owner Information Address Phone Cell LHOYT HOBSON 1270 NE 102 ST IL MIAMI SHORES FL 33138-2618 Contractor(s) Phone Cell Phone Valuation: $ 2,000.00 SOUTHERN SEPTIC CONTRACTORS 1 (305)598-8266 Total Sq Feet: 300 Type of Work:DRAINFIELD REPLACEMENT Available Inspections: Type of Piping: Inspection Type: Additional Info:DRAINFIELD REPLACEMENT 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-12-17-65933 CCF $1.20 DBPR Fee $2.25 12/18/2017 Credit Card $50.00 $621.45 DCA Fee $2.00 01/18/2018 Credit Card $621.45 $0.00 Education Surcharge $0.40 Bond#:3611 Notary Fee $5.00 Permit Fee $150.00 Scanning Fee $9.00 Technology Fee $1.60 Total: $671.45 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. i OWNER AF DAV I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construct on an z nin Futhermore, I authorize the above-named contractor to do the work stated. w January 18, 2018 Aut�i0rize Signature: caner / Applicant / Contractor / Agent Date Building D p ment Copy January 18,-2018 1 f 4 -r, f .,. 1 4 J' I I f `` • RECEIVED 3 1� Miami Shores Village DEC 18 2017 Building Department Q4�1 Z-5:1 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 fi INSPECTION LINE PHONE NUMBER:(30S)762-4949 FBC 2011 BUILDING Master Permit No.-? ZO, PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL *PLUMBING" ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 1270 NE 102 ST City: Miami Shores - CountV• Miami Dade Zip: Folio/Parcel#: 11-3205-025-0031 Is the Building Historically Designated:Yes NO X Occupancy Type:: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholde6:EDWIN CINTRON Phone#:305-205-9028 Address: 1270 NE 102 STREET City: MIAMI SHORES state: FL Zip 33138 Tenant/Lessee Name: Phone#: Email: _. CONTRACTOR:Company Name: SOUTHERN SEPTIC phone#: 305-598-8266 Address: 21051 SW 234 STREET City; HOMESTEAD State: FL _ _ _ Zip; 33031 Qualifier Name: ROBERTO RODRIGUEZ Phone#: 305-598-8.266 State Certification or Registration M. SR0021421 _ _Certificate of Competency#: DESIGNER:Architect/Engineer: NSA Phone#: Address: City: State: Zip: Value of Work for this Permit:$ `2-10 O O • D 4 Square/Linear Footage of Work:3W Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition Description of Work: DRAINFIELD REPLACEMENT Specify color of color thru tile: Submittal Fee$ _ Permit Fee$ / CCF$ CO/Cc$ . • ? Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ __ Training/Education Fee$ _ Double Fee$ I Structural Reviews$ Bond$ � U70 Q7 I TOTAL FEE NOW DUE$ ( 21 • (Revised02/24/2014) C,2- �5 Bonding Company's Name(if applicable) N/A Bonding Company's Address City State..._. Zip. Mortgage Lender's Name(if applicable) N/A Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do'the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS,HEATERS,TANKS,AIR CONDITIONERS,ETC..... OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the Issuance of a building permit.with an estimated value exceeding$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature i4ik OWNER or AGENT NTRACTOR The foregoing instrument was acknowledged before me this ac nowledged efor�.tl�e�this day of No,P�.btr 20 lZ by 20 —T b , y who is personally known s known to `e or who has produced as _-" ,t% as Identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: MAHARAI K.GONZALEZ . P, GG 044602 SSS Print: 1'YYlG1t/ a- Print: * �' EXPIRES:November u^deters Seal: Seal:mad ' EiMUNQMOSVM WC0kWkq #FF9=I **sssss*ssr s EXPIRES:Amwy9,2= 1R11�111NAldrtlRf6lbtllrwlMM +ssss****s*srsrs*s**ssssssr*ssssrsrssss*sss**sssrrsrs*ssssrrssrss APPROVED BY - Plans Examiner Zoning 4 Structural Review Clerk { (Revised02/24/2014) 4 12/18/2017 Property Search Application-Miami-Dade County -lift "FICE OF THE PROPERTY APPRAISER V �'1149 - - �5 0 Summary Report Generated On: 12/18/2017 Property Information Folio: 11-3205-025-0031 Property Address: 1270 NE 102 ST Miami Shores,FL 33138-2618 Owner EDWIN CINTRON&HOYT C r ' HOBSON Mailing Address 1270 NE 102 ST MIAMI SHORES,FL 33138-2618 PA Primary Zone 1400 SGL FAMILY-3001-3250 SQ 1 4 Primary Land Use 0101 RESIDENTIAL-SINGLE FAMILY: 1 UNIT Beds/Baths/Half 3/2/1 t_ Floors 2 f,. Living Units 1 Actual Area 3,307 Sq.Ft Living Area 2,303 Sq.Ft Adjusted Area 2,444 Sq.Ft Taxable Value Information Lot Size 11,050 Sq.Ft Year 2016 2015 Year Built 1949 County Assessment Information Exemption Value $50,000 $50,000 $50,000 Taxable Value $171,979 $167,414 $165,903 Year 2017 2016 2015 Land Value School Board $397,412 $369,886 $337,198 Building Value Exemption Value $25,000 $25,000 $25,000 g $170,102 $170,102 $170,102 Taxable Value $196,979 $192,414 $190,903 XF Value $165 $168 $136 ._......__. _ _._, City Market Value $567,679 $540,156 $507,436 Exemption Value $50,000 $50,000 $50,000 Assessed Value $221,979 $217,414; $215,903 Taxable Value 1 $171,979 $167,414 $165,903 Benefits Information Regional Exemption Value $50,000 $50,000 $50,000 Benefit Type 2017 2016 2015 - Taxable Value $171,979 $167,4141 $165,903 Save Our Homes Assessment $345,700 $322,742 $291,533 Cap Reduction Homestead Exemption Sales Information p $25,000 $25,000 $25,000 Previous Sale Price OR Book-Page Qualification Description Second Homestead Exemption $25,000 $25,000 $25,000 - -. 07/01/1997 $268,000 17699-4259 Sales which are qualified Note:Not all benefits are applicable to all Taxable Values(i.e.County,School Board,City, Regional). 03/01/1995 $172,500 16737-1543 Sales which are qualified 08/01/1991 $140,000 15136-0152 Sales which are qualified Short Legal Description PB 42-25 BAY BREEZE SEC MIAMI SHORES LOT 4 BLK 185 LOT SIZE 85.000 X 130 OR 17699-4259 0797 1 The Office of the Property Appraiser is continually editing and updating the tax roll.This website may not reflect the most current information on record.The Property Appraiser and Miami-Dade County assumes no liability,see full disclaimer and User Agreement at http://www.miamidade.gov/info/disclaimer.asp Version: PIR4mg2RU � Vic=-�,.,,� dC •.�,tC�..t-� l`'=loo` P , EE , 10-2 P-° fzT ASS- AA�; ply.-•Fcyl�u j � • AT Certified To: Steven M. /! dAuerbacher, P.A., `1zl.rjy Attorneys' Title `.Insurance Fund, Inc., Cintron, Edwin and CA Hobson, Hoyt C., and - - 1 . ?gig Chase Manhattan Maztg ty-j ` ! •E 11_T ? • • • �• • ! J ` .` Iz,0 'Corporation, it's _"r" " ----- _.- - •••••• Allit • 1 E • • • � i'i» f ,�. _ I•' -�,,, .��f.� -.St1CCeiSOr3 and/or assigns. '••.•• • r Ot�(I. property y F+ ZONE: VAE •••••• • • 1 • �� Lot 4, Block 85 • � +->•••.••" - ); This ro ort described a�: + _^ _ t vi{ ^� FLOOD INFORMATION: 1 BAY BREEZE SECTION MIAMI SHORES, 0652 •;•��a� • • •• •• "� �l2.od ;j - according to the Plat Community No. 12Suff • • • / Pana1 tio.: 93 Suffix: J ••••• 1�, • . a•••• ;• 4 i'{ thereof,reof, as recorded / / ate of e.I.R.M.: 3-2-94 000:0 • ? y 0_ t Plat Book 4"L, Page 25 ••••• • •••• , ' - .se Elevation: +8.00 N.G.V.D. 00.00• • • ' �. h of the Public Records • • 0090 . �! Dade countx, Florid., ,t No e: Underground encroachments and utilities:0000. • ••:••• �( `� { ) if any, not located. Fence ownership by ( w t� h} r visual means only, legal ownership not 0000.. .. 00.. ��,� •• ••: •00•• �' S1 Q _ �_. _ determined 000000 . ••• r, �; •••• ry C9� IQ CL -7' 01�.� L._.L" ''J�' ^r .i1..ant- -.. '_ ,_.�'JJ►..� `' 10 MTI - - �-^ Cirtron, Edwin andJ PROPER" Of Hobson, Hoyt C. 1270 N.E.. 102nd Street, Miami Shores, 33138. ♦ut.41A embo}ved M_.t!V_1_,) tgxq ,4141 - S., . ` , A K CaI A. INC. •( „ 7 ""„� < � wah Sutveyo,`,Sea! .tr. «et•,M rr. w..n •v ,.r .. +'•! ''1 r... _. 00 00 -..,_. P ..meA n..w,� �+.,, ,M �.,.., NEE ti1 R%E�Qltf, LA-,r)PLANNERS b.MS—d NW, ►ca 1«e 09 YM1AI6d$5VVES - 1432 nwwL w O(1 At<ara hu¢#gurstal Gable. Ronda ) *Chapter ' •, ( 1:�S OlOi i-.6 .., „1 .«n,n..u. _ hM1>t alklt IJ M,dmi.Ek�t„1a )11 Sr, - �•f'�'. ,yp- K •MM• ,Mn „ DAtE SW! � )�,� .- � r ►523-86(±.7 e, ,wl tilh w,. C.l- (, j '11 OR ��:Nt UR1%(, `. A)E At U 0z Recertified, I �, y ;sF�. 28439 e119i9' - Recertified, Certified To and Names ReviA 'Jzj 69811 STATE OF FLORIDA , DEPARTMENT OF HEALTH APPLICATION FOR CONSTRUCTION PERMIT Permit Application Number - --------------------------- PART II-SITEPLAN------t--------------------- Scale: Each block reresents°10 feet and 1 inch =40 feet. 100, )Dr vr F R _ DEP N F1 E ti:� X 13 TNG 90 A OI T •,.._ RI VE I W A If 2 3 ' Sr i - - TI lFa F 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, - S IZootl`�'Ll Plan ApprovedN y4 d Date ,Y - - _,_ County Health Department ALL GES MUST BE APPRbVErf BYttiE dMV HEALTH DEPARTMENT " DH 4015,08109(Obscietes previous editions which may nyt t us�d} Incotpprated:l;4E 6.b41�FAQ• Page 2 of (Stock Number: 5744-002-4015-6) '' L PERMIT #:13-SM-1801380 APPLICATIONt #:AP131'4532 STATE OF P`LORIDA y DEPARTMENT 00 HEALTH DATE PAID: _ ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID: - - SYSTEM RECEIPT #: "` { ti DOCUMENT #:PR1082051 CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: EDWARD CINTRON --- PROPERTY ADDRESS: 1270 NE_102 St Miami,FL 33138 F LOT: 4 BLOCK: 185 SUBDIVISION [SECTION, TOWNSHIP, RANGE, PARCELNUMBER PROPERTY ID #: 11-3205-025-0031 [OR TAX ID NUMBER] t 5 i SYSTEMOF SECTION MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS 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 - 4 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 I[ 900 l GALLONS / GPD 'Seotic-TANK TO REMAIN CAPACITY A [ 0 J' GALLONS / GPD :_ _. CAPACITY N,[ 0 1 GALLONS GREASE INTERCEPTOR CAPACITY (I:+AXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K`[ ]` GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24'HRS #Pumps ( J a y D [ 300 ] SQUARE FEET NEW DF IN BED CONFIG SYSTEM R [ O ] SQUARE FEET _ -SYSTEM A TYPE SYSTEM: (x] STANDARD ( ] FILLED ( ] MOUND I CONFIGURATION: ( ] TRENCH [Xj BED F LOCATION OF BENCHMARK: 10.35'TOP OF BOTTOM FLOOR AS PER CERTIFICATE ELEVATION I {ELEVATION OF PROPOSED SYSTEM SITE ( 22.20 ] ( INCHESABOVE BELOW BENCHMARK/REFERENCE POINT E ,BOTTOM OF DRAINFIELD TO BE ( 26.201 [ INCHES FT (ABOVE `BELOW BENCHMARK/REFERENCE POINT L D FILL'REQUIRED: -(',0.00 1 _INCHES - ON 'REIRED INCHES 4 1.-EXISTING 900gal.septic tank with and approved filter TO REMAIN. O l 2.- Install 300sf.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 bed or trench. (Comments Continued on Page 2.) E •• ••. • . • • . •• R' • • •• • • • • • SPECIFICATIONS BY: George Pa /77P TITLE: APPROVED BY •4MTLE: ihlr S"eialist II Dade CED Loanis X • • • • • • • DATE ISSUED: 11/13/2017A. :• ••• EXPIRATION DATE: 05/13/2019 DH 4016, 08/09 (Obsolete- all previous editions which may not be used) t Incorporated: 64E-6.003, FACsee Page 1 of 3 z v 1.1.4 • • • 1:131453Q r • SE1053369 ose • •• •• • • • •• •• I t DOCUMENT fl: PR1082051 (Comments continued on Page 2) 5.-Invert elevation of drainfield to be no less than 6.50'NGVD 6.-Bottom of drainfield elevation to be no less than 6.00'NGVD 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 400 gpd• 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. Required drainfield area based on rule 64E-6.015(6)(c)2. Install a new drainfield to achieve Drainfield size requirement. i r R 1 7 , 1 •• ••• • • • • • •• • •• • • • • ••• • • ••• • ••• ••• ••• I ••• • • • • ••• • • • • • • • • • • • • • •• •• • • • •• •• NOTICE OF RIGHTS A party whose substantial interest is affected by this order may petition for an administrative hearing pursuant to sections 120.569 and 120.57, Florida Statutes. Such proceedings are governed by Rule 28-106, Florida Administrative Code. A petition for administrative hearing must be in writing and must be received by the Agency Clerk for the Department, within twenty-one(21) days from the receipt of this order. The address of the Agency Clerk is 4052 Bald Cypress Way, BIN A-02, Tallahassee, Florida 32399. The Agency Clerk's facsimile number is 850-413-8743. Mediation is not available as an altemative remedy. Your failure to submit a petition for hearing within 21 days from receipt of this order will constitute a waiver of your right to an administrative hearing, and this order shall become a'final order. Should this order become a final order, a party who is adversely affected by it is entitled to judicial review pursuant to Section 120.68, Florida Statutes. Review proceedings are governed by the Florida Rules of Appellate Procedure. Such proceedings may be commenced by filing one copy of a Notice of Appeal with the Agency Clerk of the Department of Health and a second copy, accompanied by the filing fees required by law, with the Court of Appeal in the appropriate District Court. The notice must be filed within 30 days of rendition of the final order. b .. ... . . . . . .. . .. . . . . ... . .. ... .. . . . .. . .. . . .. . . .. ... . . . . ... . . ... . . . ... . . ' s Y 1 STATE OF FLORIDA APPLICATION # AP1314532 4' DEPARTMENT OF HEALTHPERMIT # 13-SM-1801380 w ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATION DOCUMENT #.SE1053369 APPLICANT: EDWARD CINTRON - —" CONTRACTOR / AGENT: SOUTHERN - - u•... - . LOT: 4 BLOCK: 185 SUBDIVISION: ID#:-11-3205-025-0031- TO SE COMPLETED BY ENGINEER, HEALTH DEPARTMENT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEERS MUST PROVIDE 1 REGISTRATION NUMBER-AND SIGN AND,SEAL EACH PAGE OF SUBMITTAL: COMPLETE ALL ITEM• PROPERTY SIZE CONFORMS TO SITE PLAN: [X ]YES [ ]NO NET USABLE AREA,AVAILABLE: I 0.25 ACRES TOTAL ESTIMATED SEWAGE FLOW: 400 GALLONS PER DAY [ RESIDENCES-TABLET 1/ OTHER-TABLE 2 ] AUTHORIZED SEWAGE FLOW: _625.00___ -GALLONS PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE ] UNOBSTRUCTED AREA AVAILABLE: 600.00 SOFT UNOBSTRUCTED AREA REQUIRED: 600.00 SOFT BENCHMARK/REFERENCE POINT LOCATION: 10.35'TOP OF BOTTOM FLOOR AS PER CERTIFICATE ELEVATION ELEVATION OF PROPOSED SYSTEM SITE 22.20 [ INCHES / FT ] [ ABOVE-/ HELOW ] 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 [X]NO WELLS: PUBLIC: 0 FT LIMITED USE: O FT PRIVATE: 0 FT NON-POTABLE: O FT BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: 5 FT POTABLE WATER LINES: 30 FT SITE SUBJECT TO FREQUENT FLOODING? [ ]YES EX]NO 10 YEAR FLOODING? [ ]YES [X]NgI 10 YEAR FLOOD ELEVATION FOR SITE: FT [ MSL / NGVD 7,_ SITE ELEVATION: 8.50 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 4/1- __ Loamy Sand O 10'72 10YR 411 Loamy Sand O To 72 I OBSBaVGn..WATRH TAALR: '` 1LACHES L ABOVE / BELOW] EXISTING GRADE TYPE: ^^ [ PERCHED /: APPARENT ) ES IIF ''"LSD WET"SEASCIN,WATER TABU V14VATION: INCHES [ ABOVE / HELOW ] EXISTING GRADE III:a, ilftft,TAWA VXGSTATION t [ ]YES- , .Lat-j N0 "` =MOTTLING::,[ -AYES •[X]NO DEPTH: INCHES •• ••• • • • • "• g..,•• x , z S0I1, £L7i'flTRF,faLUi L�1lPG RATR�eFOR SYSTEM SIZING, M IateWt �•�/O 60: DEPTH.OF E7[CAVATION: 42 INCHE3 t '[ QT R°(SPECIFY) D[iAiri�'IELD,.,;;?F,LGlJRA71JTi: [ l ,fSD'!CH •• E • •[• •: IZ ( -- RES 0M.!7r,Af)=TIOl1SL CRITER;A , k. 4 i,r'3 zvALUATZD BY DATE: 11/08/2017 _._� 1*rine:)(SOUTHERN SEPTIC) ••• • • • • ••• • • Pae 3 Cf 4" D8'4015, 08/0$j [( h,•yiol•tea,;pr,uii .rr,e:itio k= _r; �j� -Nay- !*M-r-0•7Pd► Iacor�uratad:,,,64E-6:001',.:FAC,., �l • •• ••.,�f c;rjy,{ • •• •• F.101801380 i ........ APPLICATION # AP1314532 0 STATE OF FLORIDA Cl) PERMIT # 13-SM-1801380 DEPARTMENT OF HEALTH p DOC # RE404653 00 " ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM — -- EXISTING SYSTEM AND SYSTEM REPAIR EVALUATION 07 A APPLICANT: EDWARD CINTRON CONTRACTOR / AGENT: SOUTHERN _ LOT: _4 ,.. BLOCK: 185 SUBDIVISION: ID#: 11-3205-026-0031 i -• TO BE COMPLETED BY A FLORIDA REGISTERED ENGINEER, DEPARTMENT EMPLOYEE, SEPTIC TANK CONTRACTOR OR OTHE6 CERTIFIED PERSON. SIGN AND SEAL ALL SUBMITTED DOCUMENTS. COMPLETE ALL APPLICABLE ITEMS. COMPLETE TAMP CERTIFICATION BELOW OR NOTE IN REMARKS WHY THE TANKS CANNOT BE CERTIFIED.,.. EXISTING TANK INFORMATION I 900 ] GALLONS Septic Tank LEGEND:Unknown MATERIAL:Concrete BAFFLED: [ Y . [ j GALLONS LEGEND: MATERIAL: BAFFLED: I Y / N ) I 7 GALLONS GREASE INTERCEPTOR LEGEND: MATERIAL: [ J GALLONS DOSING TANK LEGEND: MATERIAL: # PUMPS: [ ]. I CERTIFY THAT THE ABOVE NOTED TANKS WERE PUMPED ON 11/07/2017 BY United Septic and Grease Services Inc , THE VOLUMES SPECIFIED AS DETERMINED BY DIMENSIONS. FILLING / LEGEND ], ARE FREE OF OBSERVABLE DEFECTS OR LEAKS AND HAVE A I SOLIDS DEFLECTION DEVICE / OUTLET FILTER DEVICE ] INSTALLED. George Pate SOUTHERN SEPTIC) 11/08/2017 SIGNATURE OF LICENSED CONTRACTOR BUSINESS NAME DATE EXISTING DRAINFIELD INFORMATION I 300 ] SQUARE FEET PRIMARY DRAINFIELD SYSTEM NO. OF TRENCHES I J DIMENSIONS: 15.00 X 20.00 I ] SQUARE FEET SYSTEM NO. OF TRENCHES ( ]' DIMENSIONS: X TYPE OF SYSTEM: I X] STANDARD I ) FILLED ;[ '] MOUND I ] - __.._._ CONFIGURATION: I J TRENCH [XI BED C i. DESIGN: Il PLEADER I ] D-BOX (X'j GRAVITY SYSTEM I ] DOSED SYSTEM ELEVATION OF BOTTOM OF DRAINFIELD IN RELATION TO EXISTING GRADE _ 30.00 INCHES I ABOVE /�] f SYSTEM FAILURE AND REPAIR INFORMATION [ 01/01/1949 ) SYSTEM INSTALLATION DATE TYPE OF WASTE [X] DOMESTIC [ ] COMMERCIAL` ( 300 ] GPD ESTIMATED SEWAGE FLOW BASED ON [ ] METERED WATER [X] TABLE 1, 649-6, FAC SITE [ ] DRAINAGE STRUCTURES [X] 'POOL [ J PATIO / DECK [XJ PARKING l- CONDITIONS: [ I SLOPING PROPERTY I ] NATURE OF I ] HYDRAULIC OVERLOAD [ ] SOILS I ] MAINTENANCE I 1 SYSTEM DAMAGE FAILURE: I ] DRAINAGE / RUN OFF [X] ROOTS [ ] WATER TABLE FAILURE ( ] SEWAGE ON GROUND •• ••[• 2RNK• •[•] b-@BOX / HEADER EX) DRAINFIELD SYMPTOM:' I ] PLUMBING BACKUP •• A l•• • • • • • _ t .—_ P 4 • ••• • ••• ••• ••• • • • • • • • SUBMITTED BY:. ••• • • • TITLE/LICENSE DATE: 11/08/2017 George Pate(SOUTHERN SEPTIC) DH t4015, 08/09 (Obsoletes previous editlffts:rhi(h InaZ htt Ve u$ed) Incorporated 64E-6.001, FAC • • • ••• • • • i Page 4 of 4 v1.0.0 •i• i• •i � A;4A4 • .• •. EID1B01380 k t t 4 APPLICATION 4 AP1314532 O 00 STATE OF FLORIDA PERMIT # 13-SM-1801380 M DEPARTMENT OF HEALTH p " DOC # RE404653 ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM EXISTING SYSTEM AND SYSTEM REPAIR EVALUATION M { RY14kRKS/ADDITIONAL CRITERIA SYSTEM DRAINDFIELD HAS ROOTS AND MUST BE REPLACED TANK TO REMAIN l r 0 Goo A I i { i 4 k i Q • •• • • • • ••• • • •• • • •• • • •• SUBMITTED BY:_ ••• • •TiT&/LICEifsa • DATE: 11/08/2017 .._ George Pate(SOUTHERN SEPTIC) DH 4015, 06/09 (Obsolete* previous editionseihiah :May not be used) Incorporated 643-6.001, FAC • • • ••• • • • Page 4 of 4 • • • • • • • • • • v1.0.0 •�• �• •� Ap3A413:• EIDIBO1380