PL-18-1691\8-qpq
J
DIVISION OF
Environmental Health
Florida Health e �jS
.Miami -Dade County
.� OSTDS/We11 Division $ k •
}
e 11805 SW,26th Street •.Miami, FL 33175 t 1_ •
k. tl
Inspector w y �`!'' Date`- -' 7 'if .
(jL c / t.
Address - v t 7,;-' j� 'OSTDS # 4r / 3 r`d
1. Cominents:
.r A
*Signature
{
41
Miami Shores Village
10050 N.E. 2nd Avenue NW
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Permit
Permit NO. PL-6-18-1691
Permit Type: Plumbing - Residential
Work Classification: Septic
Permit Status: APPROVED
Issue Date: 6/25/2018 Expiration: 12/22/2018
Parcel Number
Applicant
202 NW 92 Street
Miami Shores, FL 33150-
1131010331220
Block: Lot:
REAL ESTATE EDUCATION ANC
Owner Information
Address
Phone
Cell
REAL ESTATE EDUCATION AND
202 NW 92 Street
MIAMI SHORES FL 33150-
(561)310-2585
202 NW 92 Street
MIAMI SHORES FL 33150-
Contractor(s) Phone
A`SUPER SEPTIC & DRAIN FIELD INC
Cell Phone
Valuation:
Total Sq Feet:
$ 8,000.00
200
Type of Work: INSTALLATION OF SEPTIC TANK AND DRA
Type of Piping:
Additional Info: INSTALLATION OF SEPTIC TANK AND DRA
Bond Return :
Classification: Residential
Scanning: 3
Fees Due
Bond Type - Contractors Bond
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$500.00
$4.80
$4.50
$3.00
$1.60
$300.00
$9.00
$6.40
$829.30
Pay Date Pay Type Amt Paid Amt Due
Invoice # PL-6-18-67992
06/25/2018 Credit Card $ 779.30 $ 50.00
06/20/2018 Credit Card $ 50.00 $ 0.00
Bond #: 3806
Available Inspections:
Inspection Type:
HRS Approval
Final
Review Plumbing
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: 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. Futhermore, I authorize the above -named contractor to do the work stated.
Authorize
nature:O / Applicant / Contractor / Agent
June 25, 2018
Date
Building Department Copy
June 25, 2018
1
G�h
FBC 20P
BUILDING Master Permit No. P l 18 ((A 1
Sub Permit No.
BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION RENEWAL
[PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
PERMIT APPLICATION
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
JOB ADDRESS: W e.e1
City: Miami Shores
County:
Miami Dade Zip:
Folio/Parcel#: / /- 3 /0 / - 0 3 3 • / 30 D Is the Building Historically Designated: Yes
Occupancy Type: Load: Construction Type: Flood Zone:
BFE:
RECEIVED
JUN 2 0 2018
V.14'1
3313 3
NO
FFE:
OWNER: Name (Fee Simple Titleholder): (fn ETh T I -Fa L U u P A%, n rU a Phone#:
t!'vrN H a u S r n
Address: �0�, iiJ•W• q g�Re.r d O
City: fyi I/1 M I. °Res State: zip,. _33 L.93
Tenant/Lessee Name:
Email:
Phone#:
CONTRACTOR: Company Name:A- 3&it2P 2 77e. { PCra-J.n9 F ' (d fir, Phone#: 3 6..5-' 364/''0// 3
Address: '7/70 / ' J • / 9 1-7P
City: //, (r? n-17. State: Flo f , � /4 Zip: .23 c ' V
Qualifier Name: GZ;(( KN-U .Zfq 0
Phone#: 3a5 -36 it- 0 //
State Certification or Registration #: A 01 (ot a Certificate of Competency #:
DESIGNER: Architect/Engineer: � Phone#:
Address: / City:
Value of Work for this Permit: $ O6C1
Type of Work: ❑ Addition ❑ Alteration �j /
Description of Work: T sT //,�T a� �/� V?a7 c �� /9/7c� 044/. n �P% aG
State: Zip:
Square/Linear Footage of Work: a 00 £0 . •
❑ New 0 Repair/Replace ❑ Demolition
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ 3CO r CCF $ CO/CC $
Scanning Fee $ Radon Fee $ - ' 6;. DBPR $ '' S0 Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $ � .)' CO
TOTAL FEE NOW DUE $ ir:2? (' Jv
(Revised02/24/2014)
���. 36
A.
Bonding Company's Name (if applicable) .Crr - Sp�l C Oru,'4
Bonding Company's Address 7 701 w (A 1''1 t o`I -,
r
City 14 r q l a State rLm�r y Zip ) g 0/ 4
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 jurisdict on. 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 PA0YING 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."
v
i
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 in n which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection iw Il not be pproved and a reinspection e will be charged.
OWNER or AGENT
The foregoing instrument�r"Awas{�acknowledged
day of �\ &. ,,cc
jI.
rA mUU ois�pY
before a this
20 by
r` ohCaflykn�own to
me or who has produced I C (7_-v as
identification and who did take an oath.
NOTARY PUBLIC:
Sig
Print:
Seal:
'-*• iwir , k, s= EXPIRES: Novem . er ,
".�,
,FpF K;,o?:' Bonded Thru Notary Public Underwriters
Signature
The foregoing instrument was acknowledged before e this
day of V v" , 20 t , by
-ko n •e�'( 0 , who is personally known to
1 1C(2�
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sig
Print:
Seal:
as
o: M :HARM K. GONZAL
ON # GG 044602
EXPIRES: November 2, 2020
r•��4'P`
%'•,F iD F ;o?o Bonded Thru Notary Public Underwriters
le* ***s***ss******s**************s**s****************s**.sss******s**********Ile **************s******* **
APPROVED BY
if
6-21-1
Plans Examiner Zoning
(Revised02/24/2014)
Structural Review
Clerk
6/20/2018
Property Search Application - Miami -Dade County
Summary Report
Property Information
Folio:
11-3101-033-1220
Property Address:
202 NW 92 ST
Miami Shores, FL 33150-2231
Owner
REAL ESTATE EDUCATION AND
COMMUNITY HOUSING INC
Mailing Address
202 NW 92 ST
MIAMI SHORES, FL 33150 USA,
PA Primary Zone
0800 SGL FAMILY - 1701-1900 SQ
Primary Land Use
0101 RESIDENTIAL - SINGLE
FAMILY: 1 UNIT
Beds / Baths / Half
2/1/0
Floors
1
Living Units
1
Actual Area
Sq.Ft
Living Area
Sq.Ft
Adjusted Area
1,154 Sq.Ft
Lot Size
9,930 Sq.Ft
Year Built
1940
Assessment Information
Year
2018
2017
2016
Land Value
$218,460
$218,460
$218,460
Building Value
$86,550
$80,318
$80,318
XF Value
$0
$0
$0
Market Value
$305,010
$298,778
$298,778
Assessed Value
$305,010
$298,778
$166,506
Benefits Information
Benefit
Type
2018
2017
2016
Save Our Homes Cap
Assessment Reduction
$132,272
Homestead
Exemption
$25,000
Second Homestead
Exemption
$25,000
Note: Not all benefits are applicable to all Taxable Values (i.e. County, School
Board, City, Regional).
Short Legal Description
MIAMI SHORES SEC 6 PB 10-39
LOT 1 & E1/2 LOT 2 BLK 136
LOT SIZE 79.440 X 125
OR 19647-3419 04 2001 1
Generated On : 6/20/2018
Taxable Value Information
2018
2017
2016
County
Exemption Value
$0
$0
$50,000
Taxable Value
$305,010
$298,778
$116,506
School Board i
Exemption Value
$0
$0
,. $25,000
Taxable Value
$305,010
$298,778
$141,506
City
Exemption Value
$0
$0
$50,000
Taxable Value
$305,010
$298,778
$116,506
Regional
Exemption Value
$0
$0
$50,000
Taxable Value
$305,010
$298,778
$116,506
Sales Information -
Sale Previous
Price
OR Pa 9 e Book-
Qualification Description
{
06/30/2017
$240,000
30613-1289
Federal, state or local government
agency
12/30/2016
$226,700
30372-4110
Financial inst or "In Lieu of Forclosure"
stated
09/07/2016
$100
30222-4832
Corrective, tax, or QCD, min
consideration
04/01/2001
$102,000
19647-3419
Sales which are qualified
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:
6/20/2018 Detail by Entity Name
Department of State / Division of Comerations I Search Records / Detail By Document Number /
Detail by Entity Name
Florida Not For Profit Corporation
REAL ESTATE, EDUCATION AND COMMUNITY HOUSING, INC.
Filing Information
Document Number N06000000381
FEI/EIN Number 20-4203798
Date Filed 01/13/2006
State FL
Status ACTIVE
Last Event AMENDMENT
Event Date Filed 01/16/2007
Event Effective Date NONE
Principal Address
8409 North Military Trail
Ste 111
PALM BEACH GARDENS, FL 33410
Changed: 05/11/2017
Mailing Address
8409 N MILITARY TRAIL
STE 111
PALM BEACH GARDENS, FL 33410
Changed: 05/11/2017
Registered Agent Name & Address
TRACEY, JOHN E
8409 N MILITARY TRAIL
STE 111
PALM BEACH GARDENS, FL 33410
Name Changed: 01/10/2012
Address Changed: 05/11/2017
Officer/Director Detail
Name & Address
Title CEO, President
http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?i nqui rytype=EntityN am e&di rectionType= Initi al&searchN am eOrder= R EALESTATEED U... 1/3
6/20/2018
Tracey, Patricia
8409 N MILITARY TRAIL
Ste 111,
'PALM BEACH GARDENS, FL 33410
Title Chairman
MacCall, Elizabeth
8409 North Military Trail
Ste 111
PALM BEACH GARDENS, FL 33410
Title Pastor, Secretary
Rose, Michael
8409 N Military Trail
Ste 111
Palm Beach Gardens, FL 33410
Title Director
Martinez, Albert
8409 N Military Trail
Suite 111
Palm Beach Gardens, FL 33410
Title Treasurer
Drouin, Ekaterina
8409 North Military Trail
Ste 111
PALM BEACH GARDENS, FL 33410
Title Director
Brennison, Judith
8409 North Military Trail
Ste 111
PALM BEACH GARDENS, FL 33410
Annual Reports
Report Year Filed Date
2017 02/08/2017
2017 02/27/2017
2018 02/14/2018
i
Document Images
02/14/2018 -- ANNUAL REPORT
05/11/2017 — AMENDED ANNUAL REPORT
02/27/2017 -- AMENDED ANNUAL REPORT
02/08/2017 -- ANNUAL REPORT
Detail by Entity Narne
View image in PDF format
View image in PDF format
View image in PDF format
View image in PDF format
1
http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResuItDetail?i nqui rytype=EntityN are&directionType=Initial&searchN ameOrder=REALESTATEED U... 2/3
A SUPER SEPTIC & DRAIN FIELD INC.
. CC: SR0161772
PHONE: 305-364-0113
DATE: Cr, •c)-0-1(5
STATEOF FLORIDA
COUNTY OF MIAMI-DADE
7701 WEST 18 LANE
HIALEAH, FLORIDA 33014
Licensed and Insured
.E-MAIL: ASUPERSEPTIC@GMAIL.COM
WWW.ASUPERSEPTIC.COM
FAX: 305-364-0349
BEFORE ME THIS DAY PERSONALLY APPEARED, /YF'.4.2,- WHO
}
BEING DULY SWORN, DEPOSES AND SAYS:
THAT HE OR SHE WILL BE THE ONLY PERSON WORKING ON THE PROJECT AT:
9,(4. /L, w q d 1' i 3 31 re
Contractor Signature:
SWORN TO (O AFFIRMED) AND SUBSCRIBED TO ME THIS c AY OF
, 2018, BY: (i� ri rX
• �pP� MAHARAI K. GONZALEZ
at), : MY COMMISSION # GG 044602
'*` Ira EXPIRES: November 2, 2020
Bonded Thru Notary Public Underwriters
PERSONALLY KNOWN
OR PRODUCED IDENTIFICATION
TYPE OF INFORMATION PRODUCED r l
PRINT, TYPE, OR STAMP NAME OF NOTARY
Miami Shores 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 SIGN LOW YOU ACKNOWL DGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONT
Signa
Owner
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this
By12.
Ol
20
Notary ( k
SEAL:
day of ;20tb
who is personally known to me or has produced
CQ.,r)„-c__, as identification.
;=o,;R P ,,,, MAHARAI K. GONZALEZ
MY COMMISSION 4 GG 044602
EXPIRES: November 2, 2020
•;EOFFo?• Bonded Thru Notary Public Underwriters
0
ui
M
1/2FIP
"
(NO ID)
RECEIVED
((^^JU''N 202018
CY)
Cu
LOCATION SKETCH
(N.T.S.)
9 no 1 STREET
= NW 11•92r'l STREET,..•
0
tri
O . .
13.60'
SHED
•
TILE
29.55'
ONE STORY
RESIDENCE
N• 202
0
co
8.40'
0
20.00'
• •
• • •
•• •
•
••••
• • " • •
• • • • w••
F7P
1/2'
(NO ID)
••••
• •
• •• •••
•
›•.•• o Y •
• • N p_ •
oa
•
20,00i••
cot
19.30'
••,0••
• • •
•f •
•
• • •
• •
ERMIT #:
Miami Shcrepirll
•
•
•
••E •••
•O •
• • •
•I •
•
•
• •
•••NE•
•
••••
••••pf
•
LEJ
•••• 11
• •
25.00'
z
F7P
1/2"
(NO ID)
NOTE: NO VISIBLE ENCROACHMENT OR EASEMENT VIOLATIONS OBSERVED
79.28'(13&I dDEPT
10' ALLEY
RI nr_ nE9T
/7P
1/2"
(NO ID) ...�7
SUBJECT I O CCNIPLII`NCE WI Fy ALL FEDERAL
STATE ANL) CCUN. I.1 f:t,L.S AND REGULATInnl.4
LEGAL DESCRIPTION: (FURNISHED BY CLIENT)
Lot 1 and East 1/2 of Lot 2, Block 136, of MIAMI SHORES SECTION NO 6, according to the plat thereof, as recorded in Plat Book 10,
Page(s) 39, of the Public Records of Miami -Dade County, Florida
LEGAL NOTES
MS RRVET 03E1 ICT 1E01ECT OE OETON E OVIE•l10.
ERAONTOI Di TIC ABSTRACT 6 TALE WILL NNE TO OE NNE TO OETENOIE PECO•EO
NEIROENT; f A Y. MSTFT06 TIE T7QQTT. TIR EIRVE7 B SUBJECT TO EINCATOR
LINIMENT. 116711100016. I1C102VA1NON IN MOMS OT OECD LEGAL BESWTO6
PROMO IT D fl. TIE UMLTTT E TIM SURVEY R LOOTED TO TIE COST OF TIE SURVEY.
UFO• cocwooIE10; i SIT. oat INT ROVNL TVs TON INT INT ATIEIPTO 10
LOCATE rams muss FONRATBTM• ammo NOEom= OFlmWOIT$ OT
FLOOD INF:
COMMUNITY: 120652
MAP AND PANEL: 12066C0302
SUFFIX: L
Ft000 ZONE: X
BASE FL000: N/A
FIELD WORK
DATE 05/09/2016
CERTIFIED TO:
REAL ESTATE EDUCATION COIYDNiWY ROUSING
NU WORLD TITLE, (I.0
NORTH AMERIGW TYRE INSURANCE COMPANY
FLORIDA COMMUNITY LOAN FUND.
REVISIONS
DATE
ADDRESS :
202 NW 92nd STREET. MIAMI SHORES,
FLORIDA.33150
TIES CERTIFIES TINT fill SURVEY IF TIE POdiRTY
MEMO MEIN WAS NNE uEER ET S#PQV6mN
M• TINT TIC ENE MEETS TIE IENWN TEEJ06AL
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: (Real Estate Education and Community Housing Inc.)
PROPERTY ADDRESS: 202 NW 92 St Miami, FL 33150
LOT: 1-2 BLOCK: 136 SUBDIVISION:
PROPERTY ID #: 11-3101-033-1220_
PERMIT #:13-SM-1853209
APPLICATION #: AP1348606
DATE PAID:
FEE PAID:
RECEIPT #
DOCUMENT #: PR1120577
REPAIR
WAMI DADS COUNTY HEALTH DEPART'MBNT
[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 SNOT GUARANTEE
SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANW PTi MAE.RI.AL FACTS •
WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE AiraciNT
PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEIIF••E
ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANC4••WITH
STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY. ••••••
"0••140pIFY •iiiS•
NULL. AND VQID. •
(AHER, FEDE M. •
• • •
• ••
SYSTEM DESIGN AND SPECIFICATIONS
T [ 900 ] GALLONS / GPD
A [ 0 ] GALLONS / GPD .
New Septic Tank
N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY
K [ ] GALLONS DOSING TANK CAPACITY
D [
R [
150 ] SQUARE FEET
0 ] SQUARE FEET
CAPACITY
CAPACITY
• •
•• ••
• • •
• •
• •
••••
• •
••••
•
•
• •
•
• •
[MAXIMUM CAPACITY SINGLE TANK:SZSQ (ALLONSj• • •
]GALLONS @[ ]DOSES PER 24 HRS •10s [ ]
New Drainfield Trench Con SYSTEM
SYSTEM
[ ] FILLED [ ] MOUND
[ ] BED [ ]
A TYPE SYSTEM: [x] STANDARD
I CONFIGURATION: [X] TRENCH
N
F LOCATION OF BENCHMARK: FFE 12.8'
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE
L
D FILL REQUIRED: __[_0.00 ] _INCHES
0
T
H
E
R
[ 22.80 ] [1 INCHES
[ 60.80 l [i INCHES
FT ] [ ABOVE n BELOW
FT ] [ ABOVE /) BELOW
]BENCHMARK/REFERENCE POINT
]BENCHMARK/REFERENCE POINT
EXCAVATION REQUIRED: [ 38.00] INCHES
1.- Install a 900 gal. septic tank with an approved filter
2.- 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.
3.- Install 150 sf. of drainfield in....TRENCH... configuration.
4.- Invert elevation and Bottom of drainfield to be no less than 8.23' & 7.73' NGVD respectively
THIS PERMIT IS NOT FOR ANY ADDITIONS.
The system is sized for 2 bedrooms with a maximum occupancy of 4 persons (2 per bedroom), for a total estimated flow of
SPECIFICATIONS BYi
APPROVED BY:
Erick Yerera
DATE ISSUED: 06/08/2018
A Super Septic
TITLE:
TITLE: Environmental Specialist II
Dade
EXPIRATION DATE: 09/06/2018
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC
v 1.1.4 AP1348606 8E1080792
CHD
Page 1 of 3
nocvmurr #: PR1120577
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)(f), FAC.
. . . .
.. . .... .
. .
.
.
. • .
.... ... . • .
• . • .
.... . . ..
. . • .
..• .. • • • •
•
. .
• . . •
• •
• . . .
. • •
.. . .. . • •
•
. .
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 alternative 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 irltile •••• •
appropriate District Court. The notice must be filed within 30 days of rendition of the tirial order. • '':'•
' •
•.
•
•••• •• •
• • • • •
•••• • ••
••••
•• •• ••••
•
• • •
•
• •
•
••
• • • • •
• • •
•• • •• • • •
• • •
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR CONSTRUCTION PERMIT
Permit Application Number
PART II - SITEPLAN
Scale: Each block represents 10 feet and 1 inch = 40 feet.
A
-
79.
0'
A
f
2'
`vrm
IIIMMIIMI
0
2'
TEST
HOLES
@
•
•
••••
••
•••
::;
••
•
••••
•
. ••
•
25'
0
....
•
•
•
iI:
•
•::T
O
EXISTIN
&
EW
EP
•
IC L•CA
ION
ON
ACROSS
ADJACENT
THE
PROP
STREE'
RTIES
THAT
-
A
MAY
D
-
AF
=ECT
THE
SYSTEMS
INSTAL
LAT
ON.
202
NW
92 ST
,33150
F.F.E
12.8'
v
_
,—
v
DIW
----
---
----
----
---
---
NW 92 ST
----
---
Notes: EXISTING SEPTIC TANK NOT HOLDING WATER, REPLACING EXISTING 750 GALLON & 200 SF BED, WITH
A 900 GALLON SEPTIC & 150 S.F IN TRENCH CONFIGURATION D.F
PROPERTY CURRENTLY VACANT 1 YEAR +, NO WATER CONSUMPTION AVAILABLE
Site Plan submitted by:
Plan Approved
Not Approved
CONTRACTOR
Date 6-6-18
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
(Stock Number: 5744-002-4015-6)
Page 2 of 4