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PL-17-2899Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Ave, Miami Shores, Florida 33138 Tel: 305-795-2204 Fax: 305-756-8972 Inspection Number: INSP-000351-2018 Permit Number: PL-09-18-2981 Scheduled Inspection Date: October 03, 2018 Permit Type: Plumbing - Residential Inspector: Massanet, Maykel Inspection.Type: Plumbing Final Owner: GREG BAUMANN Work Classification: Septic Address: Project: 1250 NE 91ST TER Miami Shores, FL 33138 Contractor: ALFONSO SEPTIC CONTRACTOR INC JOSE BOLANOS Phone Number: 3054678655 Parcel Number: 1132050010550 Phone Number: 7862514099 Building Department Comments PUMP AND Abandonment OF Existing TANK TO REPLACE PERMIT#PL17-2899 Checklist Item General Comments Passed False Comments Inspector Comments Passed 0 Failed {4 Correction Needed Re -inspection Fee No Additional Inspections can be scheduled until re -inspection fee is paid. October 02, 2019 For Inspections please call: 305-762-4949 Page 20 of 33 '04'4 Inspector -address Comments: Signature •; DIVISI0N Environmental Health Florida Health Health AIiami_Dade County OSTDS/Well Di 11805 S11 26th Street • Ivision amj, FL 33175 C. 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 BUILDING PERMIT APPLICATION ❑BUILDING ❑ ELECTRIC ❑ ROOFING RI PLUMBING ❑ MECHANICAL ['PUBLIC WORKS JOB ADDRESS: 12 5 e ?J E City: Miami Shores County: Folio/Parcel#: 11-3 2 0 S -001 - 0 5 Occupancy Type: R Load: Construction Type: Flood Zone: 2 7 2018 BY: FBC 20I Master Permit No.L� y 2 t 8 Sub Permit No. ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS Miami Dade Zip: Is the Building Historically Designated: Yes NO . 'I BFE: FFE: OWNER: Name (Fee Simple Titleholder): (9 R e RA U 4 A-- Phone#: O -10 66 Address:(/ 2 `" :.{ _ ; City: 't t4 tl-{! FAt') f\ Q ' State: a Zip: b'S)) t-`3 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: ! coo €P t l P C9 Cra ac (QA 11.C. Phone#: 7 -29- YO7 Address: Bea Wes-4- o CaY City: 14(,tiro_ 4._ State: P 14 -_ Qualifier Name: Aer---,A._k-az(-) tlAUlf State Certification or Registration #: S R dq%1 .9'76 .. Zip: 3 RO(`) _ Phone#: 7g6-2737-f/a f, Certificate of Competency #: SA.c3(1 l`�. DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ `y( ?Co Type of Work: ❑ Addition ri Alteration Square/Linear Footage of Work: ❑ New [N Repair/Replace ❑ Demolition Description of Work: 1 USTO.1 IA i D5t) q A\(©1,., met ►lc Tarn. 4400� .Fr DP k.R 04 kirodci Specify color of color thru,ts+le F''''' "', t J, ie Submittal Fee $ : ? . Permit Fee $ 5eG sR Scanning Fee $ Radon Fee $ DBPR $ Technology Fee $ Training/Education Fee $ Structural Reviews $ P ,K! 1 :r 1T Cd' L� � 7 t, CCF $ 4._ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ • (Revised02/24/2014) w • , Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage-L-ender-s'Addr ess 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 r 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. Signatu OWNER or AGENT The foregoing instrument was acknowledged before me this day of eVree t , 20. , by Re 6 A—OiV' , who is personally known to me or who has produced dS identification and who did take an oath. NOTARY PUBLIC: Sign: Pri Seal: JOSE BOLANOS ,j1 ,,` MY COMMISSION # GG 231457 - -I EXPIRES: October 8, 2022 :,'• Bonded Thru Notary Public tindery/filers Signature CONTRACTOR oregoing instrument was acknowledged before me this --= - - ---=- day of P CAL , 20 (8 , by �OS, who is personally known to me or who has produced �`L" b \ � tA- as identification and who did take an oath. NOTARY PUBLIC: ************ Sign: Print: ✓t �J'p( 1,JJ(e_ t►;s tg SINDIA ALVAREZ MY COMMISSION # GG 238273 EXPIRES: September 3, 2022 QOhtltllpliltbP►bl6fyPldlBEbt tlrAUnt*it******************* APPROVED BY — lb/ Ae Plans Examiner Zoning (Revised02/24/2014) Structural Review Clerk Alfonso Septic Contractor, INC. 1391 West 36 Street Hialeah, FL 33012 Alfonsoseptic@gmail.com Date: September25,2018 State of Florida County of Dade Before me this day personally appeared_Jose Bolanos who, being duty sworn, Deposes and says: That he or she will be the only person working on the project located at: 1250 NE 91 Terrace Miami Shores FLA. Contractor Signature /1ST' Sworn to (or affirmed) and subscribed before me this � day of (a .20 1.8 , by Personally Know OR Produced Identification Type of Identification Produced - ti2,KkGt U-C%€OS Print, Type or Stamp Name of Notary SINDW ALVAREZ MY COMMISSION # GG 238273 it EXPIRES: September 3, 2022 Bonded Thru Notary Public Underwr ten 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 SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: Owner State of Florida County of Miami -Dade The foregoing was acknowledge before me this '91 day of &P(edt btn , 20 / �. By 517/eC P),CLG it-(,ta_ Notary: .,. SEA ;�..niti:•._ JOSS BOUNOS MY COMMISSION # GG 231457 EXPIRES: October 8, 2C22 Bonded Thru Notary Public under who is personally known to me or has produced as identification. 8/10/2018 To: Current Owner 1250 NE 91 Terrace Miami Shores, FL Miami Shores Village Building Department 10050 NE 2 Ave, Miami Shores, FL 33138 Tel: (305)795-2204 • Fax; (305)756-8972 Permit: PL-12-17-2899 Address: 1250 NE 91 Terrace Miami Shores FL Dear Sir or Madam, Our records indicate that the above referenced permit has expired without obtaining the proper final inspection. In order to serve you better, we need to keep our files up to date. As per section 105.4.1 of the Florida Building Code, "Every permit issued shall become invalid (expired) unless the work authorized by such permit is commenced within six months after its issuance, or if the work authorized by such permit is suspended or abandoned for a period of six months after the work is commenced, or completed without obtaining the final inspection of the work performed.." Please be advised that open permits will hinder your ability to obtain new permits, refinance or sell this property. Please contact the Building Department, within 15 days of receipt of this letter in order to take care of this matter. Sincerely, Ismael Naranjo (CBO) Building Director Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address mit Permit NO. PL-12-17-2899 Permit Type: Plumbing - Residential Work Classification: Septic Permit Status: APPROVED Issue Date: 2/5/2018 Expiration: 08/04/2018 Parcel Number Applicant 1250 NE 91 Terrace Miami Shores, FL 1132050010550 Block: Lot: GREG BAUMANN Owner Information Address Phone Cell GREG BAUMANN 1250 NE 91 MIAMI SHORES FL 33138- (305)467-8655 Contractor(s) Phone ALFONSO SEPTIC CONTRACTOR INC (786)251-4099 Cell Phone Valuation: $ 4,800.00 Total Sq Feet: 1050 Type of Work: PUMP AND Abandonment OF Existing TA Type of Piping: Additional Info: 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 Amount $500.00 $3.00 $4.50 $3.00 $1.00 $300.00 $9.00 $4.00 Total: $824.50 Pay Date Pay Type Invoice # PL-12-17-65861 12/11/2017 Cash $ 50.00 $ 774.50 02/05/2018 Cash $ 774.50 $ 0.00 Bond #: 3633 Amt Paid Amt Due Available Inspections: /" 1 n InspectionfI ype: HRS Approval' Final,, a" r 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 certi hat all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zop fg. F ermore, I authorize tJ a •e e-named contractor to do the work stated. February 05, 2018 Authorized Signature: Owner ii;ant / ntractor / Agent Date Building Department Copy February 05, 2018 1 5c1+ue ✓i G A-cAnr 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 BUILDING PERMIT APPLICATION EBUILDING ❑ ELECTRIC ❑ ROOFING 12IPLUMBING Ej MECHANICAL ❑PUBLIC WORKS JOB ADDRESS: l 2 s O u F_ ❑ REVISION RECEIVED DEC 112017 FBC 2014 Master Permit No. T'-' ❑ EXTENSION El RENEWAL ❑ CANCELLATION ❑ SHOP DRAWINGS Sub Permit No. ❑ CHANGE OF CONTRACTOR City: Miami Shores County: Miami Dade Zip: 3 I 3N$' Folio/Parcel#: /1- a7 OS -001- O s sr) Is the Building Historically Designated: Yes Occupancy Type: ' . Load: Construction Type: Flood Zone: BFE: OWNER: Name (Fee Simple Titleholder): (IR a °8 nu M A i✓!J Phone#: Address: 'Ant) - N B A- ( S lioa ph_ ¥ l o o S- City: 14 t rra u.t i State: F/ a. Tenant/Lessee Name: , ( Phone#: Email: (�J NO b( FFE: Zip: � 31 g 2 _cONTRACrOR: Company Name: *Vp N cap (QT/ e (61 LTA &CTTA. Ill, Phone#: 7R6 % 5 ".. 4o rf q Address: I3g1UJ ,T 3(o Ste - City: ft/va/ep 1.1- State: pia Zip: £ 3D(2 ;,., QualifierName: ,� n�Q ��W.�j 1r°fY Phone#: 7$(�2'S-/- I/nq at State Certification or Registration #: Certificate of Competency #: F DESIGNER: Architect/Engineer: Phone#: Address: ill City: State: Zip: Value of Work for this Permit $ ill 00 Type of Work: ❑ Addition 0 mini© 0 LEI Repair/Replace D Demolition Description of Work: ItiSTQAuS. Aoklas se IP rAUk Ai/ (J zoos 41, Fr' n F t A \G.J F« I , Pk P i 1,0 6.B A L. Do Hr e ti, i iS 17'M ' Pm T6.1✓i� Square/Linear Footage of Work: 1/00 Ssik(7(� New Specify color of color thru tile: Submittal Fee $ Permit Fee $ iiV CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Feee$$rV� Structural Reviews $ Bond $ SCJ •'' II D 2`t TOTAL FEE NOW DUE $ . • So (Revised02/24/2014) SO 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 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. tSignature .10: OWNER or AGENT The foregoing instrument was acknowledged before me this �619 day of 'JP 00Y1i;O ,20 /7 , b (�45 M /3-40 , who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: prI POI ��f�ilk(YLi( Whin •�•= My Comm. Expires Dec 16, 2018 Commission 'n,`�r��� Bonded Through National Notary Assn Signature C• CTOR foregoing instrume was acknowledged before me this tl day l of -C-- , 20 1-1, by 5-cz_ 3�--.c S , who is - sonally kn n to me or who has produced • identification and who did take an oath:r '\`c 1p o�A• 9• .¢�• ':gam NOTARY PUBLIC: Sign: Print: Seal: APPROVED BY flli 1,2-4'1r Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) REGISTERED SEPTIC TANK CONTRACTOR JOSE BOLANOS 1391 WEST 36 STREET HIALEAH, FL 33012- ALFONSO SEPTIC CONTRACTOR INC Business Authorization: SA0171957 SR0971276 Registration Expires on September 30, 2018 This is to certify that the person,narned on the front of this card has satisfied the;requtr rtentso .Part III, Chapter 489, Florida Statutes, for regtstration as a: septic tank contractor and is regtstere4 y the Department of Health to provide contracting' services under.the business name listed. Report UnlawfulSep[c Tank Contracting 002719 Local Business Tax Receipt Miami -Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 7223484 BUSINESS NAME/LOCATION ALFONSO SEPTIC CONTRACTOR INC 1391 W 36 ST HIALEAH FL 33012 OWNER ALFONSO SEPTIC CONTRACTOR INC C/O SATURNINO ALFONSO Worker(s) 2 RECEIPT NO. RENEWAL 7503093 B EXPIRES SEPTEMBER 30, 2018 Must be displayed at place of business Pursuant to County Code Chapter BA - Art. 9 & 10 SEC. TYPE OF BUSINESS 196 SPECIALTY PLUMBING CONTRACTOR PAYMENT RECEIVED SA0171957 BY TAX COLLECTOR $49.50 10/08/2017 CREDITCARD-18-001558 This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license, permit, or a certification of the holders qualifications, to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT NO. above must be displayed on all commercial vehicles - Miami -Dade Code Sec 8a-276. . For more information, vis' midarte govhaxcoilector IVliami 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 SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: State of Florida County of Miami -Dade The foregoing was acknowledge before me this 9 day of herli3E , 20 / % . By CrtCli rH47/t/ who is personally known to me or has produced Notary: : • My Comm. Expires Uec 16, ZU18 SEAL: oy Commission # FF 152384 �'' '°'''' Banded Through National Notary Assn. cation. "/'., / BARBARA MONTERO F'� Mary Public - State of Florida Alfonso Septic Contractor, INC. 1391 W 36 Street Hialeah, Florida 33012 Phone: (786) 251-4099 AlfonsoSeptic@gmail.com Date: IJOQ s'-(het 21- 20 "t., State of non( 0 14— County of Da ()a._ Before me this day personally appeared �F D\IAll.i757 sworn, deposes and say: who, being duly r, y person working on the project located at / 25� � F -C1(S '% That he or she will be the only MtSPon.eS 33/3)" Sworn to (or affirmed) an subscribed before me this t day of 1T 1e 3 — 20 11 , by rOS`.- Personally know OR Produced Identification Type of Identification Produced \\\‘potA0albo///, ,.•yewnvawns�j�i nWl /9S . % �91b�'�� S_ rant, Type 1�' 3t p ss-v i �E •Q— a .ti— •��� •?o� 94�,eW ya � it . IIIIUIIN r STATE OF FLORIDA ff DEPARTMENT OF HEALTH V ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: GREG BAUMANN (tOSM PERMIT-18C APPLICATION #:AP13151'35 DATE PAID: FEE PAID: RECEIPT #' DOCUMENT #: PR1082554 PROPERTY ADDRESS: 1250 NE 91 Ter Miami, FL 33138 LOT: 30-31 BLOCK: 2 SUBDIVISION: PROPERTY ID #: 11-3205-001-0550 [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. ISSUANCE4 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 [ A [ N [ K [ 1,050 ] GALLONS / GPD NEW Septic TANK CAPACITY 0 ] GALLONS / GPD CAPACITY 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] ] GALLONS DOSING TANK CAPACITY ]GALLONS @[ ]DOSES PER 24 HRS #Pumps .[ D [ 400 ] SQUARE FEET NEW DF IN BED CONFIG SYSTEM R [ 0 ] SQUARE FEET SYSTEM A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ] I CONFIGURATION: [ ] TRENCH [x] BED [ ] N F LOCATION OF BENCHMARK: FINISH FLOOR 7.11 I ELEVATION OF PROPOSED SYSTEM SITE E BOTTOM OF DRAINFIELD TO BE L 'D FILL REQUIRED: 0 R [ 27.60 ] [ [ 43.60 ] [ INCHES / FT ][ ABOVE/BELOW] BENCHMARK/REFERENCE POINT FT ][ABOVE4BELOW]BENCHMARK/REFERENCE POINT INCHES [ 2.00] INCHES EXCAVATION REQUIRED: [ 22.00] INCHES 1.- Install a 1050 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 400 sf. of drainfield in ...BED.... configuration. 5.- 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.) SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: Loanis X 11/16/201 Alf so is APP- 1!, alez TITLE: TITLE: Engineering Specialist II Dade CHD EXPIRATION DATE: 02/14/2018 DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E-6.003, FAC ✓ 1.1.4 AP1315135 SE7.053E75 Page 1 of 3 DOCUMENT #: PR1082554 (Comments continued on Page 2 ) 6.- Invert elevation of drainfield to be no less than 3.48 ' NGVD 7.- Bottom of drainfield elevation to be no less than 2.98 ' NGVD 8.- This permit includes the abandonment of the existing septic tank. THIS PERMIT IS NOT FOR ANY ADDITIONS. The system is sized for 4 bedrooms with a maximum occupancy of 8 persons (2 per bedroom), for a total estimated flow of 400 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)(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 in the appropriate District Court. The notice must be filed within 30 days of rendition of the final order. STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATION APPLICANT: GREG BAUMANN APPLICATION # AP1315135 PERMIT # 13-SM-1802314 DOCUMENT # SE1053875 CONTRACTOR / AGENT: ALFONSO LOT : 30-31 SUBDIVISION: BLOCK: 2 ID# : 11-3205-001-0550 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 TOTAL ESTIMATED SEWAGE FLOW: 400 GALLONS PER DAY [ AUTHORIZED SEWAGE FLOW: 599.98 GALLONS PER DAY [ UNOBSTRUCTED AREA AVAILABLE: 800.00 SQFT BENCHMARK/REFERENCE POINT LOCATION: FINISH FLOOR 7.11 NET USABLE AREA AVAILABLE: 0.24 ACRES RESIDENCES-TABLE1 1500 GPD/ACRE OR / OTHER -TABLE 2 ] 2500 GPD/ACRE UNOBSTRUCTED AREA REQUIRED: 650.00 ] SQFT ELEVATION OF PROPOSED SYSTEM SITE 27.60 [ INCHES / ET ] [ ABOVE /BELOW1] 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: 0 FT PRIVATE: 0 FT NON -POTABLE: 0 FT BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: 5 FT SITE SUBJECT TO FREQUENT FLOODING? 10 YEAR FLOOD ELEVATION FOR SITE: SOIL PROFILE INFORMATION SITE 1 POTABLE WATER LINES: 50 FT [ ]YES [X]NO 10 YEAR FLOODING? [ ]YES [X]N0] FT [ MSL / NGVD ] SITE ELEVATION: 4.81 FT [ MSL / USDA SOIL SERIES: Munsell #/Color Urban land Texture Depth 10YR 5/1 Sand 0 To 14 10YR 6/1 Sand 14 To 24 10YR 7/1 Sand 24 To 72 OBSERVED WATER TABLE: ESTIMATED WET SEASON WATER TABLE ELEVATION: HIGH WATER TABLE VEGETATION: [ ]YES SOIL PROFILE INFORMATION SITE 2 NGVD USDA SOIL SERIES: Munsell #/Color Urban land Texture l Depth 10YR 5/1 Sand 0 To 14 10YR 6/1 Sand 14 To 24 10YR 7/1 Sand 24 To 72 INCHES [ ABOVE / BELOW ] EXISTING GRADE TYPE: 22 INCHES [ ABOVE / [X]NO BELOW MOTTLING: [ ]YES [X]NO [ PERCHED / EXISTING GRADE DEPTH: INCHES APPARENT SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: Replacement4-FS/0.60 DEPTH OF EXCAVATION: 22 INCHES DRAINFIELD CONFIGURATION: [ ] TRENCH [X ] BED REMARKS/ADDITIONAL CRITERIA [ ] OTHER (SPECIFY) SITE EVALUATED BY: DATE: 11/16/2017 Alfonso Septic, (Title:) (Alfonso Septic) DR 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated: 64E-6.001, FAC Page 3 of 4 AP1315135 E101802314 v 1.0.2 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM EXISTING SYSTEM AND SYSTEM REPAIR EVALUATION APPLICANT: GREG BAUMANN APPLICATION # AP1315135 PERMIT # 13-SM-1802314 DOC # RE404933 13-SM-1802314 CONTRACTOR / AGENT: ALFONSO LOT: 30-31 BLOCK: 2 SUBDIVISION: ID#: 11-3205-001-0550 TO BE COMPLETED BY A FLORIDA REGISTERED ENGINEER, DEPARTMENT EMPLOYEE, SEPTIC TANK CONTRACTOR OR OTHEP 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: [ y / [ ] GALLONS LEGEND: MATERIAL: [ ] GALLONS GREASE INTERCEPTOR LEGEND: MATERIAL: [ ] GALLONS DOSING TANK LEGEND: MATERIAL: N BAFFLED: [ Y / N ] # PUMPS:[ I CERTIFY THAT THE ABOVE NOTED TANKS WERE PUMPED ON 11/09/2017 BY Day & Night Grease Trap & Storm Drain 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. SIGNATURE OF LICENSED CONTRACTOR Alfonso Septic (Alfonso Septic) 11/13/2017 BUSINESS NAME DATE EXISTING DRAINFIELD INFORMATION [ 400 ] SQUARE FEET PRIMARY DRAINFIELD SYSTEM NO. OF TRENCHES [ ] DIMENSIONS: 20.00 x 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 [X] GRAVITY SYSTEM [ ] DOSED SYSTEM ELEVATION OF BOTTOM OF DRAINFIELD IN RELATION TO EXISTING GRADE 22.00 INCHES [ ABOVE / BELOW SYSTEM FAILURE AND REPAIR INFORMATION [ 01/01/1950 ] SYSTEM INSTALLATION DATE TYPE OF WASTE [XI DOMESTIC [ ] COMMERCIAL [ 400 ] GPD ESTIMATED SEWAGE FLOW BASED ON [ ] METERED WATER [X] TABLE 1, 64E-6, FAC SITE CONDITIONS: NATURE OF FAILURE: FAILURE SYMPTOM: SUBMITTED BY: [ ] DRAINAGE STRUCTURES [ ] SLOPING PROPERTY [ ] HYDRAULIC OVERLOAD [ ] DRAINAGE / RUN OFF [ ] SEWAGE ON GROUND [X] PLUMBING BACKUP [ ] POOL [ ] PATIO / DECK [ ] PARKING [ ] [ ] SOILS [ ] MAINTENANCE [ ] SYSTEM DAMAGE [ ] ROOTS [ ] WATER TABLE [ ] (X] TANK [ ] [ ] D-BOX / HEADER [X] DRAINFIELD TITLE/LICENSE DATE : 11/13/2017 Jose Bolanos (Alfonso Septic Contrac 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 AP1315135 EID1802314 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM EXISTING SYSTEM AND SYSTEM REPAIR EVALUATION REMARKS/ADDITIONAL CRITERIA APPLICATION # AP1315135 PERMIT # 13-SM-1802314 DOC # RE404933 13-SM-1802314 broken tank will be replaced for new 105 gallon and 400 sqf drainfield SUBMITTED BY: TITLE/LICENSE DATE : 11/13/2017 Jose Bolanos (Alfonso Septic Contrac DM 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated 64E-6.001, FAC Page 4 of 4 v 1.0.0 AP1315135 EID1802314 APPLICATION FOR CONSTRUCTION PERMIT Permit Application Number PART II - SITEPLAN Scale: Each block represents 10 feet and 1 inch = � ----' In ,��� v � , 4r;C1 S �_ X' — k4-..t '. (& � z> i'� 2� (jet' y�- L r'tI � tilt + r.:N t S r6, I, ( :tic* f 0 0 I �Pc 1-V P (}.ik--2 i3,bI' - 1 J / A_ . -.7-;' , F ci 4 117 fl_fk. Notes: J H �,—A, i 7Sc� 4J c -CI(n41L-h S A ej• (--tra___ R 6.)(kc- C: 1,( bn r2E P(Q (_ a I—'L A-c- . t-to Site Plan submitted by: Plan Approved By County Health Department Not Approved Date (/ fl j AL 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) / V' 0. 95 00YR.SAV 16— 45.00' F.I.R. NO 41 29 -2 ONE: AE N.E. 91st TERRACE 19ASPHALT to ASPrtat. r EAST 85.00' (R&M) CBS WALL 13.40' 1. 3' teS PARKWA BLOCK WR In &WOWS* CORNER ° WIN % 0 F.I.R. V,.• F. I.R. W'2°°°. NO ID. IVO 10. 3' CBS WALL 'Lemma,. 9.50 21.25', 32.30' ROOF 6-1 IoA OIAVC . COLMNN •q. cZR__r:° ONE +RESIDENCE POOL rPOW ( 16.00' 11'4 oNc. 2, 5'h 'CS .4 4.CF 1.177 :141 '1,7; BRICK, 'BAR B 111.E 3'43' Po POOL 10' OVERHANG CONC, L8 56' C5 / 15.10' CONC / / 4 50' C005.. .POOL OE NCK I 00' NOT COVERED N20. „r. • THE EASTERLY 5' .'S•c OF LOT 30, BLOCK 2 ..'""-^ LOT3I BLOCK 2 CONC, 9 4 CIMIN LINK FENCE Oi; 'I ON PL. 45 002' OL4 PI,.. _ j.. 4 I3P , lir__ r___• • • v_____._ , (.._ ,r.tR. ,00 ' ID. • ... c... WEST p..00'0?&M.). Sy:ART:1Y .9". ' g_ - -15.50' ASPML r W. U.,. . N.E. 9ist 'STREET 4NEL= 12086C0306 JITY No.: 120652 FIRM: 09-11-2009 EV.= +9.00 NGVD 1929 PROPERTY OF: GREG BAUMANN AND JENNIFER BAUMANN 1250 NE 91st TERRACE, MIAMI SHORES, FLORIDA 33138 /. = 7.27 NOTES LOWEST HABITABLE FLOOR ELEVATION. ONS SHOWN REFER TO N.G.V.D. 1929. 'ADJACENT GRADE = 5.0 62 ELEV. = 8.67 (MIAMI-DADE COUNTY) ELEV.= N/A 1.32 CERTIFIED TO: GREG BAUMANN AND JENNI RAPID TITLE SERVICES CO OLD REPUBLIC NATIONAL T. 51 LOT - 33 BLOCK - z NOT VALID WITHOUT THE SIGNATURE AND THE ORIGINAL RAISED SEAL OF A FLORIDA LICENSED SURVEYOR AND MAPPER. LEGEND A/C All CONDITIONER AVE. AVENUE BlvD. BOULEVARD BM BENCH MARK CATV CABLE TELEVISION BOX C.B. CATCH BASW CBS CONCRETE BLOCK STRUCT, CHO CHORD BEARING CH CHORD DISTANCE COR CORNER CT COURT e CENTERI IRE CL. CLEAR CONC, CONCRETE C.O. CLEAN OUT Eli ELECTRIC BOX ELEV. ET EVADON MICR ENCROACHMENT 589. ELEVATION REFERENCE PO F.F. FINISH FLOOR F FiRE HyDRANT A BOUNDARY SURVE I HEREBY CERTIFY THAT THIS BC VVAS TANTE UNDER NY SUPERVI.1 STANDARDS OF PRACTICE SET FLORIDA BOARD OF PROFESSIOJ MAPPERS IN CNAPTER SA I TOM FLORIDA ADMINISTRATIVE CODE SECTION 472.02 1, FLORIDA STAT SKETCH HEREON IS TRUE ANO C BEST OF MY KNOSVLEDGE ANDO NOTES AND NOTATIONS SNO FRANCISCO F. FAJA FLORIDA PROFESSIONAL SUM, REGISTRATION NO. 476.1. • 7 • • la II 01 18 Y117 cr / 10 18 17 20 re