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PL-18-2010Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-309154 Permit Number: PL-7-18-2010 Scheduled Inspection Date: August 22, 2018 Inspector: Massanet, Maykel Owner: TOM, VINCENT Job Address: 915 NE 91 Terrace Miami Shores, FL Project: <NONE> Contractor: A AMERICAN SEPTIC & PLUMBING Permit Type: Plumbing - Residential Inspection Type:ginal Work Classification: Drainfield Phone Number Parcel Number 1132060030070 Phone: (305)866-5600 Building Department Comments DRAINFIELD REPAIR Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed Failed' Correction Needed Re -Inspection Fee No Additional Inspections can be scheduled until re -inspection fee is paid. August 21, 2018 For Inspections please call: (305)762-4949 Page 10 of 22 ®pL-7-II- fiat/ DIVISION OF Environmental Health O�``Q Florida Health .��� Miami -Dade County OSTDS/Well Division �O 1i di Q4 11805 SW 26th Street • Miami, FL 33175 WI Inspector llei / l / - n �` T co Date g 7'—/r Address %-1— 1 y vv,n OSTDS # Comments: Signature Fir • Inspector 096 -i8- ad-i DIVISION OF Environmental Health Florida Health Miami -Dade County OSTDS/We11 Division y/ 11805 SW 26th Street • Miami, FL 33175 / ' �Tlo Address 7 %-1 ,/j/ t° / 2zP/'✓' * �O4 Date OSTDS # Comments: Signature Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address Permit NO. PL-7-1$-2010 Permit Type: Plumbing - Residential Work Classification: Drainfield Permit Status: APPROVED Issue Date: 7/2fi/2018 Expiration: 01/22/2019 Parcel Number Applicant 915 NE 91 Terrace Miami Shores, FL 1132060030070 Block: Lot: VINCENT TOM Owner Information Address Phone Cell VINCENT TOM 915 NE 91 TERR MIAMI SHORES FL 33138-3219 Contractor(s) Phone Cell Phone A AMERICAN SEPTIC & PLUMBING (305)866-5600 (786)236-5599 Valuation: Total Sq Feet: $ 4,200.00 300 Type of Work: DRAINFIELD REPAIR Type of Piping: Additional Info: Bond Return : Classification: Residential Scanning: 3 Fees Due Bond Type - Owners Bond CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $500.00 $3.00 $2.25 $2.00 $1.00 $150.00 $9.00 $4.00 $671.25 Pay Date Pay Type Invoice # PL-7-18-68356 07/26/2018 Check #: 455 07/26/2018 Check #: 456 07/26/2018 Cash Bond #: 3839 Amt Paid Amt Due $ 500.00 $ 171.25 $ 50.00 $ 121.25 $ 121.25 $ 0.00 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.�futhermo I ai7fFi�riz- a�bc i -nau • •,•. ctor to do the work stated. Authorized Signatue: Owner / Applicant on LNi•� jvt WOArc / Agent July 26, 2018 Date Building Department Copy July 26, 2018 1 Miami Shores Village 0;`% 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 PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS JOB ADDRESS: "1 15 N t 'I ( Tail City: Miami Shores County: Folio/Parcel#: to 2 O(.. b O .60 -7V Occupancy Type: Load: Construction Type: OWNER: Name (Fee Simple Titleholder): V I/.J wj jo /t Address: 411 5 v E q! -rag- City: Mt9Ml'j-o/?'C7i 204e _,d___ FBC 201? b+� Master Permit No. I Sub Permit No. ❑ REVISION ❑ CHANGE OF CONTRACTOR Miami Dade ❑ EXTENSION ❑RENEWAL ❑ CANCELLATION ❑ SHOP DRAWINGS Zip: '3 313 a Is the Building Historically Designated: Yes NO State:. Flood Zone: BFE: FFE: Phone#: 305 qP3 8b31 zip: 3313 Tenant/Lessee Name: Phone#: Email: V �AIGLGNT'hjl6IOZLv►T• �C•(-- CONTRACTOR: Company Name:/,44s,p .` 519 Address: S S"SP- 73&sc..A/ti, . 5 -© City: State: r Qualifier Name: w /f ., k'ta. Cc LJO. State Certification or Registration #: 5%z OOo 1 Z 1/ �. DESIGNER: Architect/Engineer: Address: Value of Work for this Permit: $ ZOO •L Type of Work: ❑ Addition ❑ Alteration Description of Work: Phone#: O1'—g,G- 560a Zip: 3?/y' Phone#: i i(t- -23 G Ss'5 Certificate of Competency #: Phone#: ,/1"/,. City: State, Zip. Square/Linear Footage of Work: ;MO Sq f'/ / ElNew Repair/Replace ❑ Demolition D, 7 Specify color of color thru tile: ► Submittal Fee $'.3 Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ 2 • CX:) DBPR $ 2• ZNotary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ _ Bond $ SU) • GOrD TOTAL FEE NOW DUE $ (2 ( • 2- (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 TOLLOWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. 1F 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 inust 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 'C OWNER or AGENT CON ACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of 7- ,20 (e ,by V I NC' NT 'JCDM ' who is personally known to me or who has produced t3Ef _ tkC N SL as identification and who did take an oath. NOTARY P LIC: Sign: Print: SI (`(b(A P.L-A� rids R Seal: Sindia Alvarez a My Commission FF 156750 ' - e0rO/ Expires 0910312018 *************** *jt,*,*s.**rir*+R**.A i *************** oar Po,, Notary public State of Flo { ******* APPROVED BY ) /JG /I," 2 , day of 3V , 20 I' , by wiio is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: as Print: Seal: r..eti,ti, Y .. „ . e _ }o.Gs'r P% Notary Public State of Florida ? ;c Sindia Alvarez• } ti, ..+� My Commission FF 156750 }"4.*ylo?orod"".elExpires0910*�t0.12 312018 ***1„ *s***********s***** Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) REGISTEREI5 SEPTIC TANK CONTRACTOR WILLIAM M. WOODARD 12555 BISCAYNE BLVD, #970 NORTH MIAMI, FL 33181- 104 SR0001342 A AMERICAN SEPTIC & PLUMBING, INC. Business Authorization: SA0600947 Registration Expires on September 30, 2018 J FLORIDA DEPARTMENT OF HEALTH CERTIFICATE OF AUTHORIZATION FOR SEPTIC TANK CONTRACTING HEALTH The Florida Department of Health hereby certifies the business or entity named below has satisfied the requirements of Part Ill, Chapter 489, Florida Statutes, for septic tank contracting and has been duly authorized by the Department to provide septic tank contracting services carder the name of A AMERICAN SEPTIC & PLUMBING, INC... Qualifying Contractor.: WILLIAM M. WOODARD SA0000947 May 22, 2017 March 31, 2019 Authorization Number Date Issued Expiration Date 000122 tocal Business Tax Receipt Miami -Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 4231718 BUSINESS NAMELOCATfOl'E!,—r A AMERICAN SEPTIC & PLUMBING INC 1990 NE163 ST104 ':NORTH MIAMI BEACH FL 33160 RECEIPT NO. RENEWAL 44i8836 EXPIRES SEPTEMBER 30, 2018 Must be displayed at place of business Pursuant to County Code ChapterBA Art. 9 &'10, OWNER SEC. TYPE OP BUSINESS PAYMENT RECEIVED AAMERICAN SEPTIC & PLUMBING INC 196 SPECIALTYPLUMBING CONTRACTOR CIO WILLIAM M WOODARD PRES SEP000947, Worker(s) ,1 $54 00 ';12113/2017, •,ECHECK=18-105072 This Local Business Tax Receipt only'confirms payment of the Local Business Tex. The Receipt is not a license, permit, or certification of the holder's qualifications, to do business. Holder must comply with any governmental or nongovernmental regulatory taws end requirements which apply to the business. 4. The RECEIPT N0. above must be displayed on ail commercial vehicles- Miami -Dade Cade Sec 8e-276. For more information,visitwww.miemidado.gov/taxcollector . CERTIFICATE OF LIABILITY INSURANCE DATE(MIKDDIYYYY) 02/20/2018 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 POUCIES 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(ies) must be endorsed. tf SUBROGATION IS WAIVED, subject to the terms 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 Wise Insurance Agency LLC 1410 East Georgia Street Bartow INSURED A American Septic and Plumbing 12555 Riscayre Blvd #970 Miami COVERAGES FL 33830 FL 33181 NNAMo FACT Jamie Blair ENo. Ern; (863) 534-3431 ADDRESS: Jamie@wiseinslic.com INSURERS) AFFORDING COVERAGE FAX Not. (863) 533-6485 NAIL 0 INSURER A: CATLIN Specialty INC Company INSURER B : 15989 INSURER C : INSURER 0 : INSURER E CERTIFICATE NUMBER• INSURER F : 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 POUCIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR INTR A TYPE OF INSURANCE ADOCSUBR MSG wVD POLICY NUMBER POUCYEFF MTWOOKYYY1 POLICYEXP IMMIDOIYYYYI UNITS X COMMERCIAL GENERAL LIABILITY 0900104202 08/10/2017 08/10/2018 EACH OCCURRENCE S 1,000,000 CLAIMS -MADE : nOCCUR DAMAGE TO RI Ni CU $ 100,000 PREMISES (Ea occurrence) MED EXP (Any one parson) $ 5000 PERSONAL & ADV INJURY $ 1,000,000 GENL AGGREGATE UNIT APPUES PER: GENERAL AGGREGATE S 2,000,000 PRODIJCTs - COMP/OP AGG S 2,000,000 S AUTOMOBILE — I reaa ITV ANY ALTO _ OS ED AD D SINGLE LIMIT Ea accident) S BODILY INJURY (Per person) S BODILY INJURY (POT sCCiderd► $ PROPERTY DAMAGE (Pat accident) $ $ _ iEXCESS UMBRELLA UAB UAB _OCCUR CLAIMS -MADE EACH OOCURRCE EN S AGGREGATE S _DED RETENTIONS S WORKERS COMPENSATION AND EMPLOYERS LIABILITY Y / N ANY PROPRIETOR/PAR1NERIEXECU7IVE OFFICERNEMBER EXCLUDED? (Mandatory in NH) If yye1se describe under N ( A 1 PER I STATUTE ERA E.L EACH ACCIDENT $ E.L DISEASE • EA EMPLOYEE $ E.L DISEASE -POLICY OMIT $ CEScRPTION OF OPERATIONS 1 LOCATIONS ( VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached (r more space is required) Septic tank contactor SEP000947 CERTIFICATE HMI MR Miami shores village bldg department 10050 NE 2 Avenue Miami shores FI 33138 SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POUCY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2014/01) 01988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD .�FATIVICT®t CI— FINANCRI.OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF 1AIORKERW COMPENSATION • CERTWICATE OF ELECTION TO SE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW •' CONSTRUCTION INDUSTRY EXEMPTION This certifies that the Mldhriduai )hoed below has sleeted to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 51312018 EXPIRATION DATE: 5/3 2018 PERSON: WOODARD WILLIAM' M FEN: 850980938 BUSIMISS NAME AND ADDS; A AMERICAN SEPTIC AND PLUMBING, INC 12555 BISCAYNE BLVD 970 MAW FL 33181 SCOPES OF SIMMS OR TRADE: IRRIGATION OR DRAINAGE SYSTEM Pelmet aCalli ebtet0.seaCo awOW law Ode arepaaamNsduper bySa.aromad'la u ll.�{ennneMepaeleO°teeslas wow vas g"40.0412). SO Merl%MaIleaeteerNee *sIst Ihedales de,donlobe imiet.Pareuwio6t Flakes ofdsweelobe meemman lee* mama ebMwoNaeKetany Ire else the eoakser lwwmodMaae ele,�a tallied* knot awls reaukterants dais mass far laminae ate oatiliava.loedtperoawgsad rarolma DFSFUNIC-252 CERTIRCATEOFELECTIONTO8EEXEMPTREVISEDpe.ta gtlelSnotaw(1/S0}4ls/eoCl • Proof of Coverage Page 1 of 1 JIMMY PATRONIS FLORIDA'S GRIEF FINANCIAL OFFICER WC Mobile. App WC' Iir Exemption Detail Page This database was last updated Thursday, July 26, 2018 12:08 AM. Return to Previous Page Exemption Details Search Our Data CFO Horn Name Title I Effective Date ['Termination Date [Exemption Type `"Business Activities I Employer Name WLLIAM M WOODARD May 10 2018 May 9 2020 Construction Click Here to View Activities Listed on Exemption A AMERICAN SEPTIC AND PLUMBING INC WILLIAM M WOODARD WILLIAM M WOODARD PR PR May 3 2016 Feb 16 2000 May 3 2018 Feb 15 2002 Construction Construction Click Here to View Activities Listed on Exemption Click Here to View Activities Listed on Exemption A AMERICAN SEPTIC AND PLUMBING INC A AMERICAN SEPTIC AND PLUMBING INC WILLIAM M WOODARD PR Sep 2 2008 Sep 2 2010 Construction Click Here to View Activities Listed on Exemption A AMERICAN PLUMBING INC "Termination may be through the revocation of the exemption, or expiration of the exemption. "'The exemption only applies to the business activities listed on the exemption. Return to Search Page https://apps8. fldfs.com/proofofcoverage/ExemptionDetail. aspx?pr_person_id=0008043 81 7/26/2018 SEP000947 AMERICAN SEPTIC 86 PLUMBING INC. 12555 BISCAYNE BOULEVARD #970 NORTH MIAMI, FL 33181 NORTH DADE (305) 866-5600 BROWARD (954) 922-2119 SOUTH DA DE (305) 254-8600 FAX (305) 8916905 7/26/2018 State of Florida County of Dade Before me this day personally appeared William Woodard who, being duly sworn, deposes and says: That he or she will be the only person working on the project located at: 915 NE 91 Terrace Miami Shores, FL 33138 Contractor Sig ature Sworn to (or affirmed) and subscribed before me this 2G day of tl9l , 2018, By (N t LUj . r- t\b14214. tAYs5D4=4Q7 Personally know OR Produced Identification Type of Identification Produced Et:2[ (mac.- LACE.Ngt Nb(L. Print, T ' p: , or Stamp Name of Notary } a4t,strkg, Notary Public State of Florida Sindia Alvarez My Commission FF 156750 } foFe Expires 09/03/2018 Notice to Owner — Workers' Com I ":"` W p Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 ensation 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 2 ' day of a, , 20 (Q, . By V 1 N C N l (C_ M who is personally known to me or has produced -FL -t)Pt as identification. Notary: SEAL: .- } ZoJyet vu,�, Notary Public State of Florida Sindia Alvarez My Commission FF 156750 r, a' 40910312018 - oFd RECEIVE© STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT SYSTEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: VINCENT TEM JUL 262018 AND DISPOSAL PERMIT #: 13-SM-1864832 APPLICATION #: AP1356350 DATE PAID: FEE PAID: RECEIPT #: DOCUMENT #: PR1126939 PROPERTY ADDRESS: 915 NE 91 Ter LOT: 9 PROPERTY ID #: Miami, FL 33138 BLOCK: 1 11-3206-003-0070 SUBDIVISION: [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 WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY. MATERIAL FACTS, TO MODIFY THE MADE NULL AND VOID. WITH OTHER FEDERAL, SYSTEM DESIGN AND SPECIFICATIONS T [ 1,050 ] A [ 0 ] N [ 0 ] K [ GALLONS / GPD GALLONS / GPD Septic Tank GALLONS GREASE INTERCEPTOR CAPACITY GALLONS DOSING TANK CAPACITY D [ 300 ] SQUARE FEET R [ 0 ] SQUARE FEET A TYPE SYSTEM: [X] STANDARD I CONFIGURATION: [x] TRENCH CAPACITY CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] ]GALLONS @[ ]DOSES PER 24 HRS #Pumps New Drainfield Trench Con SYSTEM SYSTEM [ ] FILLED [ ] MOUND [ ] BED [ ] N F LOCATION OF BENCHMARK: FFE 14.4 [ I ELEVATION OF PROPOSED SYSTEM SITE E BOTTOM OF DRAINFIELD TO BE L D FILL REQUIRED: 0 T H E R [ 0.00] INCHES [ 34.80 ] [ [ 89.80 ] [ INCHES / FT ] [ ABOVE / / FT ] [ ABOVE / INCHES BELOW BELOW ]BENCHMARK/REFERENCE POINT ]BENCHMARK/REFERENCE POINT EXCAVATION REQUIRED: [ 55.001 INCHES 1.-EXISTING 1050 gal septic tank with and approved filter TO REMAIN. 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 300 sf. of drainfield in ....TRENCH... configuration. 4.- Install 12 " of slightly limited soil at the bottom of the drainfield. 5.- Invert elevation and Bottom of drainfield to be no less than 7.42 ' & 6.92 ' NGVD respectively 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 SPECIFICATIONS BY: William Woodard APPROVED BY: Erick Perera DATE ISSUED: 07/25/2018 TITLE: TITLE: Environmental Specialist II DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E-6.003, FAC Dade EXPIRATION DATE: 10/23/2018 CHD Page 1 of 3 1..1.4 APi3:6350 5 _O870 DOCUMENT # : PR1126939 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. Miami Shores Viiiage Building Department SURVEY AFFIDAVIT STATE OF (FLORIDA) COUNTY OF (DADE) 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 The undersigned Affiant, .iItJGEIVt T n/ , does hereby attest that (Property owner) The attached survey, performed by pCL7t} 5v4-vei !Ai L (Name of surveyor's company) For address: .16 Ate co 7-0242 Performed on (9--01—o I (date of survey) is an accurate representation of the existing conditions and locations of all structures on the property as of this date. The purpose of this Affidavit is to induce Miami Shores Village to issue a building permit for the property without first providing a survey less than seven (7) years old old. The Affiant, as property owner, further agrees to remove or obtain permits for any structures which now may exist on the property which are not permitted or which may violate zoning or building code regulations. The Affiant further understands that the existence of any such structures may affect final inspections as applicable to this or other permits. Further, Affiant say eth naught. V/A)CGW !oM Property Owner Signature Property Owner Print Name SWORN TO AND SUBSCRIBED before me this day of Si. >---- 0,�1111111111N�.% �#(6\6 �bd10N * i''i� Affiant is personally known to me, produced r-L 02•Kir/t— a � tion. ''.% 0) G)• z , o • pV 0 7. /,',lb,*IffIIII1811 �\ �\ Revised (6/25/12)Revised on 5/22/2009/ Revised on 6/12/09 0.5' Clear _J 0 U 0 0 J l 0 z 0 0 Ci U 0 0 CO Q) a� U L o 0 cJ 0 0.0' 29' Found 1/2" Pipe No Identification 51' of 10 // N 0 U 0 0 U 3.a 0 0n Line 8.57' Found Nail N Record 25.75 11.50 3' Lot 9 and Measured 80.00' ei L O 13.7j' ✓� 4''. 3' � I 0 0 U., 00 u7 <7; N 0 Wood Fence a 19.E Tile // MS FlIsLO O 13.80' w di di 0.50' 0.50' 3' Ln 7.9' 31.90 One Story Residence No. 915 co r-) 0 18.90' oN 15.00' I r� j o °x Tile 12.8tt' 0 0 0 0 // 13.23' cf>c, ST' s9. W 0 0 u-i cJ --_Record and Measured 80.00' 0- Found 1/2" Pipe Parkway No Identification Pavement ir centerline rye I� 91 s t Te-rr Record and Measured U' DARY SUR Coral Rock Wall (Meanders along Prope•ty Line) PORTION OF LOT 9 1�1:� a rx a far 'i3:1a23 _ FS �aS�C4C L) q p' %1• LOCATION SKETCH i PLUMBING PLANS Approved Date L/2c-%.e Disapproved Date iS x .�G ! 'L-•it�,' -� 's,1`b., c-em'✓_ 7-,.ra '+ y .r,_ x YY� j srr•,f. Ye;. • { n S Jet _ - . • ^' Y —,n 'iy�`{ e ( ,t' f r ^F t '^ ! , .� F y., �t4 ``�`5 � fiC �"c1�! b. '.l' 44 Y '{'� t '"? tJ7f �� ,.t ! ',''- fa„ 1 b c S,?.�. 3 s �+ rT "P 4' 4 ' j F .• l �FF� 44:t�` �,'£ .3r+,sa�f L aSiiOF { a� 7., �, . - i 4,uy. qt y '�4 k S. „s., fi • i ; �v!`.?-` ? '. �• •.. �. . :a.. 4 1 �, ��'i•C Go „ i f• ! i ! �'W37�;.? `Y Y"71^'O S,.G.' sta .[ " .e Y '?, �.3 '.'c�fa-.-'�a r Cu �SC•�'�-"-ai • •• • •• y � • ems"' �.�- �e� .b�'• • 000000 LEGAL DESCRIPTION: The West 51 feet of Lot 9, LESS the North 7 feet and the East 29 feet of Lot 10, LESS the North 7 feet of Block 1, of BISCAYNE RIDGE, according to the Plat thereof, as recorded in Plat Book 39, at Page 41, of the Public Records of Dade County, Florida, now known as Miami —Dade County, Florida. Vincent SURVEY FOR: TOM AND RENEE EVELYN ROBEISON 915 NE 91 TERRACE MIAMI SHORES, FLORIDA 33138-3219 I HEREBY CERTIFY: That the SKETCH OF SURVEY of the above captioned property was completed under my supervision and/or direction, to the best of my knowledge and belief. This survey meets or exceeds the Minimum Technical Standards set forth by the Florida Board of Land Surveyors in Chapter 61G-17-6 Florida / I Administrative Code. Pursuant to Section 472.027, Florida Statutes. DELTA SURVEYORS, INC. 13205 SW 137TH AVENUE SUITE 225 41IAMI, FLORIDA 33186 305-253-0909 FAX: 305-253-0933 DELTVEYORS,,INC WALDO F. PAEZ REGISTERED LAND SURVEYOR NO. 6166 CERTIFICATE OF AUTHOR/ZA L.B. NO. 3386 STATE OF FLORIDA 1) • • • • ••• • •••i •• • • • •M• ••••I• • • • • • • • •••• • • • • • • • •••••b• • FLOOD ZONE: X PANEL: 0093 J COMMUNITY NO. 120652 DATE OF MAP: 3-2-94 2) THERE MAY BE ADDITIONAL RESTRICTIONS THAT ARE NOT SHOWN ON THIS SURVEY THAT MAY BE FOUND IN THE PUBLIC RECORDS OF THIS COUNTY 3) EXAMINATION OF ABSTRACT OF TITLE WILL HAVE TO BE MADE TO DETERMINE RECORDED INSTRUMENTS, IF ANY, AFFECTING PROPERTY 4) LOCATION AND IDENTIFICATION OF UT1LIT1UES, IF ANY ARE SHOWN IN ACCORDANCE WITH RECORDED PLAT 5) OWNERSHIP IS SUBJECT TO OPINION OF TITLE 6) TYPE OF SURVEY: BOUNDARY SURVEY 7) LEGAL DESCRIPTION: FURNISHED BY CLIENT 8) THIS SURVEY IS NOT VAUD WITHOUT THE SIGNATURE AND THE ORIGINAL RAISED SEAL OF A FLORIDA LICENSED SURVEYOR AND MAPPER 9) THIS PLAN OF SURVEY, HAS BEEN PREPARED FOR THE EXCLUSIVE USE OF THE ENTITIES NAMED HEREON. THE CERTIFICATE DOES NOT EXTEND TO ANY UNNAMED PARTIES 10) UNDERGROUND UTIUTIES ARE NOT DEPICTED HEREON, CONTACT THE APPROPRIATE AUTHORITY PRIOR TO ANY DESIGN WORK OR CONSTRUCTION ON THE PROPERTY HEREIN DESCRIBED. SURVEYOR SHALL BE NOTIFIED AS TO ANY DEVIATION FROM UTIUTIES SHOWN HEREON. CERTIFY TO: VINCENT TOM AND RENEE EV_,ELYN__12013EI!SON., HIS WIFE GREENPOINT MORTGAGE FUND, INC., ITS SUCCESSORS AND/OR ASSIGNS, SAMUEL SPENCER BLUM, AND ATTORNEYS' TITLE INSURANCE FUND, INC. • • FIELD SURVEY DATE: 5-31-01 ` SCALE: 1" = 20' DRAWN BY: M.A.B. DRAWING DATE: 6-01-01 FB: 202 PG: 67 DRAWING NO.: 01-499