PL-17-806`4r!.n ciEs y�! Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
FtoRiD
Permit NO. PL-3-17-80s
Permit Type: Plumbing - Residential
Pen Worts Classification: Drainfield
Permit Status: APPROVED
issue Date: 413/2017 1 Expiration: 09/30/2017
Project Address Parcel Number Applicant
1037 NE 91 Terrace 1132050010050�
Miami Shores, FL Block: Lot: ALISON HARKE
Owner Information Address Phone Cell
ALISON HARKE 1037 NE 91 TERR
MIAMI SHORES FL 33138-3401
Contractor(s) Phone Cell Phone
MIAMI DADE ENVIROMENTAL 786-251-4099
of Work: INSTALL A NEW 1050 GALLONS SEPTIC T
of Piping:
itional Info: INSTALL A NEW 1050 GALLONS SEPTIC T
Bond Return :
Classification: Residential Scanning: 1
Fees Due
Amount
CCF
$3.00
DBPR Fee
$4.50
DCA Fee
$4.50
Education Surcharge
$1.00
Notary Fee
$5.00
Permit Fee
$300.00
Scanning Fee
$3.00
Technology Fee
$4.00
Total:
$325.00
Valuation: $ 4,500.00
Total Sq Feet: 500
Pay Date Pay Type Amt Paid Amt Due
Invoice # PL-3-17-63435
03/23/2017 Credit Card $ 50.00 $ 275.00
04/03/2017 Cash $ 275.00 $ 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 zonin _ ermore. I� authorize the
e above -named contractor to do the work stated.
April 03, 2017
Signature: Owner / Applicant / Contractor / Agent
Building Department Copy
April 03, 2017 1
7� 7l ��646 �
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
y V I+; D
- i Ri
MAR 2 3 2017 I
FBC 201 f
BUILDING Master Permit No.
p(�-
PERMIT APPLICATION Sub Permit No. f L
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR
DRAWINGS
JOB ADDRESS: I0 3 1 IU C 11 /'�_
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: //- --� 2 n ;� 4)0 1-•(,-)n 2!:�_o Is the Building Historically Designated: Yes NO
Occupancy Type: _` Load: Construction Type: P Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder):_ 1 1a iU e Q hl to (L )� P Phone#:
Address: (1) `3 -]- tj E . 1:21 ► I:C n n
City: ill 6 " I S iA co 11 P State: / lQ zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: ill va rVl 1 A `Q F LIli o �/ A rl M to JL'f� / Phone#: lg(,'� 2Ttzc39,-
Address: Q 2 Cl0 [ A t e b h S �3 L1_
City: State: F(L Zip:
Qualifier Name Phone#: Zcs':2
State Certification or Registration #: S ROCt -7 )_2 :2Certificate of Competency #: -5, A Dc Q w 11
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ Square/Linear Footage of work: S 0C.)
Type of Work: ❑ Addition ❑ Alteration 50 New ❑ Repair/Replace ❑ Demolition
Description of Work: jNj1z_; 1 IA [t A New L o s o aj W 1(0 rtJ � T'A Ili f z /J Ilj v)
Specify color of color thru the:,"
Submittal Fee $ 2 Permit Fee $00C /� CCF $ CO/CC $.
Scanning Fee $ //_7 Radon Fee $ U • .>l J DBPR $ Notary $
Technology Fee $ li1 Training/Education Fee $ I Double Fee $
Structural Reviews $ Bond $ _„Li✓ �' -T "-►�
TOTAL FEE NOW DUE $ J �o
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
Zip
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 Signature
OWNER or AGE IK
CO RACTOR
The foregoing instrument was acknowledged before me this
+h day of P 6 ✓C L, 20 ) I by
,4A e k who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
as
Th c regoing instrument was acknowledged before me this
Z?J' rd day oa^fI`n�,CIYC� 20 by
, 'e f�'� n CA who is personally known to
me or who has produced_, as
identification and who did take an
NOTARY P
Sign: Sign:
Print: D IU0 f Z-i'yY I G1 Print:
Seal: Seal:
�0r •yam Notary Public State of Florida
`F. Dione Iturria
c ,per My Commission FF 240546
?o, f,,d` Expires 06115/2019
********** ************************
APPROVED BY n Plans Examiner
Structural Review
MY COMMISSION # FF 214031
EXPIRES: March 25, 2019
Bonded Thru Notary Public Underwriters
Zoning
Clerk
(Revised02/24/2014)
APPLICATION #:AP1257110
STATE OF FLORIDA PERMIT #:13-SM-1709567
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATlQBLA*&Em DOCUMENT #:F11105538
CONSTRUCTION INSPECTWXpWejqINAL APPROVAL Date DATE PAID:09/28/2016
Y,i;:,. FEE PAID:375.00
RECEIPT #:13-PID-3112684
APPLICANT: LANCE HARKE
AGENT: iSOUTHERN SEPTIC
PROPERTY ADDRESS: 1037 NE 91 Ter Miami, FL 33138
i
LOT: 6 BLOCK: 1
Approved
SUBDIVISION: Water Edge ID#: 11-3205-001-0050 A prov d Date
CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED,
TANK INSTALLATION
1011 TANK SIZE [11 1050.00 [21
[ 02 ) TANK MATERIAL Concrete
[031 OUTLET DEVICE
[041 MULTI -CHAMBERED [ Y N
[051 OUTLET FILTER Polylok PL-68
(061 LEGEND 1. 13-076-08DC3 2.
(071 WATERTIGHT
[081 LEVEL
1[091 DEPTH TO LID
DRAINFIELD INSTALLATION
[101 AREA [1) 502.5 [21 SQFT
[111 DISTRIBUTION BOX HEADER X
[121 NUMBER OF DRAINLINES 1. 6.00 2.
[131 DRAINLINE SEPARATION
1141 DRAINLINE SLOPE
[151 DEPTH OF COVER
[16] EL
SETBACKS
[ l
[271 SURFACE WATER
FT
[ l
(281 DITCHES
FT
[ l
(291 PRIVATE WELLS
FT
I l
[301 PUBLIC WELLS
FT
I l
(311 IRRIGATION WELLS
FT
[ l
[321 POTABLE WATER
33 FT
[ l
[331 BUILDING FOUNDATIONS
19 FT
[ ]
[341 PROPERTY LINES
7 FT
[ 1
[351 OTHER
FT
FILLED / MOUND SYSTEM
[ ]
[361 DRAINFIELD COVER
[ l
[371 SHOULDERS
I l
[381 SLOPES
[ l
[391 STABILIZATION
EVATION [ ABOVE / BELOW )BM 30.84 ( ]
[171 SYSTEM LOCATION [ ]
[181 DOSING PUMPS [ ]
1191 AGGREGATE SIZE [ ]
1201 AGGREGATE EXCESSIVE FINES [ ]
[211 AGGREGATE DEPTH
FILL / EXCAVATION MATERIAL
I l [221 FILL AMOUNT
[ ) [231 FILL TEXTURE
[ l [241 EXCAVATION DEPTH
[ l [251 AREA REPLACED
[ ] (261 REPLACEMENT MATERIAL
Comments: Comments are on page 2.
ADDITIONAL INFORMATION
[401 UNOBSTRUCTED AREA
[411 STORMWATER RUNOFF
[421 ALARMS
[431 MAINTENANCE AGREEMENT
[441 BUILDING AREA
(451 LOCATION CONFORMS WITH SITE PLAN
[461 FINAL SITE GRADING
K71 CONTRACTOR
[481 OTHER INFILTRATOR ARC 24
ABANDONMENT
I ] [491 TANK PUMPED
( l 1501 TANK CRUSHED 6 FILLED
CONSTRUCTION [ iAPPROVED:;/ DISAPPROVED ] Dade CHD DATE: 03/23/2017
Environmental Specialist 11 Jermaine D CrittendenShaw (Florida Depart
FINAL SYSTEM L APPROVED / DISAPPROVED ]: Dade CHD DATE: 03/23/2017
Environmental Specialist 11 Jermaine D CrittendenShaw (Florida Depar
(Explanation of Violations on following page)
DH 4016,'08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC
Pu rl'41 ._ " a ,, .
Page 2 of 3
AP1257110
E€D1709567
Violation Number
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT;AND DISPOSAL, SYSTEM
CONSTRUCTION INSPECTION AND FINAL APPROVAL
Comment
... . I t .
APPLICATION #: API 257110
PERMIT #:13-SM-1709567
DOCUMENT # : F11105538
DATE PAID:09/28/2016
FEE PAID :375.00
RECEIPT #:13-PID-3112684
:omments ..:
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.
-Angel Rosario
-33.5 chambers with trench config.
DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Page 2 of 3
Incorporated: 64E-6.003, FAC
EH Database v 1.0.1 AP1267110 Etii1709567
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT
SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR: OSTDS New
PERMIT #: 13-SM-1709567
APPLICATION #: AP1257110
AND DISPOSAL DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR1036041
APPLICANT: LANCE HARKE
PROPERTY ADDRESS: 1037 NE 91 Ter Miami; FL 33138
LOT: 6 BLOCK: 1 SUBDIVISION: Water Edge
PROPERTY ID #: 11-3205-001-0050 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
[OR TAX ID NUMBER]
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION
381.0065, F.S., AND CHAPTER 64E-6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE
SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS,
WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE
PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID.
ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL,
STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY.
SYSTEM DESIGN AND SPECIFICATIONS
T [
1,050 ] GALLONS / GPD
Seotic
CAPACITY
A [
] GALLONS / GPD
N/A
CAPACITY
N [
] GALLONS GREASE
INTERCEPTOR CAPACITY
[MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [
] GALLONS DOSING
TANK CAPACITY [
]GALLONS @[ ]DOSES PER 24 HRS #Pumps
D [ 500 ] SQUARE FEET Trench configuration drain SYSTEM
R [ ] SQUARE FEET N/A SYSTEM
A TYPE SYSTEM: (X] STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: (X] TRENCH [ ] BED [ ]
N
F LOCATION OF BENCHMARK: COR NE 91 ter., 9.00' NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 3.60 ][ INCHES FT ][ ABOVE BELOW BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 33.60][ INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: [ 72.001 INCHES
O
T
H
E
R
"Invert elevation of drainfield to be no less than 6.70' NGVD.
`Bottom of drainfield elevation to be no less than 6.20' NGVD.
*Install 42" of slightly limited soil under the bottom of drainfield.
-Perimeter of excavation area shall be at least 2 ft. wider and longer than the proposed absorption bed or drain trench.
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.
The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance with
s. 64E-6.013(3)(0, FAC.
SPECIFICATIONS BY: Jorae Millan
APPROVED BY: TITLE:
Carlos M Icaza
DATE ISSUED: 10/20/2016
TITLE:
DH 4016, 08/09 (Obsoletes all previous editions which may not be used
Incorporated: 64E-6.003, FAC
v 1.1A AP1257110
CHD
EXPIRATIONI-DA_T41,1 % ':arn@ '�unty
� ��Well Program
Page 1 of 3
SE1011054 _
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.