PL-19-2614to Iq No 114
i
Location Address
Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
1225 NE 93RD ST, Miami Shores, FL 33138
Contacts
Ise Date. 11/01/2019
Parcel Number
1132050270030
Permit tuo.::FL-10-19=2tl{4
Permit Type: Plumbing -
Work Classiflci
Permit•Stotus: Approve
Expiration: 04/29/2020
MARK & DARLENE HUTCHINSON ' Owner A AARON SUPER ROOTER Contractor
1225 NE 93 ST, MIAMI SHORES, FL 33138 JOHN TUFFY
Other: 9544459705 6022 SW 35 CT, MIRAMAR, FL 33023
Business: 3059448886 mjulie37@aol.com
Inspection Requests:
Description: replace septic tank & drainfield LValuation: $ 8,500.00
305462-4949
q Feet: 0.00
Fees Amount
Payments
Date Paid Amt Paid
100% Permit Renewal Fee $300.00
Total Fees
$300.00
Check # 9161
11/01/2019 $300.00
Total: $300.00
Amount Due:
$0.00
Building Department Copy
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.
AFFIDAVI7: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
-onstru,qtjdn and zoning. Futhermore, I authorize the above named contractor to do the work stated.
ature: Owner / Applicant / Contractor / Agent
Date
01, 2019 Page 2 of 2
ENTERED Miami Shores Village -
OCT 31 2019 Building Department 610z 10 100
BY: _ 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 \/a��a ^ Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LIfUE PHONE NUMBER: (305) 762 4949'"< +� .�'"�"✓�`" " �"'' `
w ti r *r'�. . f,,L!N
\` �b�����`i uA�;'., ,{i.,�. aat` ,.t , i •' yF ;k,. �:'r.iu I•����0 �� 1
I 1 QIQll.•!t
BUILDINGS„'` .1. �.,� .s<a. J,�S Master,PePLO
r�n`it No
14
a.a� -' R•�'wi�w�'r•r1r'.ly�• wP,:%*.'..-a,I!v\. a. •t.'y. .r....,�,,,,.
PERMIT APPLICATION sub Permit No.
BUILDING F-1 ELECTRIC 0 ROOFING Ej REVISION 0 EXTENSION RENEWAL
]PLUMBING F-1 MECHANICAL PUBLIC WORKS 0 CHANGE OF CANCELLATION SHOP
�^ CONTRACTOR DRAWINGS
JOB ADDRESS: I Z-2! Q L— 01 T
City: Miami Shores County: Miami Dade Zip: 3 (S
Folio/Parcel#: 11 — 3 2—(?,5 "o 2� ” 0030 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: M Construction Type: Flood Zone: BFF-,E: FFE:
OWNER: Name (Fee Simple Titleholder): ('ya I Pfid�le�f
Address: 122�3 NEIO
q?)Sr /
City: AAJa m�
) ��'1• W State: Zip: �!3
Tenant/Lessee Name: - Phone#:
Email: �o� �},, p�^�
CONTRACTOR: Company Name: R f �Lr` n &-PF— go" Al Phone#: ot �u -U"" 6
Address: 3S CT y
City: I State: 1 y Zip:
Qualifier Name: -T\)5A Phone#:
State Certification or Registration #: Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
®®
Value of Work for this Permit: $ Vf Square/Linear Footage of Work: '30 0
Type of Work: ❑ Addition ❑ Alteration ❑ New [\7 Repair/Replace ❑ Demolition
Description of Work: I G °1 Y -C, 1 e f
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $ b, CA
(Revised 02/24/2014)
Bonding Company's Name (if applicable)
- Bonding Company's Address V P
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 att ment. Also, a certified copy of the recorded notice of cgRlmencement must be posted at the job site
for the first inspection whic curs seven (7) days after the building permit is issue ./ n the absence of such posted notice, the
inspection will not be appr9lVelf and a reinspection fee will be charged.
Sign
ENT
The foregoing' strumentW acknowledged before me this
ay of OS"r 20 19 by
(A(01- 4V4-()N0r150n . who is personally known to
me or who has produced iF",A tb as
identification and who did take an oath.
NOTARY PUBLIC:
CONTRACTOR
The foregoing instrument was acknowledged before me this
31 day of ACA120 17 by
00 H la 15,4 who is personally known to
me or who has produced (n as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:_
Print:
Seal: Notary Public Stave of Fbr4a Seal
Teyana Solomon
My Corneissxm GG 268641
ave Expires 10/17/2022
APPROVED BY' IG�/� Plans Examiner _
t
Structural Review
(Revised02/24/2014)
�V+r NotaryaPubNc Stale of Flonda
Teyana Solomon
+� My Con"ssion GG 268641
Expires 10117(2022
*****
Zoning
Clerk
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Mark & Darlene Hutchinson
PROPERTY ADDRESS: 1225 NE 93 St Miami, FL 33138
LOT: 14 BLOCK: 1 SUBDIVISION
PROPERTY ID #: 11-3205-027-0030
PERMIT #:.I 3 -SC -1 842170
APPLICATION # : AP 1341172
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR1116228
Bay Lure
[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 NEW Septic TANK CAPACITY
A [ 0 ] GALLONS / GPD CAPACITY
N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ]
D [ 300 ] SQUARE FEET NEW DF IN TRENCH CON SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [X] STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [X] TRENCH [ ] BED [ ]
N
F LOCATION OF BENCHMARK: FFE 8.13' NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 28.50][ INCHES FT ][ ABOVE BELOW BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 55.50][ INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: [ 39.00] INCHES
0
T
H
E
R
THIS PERMIT HAS BEEN EXTENDED FOR AN ADDITIONAL 90 DAYS TO EXPIRE ON 11/15/2018. Original permit issued
by Loanis Gonzalez.
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 300 sf. of drainfield in .TRENCH... configuration.
4.- Install 12" of slightly limited soil at the bottom of the drainfield.
(Comments Continued on Page 2.)
SPECIFICATIONS BY: Teresa J Solomon TITLE: Master Septic Tank Contractor
APPROVED BY: TITLE: Engineer Supervisor III
Astra V E war s
DATE ISSUED: 05/09/2018
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC
Dade CHD
EXPIRATION DATE: 08/07/2018
v 1.1.4 AP1341172 SE1076559
Page 1 of 3
DOCUMENT #
PR1116228
5.- Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed or trench.
6.- Invert elevation of drainfield to be no less than 4.00' NGVD
7.- Bottom of drainfield elevation to be no less than 3.50' 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.
The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance with s.
64E -6.013(3)(f), FAC. Required drainfield area based on rule 64E -6.015(6)(c)2.
Install a new drainfield to achieve Drainfield size requirement.
10/31/2019
575471558.jpg
https://mail.google.com/mail/u/0/#search/1225/FMfcgxwBWSwcCSLxJ KwndILQCLjXJLSL?projector=1 &message Partld=0.1 1/1
® �tDIVISION OF
Environmental Health
et Florida Health
Miami -Dade County
ON OSTDS[Well Division
je 11805 SW 26th Street Miami, FL 33175
Date
Address�. ,,�i.� ���._� =��e. OS'FDS #_�'�—��
Comments:
5/17/2018 Property Search Application - Miami -Dade County
PROPERTY APPRAISER
]C
i in"' F to, I
� U �i
Summary Report
Property Information
Folio:
11-3205-027-0030
Property Address:
1225 NE 93 ST
Miami Shores, FL 33138-2940
Owner
MARK HUTCHINSON
DARLENE HUTCHINSON
Mailing Address
1225 NE 93 ST
MIAMI SHORES, FL 33138 USA
PA Primary Zone
1300 SGL FAMILY - 2801-3000 SQ
Primary Land Use
0101 RESIDENTIAL - SINGLE
FAMILY: 1 UNIT
Beds / Baths / Half
4/3/1
Floors
1
Living Units
1
Actual Area
3,256 Sq.Ft
Living Area
2,310 Sq.Ft
Adjusted Area
2,661 Sq.Ft
Lot Size
9,825 Sq.Ft
Year Built
1957
Assessment Information
Year 2017
2016
2015
Land Value $353,702
$329,361
$299,696
Building Value $192,347
$192,611
$192,876
XF Value $0
$0
$0
Market Value $546,049
$521,972
$492,572
Assessed Value $244,264
$239,240
$237,577
Benefits Information
Benefit
Type
2017
2016
2015
Save Our Homes
Cap
Assessment
Reduction
$301,785
$282,732
$254,995
Homestead
Exemption
$25,000
$25,000
$25,000
Second Homestead
Exemption
$25,000
$25,000
$25,000
Note: Not all benefits are applicable to all Taxable Values (i.e. County, School
Board, City, Regional).
Short Legal Description
BAY LURE PB 44-63
E50FT LOT 3 & W25FT OF LOT 4
BLK 1
LOT SIZE 75.000 X 131
Generated On : 5/17/2018
Taxable Value Information
Previous
Price
OR Book-
Qualification Description
20171 20161
2015
County
10/27/2017
$635,000
Exemption Value$50,000
Qual by exam of deed
$50,000
$50,000
Taxable Value 1
$194,264
$189,240
$187,577
School Board
consideration
05/24/2017
$615,000
Exemption Value
$25,000
$25,000
$25,000
Taxable Value
$219,264
$214,240
$212,577
City
consideration
Exemption Value
$50,000
$50,000
$50,000
Taxable Value
$194,264
$189,240
$187,577
Regional
Value
$50,000$50,000$50,000
[Exemption
able Value
$194,264
$189,2407$$187,577
Sales Information
Previous
Price
OR Book-
Qualification Description
Sale
Page
10/27/2017
$635,000
30745-4540
Qual by exam of deed
09/27/2017
$100
30699-1035
Corrective, tax or QCD; min
consideration
05/24/2017
$615,000
30550-2475
Qual by exam of deed
08/21/2015
$100
29833-2076
Corrective, tax or QCD; min
consideration
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
A'l-Ij
.,a. ii U-IMNAIS P-JP6 "B'N- 177 4 1 -7 bl
co
L, 017 T
910-1 P-Lcl CIOZlOI LlOI /
oa.,.j -'),j T 1/�/
2-%j -A Ift -A x0sv
-4
...... . ............... ..... * . ..... -
.. ..................
..........
....... .. ... ..... I ..... ..........
.................. ............................
............ - -
........ ..... I....-.*--*--.
. ...................... .
............... .......... -- . .............
0�',77,,99N
(91-00
M31A AVE? S3,VO14S IPVV'ky
Rol L I AM
:0 :00 •
:0 000 0
03AI3338
'or"o
TN
c-
M m
> TEC��)
Z 0
z 0
m
0
z
0
m
>
-rj
o
< -
m
('G'l ON)
A VM>18vd '91
00'099
.
((7.1
ON)
WA
3
-u
90) 00 g
7Z,,6
oo*ra
-00*0L
loo*z
D'a
>
z
n
m
o
>
z
0 =
<
>
-;W3AOG
f ONO oo?e
La
-0
(D
'or
m
144b -SO
---
>
z
Q)
ro*ol 07 ,7 -.0001
Q)
m
.07"L
Q,
5E
'01
r
00'0
00fl'9-A37333
'7
c_n (JI
ti SZZlt #.93N3GIS3H
Q)
�00 AHOI S.9N0
"
ro .0,
'fo
Fr—,
gf"77
'00-01 op, Pol
'00 I
g9 9
'01 99'9
.01
19'9
[71
J, 107 10
M Se
'd'd'Ma
7170
0�',77,,99N
(91-00
M31A AVE? S3,VO14S IPVV'ky
Rol L I AM
:0 :00 •
:0 000 0
03AI3338
'or"o
TN
c-
M m
> TEC��)
Z 0
z 0
m
0
z
0
m
>
-rj
o
< -
m
�
3
-u
>
z
n
m
o
>
z
0 =
<
>
La
n
m
(D
0
m
>
z
m
. ... . . . ...
PSTATE O0�L�F ID�0 ;•••;
DEPARTMENT OF 44EA,L,7H •:•
APPLICATION FOR CONSTRUCTION PERMIT
• • •
:00 Pergiit Applicatiipn NeiTber
. . .. . : . . . .
---------------------------PART :-'-'----...--•-----------"=---
scale: Each block re resents 10 feet and 1 inch = 4o teety • • • • • • • • •
III ill lo
..
Notes:
�i�iilr;�►��a:�
�.
IIIIIIIIIIIII&WIMa
_ loso
1
Site Plan submitted y:
Plan Approved Not Approved Date
County Health Department
By
ALL CHANGE UST 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
% .. . .
STATE OF FLORIDA • ••• '
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND, DZOFOSAI.
SYSTEM : : % • ':
PERMIT #: 13 -SC -1 842170
APPLICATION #: AP1341172
DATE PAID:
••• • • FEE PAID•
•' ' : •'• RECEIPT #:
• "' ' DOCUMENT #: PR1116228
.. • . . • . • • . . .
OSTDS Repair
CONSTRUCTION PERMIT FOR: ' ' ' ' ' ' •
• • • • • •
APPLICANT:• • . • • • • • •
Mark& Darlene Hutchinson •. 0 0 0 0 0 ... ..
PROPERTY ADDRESS: 1225 NE 93 St Miami, FL 33138
LOT: 3 4 BLOCK: 1 SUBDIVISION: Bay Lure
PROPERTY ID #: 11-3205-027-0030 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
[OR TAX ID NUMBER]
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION
361.0065, 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 NEW Septic TANK CAPACITY
A [ 0 ] GALLONS / GPD CAPACITY
N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY I ]GALLONS U ]DOSES PER 24 HRS #Pumps [
D [ 300 ] SQUARE FEET NEW DF IN TRENCH CON SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ) MOUND [ ]
I CONFIGURATION: [x] TRENCH [ ] BED [ ]
N
F LOCATION OF BENCHMARK: FFE 8.13' NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 28.50][ INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE 155.50][ INCHES FT ][ABOVE)BELOW BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: [ 0.00 INCHES EXCAVATION REQUIRED: [ 39.001 INCHES
1.- Install a 1050 gal. septic tank with an approved filter
0 2: The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance
T with s. 64E -6.013(32(f) FAC.
H 3: Install 300 sf. of drainfield in .TRENCH... configuration.
4: Install 12" of slightly limited soil at the bottom of the drainfield.
E 5: Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed or trench.
R (Comments Continued on Page 2.)
SPECIFICATIONS BY: Teresa J
TITLE: Master Septic Tank Contractor
APPROVED BY: -- --- TITLE: Engineering Specialist II Dade CHD
Loanis X Gonza 'a
DATE ISSUED: 05/09/2018 EXPIRATION DATE: 08/07/2018
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC Page 1 of 3
v 1.1.4 AP1341172 SE1076559
iments continued on Page 2 )
. . ... . . . ...
• • pOCFMNT 11: PR1116228
•••
. . .. . . . . . .
Invert elevation of drainfield to be no less than 4.00' NGVD . • • .' . : • . . • •
Bottom of drainfield elevation to be no less than 3.50' NGVD •. : •: :. • •.
This permit includes the abandonment of the existing septic tank • • • • • • •
IS 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.
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. Required drainfield area based on rule 64E -6.015(6)(c)2.
Install a new drainfield to achieve Drainfield size requirement.
• ... ...
. . . . . . . . . .
STATE OF FLORIDA • • • •" ' ' •
DEPARTMENT OF HEALTH • ' '•e
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM•SPSGIFICATIAN • •
• . • .• . .• • .
• • % • • • . • •
APPLICANT: Mark & Darlene Hutchinson
APPLICATION # AP1341172
PERMIT # 13—SC-1842170
DOCUMENT # SE1076559
CONTRACTOR / AGENT: Statewide • • • • • • • • • • • •
LOT: 34 BLO& i 1 • i � • • V • •
SUBDIVISION: Bay Lure ID#: 11-3205-027-0030
TO BE CC14PLETED 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: IXIYES [ ]NO NET USABLE AREA AVAILABLE: 0.23 ACRES
TOTAL ESTIMATED SEWAGE FLOW: 400 GALLONS PER DAY [RESIDENCES-TABLEI / OTHER -TABLE 2 ]
AUTHORIZED SEWAGE FLOW: 575.01 GALLONS PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE ]
UNOBSTRUCTED AREA AVAILABLE: 450.00 SQFT UNOBSTRUCTED AREA REQUIRED: 450.00 SQFT
BENCHMARK/REFERENCE POINT LOCATION: FFE 8.13
ELEVATION OF PROPOSED SYSTEM SITE 28.50 [
/ FT I [ ABOVE /I BELOW'] 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 POTABLE WATER LINES:
48 FT
SITE SUBJECT TO FREQUENT FLOODING?
I ]YES [X]NO
10 YEAR FLOODING? [ ]YES
[XINOI
10 YEAR FLOOD ELEVATION FOR SITE:
FT[ MSL /FN -=--13
SITE ELEVATION: 5.75 FT [ MSL / NGVD
CAT►_ DDAWTT.V TV%1ADMATTAN.ATTA: 1
SOIL PROFILE INFORMATION SITE 2
USDA SOIL SERIES:
Munsell #/Color
Urban land
Texture Depth
1 OYR 5/1
Sand 0 To 44
REFUSAL
Oolitic Limestone 44 To 44
USDA SOIL SERIES: Urban land
Munsell #/Color Texture Depth
10YR 5/1 Sand 0 To 38
REFUSAL Oolitic Limestone 38 To 38
OBSERVED WATER TABLE: INCHES [ ABOVE / BELOW ] EXISTING GRADE TYPE: [ PERCHED / APPARENT I
ESTIMATED WET SEASON WATER TABLE ELEVATION: 33 INCHES [ ABOVE / BELOW) EXISTING GRADE
HIGH WATER TABLE VEGETATION: I ]YES [X]NO MOTTLING: [ ]YES [X]NO DEPTH: INCHES
SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: Replacement 4-FS/0.80 DEPTH OF EXCAVATION: 39 INCHES
DRAINFIELD CONFIGURATION: [X] TRENCH [ ] BED I ] OTHER (SPECIFY)
- REMARKS/ADDITIONAL CRITERIA
SITE EVALUATED BY:
DATE: 04/24/2018
Solomon, Teresa (Title: Master Septic Tank Contractor) (Statewide Septic Connectlo
DH 4015, 08/09 (Obsoletes previous editions which may not be used) incorporated: 64E-6.001, FAC Page 3 of 4
AP1341172 EID1842170 v 1.0.2
• • • • • • • • • •
• • ••• • • • • •••
•; ••• • ••• • •
STATE OF FLORIDA ; :. • ': •' '•'PERMIT.
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTIM '
SITE EVALUATION AND SYSTEM SPECIFICATIONS
.. • • . •. •.. •.
... ./......
LOT:` BLOCK: SUBDIVISION: W i^�
PROPERTY ID [1. 11-3zn
0S'Q-7- f O—N [Section/Township/Paraol No. or Tax ID Number]
-I 7-72,S H(5' q3 &;- `S-:�139
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.
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES
SURFACE WATER: `i FT DITCHES/SWALES: ,FT NORMALLY WET? [ ] YES
] NO
WELLS: PUBLIC: N4 FT LIMITJDfUSE: � FT PRIVITEy FT NON -POTABLE: yr
BUILDING FOUNDATIONS: FT PROPERTY LINES: Lj FT POTABLE WATER LI'NE�S�: FT
SITE SUBJECT TO FREQUENT FLOODING: [ ] YES NO 10 YEAR FLOODING* I 1 ,4mS NO
10 YEAR FLOOD ELEVATION FOR SITE: Ft.MS�LINGVD SITE ELEVATION: iiTT HSL/NGVD
T.
SOIL PROFILE INFORMATION SITE 1 SOIL PROFILE INFORMATIONSITE 2
MUNSELL N COLOR TEXTURS DEPTH
r�
((� TO
iceWnJ.— TOG
TO
TO
TO
TO
SO
USDA SOIL SERIES: tjV Gn Q
MUNSELL /COLOR TEXTURE DEPTH
t0 r GI i TO
TO
G 1'O TO
TO
TO
TO
�
TO
USDA SOIL SERIES: r n I Q -n
OBSERVED WATER TABLE: l� INCHES [ABOVE / B STING GRADE. T RCHED / PARE
ESTIMATED WET SEASON WATER TABLE ELEVATION: INCHES [ABOVE XXISTIN E
HIGH WATER TABLE VEGETATION: [ ] YES [ NO MOTTLING: ( ] YES [xj N, DEPTH: INCHES
p � 1 (jam/
SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: TG bit \ DEPTH OF EXCAVATION: 27 INCHES
DRAINFIELD CONFIGURATION: [�] TRENCH [ ] BED [ ] OTHER (SPECIFY) _ !. P7 S Vfin'
REMARKS/ADDITIONAL CRITERIA:
SITE EVALUATED BY:
e
M
DH 4015, 08/09 (Obsolete• previous editions which may not be used) Incorporated: 84E-8.001, FAC Paige 3 Of 4
PROPERTY SIZE CONFORMS TO SITE PLAN: [/v
YES [ ]
NO NET USABLE AREA AVAILABLE: .2-3
ACRES
TOTAL ESTIMATED SEWAGE FLOW: GALLONS
PER DAYTABLE 1/OTHER-TABLE21
AUTHORIZED SEWAGE FLAW:
UNOBSTRUCTED AREA AVAILABLE: O
GALLONS
SQFT
PER DAY 0 GPD/ACRE OR
UNOBYSUCTED AREA REQUIRED:
j
SQFT
H=f: 8,
I�
BENCHMARK/REFERENCE POINT LOCATION:
ELEVATION OF PROPOSED SYSTEM SITE IS 79,
[ S/FTj [ABOVE, -EL BENCHMARK/RE
POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES
SURFACE WATER: `i FT DITCHES/SWALES: ,FT NORMALLY WET? [ ] YES
] NO
WELLS: PUBLIC: N4 FT LIMITJDfUSE: � FT PRIVITEy FT NON -POTABLE: yr
BUILDING FOUNDATIONS: FT PROPERTY LINES: Lj FT POTABLE WATER LI'NE�S�: FT
SITE SUBJECT TO FREQUENT FLOODING: [ ] YES NO 10 YEAR FLOODING* I 1 ,4mS NO
10 YEAR FLOOD ELEVATION FOR SITE: Ft.MS�LINGVD SITE ELEVATION: iiTT HSL/NGVD
T.
SOIL PROFILE INFORMATION SITE 1 SOIL PROFILE INFORMATIONSITE 2
MUNSELL N COLOR TEXTURS DEPTH
r�
((� TO
iceWnJ.— TOG
TO
TO
TO
TO
SO
USDA SOIL SERIES: tjV Gn Q
MUNSELL /COLOR TEXTURE DEPTH
t0 r GI i TO
TO
G 1'O TO
TO
TO
TO
�
TO
USDA SOIL SERIES: r n I Q -n
OBSERVED WATER TABLE: l� INCHES [ABOVE / B STING GRADE. T RCHED / PARE
ESTIMATED WET SEASON WATER TABLE ELEVATION: INCHES [ABOVE XXISTIN E
HIGH WATER TABLE VEGETATION: [ ] YES [ NO MOTTLING: ( ] YES [xj N, DEPTH: INCHES
p � 1 (jam/
SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: TG bit \ DEPTH OF EXCAVATION: 27 INCHES
DRAINFIELD CONFIGURATION: [�] TRENCH [ ] BED [ ] OTHER (SPECIFY) _ !. P7 S Vfin'
REMARKS/ADDITIONAL CRITERIA:
SITE EVALUATED BY:
e
M
DH 4015, 08/09 (Obsolete• previous editions which may not be used) Incorporated: 84E-8.001, FAC Paige 3 Of 4
I
i
i,a S
APPLICANT: C)n � ����V \* �
� w, •• • • • •• ••• ••
CONTRACTOR / AGENT: ��� C • ••• • • • • •• •
LOT: 4 BLOCK: I SUBDIV: • f,a Wl�j• ••• ••
"34- ID#: I� ,3ZoS` 027-
22Y r,�C 93 5-f`33t3g oo�o
CGS
TO BE COMPLETED BY FLORIDA REGISTERED ENGINEER, DEPARTMENT EMPLOYEE, SEPTIC TANK CONTRACTOR OR
OTHER CERTIFIED PERSON. SIGN AND SEAL ALL SUBMITTED DOCUMENTS. COMPLETE ALL APPLICABLE ITEMS.
COMPLETE TANK CERTIFICATION BELOW OR NOTE IN REMARKS WHY THE TANKS CANNOT BE CERTIFIED.
EXISTING TANK INFORMATION
[ OSO ] GALLONS 9i T 'T K/GPD ATU LEGEND: MATERIAL: e- nL eje BAFFLED:[Y /
[ ] GALLONS SEPTIC TANK/GPD ATU LEGEND: MATERIAL: BAFFLED:[Y / N]
[ ]'GALLONS GREASE INTERCEPTOR LEGEND: MATERIAL:
j ] GALLONS DOSING TANK LEGEND: MATERIAL: # PUMPS:[ ]
. . •.. . . . ...
. . . . . . . . . •
. . .•. . . • • ..•
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND •DSSEOSAL 9-JSTEMi
EXISTING SYSTEM AND SYSTEM MESA AZIALrIATTAN •
PERMIT #
I CERTIFY THAT THE LISTED TANKS WERE PUMPED ON / i%V' BY �,& L' 4,N U , HAVE
THE VOLUMES SPECIFIED AS DETERMINED BY [ D S / FILLING / LEGEND If ARE FREE OF OBSERVABLE
DEF OR hEJ�..,��VE A [ SOLIDS DE DEVICE / OUTLET FILTER DEVICE ] I--D�3'��1LLE�R
SI OF LICENSED CONTRACTOR BUSINESS NAME DAT--j��f(
EXISTING DRAINFIELD INFORMATION
] SQUARE FEET PRIMARY DRAINFIELD SYSTEM NO. OF TRENCHES [ J DIMENSIONS: 'io X
[ ] SQUARE FEET SYSTEM NO. OF TRENCHES [ ] DIMENSIONS: X
TYPE OF SYSTEM: [)C] STANDARD [ ] FILLED [ ] MOUND [ ]
CONFIGURATION: [ ) TRENCH [ x] BED [ ]
DESIGN: [ x] HEADER [ ] D -BOX[] GRAVITY SYSTEM DOSED SYSTEM 1
ELEVATION OF BOTTOM OF DRAINFIELD IN RELATION 0 EXISTING GRADE INCHES [ ABOVE /`ZEW
SYSTEM FAILURE AND REPAIR INFORMATION
[,q ] SYSTEM INSTALLATION DATE TYPE OF WASTE [)C] DOMESTIC [ ] COMMERCIAL
j ] GPD ESTIMATED SEWAGE FLOW BASED ON [ ] METERED WATER ] TABLE 1, 64E-6, FAC
SITE [ ] DRAINAGE STRUCTURES [ ] POOL [ ] PATIO / DECK )< ] PARKING
CONDITIONS: [ ] SLOPING PROPERTY [ ] /`
NATURE OF [ ] HYDRAULIC OVERLOAD
FAILURE: [ ] DRAINAGE / RUN OFF
FAILURE [ ] SEWAGE ON GROUND
SYMPTOM: [ ] PLUMBING BACKUP
[ ] SOILS [ ] MAINTENANCE
[ ] ROOTS [ ] WATER TABLE
TANK
j ]
[ ] D BOX/HEADER
[XI SYSTEM DAMAGE
[ ]
[x ] DRAINFIELD
REMARKS/ADDITIONAL CRITERIA TCA n F- r? l�n��`� / L �' OP
SUBMITTED BY • � - TITLE/LICENSE S 'm0Q1 i2 GZ
DH 4015, 08/ bsoletes previous editions which may not be used]
Incorporated 64E-6.001, FAC
DATE: 74-- /jig
Page 4 of 4