Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
PL-18-3556
Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address 1, f _ j 1 ; issue Date: 11/29/2018 Parcel Number 161 NE 106TH ST, Miami Shores, FL 33138 1121360060380 wnm Contacts Permit NO.: PL-11-18-3556 Permit Type: Plumbing - Residential Work Classification: Drainfield Permit Status: Approved Expiration: 05/28/2019 JEAN ROY Owner A SUPER SEPTIC & DRAIN FIELD INC Contractor 161 NE 106 ST, MIAMI SHORES, FL 33138 BRYAN K ZERO Mobile: 7864837782 7701 W 18 LN, HIALEAH, FL 33014 Description: DRAIN FIELD REPAIR REPLACED PERMIT PL17-2272 Valuation: $ 2,950.00 Inspection Requests: 305-76-4949 Total Sq Feet: 0.001 :771 Fees Amount Application Fee - Other 50.00 CCF 1.80 DBPR Fee 2.00 DCA Fee 2.00 Education Surcharge 0.60 Permit Fee 53.25 Scanning Fee 9.00 Technology Fee 2.58 Total: 121.23 Payments Date Paid Amt Paid Total Fees 121.23 Credit Card 11/29/2018 $71.23 Credit Card 11/29/2018 $50.00 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. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above named contractor to do the work stated. Authori at er / Applicant / Contractor / Agent NovemberR9, 2018 Date Page 2 of 2 BUILDING PERMIT APPLICATION Miami Shores Village RECEIVED Building Department NOV 29 2018 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 _ i Tel: (305) 795-2204 Fax: (305) 756-8972 C 1Y INSPECTION LINE PHONE NUMBER: (305) 762-4949 FB1C 20 ice' Master Permit No. 1 1- _6sw Sub Permit No F-IBUILDING ELECTRIC ROOFING REVISION EXTENSION DRENEWAL PLUMBING MECHANICAL PUBLIC WORKS CHANGE OF CANCELLATION SHOP CONTRACTOR DRAWINGS JOB ADDRESS: /4/ az E /G (,- - %fzu 'o- City: Miami Shores County: Miami Dade Zip: cV Folio/Parcel#: /I - a /J6 - 606- 0 38'0 Is the Building Historically Designated: Yes NO Occupancy Typei_ , Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): -JPAn) by C fII n W _ Phone#: Address: /la / az J' /'9 4 S°l,- ( f City: /Zigm j U9R,P_q State: `/• Zip: Tenant/Lessee Name: Email: Phone#: CONTRACTOR: Company Nam Phone#:.' del - S/— 64//.'3 Address: W 1 2dz /q '4'0h> City: State: Zip:_S90/ (/ Qualifier Name: Ad d A Ka Phone#: State Certification or egistration #: W-o l bll Z19= Certificate of Competency #: DESIGNER: Architect/Engineer: / Phone#: Address: City: State: Zip: Value of Work for this Permit: S n), [) Square/ Linea7Riepair/Replace age of Work: AM 0 Type of Work: Addition El Alteration El New Demolition Description of Work: r' / el V fl11 -22 Specify color of color thru the: Submittal Fee $ Scanning Fee $ Technology Fee $ Structural Reviews $ Permit Fee $ Radon Fee $ Training/Education Fee $ CCF $ DBPR $ CO/CC $ Notary Double F%e$,.,,,, Bond $ Revised02/24/2014) TOTAL FEE NOW DUE $ -7 I • Z S-71-7_3 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 Zi 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. Signatu AGENT The foregoing instrum nt was acknowledged before me this day of —21a // 20 1 by ifr d Va rho is personal) knnopown to me or who has produce( C i as identification and who did take an oath. l Signature g44z"I'o Z: - CONT OR The foregoing instrument was acknowledged before me this day of y 20 5 , by Ul,ii t who is personally known to me or who has produced ] I i , ] as identification and who did take an oath. NOTARY PUBLIC: Print: Seal: ' MY COMMISSION # GG 044602 r ; EXPIRES: November 2, 2020 FOF F q•• Bonded Thru Notary Public Underwriters APPROVED BY ( I /,) C Plans Examiner Zoning Structural Review Revised02/24/2014) Clerk 11/29/2018 Property Search Application - Miami -Dade County 01;, , OFFICE OF THE "'PROPERTY APPRAISER Summary Report Property Information Folio: 11-2136-006-0380 Property Address: 161 NE 106 ST Miami Shores, FL 33138-2036 Owner JEAN LUC ROY Mailing Address 161 NE 106 ST MIAMI SHORES, FL 33138 USA PA Primary Zone Primary Land Use 1000 SGL FAMILY - 2101-2300 SQ 0101 RESIDENTIAL -SINGLE FAMILY: 1 UNIT Beds / Baths / Half 3/2/0 Floors 1 Living Units 1 Actual Area 2,442 Sq.Ft Living Area 1,628 Sq.Ft Adjusted Area 1,854 Sq.Ft Lot Size 9,225 Sq.Ft Year Built 1941 Assessment Information Year 2018 2017 2016 Land Value 230,638 230,638 198,007 Building Value 256,964 116,290 116,330 XF Value 948 960 972 Market Value 1 $488,550 347,888 315,309 Assessed Value 1 488,550 275,6461, 250,588 Benefits Information Benefit IType 2018'2017 2016 Non -Homestead Cap Assessment Reduction 72,242 64,721 Note: Not all benefits are applicable to all Taxable Values (i.e. County, School Board, City, Regional). Short Legal Description DUNNINGS MIAMI SHORES EXT NO 2 PB 41-78 LOT 14 BLK 208 LOT SIZE 75.000 X 123 OR 20535-4401 07 2002 1 Generated On : 11/29/2018 Taxable Value Information 2018 20171 2016 County Exemption Value 0 0 0 Taxable Value 1 $488,550 275,646 250,588 School Board Exemption Value $0 0 0 Taxable Value $488,550 347,888 315,309 City Exemption Value 0 0 0 Taxable Value 488,550 275,646 250,588 Regional Exemption Value $0 $0 $01 Taxable Value $488,550 $275,6461 $250,588 Sales Information Previous Price OR BookORQualification Description Sale Page 03/31/2017 600,000 30509-1796 Qual by exam of deed 03/29/2017 0 30481-4996 Corrective, tax or QCD; min consideration 11/18/2014 270,400 29397-0850 Corrective, tax or QCD; min consideration 07/01/2002 286,000 20535-4401 Sales which are qualified The Office of the Property Appraiser is continually editing and updating the tax roll. This website may not reflect the most current information on record. The Property Appraiser and Miami -Dade County assumes no liability, see full disclaimer and User Agreement at http://www.miamidade.gov/info/disclaimer.asp Version: A SUPER SEPTIC & DRAIN FIELD INC. CC: SR0161772 PHONE: 305-364-0113 DATE: I L q-( STATE OF FLORIDA COUNTY OF MIAMI-DADE 7701 WEST 18 LANE HIALEAH, FLORIDA 33014 Licensed and Insured E-MAIL: ASUPERSEPTIC@GMAIL.COM WWW.ASUPERSEPTIC.COM FAX: 305-364-0349 BEFORE ME THIS DAY PERSONALLY APPEARED, =0-0 WHO BEING DULY SWORN, DEPOSES AND SAYS: THAT HE OR SHE WILL BE THE ONLY PERSON WORKING ON THE PROJECT AT: I G I A/,E. I© 5+- . I.,I THY Contractor Signature: SWORN TO (OR AFFIRMED) AND SUBSCRIBED TO ME THIS DAY OF 2018, BY: MAHARAI K. GO GG 044602 MY COMMISSION# ber2,2020EXPIRES: Novem ritersotarypublicUndeNr PERSONALLY KNOWN OR PRODUCED IDENTIFICATION TYPE OF INFORMATION PRODUCED -P l 1 PRINT, TYPE, OR STAMP NAME OF NOTARY Notice to Owner — Workers' Com Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 nsation 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. i Signature: State of Fl( County of Miami -Dade The foregoing was acknowledge before me this day of 1 C) v 20 l By 1 ../' IU V '!J who is personally known to me or has produced ratification. LOCATION MAP NOT TO SCALE X IRWOR OF BOUNDARY SURVMY SCALE: 1" = 20' 7.5' ALLEY PER P.B.42_PG. 33}------- u — — — 1u ASPHALT PAIEMENT 0 10 20 1 inch 20 ft. SURVEY SITE - .FIP3/• :ffMJ(R— F.I.P.3o4- N/ 4• N No I.O. RECEIVED LEGEND NOV 2 9 2018 C) = Calculated SYMBOLS CL. =Gear AIR CONDITIONER Center Line CONC. = Concrete Qv CABLE TV CBS. = Concrete Block Stucco E3 CATCH BASIN A = Delta ENC. = Encroachment 7, CONCRETE POLE F.F.EL. = Finish Floor Elevation V ELECTRIC BOX F.I.P. = Found Iron Pipe QS MANHOLE F.I.R. = Found Iron Rod WATER PUMP F.N. = Found Nail F.N&D, = Found Nail & Disc WATER HEATER I.D. = Identification W WATER METER L = Length WOOD POLE M) = Measured 0- EXISTING ELEVATION0/L = On Line 1 R = Property Line L=x COVERED AREA P) =Plot x— CHAIN LINK FENCE (C.LF) ,-.,, P,C. = Point of Curvature o— METAL FENCE (M.F,) P.B. = Plat Book o«— OVERHEAD LINES PG. —Page o PLASTIC FENCE (P.F.) R =Radius R) =Record WOOD FENCE (W.F.) 1 R/W = Right of Way —"— WIRE FENCE (WR,F, — U.E. = Utility Easement ® CBS. WALL a.18. 72' ALLEY PFj • P,B. 41, PG. #* • • • • 3.27' U m N o WI IZW QIv N W Z IP.3/4" MOW OR} No I.O. BLOCK COMER) n NS- 51 ate t( 0,C)d JORGE L. CABRI Profeeelonel S Mry y & Meppec d iTi LAST REVISION: 10/ r STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: Jean Luc Roy PROPERTY ADDRESS: 161 NE 106 St Miami, FL 33138 LOT 14 BLOCK: 208 SUBDIVISION: PERMIT #:13-SM-1786683 APPLICATION #: AP1305511 DATE PAID: FEE PAID: RECEIPT #: DOCUMENT # : PR1074949 PROPERTY ID #: 11-2136-006-0380 [ 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 [ 900 ] GALLONS / GPD Septic TANK TO REM IAN 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 [ 225 ] 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: F.F.E 12.4 I ELEVATION OF PROPOSED SYSTEM SITE [ 21.601C INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 63.60][ INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT L D FILL REQUIRED: [ 0.001 INCHES EXCAVATION REQUIRED: [ ] INCHES 1.-EXISTING 900gal. septic tank with and approved filter TO REMAIN. 0 2.- Install 225 sf. of drainfield in ... TRENCH.... configuration. T 3.- Install 12" of slightly limited soil at the bottom of the drainfield. H 4.- 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.) R SPECIFICATIONS BY: A APPROVED BY: 419W TITLE DATE ISSUED: 09/05/2017 TITLE: Engineering eSpecsalisb.II •' ; ; Dade CHD EXPIR2ATIO1; DATE : 12/04/2017 DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Page 1 of 3Incorporated: 64E-6.003, FAC •••• • • • • • • v 1.1.4 AP1305511 : : . 41:4*498: DOCUMENT # : PR1074949 Comments continued on Page 2 ) Invert elevation of drainfield to be no less than 7.60' NGVD Bottom of drainfield elevation to be no less than 7.10' NGVD THIS PERMIT IS NOT FOR ANY ADDITIONS. The system is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total estimated flow of 300 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) ft FAC. 00 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 APPLICATION # AP1305511 DEPARTMENT OF HEALTH PERMIT # 13-SM-1786683 ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATION DOCUMENT # SE1046498 APPLICANT: Jean Luc Roy CONTRACTOR / AGENT: A Super Septic and Drain field Inc. LOT: 14 BLOCK: 208 SUBDIVISION: ID#:11-2136-006-0380 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 NET USABLE AREA AVAILABLE: 0.21 ACRES TOTAL ESTIMATED SEWAGE FLOW: 300 GALLONS PER DAY [ RESIDENCES -TABLET / OTHER -TABLE 2 ] AUTHORIZED SEWAGE FLOW: 525.02 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: F.F.E 12.4 ELEVATION OF PROPOSED SYSTEM SITE 21.60 [ INCHES / FT ] [ ABOVE / 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: 2 FT PROPERTY LINES: 2 FT POTABLE WATER LINES: 10 FT SITE SUBJECT TO FREQUENT FLOODING? YES [X]NO 10 YEAR FLOODING? [ ]YES X]NO] FT[ MSL NGVD ] SITE ELEVATION: 10.60 FT [ MSL NGVD10YEARFLOODELEVATIONFORSITE: QnTT. VVnrTT.F. TW7nP dnTTA 4 RTTF. 1 SOIL PROFILE INFORMATION SITE 2 USDA SOIL SERIES: Munsell #/Color Urban land Texture Depth 10YR 2/1 Sand 0 To 24 10YR 8/1 Sand 24 To 72 USDA SOIL SERIES: Munsell #/Color Urban land Texture Depth 10YR 2/1 Sand 0 To 24 10YR 8/1 Sand 24 To 24 OBSERVED WATER TABLE: INCHES [ ABOVE / BELOW ] EXISTING GRADE TYPE: [ PERCHED / APPARENT ] ESTIMATED WET SEASON WATER TABLE ELEVATION: 79 INCHES [ ABOVE / BELOW ] EXISTING GRADE HIGH WATER TABLE VEGETATION: [ ]YES [X]NO MOTTLING:. [••jYES• LXINO- • DEPTH: INCHES SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: Replacement 4-FgA0.80 • •UPfH:OA.4X(%VATION: DRAINFIELD CONFIGURATION: [ X ] TRENCH [ j BED [ ] OTHER •PEO014VY)• • • • • REMARKS/ADDITIONAL CRITERIA REPAIR ,PEPLACING EXISTING 300SQ DRAINFIELD WITH A 225 SF DRAINFIELD IK%EAV COKE 0 "; ';' ';' SITE EVALUATED BY: DATE: A Super Septic, (Title: ) (A Super Sept c); DH 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporatied:i 6AE:6.Z8;, FtC • . AP1305511 EID1786683 INCHES 08/28/2017 Page 3 of 4 v 1.0.2 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM EXISTING SYSTEM AND SYSTEM REPAIR EVALUATION APPLICANT: .lean Luc Roy CONTRACTOR / AGENT: A Super Septic and Drain field Inc. LOT: 14 BLOCK: 208 SUBDIVISION: APPLICATION # AP1305511 PERMIT # 13-SM-1786683 DOC # RF401159 ID#: 11-2136-006-0380 CM 00 O O 00 I- TO BE COMPLETED BY A FLORIDA REGISTERED ENGINEER, DEPARTMENT EMPLOYEE, SEPTIC TANK CONTRACTOR OR OTHEF CERTIFIED PERSON. SIGN AND SEAL ALL SUBMITTED DOCUMENTS. COMPLETE ALL APPLICABLE ITEMS. COMPLETE TAM CERTIFICATION BELOW OR NOTE IN REMARKS WHY THE TANKS CANNOT BE CERTIFIED. EXISTING TANK INFORMATION I 9OO ] GALLONS Septic Tank LEGEND: Unknown MATERIAL: Polyethylene BAFFLED: [ Y/ N ] GALLONS LEGEND: MATERIAL: BAFFLED: [ Y / N ] GALLONS GREASE INTERCEPTOR LEGEND: MATERIAL: GALLONS DOSING TANK LEGEND: MATERIAL: # PUMPS:[ ] I CERTIFY THAT THE ABOVE NOTED TANKS WERE PUMPED ON 08/17/2017 BY Drain Masters HAVE 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. A Super Septic (A Super Septic) 08/28/2017 SIGNATURE OF LICENSED CONTRACTOR BUSINESS NAME DATE EXISTING DRAINFIELD INFORMATION 300 ] SQUARE FEET PRIMARY DRAINFIELD SYSTEM NO. OF TRENCHES [ ] DIMENSIONS: 15.00 ( 20.00 SQUARE FEET SYSTEM NO. OF TRENCHES [ ] DIMENSIONS: X TYPE OF SYSTEM: [ X ] STANDARD [ ] FILLED [ ] MOUND CONFIGURATION: [ ] TRENCH [X ] BED [ j DESIGN: [X] HEADER [ ] D-BOX [X] GRAVITY SYSTEM ELEVATION OF BOTTOM OF DRAINFIELD IN RELATION TO EXISTING GRADE SYSTEM FAILURE AND REPAIR INFORMATION DOSED SYSTEM 42.00 INCHES [ ABOVE 01/01/1941 ] SYSTEM INSTALLATION DATE TYPE OF WASTE [X] DOMESTIC 300 ] GPD ESTIMATED SEWAGE FLOW BASED ON [ ] METERED WATER SITE DRAINAGE STRUCTURES CONDITIONS: SLOPING PROPERTY NATURE OF HYDRAULIC OVERLOAD FAILURE: DRAINAGE / RUN OFF POOL [ ] PATIO / DECK COMMERCIAL X] TABLE 1, 64E-6, FAC X ] PARKING SOILS [X] MAINTENANCE [ ] SYSTEM DAMAGE ROOTS [ ] WATER TABLE [ ] FAILURE [X ] SEWAGE ON GROUND [ ] TANK [ ] 1=-BOX H EC CX] DRAINFIELD SYMPTOM: [ ] PLUMBING BACKUP [ ] • • • • • • • • • • we SUBMITTED BY: TITLE/LICENSE A Super Septic (A Super Septic) • •' ' • ' • Or DH 4015, 08/09 (Obsoletes previous editions which may not be u$edj . ; ;•; ; ; • ; Incorporated 64E-6.001, FAC ••• • ••• ••• • ••• • • V 1.0.0 AP1305511 EID1786683 DATE: 08/28/2017 Page 4 of 4 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM EXISTING SYSTEM AND SYSTEM REPAIR EVALUATION REMARKS/ADDITIONAL CRITERIA APPLICATION # AP1305511 m PERMIT # 13-SM-1786683 00 DOC # RE401159 07 A V- AIR ,REPLACING 300 SQ DRAINFIELD WITH A 225 SQ DRAINFIELD IN TRENCH CONFIGURATION SUBMITTED BY: TITLE/LICENSE A Super Septic (A Super Septic) "' • • • • DH 4015, 08/09 (Obsoletes previous editions which may not be ujedj Incorporated 64E-6.001, FAC ••• • • •• •• • • ••• • • v 1.0.0 AP1305511 EID1786683 DATE: 08/28/2017 Page 4 of 4 STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR CONSTRUCTION PERMIT Permit Application Number, PART II - SITEPLAN--------------------------- Scale: Each block represents 10 feet and.1 inch = 40 feet. r IIJIl71ii® iimold 1' i/'1 t maamsy the stew11 t!i 0111111 NON IN 1 i 11, I IIG IIii l1! I%___i® Ilr 11.11 1it 11111,! ill// CIE/'Il G 1 1Vi1 111/J 11 11// INUME Riii 11 11 NEESE NOME moll 11=CSC C7C7C: Site Plan submitted by: Plan Approved Not Approved date- BY ... • • f44ugV Health Department HIALLCHANGESMUSTBEAPPROVEDBYTHECIUK*rY 'AL rW*DEPARTM`ENT 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) • • • + • • • • • • • •