PL-13-2801a_ t"
Inspection Worksheet
Miami Shores Village
1000 N.E. 2nd Avenue Miami Shot, FL
Hon . (305)796-22,04 Fax: (30S)756-0372
Inspection NurnW IIUSP- 204531 Perrnit istumber:. PL-12-1$-2801
Scheduled Inspection Date: January '29, 2014 Oertnft 'type: Plumbing.* Residential
Inspector. Qom, Osvaldo.
Inspection Type; ,Flea!
rJuuner; SETH R LA ENZ &�I OLLY � Work Classification.- pti
1� 011 A0=007 4 t 1' Ct►tFb`1 �+
dt�b Address 'i0811 NE 11 Ayb us
113":_. Shofes, FL 33138.2120 Phone Number
Project <NONE>
contractor J,
Parcei Number 1120280380
Ph0nu :- 300202 -1.480
Suildin 'Department Comments
REPAIR TANK AND DRAINFIELD n cfic' Passed ctiilnell�s
INSPECT413 UOGAMENrS False
Inspector Comments
Pawed
HRS,IN FILE
dl
Failed
Correction
Needed
Re- Inspection
Fee l
W,Add tonal Impecdons can be scheduled until
WtspoodW lea ls;paid
For inspections please call: j702.4W
January Z7, 2ofi4 Page 9 of 29
DIVISION OF
' • •' Environmental Health
Q rida Department,of Health
® Miami -Dade County Health Department Io�o
OSTDS/Well Division �O
11805 SW 26 St. • Miami, FL 33175
inspectoro � Q Date Z ~ -L _13
0
Address ; I-+ 6 . 1) H-- .- OSTDS # Ablz W
Comments:
A
.1(/
FT
PQBTaiC Wr"S
i
IRRIGATION WELLS
FT
Signature-x'_-_.—
/�
FT
.
PROPERTY LINES
L
J
L033
OUTLET DEVICE �p-� -�- —'
[ ]
[29]
r
]
[04]
MULTI -C HI M$ERED / ]
[ ]
[30]
r
7
[05]
OUTLET KILTER 6 S
I 1
[31]
r
1
[061
LEGEND
[ 7
[321
I
]
r.071
WATERTIGHT Z
[ ]
[331
[
]
I081
LEVEL
[341
r
]
[09]
DEPTH TO T,II)
[ ]
[35]
2R$CTED .
FT
FT
PRIVATE WELLS
FT
PQBTaiC Wr"S
FT
IRRIGATION WELLS
FT
POTABTE WATER LINES ®S '
FT
BuirbiNo FOUNDATION ./ C-)
FT
.
PROPERTY LINES
FT
AFT
OTHER
[161
DRAINFIELD INSTAIr%ATIQN FILLED / Mo=. SYSTEM
r ] [10] AREA [1JLrX$f I2]3 �SQFT [ 1 I36] DRAINFIELP COVER
[ ] [11] DISTRIBUTION BOX HEADER_ [ ] .[37] SHOULDERS
f. ]
' [131
DRAINLINE SEPARATION 2
EXCAVATION DEPTH.
[ ]
{14]
DRAMINE SLOPE
REPLACEMENT MATERIMZ,
[ 1
[151
DEPTH OF COVER /d
[ ]
[161
EIBMTION [ABOVE E�1 BM
[ ]
[ ]
'[17]
SYSTEM LOCATION
[ ]
I 1
[18]
DOSING PUMPS
3 I 1
I ]
[191
AGGREGATE SIZE A f
.1#0 I
I I
[201
AGGREGATE E%CESSIVEFINES
I I
1 1 [211 AGGREGATE DEPTH N 4& • I I
[ l
FILL / EXCAVATION MATERIAL [ ]
[2 21 FILL AMOUNT
I ]
r ]
[ ]
[231
FILL TEXTU
[24]
EXCAVATION DEPTH.
[25]
AREA REPLACED
[261
REPLACEMENT MATERIMZ,
[39] STABILIZATION
ADDITIONAL IN176RMATION
[40] UNQBSTRUCTED AREA
[41] STORMWATER RUNW4
1421 ALARMS s`
[43]. MAINTENANCE AGREEMENT
(44] BUILDING AREA
[451 LOCATION CONFORMS WITH SITE PLAN
I4 61 FINAL SITE IN.G
1471 CONTRACTOR
(481 OTHER
ABANDONMENT
® [ (491 TANK PULPED /j2 /Z_
o [ ] '[50] TANK CRUSHED & FILLED
EXPLANATION OF VIOLATIONS /•REMARKS:
CONSTRUCTIO PRO /DISAPPROVED] s m • 1s ICAO a CSD DATE-- / Z ^ z C9 J 3
`INAL SYST APPROVED ISAPPROVED] :&2n; CA_.== c I CSD DATE 20 /_3
`16, 08/09 (Obsoletes all previous editions which may not be used)
rated•: 64E- 6.003, FAC• I Page 2 of 3
TL 1 "3-
191 1 Miami Shores Village
x(11 Budding Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING
PERMIT APPLICATION
Permit Type: PLUMBING
FBC 20
Permit No.
DEC 13 2013
Master Permit No. P/ %'3 — �� 1
JOB ADDRESS: W11211 �3 E 11 01tiQ,
City: Miami Shores �t County: Miami Dade Zip: !bb 131
Folio/Parcel #• Wo
Is the Building Historically Designated: Yes
OWNER: Name (Fee Simple
NO .4 Flood Zone:
Address: k�xQ\ 1 J
Via" City: _ _ i�li i�►AJl l State: VL • Zip: n ksic
Tenant
Email:
CONTRACTOR:
��Company �� Name:
Address: 1%';A\ >UV
V City: V�t State
Qualifier Name:% )ffiQn_ Phone#:
State Certification or Registration Certificate of Competency #: _
Contact Phone#: M na tdo —Email Address: is 14h
DESIGNER: Architect/Engineer:
Value of Work for this Permit: $ !9%0 •0o Square/Linear Footage of Work:
Type of Work: DAddress
Description of Work:
DAlteration ` ONew
Submittal Fee $ Permit Fee $3 001, CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
ODemolition
,Technology Fee $
TOTAL FEE NOW DUE $ ,5 AQ
Bonding Company's Name (if
Bonding Company's Address _
City '
Mortgage Lender's Name (if
Mortgage Lender's Address _
City
State
zip
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 ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 applic
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered t rson
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be po d job site
for the first inspection w occurs seven (7) days after the building permit is issued In the absence of su i sted notice, the
inspection will not be *pro ed and a reinspection fee will be charged /f
Owner or Agent
The foregoing insent was acknowledged before me
day of 20 a, by
who is personally known to me or who has prod
As identification and who did take an oath.
NOTARY PUBLIC:
0
Sign:
Print: l
My Commission Ex
Contractor
The forego mstrument was acknowledged before me this.
ICA
day o , 20 L& byS
o is personally known to me or who has produced._
as identification and who did take an oath.
NOTARY PUBLIC:
-- _I- r�r
�
APPROVED BY K / ' ✓ �-3 Plans Examiner Zoning
Structural Review Clerk
(Reviwd3/1212012XRevised 07/10 /07)(Revised 0&10f2009)(ReWwd 3/15/09)
-s1
Issued To: Jason's Septic, Inc
13341 SW 88 Avenue
Miami. FL 33176
Mail To: Jason's Septic, Inc
13152 SW 93 Place
Miami, FL 33176
Owner: Jason's Septic, Inc. (, )
SDS Trucks: 3
STATE OF i ii' s
Operating
OSTDS Service - SDS*
TTS Trucks: 0
County: Dade
Amount Paid. 70.00
Paid: 07/24/2013
Issue Da : 07/30/2013
Permit pines On: 06/30/2014
Issued
Dade County H rlment
11805 SW 26 t
Miami, FL 33175
(305) 623 -3500
The facility shown above has been inspected by a duly authorized representative of the Department of Health, and was found in
conformance with those rules promulgated by the department under the authority of chapters 381, 386 and 489 part III, Florida
Statutes, and set forth in Rule 64E-6, Florida Administrative code.
This permit grants authority to operate the above referenced facility, service, or system in conformance with department rules
and the conditions of operation shown below. This permit is revocable, upon service of notice, when it is determined by the
department that the operational conditions and department standards are not being maintained.
This permit is for the operation of a septage disposal service. Truck(s) shall be presented for inspection upon request from the
Department
°OSTDS Service Permit Abbreviations: SDS - Septage Disposal Service TTS - Temporary Tank Service I-As - Land Application Site
ATOM - ATU Maintenance Entity LSF - Lime Stabilization Facility TM - Tank Manufacturer
Original Customer. Jason's Septic. Inc (NON- TRANSFERABLE)
HEALii•((
1- -00278
issued To: Jason's Septic, Inc
13341 SW 88 Avenue
Miami, FL 33176
Mail To: Jason's Septic, Inc
13152 SW 93 Place
Miami, FL 33176
STATE OF FLORIDA
DEPARTMENT OF HEALTH
Operating Permit
OSTDS - Service - SDS
DISPLAY CERTIFICATE IN A CONSPICUOUS PLACE
County: Dade
Amount Paid: 70.00
Date Paid: 07/24/2013
Issue Date: 07130/2013
Permit Expires On: 06/3012014
Issued Sy:
Dade County Health Department
11805 SW 26 Street
Miami, FL 33175
Owner. Jason's Septic, Inc. (, ) (305) 623 -3500
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002140
Local Business Tax Receipt
Miami —Dade County, State of Florida
-THIS IS NOT A BILL - DO NOT PAY
5175567
BUSINESS NAMEILOCATIOIlt
JASONS SEPTIC INC
13341 SW 88 AVE
MIAMI FL 33176
i'
1'
RECEIPT NO. EXPIRES
RENEWAL SEPTEMBER 30, 2014
5409677 Must be displayed at place of business
Pursuant to County Code
Chapter BA - Art. e & 10
SEC. TYPE OF BUSINESS
°�N� 196 SPECIALTY PLUMBING CONTRACTOR BY TAX COLLECTOR
Worker(s) 3 SEP031444 $75.00 08/19/2013
ECHECK -13- 005998
Thin Local Business Tax Receipt only Qodnus p t of the Local Business Tex. The Receipt is not o license,
poncit or a Codification of the holder's quelificat one, to do business. Holder meet comply widh any governmental or
nongovernmental regulatory lava and requirements which apply to the business.
Tim RECEIPT N0. above most be displayed on all commercial vehicles- Miami -Dade Code Sec 8o -278.
For more information, visit wwwAamidede.98VAN calloetor
^ " CERWICAM OF LIABILITY INSURANCE 12i12i`m"'° '
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 POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTA71VE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT. If the certificate hour Is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION 13 WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer ruts to the
PROMXM
LRA6 Insurance
498 S Lake Destiny Rd
Orlando
INSURED
Jason's Septic, Xnc
13341 SW 88th Ave
!'L 32810
`MAW `'' Jacqueline Allen
ZML- R ,,,,,. (407) 838 -3445 1 sM w,,. (407)939 -3460
.con
Ins
Miami III 33176 1 INSURERF
COVERAGES e'IP0' /CIe1ATC MI IMIlCD.1 211 A rs ngwe al uceu "rem.
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 VMICH 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 POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR
TYPE OF FIANCE
POLICY NIAIIBER
LIMITS
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
CLAIMSMADE ® OCCUR
EACH OCCURRENCE
$
PREMISES I Ren
$
MED EXP (Any one person)
$
PERSONAL & ADV IN URY
$
GENERAL AGGREGATE
$
GENIAGGREGATE MIT APPLIES IER:
POLICY PRO LOC
PRODUCTS - COMP/OPAGG
$
$
AUTOMOBILE LLABIL111f
ANY ALTO
ALL OWNED SCHEDULED
ALTOS AUTOS
HIRED AUTOS �OS��
COMBINED SINGLE LIMIT
Me acid t
BODILY INJURY Per person)
$
BODILY rdJURY (Per accident)
$
PROPERTY 044AGE
$
MMULLA LUIB
EXCESS UAS
OCCUR
CLAIMS4AADE
EACH OCCXIIRREyCE
$
AGGREGATE
$
DED RETENTION $
$
WORKElt,4COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETORFARTNER�CUTIVE YIN
OFRCERIMEMBER EXCLUDED? ®
(Mandatory In K"
I4 yyees be under
DESC RIPT,ON OF OPERATIONS below
NIA
30 -51549
r
/1/2013
/1/2014
X WCSTATU- OTH-
E.L. EACH ACCIDENT
$ 100,000
E.L. DISEASE - EA EMPLOYEE
$ 100,000
E.L. DISEASE - POLICY LIMIT
$ 500,00
DESCIEPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additlonal Remarks Schedule, If more space Is nnpdred)
1(305)756 -8972
City of Miami Shores
Attn: Building Department
10050 IYE tad Avenue
Miami Shores, FL 33136
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROMONS.
AUTHDRIZED REPRESENTATIVE
Tomlinson/DCOGGO ` - t-
AGORD 25 (ZMUM5) O 1998-2010 ACORD CORPORATION. All rights reserved.
INS025 (2olms)m The ACORD name and logo are registered marks of ACORD
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CRY of it Shares
10050 NE 2nd Avemn
Miami ehms, Florida 33138
Attn: BuMV OW
Fgr0305-7i6 -8072
W ial- _...
CANCELLATION _
SHOULD ANY OF TM ABOVE DISOCIMED PGLICM IN ogpmTm
63FRAIMM DATE THEREOR, INS MOUBM 99MJR5R @DEA{tpp TO ®AAfL
30 DAYS WRffTEslll N01M TO TM HOLIMMMINDTO
THEff*T,UffFALUME7000SOBIfALLWPCWW TION WMAMLITY
OR Milt K UPON THE BISUMIL M OR _ TMFS.
The ACM r and loge we FAgbared omits Of ACORD
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'.
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till, •t.. ". f �.�'�.'. :3j'.. �TTt�T��'I �ty! � {� ■ ��1 1,11
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p�2 • 'i
CRY of it Shares
10050 NE 2nd Avemn
Miami ehms, Florida 33138
Attn: BuMV OW
Fgr0305-7i6 -8072
W ial- _...
CANCELLATION _
SHOULD ANY OF TM ABOVE DISOCIMED PGLICM IN ogpmTm
63FRAIMM DATE THEREOR, INS MOUBM 99MJR5R @DEA{tpp TO ®AAfL
30 DAYS WRffTEslll N01M TO TM HOLIMMMINDTO
THEff*T,UffFALUME7000SOBIfALLWPCWW TION WMAMLITY
OR Milt K UPON THE BISUMIL M OR _ TMFS.
The ACM r and loge we FAgbared omits Of ACORD
Property Search - Report
Page 1 of 2
Property Information:
Folio
11- 2232 - 028 -0380
Property Address
10611 NE 11 AVE
Owner Name(s)
SETH R LABENZ
MOLLY E ENGLE
Mailing Address
10611 NE 11 AVE
MIAMI SHORES FL 33138
Primary Zone
1000 SGL FAMILY - 2101 -2300 SO
Use Code
0101 RESIDENTIAL -SINGLE
FAMILY: 1 UNIT
Beds /Baths /Half
3/2/0
Floors
1
Living Units
1
Adj. Sq. Footage
1,960
Lot Size
10,400 SOFT
Year Built
1949
Full Legal Description
MIAMI SHORES ESTATES
PB 47 -58
LOT 10 BLK 3
LOT SIZE 80.00 X 130.00
OR 19750 -3241 0601 5
Assessment Information:
Year
2013
2012
Land Value
$145,728
$177,202
Building Value
$114,513
$132,447
Market Value
$260,241
$309,649
Assessed Value
$197,564
$278,698
Benefits Information:
Benefit
Type
2013
2012
Save Our Homes
Assessment
Reduction
$62,677
$30,951
Homestead
Exemption
$25,000
$25,000
Second
Homestead
Exemption
$25,000
$25,000
Nate: not all benefits are applicable to all Taxable Value (ie County,
School Board, City, Regional),
Disclaimer:
13 Aeri
Taxable Value Information:
Year
2013
Exemption/
Taxable
County
$50,000/$147,564
School Board
$25,000/$172,564
City
$50,000/$147,564
Regional
$50,000/$147,564
Sale Information:
Date Amount OR Book -Page Quali
08/19/2013 $465,000 28781 -3264 Qual i
06/01/2001 $235,500 19750 -3242 2008
Qual I
The Office of the Property Appraiser and Miami -Dade County are continually editing and updating the tax roll and GIS data to reflect the
and GIS positional accuracy. No warranties, expressed or implied, are provided for data and the positional or thematic accuracy of the di:
interpretation. Although this website is periodically updated, this information may not reflect the data currently on file at Miami -Dade Cour
Property Appraiser and Miami -Dade County assumes no liability either for any errors, omissions, or inaccuracies in the information provic
of such or for any decision made, action taken, or action not taken by the user in reliance upon any information provided herein. See Mia
disclaimer and User Agreement at http: / /www.miamidade.gov /info /disclaimer.asp.
Property information inquiries, comments, and suggestions email: pawebmail @miamidade.gov
http: / /gisweb. miamidade. gov /PropertySearch /printMap.htm 12/13/2013
REPAIR,
AALAF DAM MF1S1=-M DepARIUENT
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Molly Engle
PROPERTY ADDRESS: 10611 NE 11 Ave Miami, FL 33138
LOT: 10 BLOCK
3 SUBDIVISION: Miami Shores
PROPERTY ID #: 11- 2232 -028 -0380
PERMIT #:13 -SC- 1508775
APPLICATION #:AP1128186
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR923900
[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
T [ 900 ] GALLONS / GPD Septic CAPACITY
A [ 0 ] GALLONS / GPD CAPACITY
N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ 225 ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [
D [ 225 ] SQUARE FEET Trench confiquration drain SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [ ] STANDARD [x] FILLED [ ] MOUND [ ]
I CONFIGURATION: [x] TRENCH [ ] BED [ ]
N
F LOCATION OF BENCHMARK: FFE 4.6% NGVD
I ELEVATION OF PROPOSED SYSTEM SITE 1 9.12 ][ INCHES FT ][ABOVE BELOW BENCHMARK /REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 14.04][ INCHES FT ][ABOVE BELOW BENCHMARK /REFERENCE POINT
L
D 8
O
T
H
E
R
ILL REQUIRED: L 14.UUJ 1NC:Mb MAUAV"x LVN r— Wu.LAz"; L 10.WU J LLVl -n D
'FILL SYSTEM - This is a fill system and must comply with all the requirements of Chapter 64E- 6.009(4).
1.- Install a 900 gal min. 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 225 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: Jason Jason'' Septic
APPROVED BY
DATE ISSUED
DH 4016, 08/09
Incorporated:
TITLE:
A)% a TITLE: Engineering Specialist II
Betsy Larqa
12/06/2013 EXPIRATION DATE
(Obsoletes all previous editions which may not be used)
Dade CHD
03/09/2014
64E- 6.003, FAC
1s required to performaRol of
(Or AP11281e6he contractor )
boring adjacent to the drainfield excavation at the time of final
inspection. Prior to Final Approval, the FDOH inspector shall
witness the soil boring and compare the results to the original
site evaluatltan submitted. A reinspection fee will be assessed
if the �Ohtractor is not at the jobsite at the arranged time.
DOCUMENT #: PR923900
.- Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed or drain trench.
.-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.
'he system is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total estimated flow of
00 gpd.
'HIS PERMIT IS NOT FOR ANY ADDITIONS.
STATE OF FLORIDA APPLICATION # AP1128186
DEPARTMENT OF HEALTH PERMIT # 13 -SC- 1508775
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM DOCUMENT # SE914301
SITE EVALUATION AND SYSTEM SPECIFICATION
APPLICANT: Molly Engle
CONTRACTOR / AGENT: Jason
LOT: 10 BLOCK: 3
SUBDIVISION: Miami Shores ID #: 11- 2232 - 028 -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: 0,23 ACRES
TOTAL ESTIMATED SEWAGE FLOW: 300 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: 600.00 SQFT UNOBSTRUCTED AREA REQUIRED: 338.00 SQFT
BENCHMARK /REFERENCE POINT LOCATION: FFE 4.67' NGVD
ELEVATION OF PROPOSED SYSTEM SITE 9.12 [ INCHE9 / FT ] [ ABOVE / FBELOW13 BENCHMARK /REFERENCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES
SURFACE WATER: FT DITCHES /SWALES: FT NORMALLY WET: [ ]YES [ ]NO
WELLS: PUBLIC: FT LIMITED USE: FT PRIVATE: FT NON- POTABLE: FT
BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: 10 FT POTABLE WATER LINES: 10 FT
SITE SUBJECT TO FREQUENT FLOODING? [ ]YES IX]NO 10 YEAR FLOODING? [ ]YES [XIN03
10 YEAR FLOOD ELEVATION FOR SITE: FT [ MSL /�] SITE ELEVATION: 3.91 FT [ MSL /NGVD
cnTT. D`Qn TT.F. TNFARMnTTnN STTE 1 SOIL PROFILE INFORMATION SITE 2
USDA SOIL SERIES: Urban land
Munsell #/Color Texture Depth
1 OR 5/1 Sand 0 To 10
10YR 8/3 Oolitic Limestone 10 To 72
USDA SOIL SERIES: Urban land
Munsell #!Color Texture Depth
10YR 5/1 Sand 0 To 18
1OYR 8/3 Oolitic Limestone 18 To 72
OBSERVED WATER TABLE: INCHES I
ABOVE / FBELOW l EXISTING GRADE TYPE: [ PERCHED / APPARENT ]
ESTIMATED WET SEASON WATER TABLE ELEVATION: 10 INCHES [ ABOVE / FBELOW13 EXISTING GRADE
HIGH WATER TABLE VEGETATION: [ ]YES [X]NO MOTTLING: I ]YES [X]NO DEPTH: INCHES
SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: Replacement 3 -S, CS, LCS /O DEPTH OF EXCAVATION: 16.9 INCHES
DRAINFIELD CONFIGURATION: [X ] TRENCH I ] BED [ ] OTHER (SPECIFY)
REMARKS /ADDITIONAL CRITERIA
SITE EVALUATED BY: DATE; 12/03/2013
Jason" Septic, Jason (Title: ) (Jason" Septic)
DH 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated: 64E- 6.001, FAC Page 3 Of 4
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