PL-14-1673Miami Shores Village . —
Building Department
10056 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (365) 756.8972
INSPECTION'S PHONE NUMBER: (305) 962.4949
BUILDING
PERMIT APPLICATION
Permit Type: PLUMBING
FBC ZO c®
Permit No. T -e
Master permit No_ RC -2-13 391
JOB ADDRESS: 361 NE 97th Street,
Ciry: Miami Shares County: Miami Dade Zip: 33138
Folio/Parcelt
Is the Building Historically Designated: Yes NO Fkxxl Zone:
OWNER: Name {Fee Simple Titleholder: Jim Holt phone#: 828-781-Q563
Address. 361 -NE --97th Street,
City: Miami Shores
State FL Zip: 33138
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: 6S Y►2 Y Y� ��� �— Phone#: 30
Address:
City: r'l• eon.= State:= Zip: 33 14
Qualifier Name: T—o13 Ux -0 6COZ Phone#: "�®*^S9 !&''32k>J.
State Certification or Registration k `'a 2®O DCA'L l Certificate of Competency #:
Contact Phone#: �o c SaI e L1 ,6 Etndil Address:
DESIGNER: Architect/Engineer: tJ O . Phonek
Value of Work for this Permit: $ Z � O 'D Square/Linear Footage of Work:
Type of Work: 13 Address ❑Alteration ATew Ditepair/Reptace 131)emolition
Description of Work:
LN -N
Submittal Fee $ Permit Fee $. ' 3W, A` CCF $ CO/CC $
1
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
Technology Fee $
TOTAL FEE NOW DUE $
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name of applicable)
Mortgage Lender's Address
City
State
W'
Zip
Application is hereby made to obtain a permit to do the wort: and installations as indicated. T 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 he secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC.....
OWNER'S AFFIDANIT: I certify that all the foregoing information is accurate and that all work will he 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"
Nnnce to Applicant. As a condition to the issuance of a building Permit with an estimated value exceeding $2500, the applicant roust
Promise in gnod faith that a cop}' of tine notice of commencement and construction lien lau, brochure will he delivered to lite person
whose prnlrerty is subject to attachment. Alsn, a certified cnpy of the recorded notice of coin encenaent must he Posted at the job site
for the first inspection uhicV curs .se en (7) days after the building permit iyt d n tea absence of .such posted notice, the
inspection will not he appro ed and a r inspection fee will he chargers.
Z�a
The foregoing instrntne t knowledged before me this 26th
day of June 2014, by
who is personally knowAol me or who has produced
NOTARY
Print:
As
53
The furegomg instrument was acknowledged before me this26tF
day of June , 2b 14 by
who is personally known to me or who has produced
didEGG1ER9
MY COMMISSION #FF0014
EXPIRES March 25, 2017
Sign:
II
9
My Commission Expires: �� / My Commissfar Ex eii, � 7�o.
APPROVED BY 31 /` Plans Examines- Zoning
as identification and who did take an oath.
Structural Review Clerk
(Reviscd3/12/2012')t9cvised 07/10/07)sReviscd 06/10/2009j(Revisal 3/15/09)
DIVISION OF
Environmental Health
Florida Health
Miami -Dade County
OSTDS/Well Division
11805 SW 261 Street - Miami, FL 33175
Inspector WIC&E C Umbs
Address -.;;U f NE� W) Str& OSTDS #
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR: OSTDS New
APPLICANT: James Holtz
PROPERTY ADDRESS: 361 NE 97 St Miami, FL 33138
LOT: 19 20 BLOCK: 42 SUBDIVISION:
PROPERTY ID #: 11-3206-013-5760
PERMIT #.13 -SC -1463501
APPLICATION #: AP1102341
DATE PAID:
FEE PAID:
RECEIPT #:
DocUMENT #: PR911515
[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 [ 1,200 l GALLONS / GPD Septic CAPACITY
A [ ] GALLONS / GPD N/A CAPACITY
N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ 375 l GALLONS DOSING TANK CAPACITY 183.00 (GALLONS @[ 6 ]DOSES PER 24 HRS #Pumps [ 1 l
D [ 625 ] SQUARE FEET SYSTEM
R [ ] SQUARE FEET N/A SYSTEM
A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [x] TRENCH I ] BED [ l
N
F LOCATION OF BENCHMARK: C/L NE 97 ST 10.29'
I ELEVATION OF PROPOSED SYSTEM SITE [ 8.52 ][INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 38.52 l [INCHES FT ] [ ABOVE BELOW BENCHMARIVREFERENCE POINT
L
D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: [ 72.001 INCHES
'This permit was amended by N. Gumbs on 4/28/14 for the relocation of the septic tank and drainfield and the addition
O of a lift dosing chamber and pump.*
T 1. -Install a 1200 gal min. septic tank with an approved filter.
H 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.
E 3. -Install 625 sf of drainfield in trench configuration.
R 4. -Install 42" of slightly limited soil at the bottom of the drainfield.
BY:
APPROVED BY:
TITLE:
TITLE: Engineering Specialist II Dade CHD
--dP@cole' P Gumbs
DATE ISSUED: 07/12/2013
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC
V 1.1.4 AP1102341
EXPIRATION DATE: 01/12/2015
SE903229
Page 1 of 3
DOCUMENT #: PR911515
Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed.
.-Invert elevation of drainfield to be no less than 7.58' NGVD.
.-Bottom of drainfield elevation to be no less than 7.08' 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 sewage
ow of 300 GPD.
system is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total estimated flow of
gpd.
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 # A02, Tallahassee, Florida 32399-1703. The
Agency Clerk's facsimile number is 850-410-1448.
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.
s
STATE OF FLORIDA APPLICATION # AP1102341
DEPARTMENT OF HEALTH PERMIT # 13 -SC -1463501
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM DOCUMENT # SE903229
SITE EVALUATION AND SYSTEM SPECIFICATION
APPLICANT: James Holtz
CONTRACTOR / AGENT: Southem Septic
LOT: 19 20 BLOCK: 42
SUBDIVISION: ID#:11-3206-013-5760
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: 0.26 ACRES
TOTAL ESTIMATED SEWAGE FLOW: 500 GALLONS PER DAY [ RESIDENCES-TABLEI / OTHER -TABLE 2 ]
AUTHORIZED SEWAGE FLOW: 650.02 GALLONS PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE ]
UNOBSTRUCTED AREA AVAILABLE: 938.00 SQFT UNOBSTRUCTED AREA'REQUIRED: 938.00 SQFT
BENCHMARK/REFERENCE POINT LOCATION: C/L NE 97 ST 10.29'
ELEVATION OF PROPOSED SYSTEM SITE 8.52 [ INCHES / FT] [ ABOVE /BELOW ] BENCHMARK/REFERENCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES
SURFACE WATER: N/A FT DITCHES/SWALES: N/A FT NORMALLY WET: [ ]YES [X]NO
WELLS: PUBLIC: N/A FT LIMITED USE: N/A FT PRIVATE: N/A FT NON -POTABLE: N/A FT
BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: 5.83 FT POTABLE WATER LINES: 75 FT
SITE SUBJECT TO FREQUENT FLOODING? [ ]YES [X]NO 10 YEAR FLOODING? I ]YES IX]NO]
10 YEAR FLOOD ELEVATION FOR SITE: FT [ MSL /NGVD ] SITE ELEVATION: 9.58 FT [ MSL / NGVD
SOIL PROFILE INFORMATION SITE 1 SOIL PROFILE INFORMATION SITE 2
USDA SOIL SERIES: Urban land
Munsell #/Color Texture Depth
10YR 4/1 Loamy Sand 0 To 49
10YR 8/3 Oolitic Limestone 49 To 72
USDA SOIL SERIES:
Munsell #/Color
Urban land
Texture Depth
10YR 4/1
Loamy Sand 0 To 48
10YR 8/3
Oolitic Limestone 48 To 72
OBSERVED WATER TABLE: INCHES [ ABOVE / BELOW ] EXISTING GRADE TYPE: [ PERCHED / APPARENT ]
ESTIMATED WET SEASON WATER TABLE ELEVATION: 66 INCHES I ABOVE / MEI+ ] EXISTING GRADE
HIGH WATER TABLE VEGETATION: [ ]YES [X]NO MOTTLING: [ ]YES [X]NO DEPTH: INCHES
SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: Replacement 4-S, CS,LCS/0 DEPTH OF EXCAVATION: 72 INCHES
DRAINFIELD CONFIGURATION: IX ] TRENCH [ ] BED [ ] OTHER (SPECIFY)
r• REMARKS/ADDITIONAL CRITERIA
to use Arc 24 chambers
SITE EVALUATED BY: DATE: 03/25/2013
(Title:)
DH 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated: 64E-6.001, PAC Page 3 of 4
AP1102341 EID146MI v 1.0.2