PLC-18-1015FCORWA
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Permit NO. PLC -4-1$-1015
Permit Type: Plumbing - Commercial
ri Work Classification: Septic
Permit status: APPROVED
issue Date: 9110/2018 1 Expiration: 03/09/2019
Project Address Parcel Number Applicant
10500 BISCAYNE Boulevard 1122300010500
ICUC HOLDINGS INC
Miami Shores, FL 33138- Block: Lot:
Owner Information Address Phone Cell
ICUC HOLDINGS INC 10500 BISCAYNE Boulevard
MIAMI SHORES FL 33138-
mn minninnn n
3009 N MAIN Street
SANTA ANA CA 92705-
Contractor(s) Phone Cell Phone
BEAR PLUMBING INC (305)940-8180
of Work: SEPTIC TANK ABANDONMENT
of Piping:
itional Info: SEPTIC TANK ABANDONMENT
ification: Commercial
ning: 3
Fees Due Amount
CCF 0.60
DBPR Fee 2.25
DCA Fee 2.00
Education Surcharge 0.20
Permit Fee 150.00
Scanning Fee 9.00
Technology Fee 0.80
Total: 164.85
Valuation: $ 300.00
Total Sq Feet: 15248
Pay Date Pay Tvpe Amt Paid Amt Due I
Invoice # PLC -4-18-67199
09/10/2018 Check* 6121
04/17/2018 Check #: 6026
114.85 $ 50.00
50.00 $ 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 tha t all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoing. Futhertr&e, I authorize the above-named contractor to do the work stated.
September 10, 2018
Owner / Applicant / Contractor / Agent
Building Department Copy
September 10, 2018 1
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
BUILDING
PERMIT APPLICATION
BUILDING ELECTRIC ROOFING
A V 1-4-D
I PR 1 2018
FBC 201
Eta
Master Permit No? LC
Sub Permit No,
REVISION EXTENSION RENEWAL
DPLUMBING MECHANICAL PUBLIC WORKS CHANGE OF CANCELLATION SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 10500 BISCAYNE BLVD
City: Miami Shores County Miami Dade Zio
Folio/Parcell!: 11-2230-001-0500 Is the Building Historically Designated: Yes NO X
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): ICUC HOLDINGS INC Phone#:
Address: 10500 BISCAYNE BLVD
City: MIAMI State: FLZip: 33138
Tenant/Lessee Name: Phone#<
Email:
CONTRACTOR: Company Name: BEAR PLUMBING INC Phone#: 305-940-8180
Address: P.O. BOX 612255
Ci, NORTH MIAMI State: FL Zip; 33161
Qualifier Name: SLAVA RYCHKOV Phone#: 305-940-8180
State Certification or Registration #: CFC057720
Certificate of Competency #
DESIGNER: Architect/Engineer Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ 300 Square/Linear Footage of Work: 15,248
Type of Work: Addition Alteration New Repair/Replace Q Demolition
Description of Work: SEPTIC TANK ABANDONMENT
Specify color of color thru tile:
Submittal Fee $ c
j -
IPermit Fee $ _ CCF $ CO/CC $
Scanning Fee $ Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews
Revised02/24/2014)
DBPR $ Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $
114.as
Bonding Company's Name (if applicable)
Bonding Company's Address
City State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
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 regulatingconstructioninthisjurisdiction. 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 low 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, theinspectionwillnotbeapprovedandareinspectionfeewillbecharged.
Signature A#' Signature A—&Oc
OWNER or AGENT CONTRACTORQN
The foregoing instrument was acknowledged before me this Theforegoing instrument was acknowledged before me thisjcs7VWayofM .. M71z . 20 1 P by
y /eg
day of 1 20 & b
who is personales kn9wn t WA R `(CHro\/ who is personally known toTUP? .2 i
me or who has produced t k as me or who has produced as
identification and who did take an oath, identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:
Print: Print: =• * Notary Public - State of Florida
Seal: Warren Elbridge Boston Seal: "+. My Comm. Expires Jan 3, 2020
Bonded throu h National Notar Assn. Notary Public s y
Queensland, Australia
r+srsrrrrrsrtsr srsrrrrsrstrssss srs srrrttsrts rrrrrrrrrsssrs•srsrrr arr•rarrsssrrsrrrrrsrs t tsssssrsr
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
Revised02/24/2014)
Al
a
DIVISION OF
T, Environmental Health
Florida Health *A10Nliarni-Dade Countyst
0STDS/Well Division VaAz
11805 SVV 36tH Ste t-Nlijl,33175
Inspector Date
Address S'TDS
C01nMeT]tS:,-----,- -------
Signature-' _
d —
44x DIVISION OF
Ii,---,:- <>
Environmental Health
Florida Health
Miami -Dade County
OSTDS/Well Division
11805SN),26t[iStreet ..'vliillni,FI, 33175
A d d r e s s - — J—, 4 e
Comments:
Signatti
OSTDS
l c -a - o s
1}crn - 9 -1 g - lt)14
s
DIVISION OF
Environmental Health
Florida Health
Miarni-Dade County /
Q OSTDSlWell Division /
11805 SNV 26th Strect • Miami, 171,33175
Inspector Date--- -'f l ------------
Address G' `° - ----
coin ments: --- -----
Signature
DIVISION OF
Environmental Health
Florida stealth
Miami -Dude Countyrow0lb"Q OSTDSfWell Division
11805 SNV 26th Street • Miami, R,33175 33175
nspeetor
0
Address
Comments:
Signature;` a
fi
F
Date --- / //l 1— --------
OSTDS"—
nIOF
Environmental Health
Florida Health10
11180
0 Miami -Dade Count3
Y`
0 OSTDS/Well Division %
5 SSV 26th Street • Miami, FL 33175
Date
Address4.U —
osTns
Comments:
Signatu
DIVISION OF4>< Environmental Health
Florida Health
Miami -Dade County
OSTDS/Well Division
11805 SW 26th Street _Nfianii, Ft, 33175
Inspectors 1 Date
Address OSTDS #
Co,aments:
Signatu
DIVISION OF
Environmental Health
Florida Health
Miami -Dade County
OSTDS/NVell Division11805SW26thStreet - Mimi H, 33175
Inspector Date
Address OSTDS#-2e
Comments:
Sign at U I
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
PERMIT #:13 -SC -1928449
APPLICATION #:AP1400597
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR1205277
ABANDONMENT p,ERM,
CONSTRUCTION PERMIT FOR: OSTDS Abandonment ."PlRES 90 DAYS FROMAPPLICANT: (Icuc Holdings Inc) DATE n F ig
PROPERTY ADDRESS: 10500 Biscayne Blvd Miami, FL 33138
LOT: NA BLOCK: NA SUBDIVISION:
PROPERTY ID #: 11-2230-001-0500
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 [
A [
N [
K [
J GALLONS / GPD
GALLONS / GPD
GALLONS GREASE INTERCEPTOR CAPACITY
J GALLONS DOSING TANK CAPACITY [
D [ ] SQUARE FEET
R [ ] SQUARE FEET
A TYPE SYSTEM: [ ] STANDARD
I CONFIGURATION: [ ] TRENCH
N
F LOCATION OF BENCHMARK:
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE
L
D E
0
T
H
E
R
CAPACITY
CAPACITY
MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
GALLONS @[ ]DOSES PER 24 HRS #Pumps [
SYSTEM
SYSTEM
FILLED [ ] MOUND
BED [ ]
ABOVE/BELOW] BENCHMARK/REFERENCE POINT
ABOVE/BELOW] BENCHMARK/REFERENCE POINT
ILL REQUIRED: [ U.UU] INCHES EXCAVATION REQUIRED: [ ] INCHES
Have the tank abandoned in accordance with the following procedures:(a) The tank shall be pumped out.(b) The bottom of
the tank shall be opened or ruptured, or the entire tank collapsed so as to prevent the tank from retaining water, and(c) The
tank shall be filled with clean sand or other suitable material, and completely covered with soil. Have the system inspected
by the health department after it has been pumped and ruptured but before it is filled with sand and covered.
SPECIFICATIONS BY: TITLE:
APPROVED BY: TITLE: Environmental Specialist II
Erick Perera
DATE ISSUED: 03/01/2019 EXPIRATION DATE:
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, EAC
v 1.1.4 "1400597 SE -1
Dade CHD
05/30/2019
Page 1 of 3
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION PERMIT FOR: OSTDS Abandonment
APPLICANT: (ICUC Holdinas Inc
PERMIT #:13 -SC -1928451
APPLICATION # : AP 1400598
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: 'PRI 205096
PROPERTY ADDRESS: 10500 Biscayne Blvd Miami FL 33138
LOT: BLOCK: SUBDIVISION: Julia D Tuttle
PROPERTY ID #: 11-2230-001-0500 [
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 [
A [
N [
K [
GALLONS / GPD
GALLONS / GPD
I GALLONS GREASE INTERCEPTOR CAPACITY
GALLONS DOSING TANK CAPACITY [
D [ ] SQUARE FEET
R [ I SQUARE FEET
A TYPE SYSTEM: [ ] STANDARD
I CONFIGURATION: [ ] TRENCH
N
F LOCATION OF BENCHMARK:
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE
L
D F
0
T
H
E
R
CAPACITY
CAPACITY
MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
GALLONS @[ ]DOSES PER 24 HRS #Pumps [
SYSTEM
SYSTEM
FILLED [ ] MOUND
BED [ ]
W
ABOVE / BELOW] BENCHMARK/REFERENCE POINT
I[ABOVE / BELOW] BENCHMARK/REFERENCE POINT
LLL 1%8uV1KliL: L I INCHES EXCAVATION REQUIRED: [ ] INCHES
Have the tank abandoned in accordance with the following procedures: (a) The tank shall be pumped out. (b) The bottom of
the tank shall be opened or ruptured, or the entire tank collapsed so as to prevent the tank from retaining water, and (c) The
tank shall be filled with clean sand or other suitable material, and completely covered with soil. Have the system inspected
by the health department after it has been pumped, ruptured and filled with sand and covered.
SPECIFICATIONS BY: TITLE:
APPROVED BY: TITLE: Engineering Specialist II
Erlande Omisca
DATE ISSUED: 02/28/2019 EXPIRATION DATE
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC
v 1.1.4 AP1400598 SE -1
Dade CHD
05/29/2019
Page 1 of 3
STATE STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION PERMIT FOR: OSTDS Abandonment
APPLICANT: (ICUC Holdings Inc
PERMIT #:13 -SC -1928452
APPLICATION #: AP1400599
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PRI 205098
PROPERTY ADDRESS: 10500 Biscayne Blvd Miami, FL 33138
LOT: BLOCK: SUBDIVISION: ,Julia D Tuttle
PROPERTY ID #: 11-2230-001-0500 [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 I ] GALLONS / GPD CAPACITY
A [ ] GALLONS / GPD CAPACITY
N [ ) GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ) GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ J
D [ ] SQUARE FEET SYSTEM
R [ ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [ ] STANDARD ( ] FILLED [ j MOUND
I CONFIGURATION: [ ] TRENCH { ] BED [ ]
N
F LOCATION OF BENCHMARK:
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE [ ][ /
L
D
0
T
H
E
R
ABOVE/BELOW) BENCHMARK/REFERENCE POINT
I ABOVE/ BELOW] BENCHMARK/REFERENCE POINT
L. RSQUIRED: [ ] INCHES EXCAVATION REQUIRED: [ ] INCHES
ve the tank abandoned in accordance with the following procedures: (a) The tank shall be pumped out. (b) The bottom of
tank shall be opened or ruptured, or the entire tank collapsed so as to prevent the tank from retaining water, and (c) The
k shall be filled with clean sand or other suitable material, and completely covered with soil. Have the system inspected
the health department after it has been pumped, ruptured and filled with sand and covered.
SPECIFICATIONS BY: TITLE:
APPROVED BY: TITLE: Engineering Specialist II
Irlande Omisca
DATE ISSUED• 02(2$/201 9 EXPIRATION DATE:
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC
v 1.1.4 AR1400599 SE -1
Dade CHD
05/29/2019
Page 1 of 3
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION PERMIT FOR: OSTDS Abandonment
APPLICANT: (ICUC Holdings Inc)
PROPERTY ADDRESS: 10500 Biscayne Blvd Miami, FL 33138
PERMIT g:13 -SC -1928454
APPLICATION #: AP1400601
DATE PAID:
FEE PAID:
RECEIPT tt:
DOCUMENT tt: PR1205099
LOT: BLOCK: SUBDIVISION: Julia D Tuttle
PROPERTY ID M: 11-2230-001-0500 (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 [
A [
N [
K (
GALLONS / GPD
GALLONS / GPD
GALLONS GREASE INTERCEPTOR CAPACITY
J GALLONS DOSING TANK CAPACITY [
D [ ] SQUARE FEET
R [ ] SQUARE FEET
A TYPE SYSTEM: [ ] STANDARD
I CONFIGURATION: [ ] TRENCH
N
F LOCATION OF BENCHMARK:
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE
L
D i
0
T
H
E
R
CAPACITY
CAPACITY
MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
GALLONS @[ ]DOSES PER 24 HRS #Pumps [
SYSTEM
SYSTEM
FILLED [] MOUND
BED [ ]
ABOVE/BELOW] BENCHMARK/REFERENCE POINT
ABOVE/BELOW] BENCHMARK/REFERENCE POINT
LLL xe.Yvirr"j: L ] INCHES EXCAVATION REQUIRED: [ ] INCHES
Have the tank abandoned in accordance with the following procedures: (a) The tank shall be pumped out. (b) The bottom of
the tank shall be opened or ruptured, or the entire tank collapsed so as to prevent the tank from retaining water, and (c) The
tank shall be filled with clean sand or other suitable material, and completely covered with soil. Have the system inspected
by the health department after it has been pumped, ruptured and filled with sand and covered.
SPECIFICATIONS BY: TITLE:
APPROVED BY: TITLE: Engineering Specialist II
Erlande Oai
Dade CHD
sca
DATE ISSUED: 02/28/2019 EXPIRATION DATE:
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC
v 1.1.4 AP1400601 SE -1
05/29/2019
Page 1 of 3
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION PERMIT FOR: OSTDS Abandonment
APPLICANT: (ICUC Holdinqs INC)
PROPERTY ADDRESS: 10500 Biscayne Blvd Miami, FL 33138
PERMIT #: 13 -SC -1928456
APPLICATION # : AP1400602
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR1205106
LOT: BLOCK: SUBDIVISION: ,Julia D. Tuttles
PROPERTY ID #: 11-2230-001-0500 [
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 [
A [
N
K
GALLONS / GPD
GALLONS / GPD
GALLONS GREASE INTERCEPTOR CAPACITY
GALLONS DOSING TANK CAPACITY [
CAPACITY
CAPACITY
MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
GALLONS @[ ]DOSES PER 24 HRS #Pumps [
D ( ] SQUARE FEET SYSTEM
R [ ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [ ] STANDARD [ j FILLED [ j MOUND [ ]
I CONFIGURATION: [ ] TRENCH [ ] BED [ ]
N
F LOCATION OF BENCHMARK:
I ELEVATION OF PROPOSED SYSTEM SITE [ ][ / ]( ABOVE/BELOW] BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ ][ / ][ABOVE/BELOW] BENCHMARK/ REFERENCE POINT
L
D FILL REQUIRED: [ 0.001 INCHES EXCAVATION REQUIRED: [ j INCHES
Have the tank abandoned in accordance with the following procedures:(a) The tank shall be pumped out.(b) The bottom of
O the tank shall be opened or ruptured, or the entire tank collapsed so as to prevent the tank from retaining water, and(c) The
T tank shall be filled with clean sand or other suitable material, and completely covered with soil.Have the system inspected
H by the health department after it has been pumped , ruptured and filled with sand and covered.
E
R
SPECIFICATIONS BY:
Vill
APPROVED BY:
Loania ni
DATE ISSUED: 02/28t2019
TITLE:
TITLE: Engineering Specialist II
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC
Dade CHD
EXPIRATION DATE: 05/29/2019
v 1 1A AP1400602 3--t
Page 1 of 3
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION PERMIT FOR: OSTDS Abandonment
APPLICANT: (ICUC Holdings INC)
PROPERTY ADDRESS: 10500 Biscayne Blvd Miami, FL 33138
BLOCK:
PROPERTY ID #: 11-2230-001-0500
SUBDIVISION: Julia D. Tuttles
PERMIT #:13 -SC -1928457
APPLICATION #:AP1400604
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT # : PR1205109
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
A [
N
K [
GALLONS / GPD
GALLONS / GPD
GALLONS GREASE INTERCEPTOR CAPACITY
GALLONS DOSING TANK CAPACITY [
D [ j SQUARE FEET
R [ ] SQUARE FEET
A TYPE SYSTEM: ( ] STANDARD
I CONFIGURATION: [ ] TRENCH
N
F LOCATION OF BENCHMARK:
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE
L
CAPACITY
CAPACITY
MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
GALLONS @[ ]DOSES PER 24 HRS #Pumps [
SYSTEM
SYSTEM
FILLED [ ] MOUND
BED [ j
W
ABOVE/BELOW] BENCHMARK/REFERENCE POINT
ABOVE/BELOW] BENCHMARK/REFERENCE POINT
D FILL REQUIRED: C U.VUI INCHES EXCAVATION REQUIKED: t j INCHES
Have the tank abandoned in accordance with the following procedures:(a) The tank shall be pumped out.(b) The bottom of
O the tank shall be opened or ruptured, or the entire tank collapsed so as to prevent the tank from retaining water, and(c) The
T tank shall be filled with clean sand or other suitable material, and completely covered with soil. Have the system inspected
H by the health department after it has been pumped , ruptured but before it is filled with sand and covered.
E
R
SPECIFICATIONS BY: TITLE:
APPROVED BY:
J
TITLE: Engineering Specialist II
Loania X Gonzalez
DATE ISSUED: 02/28/2019 EXPIRATION DATE
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC
1. 1A AP1400604
Dade CHD
05/29/2019
Page 1 of 3
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION PERMIT FOR: OSTDS Abandonment
APPLICANT: (Icuc Holding Inc)
PROPERTY ADDRESS: 10500 Biscayne Miami, FL 33138
LOT: NA BLOCK: NA SUBDIVISION:
PROPERTY ID #: 11-2230-001-0500
PERMIT #:13 -SC -1928458
APPLICATION # : AP 1400605
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PRI 205112
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
A
N [
K [
GALLONS / GPD
GALLONS / GPD
GALLONS GREASE INTERCEPTOR CAPACITY
GALLONS DOSING TANK CAPACITY [
CAPACITY
CAPACITY
MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
GALLONS @[ ]DOSES PER 24 HRS #Pumps [
D [ ] SQUARE FEET SYSTEM
R [ ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [ ] STANDARD [ ] FILLED [ ] MOUND [ )
I CONFIGURATION: [ ] TRENCH [ j BED ( ]
N
F LOCATION OF BENCHMARK:
I ELEVATION OF PROPOSED SYSTEM SITE ( ][ / ][ ABOVE / BELOW] BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ ][ / )[ABOVE/BELOW] BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: [ 0.001 INCHES EXCAVATION REQUIRED_ [ ) INCHES
Have the tank abandoned in accordance with the following procedures:(a) The tank shall be pumped out.(b) The bottom of
0 the tank shall be opened or ruptured, or the entire tank collapsed so as to prevent the tank from retaining water, and(c) The
T tank shall be filled with clean sand or other suitable material, and completely covered with soil. Have the system inspected
H by the health department after it has been pumped , ruptured but before it is filled with sand and covered.
E
R
SPECIFICATIONS BY:
APPROVED BY: _
TITLE:
TITLE: Engineering Specialist II
Loanis X Gdnzh4,6z
DATE ISSUED: 02/28/2019 EXPIRATION DATE
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC
v 1 1.4 AP1400605
Dade CHD
05/29/2019
Page 1 of 3