PL-09-19-2298 FL STATE FINAL APPROVALSTATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION INSPECTION AND FINAL APPROVAL
APPLICATION #:AP1434639
PERMIT #:13-SC-1992064
DOCUMENT #:F11337018
DATE PAID - 09/21 /2019
FEE PAID •400.00
RECEIPT #:13-PID-4148827
APPLICANT: Laura Despasquale
AGENT: Mr C
PROPERTY ADDRESS: 9777 NE 5 Ave Miami, FL 33138
LOT: BLOCK:
SUBDIVISION: ID# : 11-3206-018-0010
CHECKED [XI ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED.
TANK INSTALLATION
[01] TANK SIZE [1] 900.00 [21
[021 TANK MATERIAL Concrete
[031 OUTLET DEVICE
[041 MULTI -CHAMBERED [ Y / N ]
[051 OUTLET FILTER
[ 0 61 LEGEND 1. 2.
[071 WATERTIGHT
[081 LEVEL
[091 DEPTH TO LID
DRAINFIELD INSTALLATION
[101 AREA [1] 300 [21 SQFT
[111 DISTRIBUTION BOX HEADER X
[ 12 ] NUMBER OF DRAINLINES 1. 5.00 2.
[131 DRAINLINE SEPARATION
[141 DRAINLINE SLOPE
[15] DEPTH OF COVER
SETBACKS
[ 1
[271
SURFACE WATER
FT
[ ]
[281
DITCHES
FT
[ ]
[29]
PRIVATE WELLS
FT
[ 1
[301
PUBLIC WELLS
FT
[ ]
[311
IRRIGATION WELLS
FT
[ ]
[321
POTABLE WATER 48
FT
[ ]
[331
BUILDING FOUNDATIONS 15
FT
[ ]
[341
PROPERTY LINES 10
FT
[ ]
[351
OTHER
FT
FILLED / MOUND SYSTEM
[ ]
[361
DRAINFIELD COVER
[ ]
[371
SHOULDERS
[ ]
[381
SLOPES
[ 1
[391
STABILIZATION
[161 ELEVATION [ ABOVE / BELOW ]BM 57.00 [ ]
[171 SYSTEM LOCATION [ 7
[181 DOSING PUMPS [ ]
[191 AGGREGATE SIZE [ ]
[201 AGGREGATE EXCESSIVE FINES f ]
[211 AGGREGATE DEPTH [ ]
[ ]
ADDITIONAL INFORMATION
[401 UNOBSTRUCTED AREA
[411 STORMNATER RUNOFF
[421 ALARMS
[431 MAINTENANCE AGREEMENT
[441 BUILDING AREA
[451 LOCATION CONFORMS WITH SITE PLAN
[46] FINAL SITE GRADING
FILL / EXCAVATION MATERIAL '
[ ]
[221 FILL AMOUNT
I 1
[471
CONTRACTOR
]
[231 FILL TEXTURE
[ 1
[481
OTHER ADS MPS-9 (9 pipes - 2 tier)
[ ]
[241 EXCAVATION DEPTH
ABANDONMENT
I ]
1251 AREA REPLACED
[ ]
[491
TANK PUMPED
[ 1
[261 REPLACEMENT MATERIAL
[ ]
[501
TANK CRUSHED & FILLED
Comments: Comments are on page 2.
CONSTRUCTION I APPROVED Dade CHD DATE: 10/14/2019
DISAPPROVED ] ' ENGINEERING SPECIALIST II Frantz C Toussaint (FDOH Dade County)
FINAL SYSTEM [ APPROVED DISAPPROVED ]: Dade CHD DATE: 10/14/2019
ENGINEERING SPECIALIST II Frantz C Toussaint (FDOH Dade County)
(Explanation of Violations on following page)
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC Page 2 of 3
EH Database v 1.0.1 AP1434639 EID1992064
Violation Number
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION INSPECTION AND FINAL APPROVAL
Comment
Comments
Existing tank information per DH4016 page 4.
APPLICATION # : A P 1434639
PERMIT #:13-SC-1992064
DOCMENT #:F11337018
DATE PAID - 09/21 /2019
FEE PAID .400.00
RECEIPT #:13-PID-4148827
DR 4016, 08/09 (Obsoletes all previous editions which may not be used)
Page 2 of 3
Incorporated: 64E-6.003, FAC
EH Database v 1.0.1 AP1434639 EID1992064