1241 NE 91 Terr (8)BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building —'--f •
MIAMI SHORES VILLAGE. FLORIDA
DATE
PERMIT N? 2 Contractor's
License No. i
❑ Work to be
performed under this Permit
Architect
Contractor
or Builder
Legal Lot
Description
Address of
Building
CONTRACTOR OR BUILDER
Bl.
Subdi-
vision
Value of
Project $
4 A 4- 4
e
Amount of
Permit $
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application
herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans,
drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any
time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is
granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations
pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work
done by his agents, servants or employees.
•
Signed. a /
,. r. BY
INSPECTOR i
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 ac-
cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
BY AUTHORITY
CONTRACTOR
Name
d �l�t
pp
l- 2.)vy<' T
License No. s .. G 4.8
w
Address Goa 2 „ ,c‘.4 ?,C
--
Telephone _I Lt u. ,...yk , gi a Fax
g
Qualifier Name e l cvi Tz .
r
PROPERTY OWNER
New Construction
Name C pl sit,”
Pie
w
,i, i,
Address
g
Home Telephone
Relocation of Structure
Business Telephone
Foundation Only
Fax
Other
TYPE OF MANAGEMENT (✓ )
New Construction
Enclosure
Alteration Exterior
Repair
Alteration Interior
Demolish
Relocation of Structure
Shell Only
Foundation Only
Add'l Attachment
Other
Add'l Detachment
Other
INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village:
Step 1.
Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please
print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submitted
along with this permit application.
Step 2. Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the
processing of your application, you may be asked to submit additional information.
APPLICATION
Job Address:
Folio NumbL - 32 06 o 0 ( —026 t- Description of Work rkrIc e. 61(1- fits - (i i 4w
Lot 3‘ 4- `j Block l
Subdivision PB PG Zoning Linear Feet
Current Use of Property feRi Ck.an C. Square Feet Units Floors I
Proposed Use of Property Re's' olzetee, Value of Work ' 2000. co Bldg Value
Tenant Information avn 5 - 017 0 tr Tax Assessed/Appraised Value
Flood Zone Base Floor Elev.
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
/2 Y/ i 7R
Address
Apt.
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
License No.
Address
Telephone
Fax
Master Permit No. l
Subsidiary Permit No. r ) C �" •�
M"9 ,'/
City
State
PERMIT APPLICATION
/3
Zip
ENGINEER
Name
NS
License No.
Address
Telephone
Fax
Page 2
IMPORTANT NOTICES
DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant
the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m.
to 5:00 p.m. No inspections will be conducted on weekends or holidays.
2. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN, NEAT AND SANITARY CONDITION free from construction debris.
3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE FROM DIRT AND DEBRIS.
4. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQUIPMENT OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is
required for work in or near the street/sidewalk.
5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer
which requires a separate permit.
6. PORTABLE TOILETS for a construction site require a separate permit.
7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department.
8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement.
9. Department of Health and Rehabilitative Services (HRS) approval is required for applications involving septic tanks. Department of Environmental Resources
Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers.
AFFIDAVIT - Please read carefully.
Application is hereby made to obtain a permit to do work and installation as indicated. I, the OWNER of the property, certify that all
work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits
are required for ELECTRICAL, PLUMBING, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY,
ROOFING and SIGNS and there may be additional permits required from other governmental agencies.
I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve
months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and
any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the
present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business
under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must
conform to the current code requirements of the Building Code.
WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for
improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with
your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at:
22 N.W. 1st Street, P' Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in
accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and
Choosing a Contractor.
STATE OF FLORIDA, COUNTY OF MIAMI -DADE STATE OF FL
Si gnature of Ow er
,6Jep i P. AA
Print Name _
Sworn 3
to and subscribed before me this Ad day of Q..V1 VLF
7._ .
•
Yi'ri't ''r
1 -800.3-NOTARY
_ \dP 1.0
of orida
TERESA J. SOLOMON
MY COMMISSION # CC 5546oe
EXPIRES: Jul 16, ' Uo3
�tl@f?lt4'uon
SE
Personally kn
Type of Identification Produce 1.1 ,i(i �
Signature of Co for / Qualifier
($ T
Print Name
Sworn to and subscribed before me this
j.
iii
TERE J. SOLOMON
MY COMMISSION # CC 854806
EXPIRES: Jut t e, 2003
1'6063NOTARy Fl
I!vi
SEAL:
Personally known
A, COUNTY OF MIAMI -DADE
day of
Type of Identification Produced: `d/a( V: Lle
PERMIT APPLICATION
6vI4 rairi
Lo"
Page 4
OFFICE USE ONLY
CHECKLIST
❑ OWNER - BUILDER FORM
(Attach)
❑ FIRE DEPARTMENT
APPROVAL (Commercial /
multi- family)
❑ CONCURRENCY
(New Construction)
❑ OTHER
(Specify & Attach)
$3.00 per page (Scanning Fee)
Miami Shores Village
Bond
Metropolitan Dade County (C.C.F.)
Inspector State Educational Fund
State DCA (Radon)
Code Enforcement Fine
Zoning Review
LI PROOF OF OWNERSHIP
(Attach)
❑ FIRS / DERM APPROVAL
(Septic / Sewer)
❑ IMPACT FEE
(New Construction)
❑ OTHER
(Specify & Attach)
$
$ j % a D (sq.ft. = x/1000
x ¢.60)
$ (¢.005 / sq.ft.)
$ (0.01/sq.ft.)
REVIEWED AND PREPARED BY:
SECTION
Zoning
Electrical
Mechanical
Plumbing
Fire
Public Works
Structural
Building Official
BY
DATE
°2- Bu- 6j,
PERMIT APPLICATION
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
PERMIT FEES
TOTAL $ ( 1 A 0
ISSUING OFFICIAL
DATE:
CONDITION OF APPROVAL
Revised July 2001
10050 N.E. 2N AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com
ELECTRICAL
TYPE
Minimum Fee
QTY.
TYPE
Dryer
QTY.
TYPE
Outlet, Appliance
QTY.
TYPE
Service Repair
QTY.
A/C Central 1 -3 Ton
Fan
Outlet, Wall
Service, Temporary
A/C Central 4 -7 Ton
Fire Pump
Outlet, Switch
Signs
A/C Central 8 -15 Ton
Fixture - Fluorescent
Oven
Space Heater (kw)
A/C Central 16-20 Ton
Fixture Light
Parking Lot Lights
Spas/Hot Tubs
A/C Central 20+ Ton
Flood Lights
Plugmold/Strip
Subfeeds, No. of Amps
A/C Window
FPL - Load Central
Posts
Swim Pool, Commercial
Air Conditioners
Garbage Disposal
Range/Range Top
Swim Pool, Residential
Chiller
Generators, etc.
Receptacles
Switchboards
Clear Violations
Heat Recovery
Refrigerator, Comm. (p/PH)
Temp Serv., Construction
Compactor
Low -volt, Burglar
Refrigerator, Domestic
Temp for Test - 30 days
Deep Freezer
Low -volt, Fire
Renew - Temp Service
Water Closet
Demolition
Low -volt, Intercom/Teleph.
Repair Circuits
Water Heater
Dishwasher
Low -volt, Television
Service, Number of Amps
Water Heater New
MECHANICAL
TYPE
Minimum Fee
QTY.
TYPE
Condensate Drain
QTY.
TYPE,
Generator
QTY.
TYPE
Refrigeration, Tons
QTY.
A/C Central, Tons
Cooling Tower
Heating Strips, each
Vent Hood, Cost
A/C Wall/Win. Tons
Dryer Vents, Number of
Paint Booth
Ventilation, Cost
Air Handler, Tons
Ductwork, Cost of
Piping, Flammable Liquid
Periodic Inspections
Barbecue
Fire Sprinkler System
Process/Pressure Piping
Supply, AC Well
Bath Fan - Vented, #
Fireplaces, Number of
Pressure Vessel
_
PLUMBING
TYPE
A/C Condensate
QTY.
TYPE
Drains, Roof
QTY.
TYPE
Miscellaneous Fixture
QTY.
TYPE
Soakage Pit
QTY.
Bath Tub
Drinking Fountain
Miscellaneous Repairs
Solar Water Heater
Bidet
Filter Replace
Pool Piping
Sprinkler Repair
Cap - Fixture
Fountain
Pump and Abandon
Sprinkler System
Cap - Water
Gas - Appliance
Pump, Domestic
Supply, AC Well
Cap - Sewer
Gas - Natural
Pump, Fire Stand
Temporary Toilet
Catch Basin
Gas - Propane
Pump, Re- circulate
Temporary Water Closet
Clothes Washer
Gas Piping
Pump, Replace - Pool
Urinal
Dental Chair
Grease Trap
Pump, Sprinkler
Utility - Sewer
Discharge Well
Ice Maker
Pump, Sump
Utility - Water
Dishwasher
Indirect Wastes
Relay Repair
Vacuum Pump
Disposal
Interceptor
Roof Inlet
Water Closet
Domestic Well
Laundry Tray
Septic Connection
Water Heater
Drainfield, 4" Tile/Res.
Lavatory
Septic Tank
Water Heater New
Drains, Area
Meter Set (Gas)
Sewer Connection
Water Re -pipe
Drains, Floor
Minimum Fee
Shower
Water Service
Drains, French
Miscellaneous Equipment
Sink
Well, Supply
Page 3
PERMIT APPLICATION
INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below.
RECEIVED AND REVIEWED BY: DATE:
CONSTRUCTION PERMIT FOR;
[ NJ ] New System
00 Repair (4-q1
APPLICANT:
-
PROPERTY ADDRESS:
LOT:
PROPERTY ID #: %
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 SAFTISFACTORY
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 [(7',„0 ] LONS )/ GPDQSEPTIC TAN15/AEROBIC UNIT CAPACITY
A [ ] GALLONS / GPD CAPACITY
N [
K [
SPECIFICATIONS BY:
APPROVED BY:
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
] GALLONS GREASE INTERCEPTOR CAPACITY
] GALLONS DOSING TANK CAPACITY [ ]GALLONS @ [
m- r y
D [ ) aty] SQUARE FEET PRIMARY DRAINFIELD SYSTEM
R [ ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [ 4 STANARD [ ] FILLED [ ] MOUND [ ] _
I CONFIGURATION: [ ] TRENCH [` BED [ 1
N Z.
F LOCATION OF BENCHMARK: ( � , ' �'
I ELEVATION OF PROPOSED SYSTEM SITE I2NCHESJFT] [ABOVFS/BELOW BENCHMARKR 1 I T�
E BOTTOM OF DRAINFIELD TO BE [';` (INCHES,FT] [ABOVE BELOW BENCHMARK/REFERENCE POINT
D FILL REQUIRED: [ ] INCHES EXCAVATION REQUIRED: [ �. -, ] INCHES
0
T
H
E
R -
TITLE: a' „ 4 CHD
EXPIRATION DATE:
Page 1 of 3
DATE ISSUED:
Existing System ['] Holding Tank
Abandonment [ +''] Temporary
BLOCK:
s
D E✓�
Li 9
DH 4016, 12/99 (Page 1) (Previous Editions May Be Used)
SUBDIVISION:
[SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
[OR TAX ID NUMBER]
JMUL T- ` ( /IN- SERIES N]
MULTI- CHAMBE ED /IN- SERIES ( ]
[MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS]
]
TITLE:
DOSES PER 24 HRS # PUMPS [ ]
at. 3: !iu'ia.11or /Conirsctor
PERMIT NO.
DATE PAID: 2 1-al
FEE PAID: i' i 0 .)
RECEIPT #: G` c/ 2
[ , ' f ] Innovative
[ ]
1
f 1j;,/
INSTRUCTIONS:
PERMIT NUMBER: Permit tracking number assigned by CPHU.
CONSTRUCTION
PERMIT FOR: Check type of permit, if "Other" specify type in blank.
APPLICANT: Property owner's full name.
TELEPHONE: Telephone number for applicant or agent
AGENT: Property owner's legally authorized representative.
MAILING ADDRESS: P.O. Box or street mailing address for applicant or agent.
LOT, BLOCK, SUBDIVISION or
PROPERTY ID#: 27 character id number for property. (CHD may require property appraiser ID # or section/township /range/parcel number)
SYSTEM DESIGN AND
SPECIFICATIONS:
TANK: Minimum specifications from Chapter 64E-6, FAC.
DRAINFIELD: Minimum specifications from Chapter 64E-6, FAC.
OTHER: Other specifications, such as operating permit requirements, low- volume flush toilets, variance provisos.
SPECIFICATIONS BY: Name of individual providing specifications. If designed by a registered engineer must be sealed.
APPROVED BY: County Health Department (CHD) personnel reviewing and approving permit.
DATE ISSUED: Date permit is issued by CHD
EXPIRATION DATE: One year from date issued if the system has not been installed. Permits for system repairs become void 90 days from the date
issued.
Scale: Each block represents 5 feet and 1 inch = 50 feet.
Notes:
I , !
; • I
Site Plan submitted by:
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number
J . _
!I
:
- !". - 1•1
• v• 47
•
///
PART II SITE PLAN- — — — — —
- -
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Signature
..„ . ,
Plan Approved ' Not Approved
.... i,
-
By
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
OH 4015. 1W96 (Replaces HRS-H Form 4015 which may be used)
(SaxIt Number: 5744-002-4015-6)
Tale
, )
Date - , -
County Health Department
Page 2 of 3
APPLICANT:
LOT:
BLOCK:
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
PROPERTY ID #:
TO BE COMPLETED BY ENGINEER, HEALTH UNIT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEER'S MUST
PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS.
PROPERTY SIZE CONFORMS TO SITE PLAN: [A
TOTAL ESTIMATED SEWAGE FLOW: ��C,'�
AUTHORIZED SEWAGE FLOW:
UNOBSTRUCTED AREA AVAILABLE:
BENCHMARK /REFERENCE POINT LOCATION:
ELEVATION OF PROPOSED SYSTEM SITE IS
Munsell # /Col,or Texture Depth
' ' >j0 ] ° �i ?i� C 1 tO 712. 90
to
to
to
to
to
to
to
to
USDA SOIL SERIES: Ub 1%,)•A; 1 (1 h D
OBSERVED WATER TABLE: > INCHES [ABOVE /
ESTIMATED WET SEASON WATER TABLE ELEVATION:
HIGH WATER TABLE VEGETATION: [ ] YES () NO
SOIL TEXTURE /LOADING RATE FOR SYSM SIZING:
DRAINFIELD CONFIGURATION: [ ] ] ENCH [A]
REMARKS /ADDITIONAL CRITERIA:
SITE EVALUATED BY:
SUBDIVISION: 1
DH 4015, 10/96 (Replaces HRS -H Form 4015 [Page 3) which may be used)
(Stock Number: 5744- 003 - 4015 -1)
YES [ ] NO NET USABLE AREA AVAILABLE: ® "1 ACRES
GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2]
GALLONS PER DAY [1500 GPD /ACRE OR 2500 GPD /ACRE]
SQFT UNOBSTRUCTED AREA REQUIRED: (XJ ) SQFT
(Section /Township /Range /Parcel No. or Tax ID Number]
AGENT: /`
i
D
PERMIT #
[INCHES [ABOVE / OW] BENCHMARK /R POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES:
SURFACE WATER: NA FT DITCHES /SWALES: FT NORMALLY WET? [ ] YES [`] NO
WELLS: PUBLIC: No FT LIMITED USE: NJA FT PRIVATE:; ' FT NON- POTABLE: j ; FT
BUILDING FOUNDATIONS: FT PROPERTY LINES: - FT POTABLE WATER LINES: 0` FT
SITE SUBJECT TO FREQUENT FLOODING: [ ] YES [y] NO 10 YEAR FLOODING? [ ] YES [x) NO
10 YEAR FLOOD ELEVATION FOR SITE: FT MSL /NGVD. SITE ELEVATION: ' < FT MSL /NGVD
SOIL PROFILE INFORMATION SITE 1
SOIL PROFILE INFORMATION SITE 2
Munsell if /Color Texture
USDA SOIL SERIES: ;s9 << ,1\1 ()`N
Depth
to ? )`
to
to
to
to
to
to
to
to
BI L('1] EXISTING GRADE. TYPE: 'PERCHED / AI4 NT]
INCHES [ ABOVE / EL W ] EXISTING GRADE.
MOTTLING: ( ] YES [ ] NO DEPTH: \Gi INCHES
DEPTH OF EXCAVATION: INCHES
BED _[ ] OTHER (SPECIFY)
DATE : H .a
Page 3 of 3
�. .
INSTRUCTIONS:
PERMIT NUMBER: Permit tracking number by County Health Department.
APPLICANT: Property owner's full name.
AGENT: Property owner's legally authorized representative.
LOT, BLOCK, SUBDIVISION: Lot, block, and subdivision for lot.
PROPERTY ID NUMBER: 27 character number for property (property appraiser ID number or section /township /range /parcel number).
PROPERTY SIZE: Check if property at site conforms to submitted site plan. Record net usable area available - lot area exclusive of
all paved areas and prepared road beds within public rights -of -way or easements and exclusive of streams, lakes,
normally wet drainage ditches, marshes, or other such bodies of water.
SEWAGE FLOW:
UNOBSTRUCTED AREA:
MINIMUM SETBACKS:
Record the estimated sewage flow for the establishment from Table 1 (residence) or Table 2 (non - residential),
Chapter 10D-6, FAC. Record the authorized sewage flow for the lot based on net usable area and water supply
(1500 gallons per day per acre for private water supplies and 2500 gpd per acre for public water supplies). If
authorized sewage flow does not equal or exceed the estimated sewage flow, the application must be denied.
Record the square feet of unobstructed area available and the amount required. Unobstructed area must be at
least 2 times as large as the drainfield absorption area and at least 75 percent of the unobstructed area must meet
minimum setbacks in Chapter 10D -6, FAC. The unobstructed area must be contiguous to the drainfield.
BENCHMARK INFORMATION: Record the location of the benchmark. If using a surveyor's benchmark record the actual elevation. Record the
elevation of the proposed system site in relation (above or below) to the benchmark.
Record minimum setbacks which can be meet to all listed features. Actual measurements must be recorded or
"NA" for nonapplicable features. Features on site plan or within 75 feet of the applicant lot must be measured.
The location of any public drinking well within 200 feet of the applicant's lot must also be verified.
FLOOD INFORMATION: Record information on lot's subject to flooding. For lots subject to flooding record 10 year flood elevation for
site and actual site elevation.
SOIL PROFILE INFORMATION: Two soil profiles within the proposed absorption area to a minimum depth of 6 feet or refusal are required. Soil
identification will use USDA Soil Classification methodology (Munsell colors and USDA soil textures). Refusals
must be clearly documented. Provide USDA soil series if available, record "UNK" if the series cannot be
determined.
WATER TABLE: Record the depth of the observed water table at the time of the evaluation. Mark "perched" or "apparent" as
appropriate. Record the estimated wet season water table elevation based on site evaluation, USDA soil maps,
and historical information. Indicate if there is high water table vegetation present. Indicate if mottling is present
and depth.
SOIL TEXTURE: Record soil texture or loading rate for system sizing.
DEPTH OF EXCAVATION: If applicable record depth of excavation required. Record "NA" if not applicable.
DRAINFIELD CONFIGURATION: Check drainfield configuration required. If other, specify type.
ADDITIONAL CRITERIA: Record any additional remarks pertinent to site or installation. Ex. dosing required.
SITE EVALUATED BY: Signature of evaluator, title, and date of evaluation. Professional engineers must seal all documents submitted.
ELEVATION WORKSHEET ELEVATION OF BENCHMARK / REFERENCE POINT IS:
BENCHMARK SITE I SITE 2 SITE 3
[ + ] SHOT H.I. H.I. H.I.
H.I. [ - ] SHOT [ - ) SHOT [ - ] SHOT
Permit No.
Date
Requested
in
Address
Contractor / Phone
Date
Requested
for
.
Inspector
Comments
02- 0317 -R
20 -Feb
1241 NE 91 terr
A aaron Super Rooter
305 - 944 -8886
21 -Feb
J.Capers
Please cancel inspection.
Will call re-schedule. 2/22
Inspection cancelled_for,
today :.
Milena M. Mateo
Senior Clerk
On -Site Sewage Disposal
Department of Health
7755 NW 48th Street
Building `E• Suite .130
Miami, FL 33166
2/22/0210:28 AM
Phone: (305) 513 -3466
E -Mall: Milena _M teo @doh, to e.ti us
Septic 2002.xls
(PL--co
- T n S C2e0 S oe
CGnoelecl -
- 25 -- _ �I
Inspections Request Log 2002
Type Insp'n e1,
Permit No. S P ,2,0a02- 23
Name D7/ t
Address /02 ` l T / J 1/ N 4/ ow
Company P 7a/, 4Jo 7
Phone # 305' k4 9%. 3/ G
if o
For Inspector: 5 1a _az Name
Approved
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date 3 - /I 6Z Time
Date
Type Insp'n
Permit No.
Name
Address /
Company
Phone #
For Inspector:
Approved )/3
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Time
tu
Name :1ate
a
ao
CD
0
CD
cn
Permit No.
Date
Requested
in
Address
Contractor / Phone
Date
Requested
for
Inspector
Comments
02- 0317 -R
20 -Feb
1241 NE 91 terr
A aaron Super Rooter
305 - 944 -8886
21 -Feb
J.Capers
Please cancel inspection.
Will call re-schedule. 2/22
Inspection cancelled.for.,
:today ,
Milena M. Mateo
Senior Clerk
On -Site Sewage Disposal
Department of Health
7755 NW 48th Street
Building °E•, Suite 130
Miami, FL 33166
2/22/0210:28 AM
Ph: (305) 513 -3466
E -Mail: Milena M teo one®doh.state.fl.us
Septic 2002.xls
conoeea .
SCD
Inspections Request Log 2002