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DRAINFIELD PERMITPERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date 4/17/96 Legal Description Historically Designated: Yes No Owner/Lessee / Tenant BALDER Master Permit # Owner's Address 1025 NE 92 STREET, MIAMI SHRES Contracting Co. NORTH DADE SEPTIC TANK Address 800 NW 111 STREET, MIAMI 33168 Qualifier DENNIS NEVILLE SS# Phone 754 -3375 State # 025836 -8 Municipal # Competency # 12842 Ins. Co. TRAVELERS /ESIF Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): nitAirtiangfaDIM PLUMBING WORK DESCRIPTION INSTALL DRAINFIELD Square Ft. 200 Estimated Cost (value) $1000.00 WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO 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.) Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I 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, SIGNS, POOLS, ROOFING and MECHANICAL WORK. OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate an . at a work will be done in compliance with all applicable laws regulating construction and zoning. Furthermore, I authorize the above -n . co trac .r to do the Signature of owner and/or Condo President Date Job Address 1025 NE 92 STREET R dokPres Notary `s - Le'Owner and/o My Commission Expires: CC 1S�tS�iS;Catt' �::�i :; .° • . 'a4,�t' �i t �y � �:1 i � � � � ; �5 S• ��< > 1- E013- NOTARY - ;:olfin ^,+:.t. {t ) • ® v FEES: PERMIT RADON C.C.F. APPROVED: Zoning Building Mechanical Plumbing' L/ Tax Folio Phone 754 -7205 MEA ► MIXX 's tX SMINICA }IEMBA) T N.j 1i Contractor -r -B ilder Date My ommission Expires o 0,0 ° �o Tc: acs J. Fc ?:i :r > ' Z n ! ( { � Notary Put."..:.. Ct .' : c '7 '_;. v y Cii.V e C cr rni :c oL N. CC 4 3G7 ( t > 'fi °Fro' My Conrz.3 :aa 2sri7C.:0 //: 'i ', > 1- 800.34 7TARY - [la. Neal ^ -re : '" C'' Pa1cuz� Co ' e eatetetatereeteeteareetete 'itetea te(eteceee4 may -, VC NOTARY TOTAL DUE 6. `-' Electrical Engineering APPLICANT: HPLJDER AGENT: MAILING ADDRESS: 800 NJ 111 SMUT, d T, IAPJ 333 LOT: PROPERTY ID #: PROPERTY SIZE: NORTH DADE SEPTIC T ' BLOCK: PROPERTY STREET ADDRESS: 1025 NE 92 S.R.EET, 41AZJI SA RE 33138 DIRECTIONS TO PROPERTY: BUILDING INFORMATION Unit Type of No Establishment STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM APPLICATION FOR CONSTRUCTION PERMIT Authority: Chapter 381, FS & Chapter 10D -6, FAC SUBDIVISION: 1 SFR 2 BEDROOMS 2 3 4 APPLICANT'S SIGNATURE: IX ] RESIDENTIAL [ ] COMMERCIAL Bedrooms Area Sgft Served HRS-H Form 4015, Mar 92 (Obsoletes previous editions which may not be used) (Stock Number: 5744- 001- 4015 -1) PERMIT # DATE PAID FEE PAID RECEIPT # TELEPHONE :75/x- -72G: D / ` e 1 /k — yam $ 4c . W1 APPLICATION FOR: [?y ] New System ['° ] Existing System (J ] Holding Tanks= [;' ] Temporary /Experimental p! Repair [N ] Abandonment (N ] Other(Specify) 754-3377; TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. ATTACH BUILDING PLAN AND TO -SCALE SITE PLAN SHOWING PERTINENT FEATURES REQUIRED BY CHAPTER 10D -6, FLORIDA ADMINISTRATIVE CODE. PROPERTY INFORMATION [IF LOT IS NOT IN A RECORDED SUBDIVISION, ATTACH LEGAL DESCRIPTION OR DEED] DATE OF &,} fOP ° 72 SUBDIVISION. [Section /Township /Range /Parcel No.] ZONING: ACRES [Sqft /43560] PROPERTY WATER SUPPLY: [ ] PRIVATE [y ] PUBLIC No. of Building # Persons Business Activity For Commercial Only [; ] Garbage Grinders /Dispose [X ] Spas /Hot Tubs [r, ] Floor /Equipment Drains [„ ] Ultra -low Volume Flush /oile (y ) Other (Specify) - Page 1 of 3 Scale: Each block rep lip J1— 1ri + t 1 1 1 1 I 11111 iI 1 1 i 1 I 1 I I I I I I 1 1 III 1 1 - - - ' 1 I I 1 I L I _I 1. 1 1 1- I I I 1 I L 1 1 1; 1. 1 L--- .I 1 1 ' 1 1 IIIi11II I 1 1 1, 11 1 1 ! ; I' i I L 1 1 , 1 1 1 1_ 1 1 1 1 1 I I I ! I i I J_ 1 I 1 1 1.11[1 r 1 1 1 1 I_I I 1 11 1 i 1 I 1 1 I_1 1 1 1 1 11 1 1 I I I 1_ 1 11 ! ■ I 1 I 1 I I L -II ir 11 I,! 1Ii- _1I - 111I 11 11 I, ii_ _ I_ 11_ I I I L I I .t' 1 1 1 1]_ I LI 1 1 ;- I 1 I i1 1 II. I 1 , ' 1 1.1 11 111 1111 1 Itt1 Notes: Site Plan submitted by: Plan Approved By STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERWT Permit Application Number (t /< /o r o FFEJ O. ' msl esents 5 feet and 1 inch = 50 feet 3 FIALDER: 1025 NE 92 STREET, 33138 HRS -H Form 4015, Feb 85 (Obsoletes previous editions which may not be used) (Stock Number. 5744-002-4015-6) PART II - SITE PLAN - - I_ 1 I I 11 I I I I 1 _ + .- I 1 1 1 � �1 ,1 1 1 i a 1 i1 ' 1 1 1. 1 1 r I I_ 1 11 1 1 =1 11 1 1 - J 1 ' 1 _ I l i i t I1 I I I _11 T 1 - __ 1111 I 1I 11I_1I I I I I 1 1 1 1 ILL I 1 J I (1 J JJ 1 1 1 1 1 j 1 1 I 1 1 _._II _ ) I J I I 1 1 1 1 I I 1 1.1 J 1.1. ,_ 1 1 1- j I I 1 11 1 1 1 1 ' 1 1 1 1 1 1 I 1 1 1 — I I 1 - 1 == I– -_ IIe , ! I 1 � _ I -� _ _ IJ __ L _ 1 T 1 - ) -- -_1 C I J- - 1 _ 1__ I IJI- -I!1 1 � t I _ , 1 1 1 J L I 1 _ — I 1 H- _ 1 I 1 I J 1- - 1-- - -- - I_J I 1- i 1 ! - I t _ _ �-y .� _ I 1 i , i SEP'T'IC TANR PUMPED: 2/01/96 Not Approved }} 1 I I 1 1 OLD SYSTEM OVERFLOWNG. WATER CONSUMPTION: NOT WVAILABLE. 1 _ -_ -1 f 1 1 r L J 1 - I I I I 1- 1 1- 1 1 1 I II _J_I - A 1 f l 1 I t ' L 1 1 I J_ I F I 1 1 ' 1 1 1- ; ill hi 1, i [ M+ 1 i1 - 1 j i i� - -ii I i _ L 1 � L- - -- I L 1 I J I I I 11 I 1 1 1' +1 1 I 11 1 11111 1 1 1 1 1 1 1 -- 1 I I_ j I _ . I lid �I II (- 1 1 11 I-1 I_I I I IGNATURE TITLE Date G — J 1I ALL CHA S MUST BE APPROVED BY THE COUNTY PUBLIC HEALTH UNIT County Public Unit Page 2 of 3 LOT: PROPERTY ID #: SOIL PROFILE INFORMATION SITE 1 STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS BALDER BLOCK: SUBDIVISION: 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: [ Y] TOTAL ESTIMATED SEWAGE FLOW: a © O AUTHORIZED SEWAGE FLOW: 4 o UNOBSTRUCTED AREA AVAILABLE: © p BENCHMARK /REFERENCE POINT LOCATION: /C.D . og , ELEVATION OF PROPOSED SYSTEM SITE IS ha [ C ES ] [ABOVE/Re5WBENCHMARKOESISM POINT THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE SURFACE WATER: 100+ FT DITCHES /SWALES: WELLS: PUBLIC: 100+ FT LIMITED USE: -" FT BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: SITE SUBJECT TO FREQUENT FLOODING: [ ] YES (XJ NO 10 YEAR FLOOD ELEVATION FOR SITE: W.T. 3.0 FT Munsell # /Color Texture Depth BROWN SANDY 0" to 72" USDA SOIL SERIES: SNDY to to to to to to to to SITE EVALUATED BY: HRS-H Form 4015, Mar 92 (0b?(oletes previous editio's w (Stock Number: 5744- 003 - 4015 -1) ;R • r ■ PERMIT # q6/ to 91 AGENT: NORTH DADE SEYTIOA ` f [Section /Township /Range /Parcel No. or Tax ID Number] YES [ ] NO NET USABLE AREA AVAILABLE: ,! L ACRES GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2] GALLONS PER DAY [1500 GPD /ACRE OR 2500 GPD ACRE] SQFT UNOBSTRUCTED AREA REQUIRED: ? SQFT PROPOSED SYSTEM TO THE FOLLOWING FEATURES: 100+ FT NORMALLY WET? [ ] YES ()C1 NO PRIVATE: — FT NON - POTABLE: — FT 5 FT POTABLE WATER LINES: 1 FT 10 YEAR FLOODING? ] YES [ I NO GVD SITE ELEVATION: 9.0 FT 4/NGVD SOIL PROFILE INFORMATION SITE 2 Munsell # /Color Texture BROWN SASSY USDA SOIL SERIES : b Ai4DY Q " Depth to 72" to to to to to to to to OBSERVED WATER TABLE: 60 INCHES [X/ BELOW] EXISTING GRADE. TYPE: [P O&X/ APPARENT] ESTIMATED WET SEASON WATER TABLE ELEVATION: 108 INCHES [ iiX/ BELOW ] EXISTING GRADE. HIGH WATER TABLE VEGETATION: [ ] YES [X] NO MOTTLING: [ ] YES [X] NO DEPTH: INCHES SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: 1.25 DEPTH OF EXCAVATION: 3' INCHES DRAINFIELD CONFIGURATION: [ ] TRENCH [XX] BED [ ] OTHER (SPECIFY) REMARKS /ADDITIONAL CRITERIA: DATE: 4/17/96 Page 3 of 3 CONSTRUCTION PERMIT FOR: [ N] New System [ N] Existing System [ N] Holding Tank [ N] Temporary /Experimental [ y] Repair [ LJ] Abandonment [ IJ] Other(Specify) APPLICANT: HAILER PROPERTY STREET ADDRESS: 1025 NE 92 STREET MIAMI 33168 LOT: PROPERTY ID #: PERMIT # 96 t" lapgilV I DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES DATE PAID 4 -i -lc ONSITE SEWAGE DISPOSAL SYSTEM FEE PAID $ 4. C^.oda CONSTRUCTION PERMIT RECEIPT # Authority: Chapter 381, FS & Chapter 10D -6, FAC /0,_9/6 . STATE OF FLORIDA BLOCK: SUBDIVISION: SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 10D -6, FAC REPAIR PERMITS AND HOLDING TANK PERMITS EXPIRE 90 DAYS FROM THE DATE OF ISSUE. ALL OTHER PERMITS EXPIRE ONE YEAR FROM THE DATE OF ISSUE. HRS 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. SYSTEM DESIGN AND SPECIFICATIONS EXISTING T [ 750 ] [GALLONS / ERR] SEPTIC TANK /AEROBIC UNIT CAPACITY MULTI- CHAMBERED /IN SERIES:[ ] A [ ] [GALLONS / GPD] CAPACITY MULTI- CHAMBERED /IN SERIES:[ N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS] K [ ] GALLONS PER DOSE DOSING TANK CAPACITY DOSE RATE [ ] PER 24 HRS NO. OF PUMPS: [ ] SPECIFICATIONS BY: D [ 200 ] SQUARE FEET MAMA DRAINFIELD SYSTEM R [ ] SQUARE FEET A TYPE SYSTEM: I CONFIGURATION: N F LOCATION OF BENCHMARK: FFE: SYSTEM [XX] STANDARD [1✓] FILLED [W] TRENCH [XX] BED msi I ELEVATION OF PROPOSED SYSTEM SITE [ 7.0e1 [ CHES E BOTTOM OF DRAINFIELD TO BE [ ®S ] [INCHES D FILL REQUIRED: [ ] INCHES 0 �STALL 12" OF LOAMY COARSE SAND UNDER BOTTOM OF DRAINFIELD H UB MIT BENCHMARK BEFORE INSPECTION. THI ,.BERMIT IS NOT FOR ADDITIONS. INVERT ELEVATION: 4L J BOTTOM OF DRAINFIELD ELEVATION: NC0 [SECTION /TOWNSHIP /RANGE /PARCEL NUMBER] [OR TAX ID NUMBER] APPLICANT AGENT: NORTH DADE SEPTIC TANK TITLE: [ rI ] MOUND. [ ] [ [ABOVE [ABOVE ELOW EXCAVATION REQUIRED: [3 , ] INCHES BENC POINT BENCHMARK POINT APPROVED BY: TITLE: .-. CPHU DATE ISSUED: A /2-.X EXPIRATION DATE: 7 T SEPTIC TANK SHALL BE PUMPED AND A _ RiLID DEFLECTION DEVICE INSTALLED ON THE OUTLET TEE. HRS -H Form 4016, Mar 92 (Obsoletes previous editions which may not be used) Page 1 of 2 (Stock Number: 5744-001-4016-0) INSTRUCTIONS: PERMIT NUMBER: Permit tracking ruaiber assigned by CPHU. APPLICATION FOR: Check Type of permit, if "Other" specify !yin; in blank. APPLICANT: Property owner's full name. TELEPHONE: Telephone uurnbcr for applicant or agent. AGENT: xl'ci erty ownzr's legally authorized representative. MAILING ADDRES?: P.O. box or street mailing address for applicant or agent. LOT, BLOCK. SUBDIV1S ON PROPERTY ID#: 27 clutr; ctsr 'd Di mucr for proesrty. (CP'i7J may require prape :'.y appraiser 0) k or aectioritowr_ _ship /range /parcel number) SYSTEM DESIGN AND SPECIFICATIONS: TANK: Minimum �pecifis tions from Chapter 10D-6, PAC. DRAINFIELD: Minimum specifIcati.ons from Chapter 10D-6, FAC. OTHER: Cti'.:r spacif cartel !, saclt as cp::_;:ting pernit requirements, low-volume flush toilets, vc^ mre provisos. SPECIFICATItNS BY: Na: ,:e of individual providing spnci:iesuiors. If designed by a registered engiralr mu::: be r r.I:;d. APPROVED BY: County ? blis Health Unit (CPHU) li:rconnei r.vi.:wing and approving penvit. DATE. ISSUED' D.;'.: permit is k ;usd by CPWJ. r_ DATE.. C,i }.: ;rem drle i!•rued if the : :ern has not b u installed. P.:.mit' for sysr_;.. _ L ames become void 90 days from the drat; issued.