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DRAINFIELDSTATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: [ ]New System [ X ]Existing System [ ]Holding Tank [ ] Innovative Other [ ]Repair [ ] Abandonment [ ]Temporary [ NA ] APPLICANT: Gordon, Cordinel AGENT: OWNER, PROPERTY STREET ADDRESS: 135 NE 94 St Miami Shores FL 33138 LOT: 19 BLOCK: 21 SUBDIVISION: Miami Shores [Section /Township /Range /Parcel No.] PROPERTY ID #: 11- 3206 - 013 -2881 [OR TAX ID NUMBER] SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 64E -6,FAC DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC TIME PERIOD. 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 PROPERTY DEVELOPMENT. SYSTEM DESIGN AND SPECIFICATIONS T [ 900 ]Gallons SEPTIC TANK MULTI- CHAMBERED /IN SERIES: [Y ] A [ 0 ]Gallons MULTI- CHAMBERED /IN SERIES: [Y ] N [ 0 ]-GALLONS GREASE INTERCEPTOR CAPACITY K [ 0 ]GALLONS DOSING TANK CAPACITY [ 0 ]GALLONS @ [0 ]DOSES PER 24 HRS # PUMPS[ 0 ] D [ 300 ]SQUARE FEET PRIMARY DRAINFIELD SYSTEM R [ 0 ]SQUARE FEET SYSTEM A TYPE SYSTEM: [ N ]STANDARD [ N ]FILLED [ N ]MOUND [ N ] I CONFIGURATION: [ N ]TRENCH [ N ]BED [ N ] N F LOCATION TO BENCHMARK: I ELEVATION OF PROPOSED SYSTEM SITE [ 0.0 ] [ FEET ] [ BELOW] BENCHMARK /REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 0.0 ] [ FEET ] [ ]BENCHMARK /REFERENCE POINT L D FILL REQUIRED: [ 0.0 ]INCHES EXCAVATION REQUIRED: [ 0.0 ] INCHES OTHER REMARKS: [CP] Scope of work: Enclose existing terrace to create new family room [200 sq. ft.]. Will not be increase in sewage flow, change in characteristics or expected disruption to the existing septic system or invalidating unobstructed reserve area reduction. No action shall be taken. SPECIFICATIONS BY: RAM, Arrieta, R.lan APPROVED BY: Test II, DATE ISSUED: 3/3/05 TITLE: DH 4016, 03/97 (Obsoletes previous e•itions which may not be used) (Stock Number: 5744- 001 - 4016 -0) [ostds_cons_4016 -1) CENTRAX #: 13 -SG -24088 DATE PAID: FEE PAID : $ RECEIPT . OSTDSNBR : 05-0675- -E TITLE: EH Specialist I Dade CHD EXPIRATION DATE: Page 1 of 2 APPLICATION FOR: [ ] New System [ ] Existing System [ ] Repair [ ] Abandonment APPLICANT,,: ; R ;'s ;i yJ ' c) 1 1^ -; ! AGENTS ! )r '� / I J MAILING ADDRESS: PROPERTY INFORMATION LOT: 1q PROPERTY ID #: DIRECTIONS TO PROPERTY: ki Pj1 u •, t f (iA, k r fn tr', BUILDING INFORMATION 1 2 3 4 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE DISPOSAL SYSTEM APPLICATION FOR CONSTRUCTION PERMIT N L "{ L • (,I0 ,7 0 ( •\ BLOCK: 2? SUBDIVISION: 1 r.� .(7 U1 SIGNATURE: C. 17 r Ge t. I r' - . -t - ( ; {; C_f:,i. ! 2• DH 4015, 10/97 – Page 1 (Previous editions may be used) Stock Number: 5744 - 001 - 4015 -1 Y(; 1' ,""). ] .:olding Tank ] Temporary TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. SYSTEMS MUST BE CONSTRUCTED BY A PERSON LICENSED PURSUANT TO 489.105(3)(m) OR 489.552, FLORIDA STATUTES. ---- -----------------------------==_ __--___________— _______— ___ —___ ZONING: I/M OR EQUIVALENT• [ Y / N ] PROPERY SIZE: Ps 2j ACRES WATER SUPPLY: [ ] PRIVATE PUBLIC [•'`] <= 2000GPD [ ] >2000GPD IS SEWER AVAILABLE AS PER 381.0065, FS? [ [ %, Id ] DISTANCE TO SEWER: PT PROPERTY ADDRESS: f f l' , cJ [ ✓ ] RESIDENTIAL [ ] COMMERCIAL - '-PERMIT NO: V !' DATE PAID: r, FEE PAID: RECEIPT #: • [ ] [ ] TELEPHONE: Innovative PLATTED: 1 ( Unit Type of No. of Building Commercial /Institutional System Design No Establishment Bedrooms Area Sqft Table 1, Chapter 64E -6, FAC [ ] Floor /Equipment Drains ( ] Other (Specify) DATE: Page 1 of 3 Permit Application Number PART II - SITE PLAN- Scale: Each block represents 5 feet and 1 inch = 50 feet. - -$ Notes: 41 ‘:;ai: DH 4015, 10/96 (Replaces HRS.H Form 4015 Midi may be used) (Stock Nurrber: 5744-002-4015-6) APPLICATION FOR ONSITE SEWAGE CONSTRUCTION PERMIT STATE OF FLORIDA DEPARTMENT OF HEALTH eA - • - I / / ' Signature Not Approved Jvv IT" 1 • 1L„, /-`-) • t Date tvJ lez/2 Site Plan submitted by: Plan Approved By County Health Department ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT */%z Cfpek: ),&4;4 y M;7 Title Page 2 of 3 Scale: Each block represents 5 feet and 1 inch = 50 feet. ; Notes: H , n . Site Plan submitted by: STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL•SYSTEM CONSTRUCTION PERMIT Permit Application Number DH 4015. 10196 (Replaces HRS-H Form 4015 which may be used) (Stock Number: 5744-002-4015-6) i L PART II - SITE PLAN ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT Signature Title Plan Approved Not Approved Date By County Health Department Page 2 of 3 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE DISPOSAL SYSTEM '°) SITE EVALUATION AND SYSTEM SPECIFICATIONS PROPERTY ID #: - 0/3 -E0/ PERMIT # APPLICANT: t�' aidrl� AGENT:¢ ( S LOT: BLOCK: SUBDIVISION: F [Section /Township /Range /Parcel No. or Tax ID Number] 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: [ ] YES [ ] NO NET USABLE AREA AVAILABLE: '2 ACRES TOTAL ESTIMATED SEWAGE FLOW: 3b-e. GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2] AUTHORIZED SEWAGE FLOW: �y, GALLONS PER DAY [1500 GPD /ACRE OR 2500 GPD /ACRE] UNOBSTRUCTED AREA AVAILABLE: 4a.) SQFT UNOBSTRUCTED AREA REQUIRED: G SY� SQFT BENCHMARK /REFERENCE POINT LOCATION: t� ' L h ye1.C(rr f ;47)(t. ELEVATION OF PROPOSED SYSTEM SITE IS 3 •d7- [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES: SURFACE WATER: /pri FT DITCHES /SWALES: / � FT NORMALLY WET? [ ] YES [,/f NO WELLS: PUBLIC: .Jp.A FT LIMITED USE: , JA FT PRIVATE: fl jr, FT NON - POTABLE: p ks FT BUILDING FOUNDATIONS: )~ FT PROPERTY LINES: /3 FT POTABLE WATER LINES: 2; FT SITE SUBJECT TO FREQUENT FLOODING: [ ] YES [.4 NO SOIL PROFILE INFORMATION SITE 1 Munsell / /Color Texture Depth � to _5 Ito P ' t0 t0 1 to 1 to 1 to to 1 USDA SOIL SERIES: to SITE EVALUATED BY: DH 4015, 10/96 (Replaces HRS -H Form 4015 [Page 3) which may be used) (Stock Number: 5744- 003 - 4015 -1) 10 YEAR FLOODING? [ ] YES [1 NO 10 YEAR FLOOD ELEVATION FOR SITE: FT MSL /NGVD SITE ELEVATION: AV" FT MSL /NGVD SOIL PROFILE INFORMATION SITE 2 OBSERVED WATER TABLE: d la INCHES [ABOVE / BELOW] EXISTING GRADE. TYPE: [PERCHED / APPARENT] ESTIMATED WET SEASON WATER TABLE ELEVATION•: INCHES [ ABOVE / BELOW ] EXISTING GRADE. HIGH WATER TABLE VEGETATION: [ ) YES [d MOTTLING: [ ] YES [-I NO DEPTH: INCHES SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: i/•4iLL DEPTH OF EXCAVATION: DRAINFIELD CONFIGURATION: [ ) TRENCH [ /) BED [ ] OTHER (SPECIFY) REMARKS /ADDITIONAL CRITERIA: / •/ INCHES DATE: ?// / Page 3 of 3 tVil''ge of Miami Shores N 4028 JOB ADDRESS /(5L3-- e pi INSPECTION � - - 41�� TIME READY REMARKS 1/ _ &I'M/4* INSPECTOR Date 1/02/96 PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Job Address 135 NE 94 STREET Tax Folio Legal Description Historically Designated: Yes No Owner/Lessee / Tenant MAJORES Master Permit # Owner's Address 135 NE 94 STREET Phone 795 -2207 ContractingCo. NORTH DADE SEPTIC TANK ��alifier DFNNTS NEVTT,T.E SS# Phone 754 -3375 State # 0 2 5 8 3 6— 8 Municipal # Competency # 12 8 4 2 Ins. CoT R A V E L E R S/ E S I F Architect/Engineer Address _ Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION INSTALL DRAINFIELD Square Ft 300 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. FIDAVIT: I cert i • t all the foregoing information is accurate and that all work will be done-i compliance with all applicable construction : zo g. Furthermore, I authorize the above-n. - • • actor to do work stat d. 1 02 96 S gnature of owne and/or Con y t 'resident Date Notary Owner and/or My Commission Expires: FEES: PERMIT 3 s RADON APPROVED: Zoning Merhtmical do 'resi i ent Date %Watt Ott «tttattatttttWtcV■titttitt%tt P °0 e Teresa J. Felder No :ary Public, Slate of Florida A 1'7 7 Commission No. CC 480807 'd'OF re My Commission Expires 07/16/99 > 1-600-1-NOTARY - Fla. Nola:) Seroiro b2 Bonding Co. • Not Contractor or My Commission Expires C.C.F. - .�D NOTARY 3 R 9/3 Address 800 NW 111 STREET, MTQMT 33168 /II prof Co ctor or Owner - : uilder Electrical , Date er -Bu lder D ate Notary Public, State of % «««r\%s % %t %% m%%tw, % %% �, , a �Pi,r Pte Teresa J. Felder % .r/'OF ` ' " o Commission No. CC 480807 : n MY Commission Expires 07/16/99 • ; ! - Fla. Nottiy Setvic,, A Boadinc Co. • i a TOTAL DUE 3 Engineering OI�STRUCTION PERMIT FjOR: ] New System [ , Existing System [/ ' ]/Holding Tank [� Repair [t ] Abandonment [ ] Other(Specify) ] � APPLICANT: l ez AGENT: }��� � 3EPr'c A l PROPERTY STREET ADDRESS : 433' -"pc 1 4/ "°%'1 a°' LOT: PROPERTY ID #: z „, d ) fj STATE OF FLORIDA - PERMIT # C R 0®3 � DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES DATE PAID I° 0 3— g ONSITE SEWAGE DISPOSAL SYSTEM FEE PAID $ e:P• CONSTRUCTION PERMIT RECEIPT # / Y 0 Authority: Chapter 381, FS & Chapter 10D -6, FAC BLOCK: SUBDIVISION: [SECTION /TOWNSHIP /RANGE /PARCEL NUMBER] [OR TAX ID NUMBER] ] - - 4 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 PERMIT£ 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. SU( MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID. SYSTEM DESIGIND SPECIF,KATIONS T [1r ], [GGAL LO a, / GPDJ 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: [ ] D [5 ] SQUARE FE PRIMARY DRAINFIELD SYSTEM R [ ] SQUARE FEET SYSTEM A TYPE SYSTEM: [ ] STANDARD [ ]FILLED I CONFIGURATION: [ ] TRENCH [ �] BED N /1 F LOCATION OF BENCHMARK: I ELEVATION OF PROPOSED SYSTEM SITE [ ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT D FILL .REQ(J71kED:'r ] -INCHES f ` EXCAVATION REQUIRED: [ ) INCHES j ri: .lJ O �� ., r , ;(3) SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: QPPdO©A T TITLE: TITLE: [ ] MOUND [ ] [ 11:7; n C Gb )0.;,]; tl 3511 ;ID HRS -H Form 4016, Mar 92 (Obsoletes previous editions which may noQL`b �510ERT";H'I l °.E"�Qr )apU'�PiNpUE- (Stock Number: 5744-001- 4016 -0) 17-73 CPHU EXPIRATION DATE: v _ Page 1 of 2 STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Num 0 32 PART II - SITE PLAN Scale: Each block represents 5 feet and 1 inch = 50 feet. 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MM!��•■•■ ■111 ■ ■ ■• ■ ■■ Z1 Z' ME= _ .•••..,'■• ••••• IEEE ■■■■■If/ •••■■M•r - ■• ■•••IIME ■•■•■■■•■ •••••••• ■•■•• ■•■ •••■•••••.=*�Ili' ■••11MER►A• ■___ ■•■M••■•■ ■•■••■•■ !M!I!•■!1•11� FAIMEJ•111III■ IMMINNEMININI ■•••■ 1 ■■� ■ ■ ■ ■�.■ ■ ■�■■ ■■■III MIMMIMMENIE■MIEMEM ■• ■•• ■1.111 ••111 ••••••••• ■•■••••ill ■•111 ■ ■ ■ ■ ■ ■ � ■� ■�� ■•Ul /EMI MMENUI •Miiou i ■�111■�■ ■■■■� ■• ■••••1■ ■•111 ■� ■ ■ ■ ■■ ■�11 ■�■ ■■ ■ ■•11■•■■■ ■ .771111:, r■Zsnr1 �1sil�arr fi gala 1'J11 iR>�r9r) FE ■1(IIli a■ ■ ■■■ 'C ..wiifii 1•••■ •••11i••••••••• MIN ••••• • 1•■ •■■ •■■ii.■••••1•■ ••11■ ■ •■■■•■ • ■11■■•••••■ • ■11 ■■ •■■•■ • ■11 ■■■■ ■■•■ Notes: NAJORES o 135 NE 94 STREET, 33138 OLD SYSTEl OVERIL° LGUING a Site Plan submitted by: Plan Approved By SIGNATURE FIRS-H Form 4015, Feb 85 (Obsoletes previous editions which may not be used (Stock Number. 5744.002- 4015.6) _ Not Approved 6 ALL CHANGES MUST BE A PROVED B T E COUNTY PUBLIC HEALTH UNIT TITLE Date I - County Public Unit Page 2 of 3 APPLICATION FOR: a ] New System I J Repair APPLICANT: MAJORES AGENT: MAILING ADDRESS: 800 NV 111 STREET, MIAMI 33168 TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. ATTACH BUILDING PLAN AND SITE PLAN SHOWING PERTINENT FEATURES REQUIRED BY CHAPTER 10D -6, FLORIDA ADMINISTRATIVA LEGAL DESCRIP IQI OR DEr, DATE OF BFORR 72 SUBDIVISION: ,.� PROPERTY INFORMATION [IF LOT IS LOT: BLOCK: PROPERTY ID #: PROPERTY SIZE: ACRES [Sqft /43560] PROPERTY STREET ADDRESS: 135 NE 94 STREET, 33138 DIRECTIONS TO PROPERTY: BUILDING INFORMATION Unit Type of No Establishment 1 2 3 4 SFR j ] Garbage Grinders /D g ] Ultra -low Volume APPLICANT'S SIGNATURE 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 1[ ] Existing System I ] Holding Tank P[ ]�{ ] Abandonment H ] Other(Specify) NORTH DADE SEPTIC TANK NOT IN A RECORDED SUBDIVISION, ATTACH SUBDIVISION: [X ] RESIDENTIAL No. of Bedrooms 3 BEDROOMS s ilets [Section /Township /Range /Parcel No.] ZONING:' PROPERTY WATER SUPPLY: ,r Building Area Sqft HRS -H Form 4015, Mar 92 (Obsotetes previous editio s ic may not beused) (Stock Number: 5744- 001-4015-1) ";Y ? [ PERMIT # - I ' 1 • 3 DATE PAID 103 96 FEE PAID $ 40.00 RECEIPT # /(Ye ] Temporary /Experimental TELEPHONE :795 - 2207 [ 754-3375 ] COMMERCIAL # Persons Business Activity Served For Commercial Only ] PRIVATE ] PUBLIC g ] Spas /Hot Tubs [ ] Floor /Equipment Drains j ] Other (Specify) GALE Page 1 of 3 -