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311 NE 94 St (14)MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date 3 \ •S' Type Insp'n RA/4-1 /j Permit No. / 9 0 7 — 9 Name , �f /l �1/ Address 3'l i ?. Qq 5 Inspection Date Approved Correction Re-Insp'n Fee Nt Company Phone # MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date 3\ ?5 Type Insp'n R A/4I / 8/-6 (� Permit No. / Os 109 Name 4 e r Approved Correction Re- Insp'n Fee Address Company Phone # Inspection Date - APPLICANT: 71;;Al„ LOT: i�r/4 BLOCK: r .� '4 �/� r . 4 ( ( pc._ SUBDIVISION: -- 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: [9- - YES [ ] TOTAL ESTIMATED SEWAGE FLOW: r;' GALLONS AUTHORIZED SEWAGE FLOW: )¢ GALLONS UNOBSTRUCTED AREA AVAILABLE: SQFT BENCHMARK /REFERENCE POINT LOCATION: a> ELEVATION OF PROPOSED SYSTEM SITE IS '/y�7 [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES: SURFACE WATER: FT DITCHES /SWALES: 7'd- 11-1_4 FT NORMALLY WET? [ ] YES c,--Two WELLS: PUBLIC: pu...a- FT LIMITED USE: 44ilt FT PRIVATE: P'' N FT NON - POTABLE: P FT BUILDING FOUNDATIONS: FT PROPERTY LINES: FT POTABLE WATER LINES: /c2 FT SITE SUBJECT TO FREQUENT FLOODING: [ ] YES [ 4 —NO 10 YEAR FLOODING , ) ] YES [ r10 10 YEAR FLOOD ELEVATION FOR SITE: IJ FT MSL /NGVD SITE ELEVATION: FT MSL /NGVD SOIL PROFILE INFORMATION SITE 1 Munsell # /Color Texture Depth Lri<fl 5 �/ tO v' <- to 7 to to to to to to to USDA SOIL SERIES: OBSERVED WATER TABLE: INCHES [ABOVE / BELOW] EXISTING GRADE. TYPE: [PERCHED / APPARENT] ESTIMATED WET SEASON WA ER TABLE ELEVATION: 5 / Q INCHES [ ABOVE / BELOW ] EXISTING GRADE. HIGH WATER TABLE VEGETATION: [ ] YES [ &. }O MOTTLING: [ ] YES [!NODEPTH: INCHES SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: DEPTH OF EXCAVATION: DRAINFIELD CONFIGURATION: [ ] TRENCH [ [ ] OTHER (SPECIFY) REMARKS /ADDITIONAL CRITERIA:74 - i) 0 /A/ `%i i`e. SITE EVALUATED BY: STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS ) < V' AGENT: JP--A,,deeg [Section /Township /Range /Parcel No. or Tax ID Number] PERMIT # /A, NO Z NO NET USABLE AREA AVAILABLE: � ACRES PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2] PER DAY [1500 GPD /ACRE OR 2500 GPD /ACRE] p UNOBSTRUCTED AREA REQUIRED: �c?�; SQFT SOIL PROFILE INFORMATION SITE 2 Munsell # /Color Texture Depth v-„,/ 69 to 6' , = ��, �' .a 4 to ) i' • to to to to to to to USDA SOIL SERIES: INCHES DATE: (may 2 ' oe/ HRS -H Form 4015, Mar 92 (Obsoletes previous editions which may not be used) Page 3 of 3 (Stock Number: 5744 - 003 - 4015 -1) INSTRUCTIONS: PERMIT o: APPLICANT: AGENT: LOT, BLOCK, SUBDIVISION: PROPERTY ED//: SEWAGE FLOW: UNOBSTRUCTED AREA: BENCHMARK INFORMATION: Record the location of the benchmark. If using a surveyor's benchmark record the r:c_uaI elevation. Record the elevation of the proposed system site in relation (above or below) to the benchmark. MINIMUM SETBACKS: Permit tracking number assigned by CPHU. Property owner's full name. Properly owner's legally authorized repremntative. Lot, block, and subdivision for lot. 27 character number for property. (properly appraiser ID 0 or cection/towriship /rar : /parcel number) 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 VALUATED BY: Signature of evaluator, title, and date of evaluation. Professional engineers must s.: ::l all documentation submitted. ELEVATION WOLRKSXEET ELEVATION OF BENCHMARK / REFERENCE POINT ES: BENCHMARK SITE 1 SITE 2 SITE 3 [Y) SHOT: H.I. H.I. H.I. U. [ -] SHOT [ -1 SHOT [ -] SNOT • PROPERTY SIZE: Check if property size at site conforms to submitted site plan. Record net usable arc,. available - lot area exclusive of all paved areas and prepared road beds within public rights-of-way or easements c:tr: c : :clusivo of streams, lakes, normally wet drainage ditches, marshes, or other such bodies of water. Record the estimated sewage flow for the establishment from Table I (residences) c: " ::ble 2 (non- residentic), Chapter 10D -6, FAC. Record the authori ,2d a;wage flow for the sot based on net usable a:\ .d water supply (1509 Ballone per day per acre for private water supplies and 2500 gpd per rctr for public weer c ,n?Lea). llf authorized sewage flow does not equal or exceed the estimated sewage flow, the application must be denied. Record the square feet of unobstn cted area available and the amount required. Ur_ ;'rc :rutted area must be et Lena 2 times as large as the drainfield abso± lion area and at least 75 percent of the unobc' :::c ^ ^d area must meet minimum setbacks in Chapter 1OD -6, FAC. The unobstructed area must be contiguous to the c: cinfield. Record minimum setbacks which can be meet to all listed features. Actual measure-?snts must be recorded or "NA" for non applicable features. Features on site plan or within 75 feet of the applicant Lai 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 ?0 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 o.; 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 aeries cannot be determined. WATER TABLE: Record the depth of the observed water table at the time of the evaluation. Mark "p':rched" 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. APPLICATION FOR: W] New System (/1] Existing System [ti] Holding Tank [y /] Repair [/)1] Abandonment [/!] Other(Specify) APPLICANT: AGENT: MAILING ADDRESS: /52 5 - S � 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] LOT: PROPERTY ID #: PROPERTY SIZE: BLOCK: PROPERTY STREET ADDRESS: 30 A DIRECTIONS TO PROPERTY: BUILDING INFORMATION Unit Type of No Establishment 1 2 3 4 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: PERMIT # DATE PAID FEE PAID $ RECEIPT # emporary /Experimental TELEPHONE: 7 e(� DATE OF SUBDIVISION: [Section /Township /Range /Parcel No.] ZONING: ACRES [Sgft /43560] PROPERTY WATER SUPPLY: [ ] PRIVATE [ e___1,-PUBLIC [ 4]- RESIDENTIAL [ ] COMMERCIAL No. of Building # Persons Bedrooms Area Saft Served [44 Garbage Grinders /Disposals 00 Spas /Hot Tubs (/ /] Floor /Equipment Drains [ ,ti ] Ultra -low Volume Flush Toilets [AO . her (Specify) Hit— it-- T � APPLICANT'S SIGNATURE: fie! , HRS-H Form 4015, Mar 92 (Obsoletes previous editions which may not be used) (Stock Number: 5744 - 001 - 4015-1) Business Activity For Commercial Only ) 3 iv/A DATE: 9 Page 1 of 3 INSTRUCTIONS: APPLICATION 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, city, state and zip code cnr ii.ia3 adeiress for appltccn't or agent. LOT, BLOC t, , Lot, block, and subdivision for lot (recorded or unrecorded subdivision). Ind is not in a recorc •: ->ubdiviaion, a copy of a lot SU3D"V S;.ON: icgal desc ription or deed muse be attached. DAll OL SUBDIVISION: Official date of subdivision recorded in co:ra :y It books (month/day/year) or date lot originafiy •oreled. Dividing an approved tot into two or more parcels for the purpose o2 convey :ng owncrship chill be considered a subdiv' - '.nn of the lot. iOP,ERTY EDQ: 27 character number for property. (CF;n1U muy require property appraiser PROPERTY SIZE.. Il 0 or cection/toear : /range /pereel number. Net usable area of property in acres (squcr; r ^1 divided by 43,560 a f,;Yzre feet) exclusive c!'.' ?aved antis and prepcmd road beds within public rights -of way or easements :.. c inclusive of c",rearrv, lases, narsnally wet drei- ;s ditches, marshes, or other such bodies of water. Contiguous unpaved anti noncomprcted road rig'tta -of -way and easements t r:ila no subsurface obstruction may be included in calculating lot area. WATER SUPPLY: Check private or public. PROPERTY ADDRESS: Street address for property. For lots without an assigned street address, indicate street or road ri,r: ;scale in county. DIRECTIONS: Provide detailed instructions to lot or attach an area map showing lot location. BUILDING INFORMATION: Check residential or commercial. TYPE ESTABLISHMENT: List type of establishment from Table II, Chapter 10D-6, FAC. Examples: single family, single wide mobile home, restaurant, doctor's office. NO. BEDROOMS: Count all rooms designed primarily for sleeping and those areas expected to routinely provide sleeping accommodations for occupants. BUILDING AREA: Total square footage of enclosed habitable area of dwelling unit, excluding. garage, carport, exte_ior storage shed, or open or fully screened patios or decks. Based on outside measurements for each story of structure. II PERSONS: Number of persons residing, using, or working, in establishment. For residential establishment, ipsrsona per bedroom are assumed. BUSINESS ACTIVITY: For commercial applications only. List number of employees, ahi1 a, r;'rsl.hours of operation, or -er information required by Table 11, Chapter 1OD -6, FAC. FDCTURES: Mark each listed fixture with number installed or "NA" if not applicable. SIGNATURE: Signature of applicant or agent. Date application one day submitted to the CPHU with appropric.:; fees and attachments. ATTACHMENTS: A site plan drawn to scale, showing boundaries with dimensions, locations of residences or buil%',. al, swimming pools, recorded easements, onsite sewage disposal system components and location, slope of property, any exist-' ; or proposed wells, drainage features, filled areas, obstnicted areas, rnd curkce water. Location of wells, onsite sewage die :ie:' ;J systems, surface waters, and other pertinent facilities or features on adjccene, p eperty, if the features are with 75 feet of the c ; ;. :'.cant lot. Location of any public well within 200 feet of lot. For residences, a floor plan (residences) showing number of bedroom and building area of ecN. : :. -ii. For nonrea deistic! establishments, a floor plan showing the srp.sar; footage o7'the establishnters, all plumbing drain:, -i fixture typca, and other features necessary to determine composition and quantity of wastewater. 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OW f..-.s...w.f��ww.Ti...ttti..T ... #Wttl ■.■..wWwi ■ .wItii...fi_.f�i.(i�I•...aw wi I ..L.w Notes: -- RPt siBiOrca.6 113 STI SIGNATURE Not Approved Permit Application Number ALL CHANGES MUST BE APPROVED BY THE COUNTY PUBLIC HEALTH UNIT TITLE Date L • 4' 9 County Public Unit Page 2 of CONSTRUCTION PERMIT FOR: [PI New System [1 Existing System [7'] Repair Abandonment APPLICANT: = ` r¢ LOT: T A N K D R A I N F I E L D 0 T H E R ck DATE ISSUED: STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Authority: Chapter 381, FS & Chapter 10D -6, FAC BLOCK: [3)O] SQUARE [ -- SQUARE TYPE SYSTEM: CONFIGURATION: SPECIFICATIONS BY: 11l PROPERTY STREET ADDRESS: 3// k/ SYSTEM DESIGN AND SPECIFICATIONS FEET PRIMARY DRAINFIELD SYSTEM FEET SYSTEM [� FILLED BED i)STANDARD L] TRENCH LOCATION OF ti BENCHMARK: ELEVATION OF PROPOSED SYSTEM SITE [ BOTTOM OF DRAINFIELD TO BE [ s• 1 .5t - z??' ,- �` �' l t= i ,P SUBDIVISION: APPROVED BY: HRS -H Form 4016, Mar 92 (Obsoletes previous editions (Stock Number: 5744 - 001 - 4016 -0) [Al] Holding Tank [f /] emporary [ f�f] Other(Specify) A/ // 7 AGENT: which may not be usIdA PERMIT # DATE PAID FEE PAID $ RECEIPT # PROPERTY ID #: [SECTION /TOWNSHIP /RANGE /PARCEL NUMBER] [OR TAX ID NUMBER] 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. y F [GALLONS / GPD] SEPTIC TANK /AEROBIC UNIT CAPACITY MULTI- CHAMBERED /IN SERIES:[ ] [GALLONS / GPD] CAPACITY MULTI- CHAMBERED /IN SERIES:[ GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS] GALLONS PER DOSE DOSING TANK CAPACITY DOSE RATE [ ] PER 24 HRS NO. OF PUMPS: [ ] MOUND • e`'.= r ! T / )42. a FILL REQUIRED: [/j ] INCHES EXCAVATION REQUIRED: [5f. ] INCHES Experimental ye. 4; TITLE • � `' � ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT • t P Hu t1 EXPIRATION DATE:GE Page 1 of 2 INSTRUCTIONS: PERMIT NUMBER: Permit tracking number assigned by CPHU. APPLICATION 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. (CPHU may require property appraiser ID # or section/township /range /parcel number) SYSTEM DESIGN AND SPECIFICATIONS: TANK: Minimum specifications from Chapter 1OD-6, FAC. DRAINFIELD: Minimum specifications from Chapter 10D -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 Public Health Unit (CPHU) personnel reviewing and approving permit. DATE ISSUED: Date permit is issued by CPHU. 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.