940 NE 95 St (6)Scale: Each block represent f
feet and 1 inch = 50 f
feet. _
■■ I
I ■■■ ■
■� 1 1
■■ a
a ■
_
■P) U
U i
i■ [
[ i
i ■
1 1" ■
Notes:
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTI PE M MI I �i
Permit Application Number TI
PART II - SITE PLAN
R t,LOC,A4 0 FO EC/ e
Site Plan submitted by:
SIGNATURE
B
� t
ALL CHANGES MUST BE APPROVED By THE COUNTY PUBLIC HEALTH UNIT
HRS -I-I Form 4015, Feb 85 (Obsoletes previous editions which may not be used)
(Stock Number. 5744- 002 - 4015 -6)
TITLE
Plan Approved (./ Not Approved Date )
County Public Unit
Page 2 of 3
APPLICATION FOR:
U New System [A. Existing System
] Repair (), ] Abandonment
APPLICANT: /.I.- E 9F D U
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
APPLICATION FOR CONSTRUCTION PERMIT
Authority: Chapte: 381, FS & Chapter 10D -6, FAC
AGENT: A-c r S p L e _
MAILING ADDRESS: / 09 51,..) 9 / „ ' i1 l /ZI2 3 - 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.
J r
PROPERTY INFORMATION [IF LOT IS NOT IN A CORDED SUBDIVISION, ATTACH DESCRIPTION OR DEED]
SUBDIVISION: 1 5) o llA S DATE OF �t5�
SUBDIVISION:
PROPERTY ID #: [Section /Township /Range /Parcel No.] ZONING:
LOT: BLOCK:
PROPERTY SIZE: ACRES [Sgft /43560]
PROPERTY STREET ADDRESS: qt(z) "..4: S
DIRECTIONS TO PROPERTY:
BUILDING INFORMATION ($ ] RESIDENTIAL
Unit Type of No. of
No Establishment Bedrooms
1
2
3
4
5F
[ ] Garbage Grinders /Disposals
[A') Ultra -low Volume Flush Toilets
APPLICANT'S SIGNATURE:
[A- Holding Tank [,"-'] Temporary /Experimental
[AI] Other(Specify)
PROPERTY WATER SUPPLY: [N ] PRIVATE [Y] PUBLIC
Building
Area Scft
lobo
[C] COMMERCIAL
# Persons
Served
HRS-H Form 4015, Mar 92 (Obsoletes previous editions which may not be used)
(Stock Number: 5744- 001 - 4015-1)
pas /Hot Tubs [/ Floor /Equipment Drains
Other (Specify) s�
PERMIT #
DATE PAID
FEE PAID $
RECEIPT #
TELEPHONE : y (`O
03�
Business Activity
For Commercial Only
DATE: ! s ` Y1
Page 1 of 3
RNSMUCTIONS:
AJPPLICATION Check type of pcoznh, if °Other spccify ^-yo in hicnk.
APPLECA1\17: Property owner's full mime.
TELEPHONIS: Telephone number nurnbe: oo appliccnt C.7 C.
Pro:,:orty avrter's cUy authoni.T.s!s"
1:ox of ci7, slats co z!:
iLCT, !3:1,0CX
SIT3:;NISECN:
Pi1C.P7.:171!
block, r std. fo: (.:'de' : • To: is n_e: in :;
deccriptior C.csr.: !:711.1L 7 0.Q C."111.C
DA",:ci3 OF S:..1:3DAVY.S7.C: date in
icl c: r,:rr.leio fa:
InC?7)1:17 7730: 77 C17 .;': :.-;
.tasble in r:crcs. • . •
7 14:1: wiThin wr.y • ' . ---
sn...."1 bodies of r/stc:-. Contiguous - _ , n , -...Lvf07. nence Cr?, „0
...may he incluri.lr.: cciculating !o o:.
Wg.171 SUPPLX: Check private or public.
P:107ERTY ADDZU.7:.'SS: Str;:et address for procerty. or lots with.o.!: :secs" on :.c.7c.1.3 r 'y
Provide detailed instructions to lot or attach cn arca 1111'...; :L}Cr.tion.
BUILDING INFO.W.A77.ON: rzsidentiai
TYP7 STAB' IST- Lis: type of estchlishment from ::: :inc :00700:;
doctor's office.
NO. 33DIZOOMS: 1.7.cunt all room designed primarily or .:c,in g cnd thco.: : : r:nr.2: :o sleor:in,s
occupants.
311E-DING AREA: Total squaro footage of enclosed hchitable cre's of clwc. CCIT1C1 2C.71:50
sc patios or decks. Based oo onts!da
0 PiEaSONS: Number of persons residing, using, or Ivo:Icing i estr'3"ir . ca..r 2 :1';'.7..-7,13 7:0?
CSSUMCd.
BUS:NESS ACT:VITY: 7 :"7 only. 7:r : .'7.r171-..r.: of cr
7°7 ccrilm2cic PAC.
Table II, Cnap 0D-6, :
FIXTIMES: i11.:zrk each listed fixture with 12M17: I "NA"
SIGNA7U/11": Sirrnature of applicant or agent. Date cpplicalion one
ATTACHIiNITS: A site pl:In drawn tc male, shovrin3 r77 7 :7 .T."'&,..""f,.. ;^.;
onsite dispoa:1 ' T.:
fc7.Iure.s, f11ed amas, obatz 01\37., 171:2 '7.. :"OV. c",irsfzes Frs
0: pertir.ert Czeilitiei or fect 7 3 0
public well wiLhin CO :feet of :ot.
ivaidences, s floor plc: • • 11
f. pinn ": •
f:ctures neer:sm.:7 00 nins cne
APPLICANT: -�� 6 b
LOT:
THE MINIMUM SETBACK WHICH
SURFACE WATER: /0C) FT
WELLS: PUBLIC: c'01- FT
BUILDING FOUNDATIONS:
BLOCK: SUBDIVISION:
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
SITE SUBJECT TO FREQUENT FLOODING:
10 YEAR FLOOD ELEVATION FOR SITE:
SOIL PROFILE INFORMATION SITE 1
[ ] YES
S6
7; # /Color Texture Depth
iv ) E7 / ► t- O to ) -
t )(1
to
to
to
to
to
to
to
USDA SOIL SERIES: ' LCIQ \J {�--
OBSERVED WATER TABLE: 7) NCHES [ABOVE
ESTIMATED WET SEASON WATER TABLE ELEVATION:
HIGH WATER TABLE VEGETATION: [ ] YES C] NO
SITE EVALUATED BY:
HRS -H Form 4015, Mar 92 (Obsoletes previous editions which may not be sed)
(Stock Number: 5744 - 003-4015 -1)
AGENT: ciL c_
1 / /gm
PERMIT # / qi
PROPERTY ID #: q(63 , L q 5 i -- [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: ACRES
TOTAL ESTIMATED SEWAGE FLOW: 750 GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2]
AUTHORIZED SEWAGE FLOW: - 750 GALLONS PER DAY [1500 GPD /ACRE OR 2500 GPD /ACRE]
UNOBSTRUCTED AREA AVAILABLE: .�ao /ODO SQFT UNOBSTRUCTED AREA REQUIRED: / v 6 V SQFT
BENCHMARK /REFERENCE POINT LOCATION: F
ELEVATION OF PROPOSED SYSTEM SITE IS 4IILCH /FT] [ABOVEOELO BENCHMARK /REFERENCE POINT
'r4"
CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES:
DITCHES /SWALES: FT NORMALLY WET? [ ] YES r NO
LIMITED USE: — FT PRIVATE: FT NON - POTABLE: FT
FT PROPERTY LINES: S FT POTABLE WATER LINES: /0 FT
[X] NO
FT MSL /NGVD SITE ELEVATION: 7' 0 FT MSL /NGVD
10 YEAR FLOODING? [ ] YES ['] NO
SOIL PROFILE INFORMATION SITE 2
Munsell # /Color Texture
2. 1 b9SoiL
S
Depth
0 to
to - 7 2
to
to
to
to
to
to
1 ' to
USDA SOIL SERIES: 1 U
EXISTING GRADE. TYPp: [PERCHED / APPARENT]
5 (INCHE [ ABOVE /CisELOW EXISTING GRADE.
MOTTLING: [ ] YES [tom] NO DEPTH: — INCHES
DEPTH OF EXCAVATION:
SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING:
DRAINFIELD CONFIGURATION: [ ] TRENCH v:] BED [ ] OTHER (SPECIFY)
REMARKS /ADDITIONAL CRITERIA:
�
o
DATE: /° 8 l
INCHES
Page 3 of 3
INSTRUCTIONS:
PERMIT 0:
APPLICANT:
AGENT:
LOT, BLOCK, SUBDXVISION:
PZIOPERTY !DO:
PaOPERTY SUE:
SWAG :ow:
S".73A0l(S:
:7037.;
VW:Ea TA37-lEl:
7,1=7,J,13:
017. L'EXCAVA:20N:
DaAINFiELD CON:KOUTIAT:ON:
A)DMONAL CRITZ211A:
STE EVALUATED 3Y:
13ENCEIMAAK
[-:-] SHOT:
Permit tracking number assigned by CPU.
Property owner's full !tame.
Property owner's legally authorized repre=:KaIlve.
Lot, block, and subdivision for loa.
27 character number for propeAy. (propy fl o section/town ship/range/parci r_umbec..)
Check if property 81Ze at site conforms to C.:L:7 „li'a plan. accord net usable araz avci!abls - toz craz oncE:2siv:; of
all paved areas and preparze :ace, :lads Ft:Ito-of-way or easzments and exclusive of z2.:,m Ickes,
normally wet drainage ditches, marshes, cr dic of water.
azcore the estimated sewzge fiow :OT the 7 able i (resido2ces) or 7thla 2 (non.-:. CL cp;
7AC. ' en :le: :Mr.1
L onF clay per acre fo: 1 tleFe for
r!o: aquat or exceesi ; -,)
:
i..n F'• ' '• i5 ;;;;;Fcer
oc in Chaptcy • . ' •
aeaord the location Cl ' • be;:lchnr:r..t !! -"
of the pro?c.r.o.:: sy ...I::: in . ;
atceic: Fninimon
fur :•ori applies:oh: 7 "7..7..e. Fp • .• '
of eny public drInitir well 2C0 • - 'no
infOtatiOn e.:. lat'u .
17.1"OfIlei" •••
idt.n1tiiTeZZ1011174
be elcrrly document:. ?Fovic::: USDA .
accord the dcpti. of the obc,jcI tvate-:-
rpr Reccr6 fle weZ L22
historical information. F:xsi:et.:..;
nt:C37::: COD texture -•.
If applicable record ic:epth of oxcavation "N A" if no:
Chcca docinfield corFnguration rce typo.
accord any additiozn!
Signature of evaluator, title, and claie el.7.E;Eree:e
ELEVATION WOIKSHEET Lc..:ELVATiON O 31ENCHW., AX / ::=.7 :
Slqg I
[-I SHOT
-"• cf the evaluation. Mai "percbcd"
,•. elevr.t.lon baar,e, on zit.; crt:
• ' "'''e • „•
r-; -;
re:core "1.;N:lc if the. .'..:;." Cie:
alociris rcquircr.i.
ti
CONSTRUCTION PERMIT FOR: '
New System [P] Existing System ( �V ] Holding Tank [A/] Temporary /Experimental
[y ] Repair [JJ] Abandonment fF ] Other(Specify)
r /
66
PROPERTY STREET #
DDRESS:
APPLICANT:
LOT:
PROPERTY ID #:
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
T [ � J GALLONS GPD) EPTIC TES /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 ] SQUARE FEET PRIMARY DRAINFIELD SYSTEM
SYSTEM
0
T
H
E
R
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
CONSTRUCTION PERMIT
Authority: Chapter 381, FS & Chapter 10D -6, FAC
BLOCK:
D
R [ ] SQUARE FEET
L
D FILL REQUIRED: [
A TYPE SYSTEM: [ ] STANDARD [r ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [ ] TRENCH IJ BED [ ]
F LOCATION OF BENCHMARK:
I ELEVATION OF PROPOSED SYSTEM SITE [ J [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
] INCHES
i 1 0 j /
SPECIFICATIONS BY:
DATE ISSUED: ® ( P , /74
APPROVED BY:
'740 74
SUBDIVISION:
AGENT:
EXCAVATION REQUIRED: [ ] INCHES
TITLE:
HRS -H Form 4016, Mar 92 (Obsoletes previous editions which may not be used)
(Stock Number: 5744 - 001 - 4016 -0)
PERMIT #
DATE PAID
FEE PAID . $ fi r✓ o
RECEIPT #
kce iC
[SECTION /TOWNSHIP /RANGE /PARCEL NUMBER]
[OR TAX ID NUMBER]
TITLE: z , 4/+
i
' f r\ / CPHU
EXPIRATION DATE: / /�,
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 fuli 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 IDUI: 27 character id number for property. (CPHU may require property appraiser ID n or section/township /range /parcel number)
SYSTEM DESIGN AND
SPECIFICATIONS:
TANK: Minimum specifications from Chapter 1OD-6, FAC.
DRAINFIELD: Minimum specifications from Chapter IOD-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.
PERMIT NO. TAX FOLIO NO.
STATE OF FLORIDA:
9.4-R47572 1994 OCT 11 12:15
COUNTY OF DADE:
THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property. and in accordance with
Chapter 713, Florida Statutes. the following information is 4 in this Notice of Commencement.
1. Legal description of property and street address: C i 4 0 N. 9..0 S tv- e e--(
2. Description of improvement: Pp c J a.f Q n o IAA P .
u LA I /
3. Owner(s) name and address: ► —r ..... k k [ a 444 1 tv ' ti ( t. 5 44,t4
Interest in property: 0 vv v A le—
Name and address of fee simple titleholder: q ■,, k WaILL (e v< /-Hes c9J k.c,S
4. Contractor's name and address: ' \P .r�s s
5. Surety:(Payment bond required by owner from contractor, if any)
Name and address:
Amount of bond S A
6. Lender's name and address:
7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided
by Section 713.13(1)(a)7., Florida Statutes,
Name and address: ( r .(i LA ice' V
8. In addition to himself, Owner designates the following person(s) to receive a copy of the Lienor's Notice as provided in
Section 713.13(1)(b), Florida Statutes.
Name and address:
9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a
different date is specified)
NOTICE OF COMMENCEMENT
(fl -7851
- - - - --
4 , .'__
Signature of Owner nC hi �
Print Owners Name � 0. ti k 1 I °�� P. t� S /� r
Sworn to and subscribed before me this CM day of 19W.
C9U,cllY/O� D -s 7¢7c o/'/ 0'4 Address: CNN) /3 °S ST
Notary Public < L- -" �- —�—, 11.KUP're'4<. F�
Print Notary's Name // VFPRN 4 (' R `! :`=TARK
My Commission Expires: Notary ,; I i I; rido
,Ivry I;,, 1997
Co. a io;t roc. CC 25 '22
riTATE OF FLORIDAD COUNTY OF DADE
1'8 HEREBY CERTIFY that this is a true copy of fho
Mg; al filgd in this offico on dc,, of
' A• 0• 99
WITNESS my h -nd and Official Solt.
HA YRUV ,N,CL 'K, rrc.itand
B
t G Lt / I/" e /J C
td w 2 f.r D ,lti
M tf- An'vIkA-f( F\ 530
Prepared by: c s