797 NE 94 St (14)Date 2/26/96 Job Address 797 NE 94 STREET
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant MANDEL Master Permit # 3 '.„,\- %/
Owner's Address 797 NE 94 STREET, MIAMI SHORES 33138 Phone 757 -2769
Contracting Co. NORTH DADE SEPTIC TANK Address 800 NW 111 STREET, MIAMI 33168
Qualifier DENNIS NEVILLE
State # 025836 -8 Municipal # Competency # 12842 Ins. Co. TRAVELERS /FSSTF
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): #XAiM• PLUMBING 4tj}{{}k'{MilfiNc
WORK DESCRIPTION INSTALL DRAINFIELD
Square Ft. 300
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 11 wor a done in compliance with all applicable
laws regulating construction and zoning. Furthermore, I authorize the above -n..: • contr.' t•. o do the •rk stated.
igna e of owner and/or Condo President
My
N1tary asjo Owner and/
FEES: PERMIT
APPROVED:
Zoning
Mechanical
ssion Expir
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PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date
f*
sident Date
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owl P
ao Icr,asa J. Felder
� ' " N No. Public, Stare o,` F.: :,itch <
Commission No. CC <a if
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Vet 1-800-3 -NOTARY- - Fla. Narary f:rrviae & Boxtias Co. • <
RADON `C.C.F.
Tax Folio
Building
Plumbing 4 - ¶ 727/
SS# Phone 754 -3375
Estimated Cost (value) $1000.00
Signa ure of t ontractor or • er- Builder Date
s to Contr ctor o
y ommission Expir ttttttttttttttstttttttttttttittmt «sw.sz
r °4 a Teresa J. Felder '<
Notary Pubic, State of F pride
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9 � e Commission No. CC 4',30f67 S+
'0 'oF F�o My Commission Expires 07 /109 ;><
9
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1 .4300- 3•N•*OTAAY - Fla Notary !;,-;vice & Boadins Co. X
TOTAL DUE •'5
NOTARY
Electrical
Bur der Date
Engineering
APPLICATION FOR:
[NT] New System [ N] Existing System [ N] Holding Tank [NI Temporary /Experimental
(y ] Repair [ N ] Abandonment [ N ] Other(Specify)
APPLICANT: F ANDEL
AGENT:
MAILING ADDRESS: 800 NW 111 STREET, MIAMI 33168
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:
DIRECTIONS TO PROPERTY:
BUILDING INFORMATION
Unit Type of
No Establishment
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
WM DADE SEPTIC TANK
BLOCK:
SUBDIVISION:
PROPERTY STREET ADDRESS: 797 NE 94 STREET, 33138
1 SFR 3 BEDROOMS
2
3
4
t N
HRS-H Form 4015, Mar 92 (Obsoletes previous editions which may not be used)
(Stock Number: 5744 - 001 - 4015-1)
r / ) 9
TELEPHONE:757 - 2769
PERMIT #
DATE PAID
FEE PAID $ ®• c
RECEIPT # /7 7?f
754 -8375
DATE OF BEFORE 72
SUBDIVISION.
[Section /Township /Range /Parcel No.] ZONING:
ACRES [Sqft /43560] PROPERTY WATER SUPPLY: [ ] PRIVATE (f(](] PUBLIC
[;t( ] RESIDENTIAL [ ] COMMERCIAL
No. of Building # Persons Business Activity
Bedrooms Area Sgft Served
[`y1 ] Garbage Grinders /Dispo a [� ] Spas /Hot Tubs [N] Floor /Equipment Drains
[iv ] Ultra -low Volume Flush To lets ] Other (Specify)
For Commercial Only
DATE: 2/26/96
Page 1 of 3
APPLICANT: MANDEL
LOT:
PROPERTY ID #:
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
NA BLOCK:
NA
NA
TO BE COMPLETED BY ENGINEER, HEALTH UNIT EMPLOYEE, 0 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:
TOTAL ESTIMATED SEWAGE FLOW: g Q4)
AUTHORIZED SEWAGE FLOW: cl 4
UNOBSTRUCTED AREA AVAILABLE: ((O
SUBDIVISION: NA
[Section /Township /Range /Parcel No. or Tax ID Number]
YES [ ] NO NET USABLE AREA ?;VAILABLE: • a 9& ACRES
GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2]
GALLONS PER DAY [1500 GPD /ACRE OR 2500 GPD /ACRE]
SQFT UNOBSTRUCTED AREA REQUIRED: (7 00 SQFT
BENCHMARK /REFERENCE POINT LOCATION:
ELEVATION OF PROPOSED SYSTEM SITE IS ). [0 /FT] [ABOVE] BENCHMARK /:. "FERENC
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES:
SURFACE WATER: in(+ FT DITCHES /SWALES: _ FT NORMALLY WET? [ ] YES i ] NO
WELLS: PUBLIC: inner FT LIMITED USE: M FT PRIVATE: _ FT NON - POTABLE: __ FT
BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: S FT POTABLE WATER LINES: 1S FT
SITE SUBJECT TO FREQUENT FLOODING: [ ] YES [ NO 10 YEAR FLOODING? ] YES [ ] NO
10 YEAR FLOOD ELEVATION FOR SITE: W,T- A,n FT NGVD SITE ELEVATION:
+1S , ( FT NGVD
SOIL PROFILE INFORMATION SITE 1
Munsell # /Color Texture Depth
BROW SANDY 099 t 79°e
to
to
USDA SOIL SERIES: SANDY
to
to
to
to
to
to
SITE EVALUATED BY:
PERMIT # % Rasi
AGENT: NORTH DADE SEPTIC TANIC
9 r \
SOIL PROFILE INFORMATION SITE 2
POINT
Munsell # /Color Texture Depth
RRnIA1RT SANDY
to
to
to
to
to
to
to
USDA SOIL SERIES: SANDY
to
OBSERVED WATER TABLE: INCHES [m (/ BELOW] EXISTING GRADE. TYPE: mo p / APPARENT]
ESTIMATED WET SEASON WATER TABLE ELEVATION: 108 INCHES [AB / BELOW ] EXISTING GRADE.
HIGH WATER TABLE VEGETATION: [ ] YES CO NO MOTTLING: [ ] YES p(] NO DEPTH: INCHES
SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: 1,25 DEPTH OF EXCAVATION: 10 INCHES
DRAINFIELD CONFIGURATION: [ ] TRENCH [X ] BED [ ] OTHER (SPECIFY)
REMARKS /ADDITIONAL CRITERIA:
HRS -H Form 4015, Mar 92 (Obsoletes previous editions whi h may not be used) Page 3 of 3
(Stock Number: 5744- 003 - 4015 -1)
7b,ENC HIV: 'ail
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arty `.CG!i!P7!`:i °e"!? 'i : _ .... : ,Q '.0 Q7
3 Signature of evslutto: -, title, .
.... ' \...Jn. ��: ..::f: (IT 6Vi :'.Ci!Q:!. ....... ,,,,;,.IInt:S engine= ':+u:,2
.3vA" . :OiU / !CfE;70:E
SH'H'IE 3
H SNOT
APPLICANT: MANDEL
LOT: NA BLOCK: NA
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
CONSTRUCTION PERMIT
Authority: Chapter 381,- FS & Chapter 10D -6, FAC
CONSTRUCTION PERMIT FOR:
[ NJ New - System [N ] Existing System [N ] Holding Tank [N ] Temporary /Experimental
( Repair [N ] Abandonment [N ] Other(Specify)
PROPERTY STREET ADDRESS: 797 NE 94 STREET, 33138
SUBDIVISION:
NA
PROPERTY ID #: [ SECTION /TOWNSHIP /RANGE /PARCEL NUMBER]
797 NE 94 STREET, MIAMI SHORES [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.
SYSTEM DESIGN ANDSPECIFICATIONS
T [ 00] [GALLONS / GP PTIC TAN /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 [ 300 ] SQUARE FEET PRIMARY DRAINFIELD SYSTEM
R [ ] SQUARE FEET S YSTEM
D
A TYPE SYSTEM: [ X] STANDARD [ " ] FILLED [ ki MOUND
I CONFIGURATION: [ y ] TRENCH [X ] BED OA]
N
F LOCATION OF BENCHMARK: � R/ v E f 5, 47 �S° ( P
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
L
D FILL REQUIRED: [ ] INCHES EXCAVATION REQUIRED: [ 3' ] INCHES
G INSTALL 12 OF LOAMY COARSE SAND UNDER BO MA
T
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g111FI t`1' ELM/UAW (WININUikl) o 5 • "
aYg fUN Off' M JAk iEL D ELWAIION (k'LI 91"(UN):
SPECIFICATIONS BY: TITLE:
APPROVED BY: �" % f-' TITLE: G
HRS-H Form 4016, Mar 92 (Obsoletes previous editions which may not be used)
(Stock Number: 5744 - 001 - 4016 -0)
AGENT: NORTH DADE SEPTIC TANK
PERMIT # (74(?C)S7-
DATE PAID lg. - ,.6- 6
FEE PAID $ -O •
RECEIPT #
[
CPHU
DATE ISSUED : ,- 2 THE SEPTIC TANK SHALL BE PUMPED AND A SOLID EXPIRATION DATE: S
DEFLECTION DEVICE INSTALLED ON THE OUTLET TEE°
Page 1 of 2
assigned by CPHij.
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1 n?.:1:y ow:; nr.r.12.
ru:nbc: for app!Icant or agent.
nvint:r's LEnliy aut2zoriY.ed
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rrumbe: fer p:4. (C?:. propnr,y (.z :7 or mct.;_on/ZownrY.pt:is.77,::./11:aveT.
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front CT1t:ptes :CAC.
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(C7t.!.S.J) r,:vfinn Jr apprav"...ng perrnit.
ila:ucc: by ".C.2}.11.1.
ist:ucii jf the no' I. 'At7ac!. Byste xpm bt:ccn vase 30 yc from Ale datz
Scale: Each block represents 5 feet and 1 inch = 50 feet.
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Notes:
Site Plan submitted by:
By
STATE'OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERV
APPLICATION FOR ONSIITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number
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HANDEL: 797 NE 94 STREET n 33138
OLD SYST` M OVERFLZZING
Y 1 1. _ _ cur•
Plan Approved
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ALL CHANGES MUST BE APPROV D 03Y TI.9E COUNTY PUBLIC HEALTH UNIT
HRS -H Form 4015, Feb 85 (Obsoletes previous editions which may not be used)
(Stock Number. 5744-002-4015-6)
PART 00 - SITE PLAN
SIGNATURE
Not Approved
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TITLE
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Date 2
County Public Unit
Page 2 of 3
96
01/