1235 NE 96 St (2)BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building N 1 C•'-, 4 .■ s tD W
Architect
Contractor y
or Builder f �' i •) +—
MIAMI SHORES VILLAGE, FLORIDA
❑ DATE 2. _ 3 19
° PERMIT N9 '719 9 Contractors . i � ie
❑ License No.
❑ Work to be performed under this Permit —_
+11..) rise`
4 --
Legal Lot Subdi-
Signed•
• /' -F--
CONTRACTOR OR BUILDER BY
r2 4 444 .
Description BI vision
Address of e G c:r Value of Amount of rsV Building 3 S Protect $ I I Permit $
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in t r. he j-"--1/4)
tion herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any
plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked
at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this
permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough Wledge of the ordinances and
regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements %or specificatii s and that he assumes respon-
sibility for work done by his agents, servants or employees.
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance th all ordinances mad regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper autho ies of Miami Shores Village. In ao
cepting this permit I assume responsibility for ell work done by either, myself, my agent, rvant ye employee.
INSPECTOR
AUTHORITY •O SOT 4139!*'
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION AND INSTALLATION PERMIT
Applicant tip ili.dr -i 3 -43 P,prmit Number 8' 7 / ,
lot 4-'S Al E�4 G— v L If o .
-7 1 4.0
PART II - SYSTEM INSTALLATION INSPECTION AND FINAL INSTALLATION APPROVAL
Installer LL-v y , b & v ' 7 ? - '-- Tank Manufacturer Wit
Proper tank legend: Yes P No Tank material C --( 4 Tank level: Yes ig1'a No
Tanks watertight: Yes Nia" No Tank size• gallons gallons J} gallons
Proper tank outlet device: YewYXI No Manhole or marker to grade: Yes frfr No
Drainfield Trench
Length Width Length Width
feet feet feet feet
feet feet feet feet
feet feet feet feet
Total = ft Total = ft
i
Systems located as permitted: Yes No
Systems including plumbing stub -outs installed at proper elevation:
Average depth to drainpipe invert from finished grade: 1' ''f inches
Average depth of drainfield gr vel: inches Minimum depth
gravel
Proper ravel size: Yes No Gravel is suitable
P
Backfill or fill material as required: (Quality) Yes 1 No
Other findings: /Z ) A - -
Inspected by: ' /-
Date Ol ll Approved by:
HRS —H Form 4016, Jan 86 (Replaces Feb 85 edition which may be used)
(Stock Number: 5744002 - 4016 -4)
PART F I IP LNSTALLATION APPROVAL
Absorption Bed
Length a21 feet x L fl feet = ft
Length —' - feet x 41 " feet = ft
Proper No. drainlines: Yes ( No (
Proper pipe separation: Yes ✓ No
Distribution box level: Yes No Ant
Yes No P
Maximum depth: Inches
of gravel: Lb_�ches
quality: Yes No
(Quantity) Yes ' No
Date e Y 07
AN APPROVED INSTAL Y TION I OES NOT GUARANTEE PERFORMANCE
COUNTY PUBLIC HEALTH UNIT
Note: Completed copies of this form will be 'rovided to the applicant, installer and the building department.
Page 2 of 2
Notes
Site Plan Submitted by
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number
PART II - SITE PLAN
HRS-H Form 4015, Feb 65 (Obsoletes previous editions which may not be used)
(Stock Number: 5744-002-4015-6)
SIGNATURE
TITLE
Plan Approved Not Approved Date
By County Public Unit
ALL CHANGES MUST BE APPROVED BY THE COUNTY PUBLIC HEALTH UNIT
Page 2 of 3
Datt% 14'.9/98
Owner/Lessee / Tenant Mr . & Mr .
Owner's Address 1235 N. E. 96 S t.
Qualifier Carl C u n d i f f
State# 97 -9327
Job Address
Eat e—A,
Si atur
A.K.010
Irary as to Owner • d/or Condo President ate
My Commission expires:
MARK). 9CHBEK
24:7;1414 Publk`., Stated Fronds
5,
FEES: PERMIT q_s • RADON
.fit
APPROVED:
Zoning
Mechanical
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
1235 N.E. 96 St. Tax Folio
Legal Description
ContractingCo. Carl ' s Septic Service Inc.
Architect/Engineer Address
Bonding Company Address
Historically Designated: Yes No
W i 11 i a m s o n Master Permit #
Municipal # Competency #000900327 Ins. Co. G r a n a d a
Mortgagor Address
M
Permit Type (circle one): BUILDING ELECTRICA LU
BIN /MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION Install a New Drainfield.
Square Ft. 300 Estimated Cost (value) 1900 .0 0
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 and that all work will be done in compliance with all applicable
laws regulating construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated.
49
Y
a Dat
of owner
d/or Condo President
C.C.F. NOTARY
Phone 751 -8991
Address 10801– B– N.W.So. River Dr. 1
� Lr3 �Si
SS# Phone 826 -1418 33af
Signature of Contractor wner- Builder
�. `_
Notary as to Contractor or Owner- Builder
My Cq ^u� i °�i oi . �.
® ��,9' / I'U OFFICIAL NOTARY SEAL
aAN!RA M MONTIEL
N 4'. . �i S;OMMISSION NUMBER
, s A CC401211
t • Mr )MMISSiON , EXP .
1 - 1 AUG. 1y 1621
BOND
Date
3 - 6 ( r'
'2G
TOTAL DUE 39/.
CONSTRUCTION PERMIT FOR:
[!l] New System [t ] Existing System [ Holding Tank [ "I' Temporary /Experimental
[Li] Repair [4J] Abandonment [,J ] Other(Specify)
APPLICANT: /J
f
PROPERTY STREET ADDRESS: ,,
/. ":1 w-
LOT: BLOCK:
PROPERTY ID #:
6
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
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
``y �� 3 [SECTION /TOWNSHIP /RANGE /PARCEL NUMBER]
[OR TAX ID NUMBER]
T [ ` )] [GALLONS / GPD] SEPTIC TANK /AEROBIC UNIT CAPACITY
A [ ] [GALLONS / GPD] CAPACITY
N [
K [
MULTI- CHAMBERED /IN SERIES:[ ]
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: [ ]
D [
] SQUARE FEET PRIMARY DRAINFIELD SYSTEM
R [ ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [ 1 1 / ] STANDARD [ FILLED [ MOUND [A-4
I CONFIGURATION: ( TRENCH ['] BED [,,-J]
N
F LOCATION OF BENCHMARK: 'z --f ik-r= - c--.)'---i i `-
I ELEVATION OF PROPOSED SYSTEM SITE [ N)Yc5] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ .t / ' r,. ] [ INCHF /FT1 ,[ABOVE /$FLOW] BENCHMARK /RF�FER6pe POINT
r
] INCHES EXCAVATION REQUIRED: [ :33 ] INCHES
L
D FILL REQUIRED: [
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED: I
REPAIR
AGENT:
I 1 7
TITLE:
HRS -H Form 4016, Mar 92 (Obsoletes previou§ editions - whitti may,Tiot be used)
(Stock Number: 5744 - 001-4016 -0)
SUBDIVISION:
TITLE:
APPLICANT
4
PERMIT # r 8k ' - 6' ,0 Z
DATE PAID 2- _ - 1 8
FEE PAID $ ;S D . °
RECEIPT # rte, L . 7
EXPIRATION DATE:
-t
CPHU
B
Page `l of 2
uNS RIK TtONS:
Pam :7 NUMBER: Permit tracking number assigned by CPH:J.
APPL'- CATION 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.
ibMAILIN' ADDRESS: P.O. box or street mailing ac:d_ess for applicant or agent.
SYSTEM DESIGN AND
SPECIFICATIONS:
LOT, BLOCK, SUBDIVISION or
PROPERTY MI!: 27 character id number for property. (CPHU may require property appraiser ID 1) or section/township /range /parcel number)
.
TANK: Minimum specifications from Chapter I0D -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.
PROPERTY ID #:
LOT: BLOCK:
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
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:
TOTAL ESTIMATED SEWAGE FLOW:
AUTHORIZED SEWAGE FLOW:
UNOBSTRUCTED AREA AVAILABLE:
THE MINIMUM SETBACK WHICH
SURFACE WATER: �' FT
WELLS: PUBLIC: J;: / /4- FT
BUILDING FOUNDATIONS:
BENCHMARK /REFERENCE POINT LOCATION:
SOIL PROFILE INFORMATION SITE 1
L» ]
ELEVATION OF PROPOSED SYSTEM SITE IS
SITE SUBJECT TO FREQUENT FLOODING: [ ] YES
10 YEAR FLOOD ELEVATION FOR SITE:
Munsell f /Color
USDA SOIL SERIES:
Texture
�A. ' ;
i
Depth
°i to
to
to
to
to
to
to
to
to
SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING:
DRAINFIELD CONFIGURATION: [ ] TRENCH (`.') BED
REMARKS /ADDITIONAL CRITERIA:
5`
P l,:
HRS - Form 4015, Mar 92 (Obsotetes previous editions which may not be used)
(Stock Number: 5744 - 003 - 4015 -1)
SITE EVALUATED BY:
AGENT:
PERMIT
it
[Section /Township /Range /Parcel No. or Tax ID Number]
YES [ ] NO NET USABLE AREA AVAILABLE: / /7' ACRES
GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2]
GALLONS PER DAY [1500 GPD /ACRE OR 2500 GPD /ACRE]
SQFT UNOBSTRUCTED AREA REQUIRED: i,,, K)li SQFT
y �
[INCHES /FT] [ABOVE /HiLOW N HMAR* /REFERENCE POINT
CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES:
DITCHES /$WALES: a r -' FT NORMALLY WET? [ ] YES CO
LIMITED USE: _ 'fit FT PRIVATE: f,/,A- FT NON- POTABLE: / FT
FT PROPERTY LINES: " FT POTABLE WATER LINES: /D FT
(,J NO
FT MSL /NGVD SITE ELEVATION: ,/ . cFT MSL /NGVD
SOIL PROFILE INFORMATION SITE 2
Munsell #/Color Texture Depth
b ,` _:;q A t i' O
to
to
to
to
to
to
to
to
USDA SOIL SERIES:
4
OBSERVED WATER TABLE: 0411 INCHES [ABOVE /-`BELOW) EXISTING GRADE. TYPE: jPERCHED /i,APPARENF)
ESTIMATED WET SEASON WATER TABLE ELEVATION: ■ , �- INCHES [ ABOVE / QJJJ] EXISTING GRADE.
HIGH WATER TABLE VEGETATION: [ ] YES ( ] NO MOTTLING: [ ] YES [ ] NO DEPTH: INCHES
[ ) OTHER (SPECIFY)
10 YEAR FLOODING? [ ] YES [`c] NO
DEPTH OF EXCAVATION: -3! -' INCHES
DATE:
Page - 3 of 3
SEWAGE FLOW:
UNOBSTRUCTED AREA:
MINIMUM SETBACKS:
INSTRUCTIONS:
PERMIT h: Permit tracking number assigned by CPHU. Ai,
APPLICANT: Property owner's full name.
AGENT: Property owner's legally authorized representative.
LOT, BLOCK, SUBDIVISION: Lot, block, and subdivision for lot.
PROPERTY ID#: 27 character number for property. (property appraiser ID 0 or section/township /range /parcel number)
PROPERTY SIZE: Check if property size at site conforms to submitted site plan. Record net usable area available - lot area exclusive of
all paved areas and prepared road beds within public rights- of-way or easements and exclusive of atreama, lakes,
normally wet drainage ditches, marshes, or other such bodies of water.
Record the estimated sewage flow for the establishment from Table 1 (residences) or Table 2 (non - residential), Chapter
10D -6, FAC. Record the authorized sewage flow for the lot based on net usable area and water supply (1500 gallon
per day per acre for private water supplies and 2500 gpd per acre for public water supplies). If authorized =age flow
does not equal or exceed the estimated sewage flow, the application must be denied.
Record the square feet of unobstructed area available and the amount required. Unobstructed area must be at least 2
times as large as the drainfield absorption area and at least 75 percent of the unobstructed area must meet minimum
setbacks in Chapter IOD-6, FAC. The unobstructed area must be contiguous to the drainfreld.
BENCHMARK INFORMATION: Record the location of the benchmark. If using a surveyor's benchmark record the actual elevation. Record the
elevation of the proposed system site in relation (above or below) to the benchmark.
Record minimum setbacks which can be meet to all listed features. Actual measurements must be recorded or 'NA"
for non applicable features. Features on site plan or within 75 feet of the applicant lot must be measured. The location
of any public drinking well within 200 feet of the applicant's lot muss also be verified.
FLOOD INFORMATION: Record information on lot's subject to flooding. For lots subject to flooding record 10 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 or 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 series cannot be determined.
WATER TABLE: Record the depth of the observed water table at the time of the evaluation. Mark "perched" or "apparent' es
.appropriate. Record the estimated wet season water table elevation based on site evaluation, USDA roil 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.
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 EVALUATED BY: Signature of evaluator, title, and date of evaluation. Professional engineers must seal all documentation submitted.
ELEVATION WORKSHEET ELEVATION OF BENCHMARK / REFERENCE POINT IS:
BENCHMARK SITE I SITE 2 SITE 3
[ +] SHOT: H.I. H.I. H.I.
H.I. ( -1 SHOT [ -] SHOT [ -] SHOT