42 NE 96 St (9)L
FLORIDA
DEPARTMENT
OF HEALTH
APPROVED
(305) 5i 3 -3459
APPLICANT:
AGENT:
PROPERTY ADDRESS:
LOT:
ass:s sss ssss:s:ss sassasasssas:ssasasssssssummumn sssassasmssssaas==== =s= c=c=== ==
CHECKED [X] ITEMS ARE NOT IN COMPLIANCE
==============i======================
TANK
[01]
[02]
[03]
[04]
[05]
[06]
[07]
[08]
[09]
DRAINFIELD INSTALLATION
[10] AREA [1]/ [2] >'
[11] DISTRIBUTION BOX _
[12] NUMBER OF DRAINLINES
[13] DRAINLINE SEPARATION
[14] DRAINLINE SLOPE
[15] DEPTH OF COVER
[16] ELEVATION [ABOVE /BELOW] BM
[17] SYSTEM LOCATION
[18] DOSING PUMPS
[19] AGGREGATE SIZE r c..
[20] AGGREGATE EXCESSIVE FINES
[21] AGGREGATE DEPTH
FILL
[22]
[23]
[
[25]
[26]
BLOCK: SUBDIVISION:
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DIPOSAL SYSTEM
CONSTRUCTION INSPECTION AND FINAL APPROVAL
INSTALLATION
TANK SIZE [1]
TANK MATERIAL
OUTLET DEVICE
MULTI- CHAMBERED
OUTLET FILTER
LEGEND
WATERTIGHT
LEVEL
DEPTH TO LID
[
[ Y /' l
/ EXCAVATION MATERIAL
FILL AMOUNT
FILL TEXTURE
EXCAVATION DEPTH
AREA REPLACED
REPLACEMENT MATERIAL`.•
EXPLANATION OF VIOLATIONS / REMARKS:
[
[
[ ]
•[. ]„
_ SQFT
HEADER
WITH STATUTE OR RULE AND MUST BE CORRECTED.
l
]
l
l
1
l
1
[4 [27]
[ '] [
PERMIT NO.
DATE PAID:
FEE PAID:
RECEIPT 1:
PROPERTY ID #:.
SETBACKS
SURFACE WATER
DITCHES
PRIVATE WELLS
If ] [
[t ] .[30] PUBLIC WELLS
[ 4 ] [31 ] IRRIGATION WELLS
[ ] (32]"'° POTABLE WATER LINES
[ ] [33] BUILDING FOUNDATION
[ ] [34] PROPERTY LINES
[ ] [35] OTHER
FILLED / MOUND SYSTEM
[36] DRAINFIELD COVER
[37] SHOULDERS
[38] SLOPES
[39] STABILIZATION
ADDITIONAL INFORMATION
[40] UNOBSTRUCTED AREA
[41] STORMWATER RUNOFF
[42] ALARMS
[43] MAINTENANCE AGREEMENT
[44] BUILDING AREA
[45] LOCATION CONFORMS WITH SITE PLAN
[46] FINAL SITE GRADING
[47) CONTRACTOR f - , „7 t• • '
[48] OTHER
ABANDONMENT
[49] TANK PUMPED _ /_ /
[50] TANK CRUSHED & FILLED
FT
FT
FT
FT
FT
FT
FT
FT
FT
l,r
1111h Editions May Be Used)
)
CTION 1
CONSTRU . l�
(APPAOVgn /nisAppAOVSnt: ?;. , CHD DATE:
CHD DATE
Page 2 of 3
'Installer / Contractor
LOT: 6
STATE OF FLORIDA
DEPARTMENT OF HEALTH
• ,r_ONSITE SWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR:
[ ]New System [ ]Existing System [
[ X ]Repair [ ]Abandonment
APPLICANT: Grimes, Roger AGENT: SR0001343, Crockett Lester
PROPERTY STREET ADDRESS: 42 NE 96 St Miami Shores FL 33138
BLOCK: 5 SUBDIVISION: Miami Shores
[Section /Township /Range /Parcel No.]
PROPERTY ID #: 11- 3206 - 013 -0640 [OR TAX ID NUMBER]
CENTRAX #: 13 -SG -20248
DATE PAID:
FEE PAID : $
RECEIPT .
OSTDSNBR : 04 -1218- -R
]Holding Tank [ ] Innovative Other
]Temporary [ NA ]
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 ( . 1050 ] Gallons SEPTIC TANK
A [ 0 ]Gallons
N [ 0 ]GALLONS GREASE INTERCEPTOR CAPACITY
K [ 0 ]GALLONS DOSING TANK CAPACITY [ 0 ]GALLONS @ [0
D [ 300 ]SQUARE FEET PRIMARY DRAINFIELD SYSTEM
R [ 0 ]SQUARE FEET SYSTEM
A TYPE SYSTEM: [ N ]STANDARD [ N ]FILLED
I CONFIGURATION: [ N ]TRENCH [ N ]BED
N
F
I
E
L
D
LOCATION TO BENCHMARK: Finished Floor of Existing Residence Elev. 12.9' NGVD
ELEVATION OF PROPOSED SYSTEM SITE [ 1.8 ] [ FEET ] [ BELOW BENCHMARK /REFERENCE
BOTTOM OF DRAINFIELD TO BE [ 4.3 ] [ FEET ] [ BELOW BENCHMARK /REFERENCE
FILL REQUIRED: [ 0.0 ]INCHES EXCAVATION REQUIRED: [ 30.0 ] INCHES
OTHER REMARKS:
1- Existing 1050 gals. septic tank to remain.
2- Install 300 sq. ft. drainfield in bed configuration.
3- Invert elevation of drainfield to be no less than 9.10' NGVD.
4- Bottom of drainfield elevation to be no less than 8.60' NGVD.
SPECIFICATIONS BY: Andre, Paul
APPROVED BY: Andre, Paul
DATE ISSUED: 3/31/04
DH 4016, 03/97 (Obsoletes previous editions which may 4tot be used)
-.......,\\) TITLE:
MULTI - CHAMBERED /IN SERIES: [Y ]
MULTI - CHAMBERED /IN SERIES: [Y ]
]DOSES PER 24 HRS # PUMPS[ 0 ]
[ N ]MOUND [ N ]
[ N ]
TITLE: Professional Engin Dade
EXPIRATION DATE: 6/29/04
POINT
POINT
CHD
Deno 1 �� ')
it
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION P MI/11T
Permit Application -Numb r
Scale: Each block represents 5 feet and 1 inch = 50 feet.
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PART II - SITE PLAN -
/4
Notes:
&AM --PC/A/ ce€4,g- —� C a J - /.-e/de- • 4' A)-E=
Site Plan submitted b
Plan Approved
By
6/4
Signature^
Not Approved
ALL CHAN ES MUS BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
DH 4015. 10/96 (Replaces HRS-H Fan' 4015 which may i s used)
(Stook Number: 5744 -002. 4015.8)
a: 7)7/C 3 A)
Title
Date
County Health Department
Page 2 of 3
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
APPLICANT: 6- AGENT: L £ O /D 41.1O , PT. = 1)/4 17 Z : 45C /G
LOT: ( BLOCK: _S` SUBDIVISION: fp/ / A �� / � 5
PROPERTY ID #: // - O 64 O [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.
YES [ ] NO NET USABLE AREA AVAILABLE: ...2r ACRES
GALLONS PER DAY Tj SIDENCES -TABLE 1.J OTHER -TABLE 2]
GALLONS PER DAY [1500 GPD /ACRE OR 2500 GPD /ACRE]
SQFT UNOBSTRUCTED AREA REQUIRED: 6(7) SQFT
BENCHMARK /REFERENCE POINT LOCATION: r / /0 //L2 f LL`bJ ' \,
ELEVATION OF PROPOSED SYSTEM SITE IS p_f [INCHES) [ABOVE /BELOW
PROPERTY SIZE CONFORMS TO SITE PLAN: [ �]
TOTAL ESTIMATED SEWAGE FLOW: 25(..:2)
AUTHORIZED SEWAGE FLOWN 6a
UNOBSTRUCTED AREA AVAILABLE: -Y-30
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES:
SURFACE WATER: /'J- /f 4 FT DITCHES /SWALES: /U•/7. FT NORMALLY WET? [ ] YES'U4 [ ] NO
WELLS: PUBLIC: A.44. FT (( LIMITED USE: 4/.41. FT PRIVATE: /UA • FT NON- POTABLE: j) FT
BUILDING FOUNDATIONS: .1
FT PROPERTY LINES: FT POTABLE WATER LINES: /9 FT
SITE SUBJECT TO FREQUENT FLOODING: [ ] YES (PI 10 YEAR FLOODING? [ ] YES [�] / NO
10 YEAR FLOOD ELEVATION FOR SITE: r 3.,� MSI./NGVD SITE ELEVATION: //,/ ! NGVD
SOIL PROFILE INFORMATION SITE 1
Munsell #/Color Texture
/0 'I /l L0/74T/
/0 `/R 7/i ..5 Ail) /o"
G AL=
.5)•=i4)
1/ /1
/ /
1 !
/'
USDA SOIL SERIES: OP /tJLA/(2
Depth
0 // to
to
to
to
to
to
to
to
to
OBSERVED WATER TABLE: /1)A• INCHES [ABOVE /
ESTIMATED WET SEASON WATER TABLE ELEVATION-:
HIGH WATER TABLE VEGETATION: [ ] YES [ ] NO
SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING:
DRAINFIELD CONFIGURATION: [ ] TRENCH [
REMARKS /ADDITIONAL CRITERIA:
/•
BELOW] EXISTING - GRADE.
97. 1, ( INCHES ABO
MOTTLING: ] YES
[
BED [ ] OTHER (SPECIFY)
SOIL PROFILE INFORMATION SITE 2
/ x�
r r' ( cs
BENCHMARK /REFERENCE POINT
Munsell # /Color
l� yp
(,RL=`/
/p er/P 7/2
/ (
if
I(
/(
/ /
Texture
L oam y
AID
/r
1'
USDA SOIL SERIES: (,): j4/Lfal,0
Depth
O// to
to /0-/
/6" to
to
to
to
to
to
// to 7�"
TYPE: (PERCHED'/ APPARENT]
-I EXISTING GRADE.
NO DEPTH: /(JA INCHES
DEPTH OF EXCAVATION: 39 INCHES
SITE EVALUATED BY: � .� .�(/�- __�- -' �r G � DATE: v • 3 /- DC/
C Cy/?OC � //
OH 4015, 10/96 (Replaces HRS -H Form 4015 [Page 3[ which may be used)
(Stock Number: 5744- 003 - 4015 -1)
Page 3 of 3