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546 NE 97 St (5)Fig en • • 11 !. ff • A I 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 8/16/2005 Applicant: KENNETH Owner: KODISH JOB ADDRESS: 546 NE Contractor Local Phone: 305 - 754 -3375 Parcel # 1132060171520 97 Signed: (INSPECTOR) PM Signed: (Contractor or Builder) KODISH KENNETH ST Permit Status: APPROVED Permit Expiration: 2/7/2006 Construction Value: $1,200.00 Work: REPLACE DRAINFIELD BY: Permit Number: PL2005 -253 LLOYD NORTH DADE SEPTIC TANK SERVIDEdNti'actor's Address: 750 NW 107 ST Page 1 of 1 Legal Description: MIAMI SHORES SEC 4 AMD PB 15 -14 LOT 4 & LOT 5 BLK 99 LOT SIZE Fees: FEE2005 -11229 FEE2005 -11230 FEE2005 -11231 FEE2005 -11232 FEE2005 -11233 FEE2005 -11234 FEE2005 -11235 Description Building Fee CCF Notary Fee Training and Education Fee Technology Fee Scanning Fee Builders Bond Total Fees: Amount $175.00 $1.20 $5.00 $0.40 $4.40 $3.00 $300.00 $489.00 Total Fees: $489.00 Total Receipts: $489.00 NOV 15 PAID In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responisibility for all work done by either myself, my agent, servants or employes. Inspection Number: INSP-5383100 Permit Number: PL2005 -253 Inspection Date: 01/06/2006 Inspector: Levrack, James Owner: KODISH, VALA Job Address: 546 97 Street NE Project: <NONE> Miami Shores Village, FL 33138- Contractor: LLOYD NORTH DADE SEPTIC TANK SERVICE INC Building Department Comments Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Block: Permit Type: Imported Permit Inspection Type: Final Work Classification: Septic Phone Number Parcel Number 1132060171520 Lot: Phone: 305 - 754 -3375 Friday, January 6, 2006 Page 1 of 2 Passed Insptictot Comments ,,. i ,. , ° Failed Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled re- inspection fee is paid. until Inspection Number: INSP-5383100 Permit Number: PL2005 -253 Inspection Date: 01/06/2006 Inspector: Levrack, James Owner: KODISH, VALA Job Address: 546 97 Street NE Project: <NONE> Miami Shores Village, FL 33138- Contractor: LLOYD NORTH DADE SEPTIC TANK SERVICE INC Building Department Comments Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Block: Permit Type: Imported Permit Inspection Type: Final Work Classification: Septic Phone Number Parcel Number 1132060171520 Lot: Phone: 305 - 754 -3375 Friday, January 6, 2006 Page 1 of 2 Inspection Number: INSP -5383 Permit Number: PL2005 -253 Inspection Date: 01/06/2006 Inspector: Levrack, James Owner: KODISH, VALA Job Address: 546 97 Street NE Project: <NONE> Contractor: LLOYD NORTH DADE SEPTIC TANK SERVICE INC Building Department Comments Friday, January 6, 2006 Miami Shores Village, FL 33138- Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Block: Permit Type: Imported Permit Inspection Type: Final Work Classification: Septic Phone Number Parcel Number 1132060171520 Lot: Phone: 305 - 754 -3375 Page 2 of 2 Passed /' / " Comments ' �� _, �t „ ' Failed Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled re- inspection fee is paid. until Inspection Number: INSP -5383 Permit Number: PL2005 -253 Inspection Date: 01/06/2006 Inspector: Levrack, James Owner: KODISH, VALA Job Address: 546 97 Street NE Project: <NONE> Contractor: LLOYD NORTH DADE SEPTIC TANK SERVICE INC Building Department Comments Friday, January 6, 2006 Miami Shores Village, FL 33138- Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Block: Permit Type: Imported Permit Inspection Type: Final Work Classification: Septic Phone Number Parcel Number 1132060171520 Lot: Phone: 305 - 754 -3375 Page 2 of 2 // Passed a Inspectoromments J J I Failed Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled re- inspection fee is paid. until Inspection Number: INSP -5384 Inspection Date: 01/06/2006 Inspector: Levrack, James Owner: KODISH, VALA Job Address: 546 97 Street NE Project: <NONE> Friday, January 6, 2006 Miami Shores Village, FL 33138- Contractor: LLOYD NORTH DADE SEPTIC TANK SERVICE INC Building Department Comments Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Block: Permit Number: PL2005 -253 Permit Type: Imported Permit Inspection Type: Landscaping Work Classification: Septic Phone Number Parcel Number 1132060171520 Lot: Phone: 305 - 754 -3375 Page 1 of 2 H Passed 1 4n Pecto f Comments Y I , / Failed Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled re- inspection fee is paid. until Inspection Number: INSP -5384 Inspection Date: 01/06/2006 Inspector: Levrack, James Owner: KODISH, VALA Job Address: 546 97 Street NE Project: <NONE> Miami Shores Village, FL 33138- Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Contractor: LLOYD NORTH DADE SEPTIC TANK SERVICE INC Building Department Comments Friday, January 6, 2006 Block: Permit Number: PL2005 -253 Permit Type: Imported Permit Inspection Type: Landscaping Work Classification: Septic Phone Number Parcel Number 1132060171520 Lot: Phone: 305 - 754 -3375 Page 2 of 2 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 • Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING Z^ �' � �'` ' '..-- ' Permit No P -263 PERMIT APPLICATION 40G � Master Permit No. FBC 2001 Permit Type (circle): Building Electrica Plumbing Mechanical Roofing Owner's Name (Fee Simple Titleholder) &L 1)CT/ k©E1 /e.51 Phone # 7S( " i - // Owner's Address City rnIts/nt c /-1OZ3 State CA., Zip 33/3Y' Tenant/Lessee Name Phone # Job Address (where the work is being done) G' %�.)• [, `1 i 71/ City Miami Shores Village County Miami -Dade Zip 3 /Ot' Is Building Historically Designated YES NO Contractor's Company Name LLOYD AJ0?7 -/ Drat G Phone # Contractor's Address 7S A). 1/U /0 S272EL- 3316 k" City 1 in/ State t L . Zip Qualifier 1- /.7 L . C / ?O �z.�L i2 /3 443 Architect/Engineer's Name (if applicable) Phone # $ Value of Work For this Permit ' 'c CD. Square Footage Of Work: did 1 Type of Work: ❑Addition DAlteration ❑New L'f Repair/Replace Demolition Describe Work: RLPL.floc- scram/ A,'I /L-z2) (Continued on opposite side) 4 .51 E •••• * * * * * * * *a * * * *aa *a * * * *a F ees * * * * * * * * * * * * * * * * * * * * *as * * * * * ** Total Fee Now Due $ 4 84 • C Submittal Fee $ - Permit Fee $ 175. CCF $ 1 • Notary $ 5. 00 Training/Education Fee $ 0. Technology Fee $ 4 .4C) Scanning $ 3.00 Radon $ Bond $ 3004 CO Code Enforcement $ Structural Plan Review. $ 1 122 --- AUG 1 1 PAID LW > E4 Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC 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. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR EVIPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is ' In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature kk. \ -1,1:9-) Owner or Agent The fore _oing instrument was acknowledged before me this 11 day of _, . ' 0.3: by kEEwJL7'-1 ,C ±D/ci9 , who is personally known to me Chc 10/14/03 My Commission Expires: — p- State Certificate or Registration No. ************** * * * * * * * * * * * * * * * * * * * * * * * ***** * * ** APPLICATION APPROVED BY: / LJ r who has produced cation and who did take an oath. Signature Zip Contractor The foregoing instrument was acknowledged before me this day of ,20by who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: (Certificate of Competency Holder) ertificate of Competency No. * * * ** ************************ * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** l 2 '17 Plans Examiner Engineer Zoning CONSTRUCTION PERMIT FOR: [ ]New System [ ]Existing System [ [ X ]Repair [ ]Abandonment APPLICANT: Kodish, Kenneth & Vala AGENT: SR0931123, Bryant Roland PROPERTY STREET ADDRESS: 546 NE 97 St Miami Shores FL 33138 LOT: 4 BLOCK: 99 PROPERTY ID #: 11- 3206 - 017 -1520 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 [ 900 ]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: ]STANDARD [ N ]FILLED [ N ]MOUND [ N ] I CONFIGURATION: [ N ]TRENCH y ]BED [ N ] N F LOCATION TO BENCHMARK: Crown of Road EL: 9.1' NGVD I ELEVATION OF PROPOSED SYSTEM SITE [ 0.7 ] [ FEET ] [ BELOW BENCHMARK /REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 3.2 ] [ FEET ] [ BELOW BENCHMARK /REFERENCE POINT L D FILL REQUIRED: [ 0.0 ]INCHES EXCAVATION REQUIRED: [ 54.0 ] INCHES OTHER REMARKS: 1 - Install 900 gal. category -2 septic tank equipped with an approved filter. 2 -The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance with sec. 64E- 6.013(3)(f), FAC. 3 - Install 300 sf of drainfield in bed configuration. 4 - Install 24" of slightly limited soil under the bottom of drainfield. 5 - Perimeter of excavation area shall be at least 2 ft. wider and longer than the proposed absortion bed. 6 - Invert elevation of drainfield to be no less than 6.4' NGVD. 7 - Bottom of drainfield elevation to be no less than 5.9' NGVD. This permit is NOT for Addition(s). SPECIFICATIONS BY: Millan, Jorge APPROVED BY: Milian, Jorge DATE ISSUED: 8/9/05 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT Jar r ]Holding Tank [ ] Innovative Other ]Temporary [ NA ] SUBDIVISION: Miami Shores Sec 4 [Section /Township /Range /Parcel No.] [OR TAX ID NUMBER] TITLE: pia TITLE: Engineer I CENTRAX #: 13 -SG -26081 DATE PAID: FEE PAID : $ RECEIPT . OSTDSNBR : 05 -2650- -R MULTI - CHAMBERED /IN SERIES: [Y ] MULTI - CHAMBERED /IN SERIES: [Y ] ]DOSES PER 24 HRS # PUMPS[ 0 ] Dade CHD EXPIRATION DATE: 11/7/05 DH 4016, 03/97 (Obsoletes previous editions which may not be used) (Stock Number: 5744- 001 - 4016 -0) [ostds_cons_4016 -1] Page 1 of 2 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM ' CONSTRUCTION PERMIT t iA CONSTRUCTION PERMIT FOR: [ ]New System [ ]Existing System [ [ X ]Repair [ ]Abandonment APPLICANT: Kodish, Kenneth & Vala ]Holding Tank PROPERTY STREET ADDRESS: 546 NE 97 St Miami Shores FL 33138 LOT: 4 BLOCK: 99 PROPERTY ID #: 11- 3206 - 017 -1520 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 [ 900 ]Gallons SEPTIC TANK A [ 0 ]Gallons N [ 0 ]GALLONS GREASE INTERCEPTOR CAPACITY K [ 0 ]GALLONS DOSING TANK CAPACITY [ 0 ]GALLONS @ D [ 300 ]SQUARE FEET PRIMARY DRAINFIELD SYSTEM R [ 0 ]SQUARE FEET SYSTEM A TYPE SYSTEM: ]STANDARD [ N ]FILLED I CONFIGURATION: [ N ]TRENCH E ]BED N F LOCATION TO BENCHMARK: Crown of Road EL: 9.1' NGVD I ELEVATION OF PROPOSED SYSTEM SITE [ 0.7 ] [ FEET ] [ BELOW BENCHMARK /REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 3.2 ] [ FEET ] [ BELOW BENCHMARK /REFERENCE POINT L D FILL REQUIRED: [ 0.0 ]INCHES EXCAVATION REQUIRED: [ 54.0 ] INCHES OTHER REMARKS: 1 - Install 900 gal. category -2 septic tank equipped with an approved filter. 2 -The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance with sec. 64E- 6.013(3)(f), FAC. 3 - Install 300 sf of drainfield in bed configuration. 4 - Install 24" of slightly limited soil under the bottom of drainfield. 5 - Perimeter of excavation area shall be at least 2 ft. wider and longer than the proposed absortion bed. 6 - Invert elevation of drainfield to be no less than 6.4' NGVD. 7 - Bottom of drainfield elevation to be no less than 5.9' NGVD. This permit is NOT for Addition(s). SPECIFICATIONS BY: Millan, Jorge APPROVED BY: Milian, Jorge DATE ISSUED: 8/9/05 TITLE: DH 4016, 03/97 (Obsoletes previous editions which may not be used) (Stock Number: 5744- 001 - 4016 -0) [ostds cons 4016 -1] ]Temporary [ NA ] AGENT: SR0931123, Bryant Roland SUBDIVISION: Miami Shores Sec 4 [Section /Township /Range /Parcel No.] [OR TAX ID NUMBER] TITLE: Engineer I CENTRAX #: 13 -SG -26081 DATE PAID: FEE PAID : $ RECEIPT . OSTDSNBR : 05 -2650- -R [ ] Innovative Other MULTI - CHAMBERED /IN SERIES: [Y ] MULTI - CHAMBERED /IN SERIES: [Y ] [0 ]DOSES PER 24 HRS # PUMPS[ 0 ] [ N ]MOUND [ N ] [ N ] Dade CHD EXPIRATION DATE: 11/7/05 Page 1 of 2 APPLICANT: LOT: THE MINIMUM SETBACK WHICH SURFACE WATER: ' FT WELLS: PUBLIC: ?\ FT BUILDING FOUNDATIONS: '/a a BLOCK: SITE EVALUATED BY: STATE OF FLORIDA DEPARTMENT OF HEALTH y?NSITE SEWAGE DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS PROPERTY ID #: PROPERTY SIZE CONFORMS TO SITE PLAN: TOTAL ESTIMATED SEWAGE FLOW: AUTHORIZED SEWAGE FLOW: UNOBSTRUCTED AREA AVAILABLE: SITE SUBJECT TO FREQUENT FLOODING: [ ] YES (-1 NO SOIL PROFILE INFORMATION SITE 1 Munsell # /Color Texture USDA SOIL SERIES: c Depth to to to to to to to to to SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: = :`; DRAINFIELD CONFIGURATION: [ ] TRENCH [] BED REMARKS /ADDITIONAL CRITERIA: DH 4015, 10/96 (Replaces HRS -H Form 4015 [Page 31 which may be used) (Stock Number: 5744- 003 - 4015 -1) SUBDIVISION: (,i YES ( ] GALLONS GALLONS SQFT AGENT: PERMIT # [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. NO NET USABLE AREA AVAILABLE: ACRES PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2] PER DAY [1500 GPD /ACRE CR 2500 GPD /ACRE] UNOBSTRUCTED AREA REQUIRED: SQFT BENCHMARK /REFERENCE POINT LOCATION: ELEVATION OF PROPOSED SYSTEM SITE IS ( [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES: DITCHES /SWALES: FT NORMALLY WET? [ ] YES LIMITED USE: FT PRIVATE: FT NON- POTABLE: FT PROPERTY LINES: FT POTABLE WATER LINES: 10 YEAR FLOODING? [ ] YES [ 1 NO 10 YEAR FLOOD ELEVATION FOR SITE: z FT MSL /NGVD SITE ELEVATION: FT MSL /NGVD SOIL PROFILE INFORMATION SITE 2 Munsell # /Color Texture Depth to to to to to to to to to USDA SOIL SERIES: [ ] OTHER (SPECIFY) DATE: [ . J NO FT FT OBSERVED WATER TABLE: INCHES [ABOVE / BELOW] EXISTING GRADE. TYPE: [PERCHED / APPARENT] ESTIMATED WET SEASON WATER TABLE ELEVATION: INCHES [ ABOVE / BELOW ] EXISTING GRADE. HIGH WATER TABLE VEGETATION: [ ] YES [r] NO MOTTLING: [ ] YES [ NO DEPTH: INCHES DEPTH OF EXCAVATXON: ;INCHES Page 3 of 3 1 1NSTRUCTIONS: • PERMIT NUMBER: Permit tracking number by County Health Department. APPLICANT: Property owner's full name. AGENT: Property owner's legally authorized representative. LOT, BLOCK, SUBDIVISION: Lot, block, and subdivision for lot. PROPERTY ID NUMBER: 27 character number for property (property appraiser ID number or section /township /range /parcel number). PROPERTY SIZE: Check if property 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 streams, lakes, normally wet drainage ditches, marshes, or other such bodies of water. SEWAGE FLOW: UNOBSTRUCTED AREA: MINIMUM SETBACKS: Record the estimated sewage flow for the establishment from Table 1 (residence) 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 gallons per day per acre for private water supplies and 2500 gpd per acre for public water supplies). If authorized sewage 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 10D -6, FAC. The unobstructed area must be contiguous to the drainfield. 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 nonapplicable 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 must 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" 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. DEPTI -1 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 documents submitted. ELEVATION WORKSHEET ELEVATION OF BENCHMARK / REFERENCE POINT IS: BENCHMARK SITE 1 SITE 2 SITE 3 [ + 1 SHOT H.I. H.1. H.I. H.I. [ - ]SHOT [ - ]SHOT [ - ] SHOT ly Each block represents 5 feet and 1 inch = 50 feet. j - t STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PEWIT , �.., Permit Application Numbet 1 4 4 iite Plan submitted by: 'Ian Approved ✓ i. xi tit 300sq # D dinfield 1 ' } 4- Proposed 300sq Driinfield - • T •r 000gaI tank PART II - SITE PLAN Lot Size 3,019 Sq Ft Pool Hou$e 546 NE 9,7 St. North -East 97 St. otes: System being replaced because drainfield failure. Roland Bryant 14015. 10/98 (Replaces HRS-H Form 1015 which may be used) ■w.i. Ii......e.. C9A I -M9. A M C.CI ti .ft Signature Not Approved Water line Contractor ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT Title Date u 6 (A- LTA (-) L ide County Health Department Page 2 of 3 RECEIVED FROM ACCOUNT PAYMENT BAL. DUE 0FOR RENT Q FOR OCASH FROM TO OCHECK MONEY ORDER BY' STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION AND INSTALLATION PERMIT Applicant Permit Nvinber - , ` 1 , R c l - _ Cs PART II S YSTEM INSTALLATION INSPECTION AND FINAL INSTALLATION PPROVAL- Installer U-� � � Tank Manufacturer Proper tank legend: Y Tanks watertight: Yes No Proper tank outlet device: Inspected by Ye Drainfield Trench No Tank material CA - 4 Tank level: Yes/ Tank size HRS —H Form 4016, Jan 86 (Replaces Feb 85 edition which may be used) (Stock Number: 5744.002-4016-4) ll,ength Width Length Width Manhole or marker to grade: Yes Absorption Bed Date 1) gallons gallons gallons No Length feet x y feet = .2 3-4" ft feet feet feet feet Length feet x __ feet = ft feet feet Alin feet feet Proper No. drainlines: Yes V No feet feet feet feet Proper pipe separation: Yes ?t No Total = ft Total = ft Distribution box level: Yes No _jam Systems located as permitted: Yes No Systems including plumbing stub -outs installed at proper elevation: Yes Jdf i4 No Average depth to drainpipe invert from finished grade: inches Maximum depth: -LY Inches Average depth of drainfield gravel: 13 inches Minimum depth of gravel inches Proper gravel size: Yes • No Gravel is suitable quality: Yes i No___ 13ackfill or fill material as required: (Quality) Yes / No (Quantity) Yes ' No Other findings. 7 PART III - FINAL NSTALLATION APPROVAL- ec, � � Datei)' © Approved by:. - ' - -'�, ez- �--- F° C UNTY PLBLIC HEALTH UNIT AN APPROVED INSTALLATION DOES NOT GUARANTEE PERFORMANCE Note: Completed copies of this form will be provided to the applicant, installer and the building department. Page 2 of 2 E UILDING ELECTIIAL PLUMBINvf Contractor or Builder- - Legal Description e I Work to be performed under this Permit Owner Building Lot In consideration of pertaining thereto and in In accepting this permit I CONTRACT L l OH OR B6LDV,R PERMIT N° 6426 Architect MIAMI SHORES VILLAGE, FLORIDA DATE 194_2 / L Bl. Subdi- vision Address of Value of Building / f" ' , j/ Project Contractor's License No. 1 t... This permit is granted to the contrac or or builder named above to construct the building or to install the equipment or device described in the appli- cation 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 knowledge • ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawg or in t tatemeyfs or spe fj tior s, an . at e ..sumes respon- Signed • sibility for work done by his agents, servants or employees. % j ; ` ' ` ` ' �'tt t � [ N ' C Z , hNSPE OR the issuance to me of this permit I agree to perforpl the work covered hereunder in compliance with .all.ordinances and{egylagonS`; strict conformity with the plans, drawings, st "tements or specifications submitted to the proper authorities of Miami Shotefi'Vifl age. assume responsibility for all work done by eit jet myself, my agent, servant or employee. Amt. of Permit BY AUTHORITY MIAMI SHORES VILLAGE, FLORID i . BUILDING ' ELECTRICAL PLUMBING Owner ¢1.- Buildi' r Work to be perf rmed undgr this Permit / l O -- Architect Contractor or Build Legal L9( Description Address of , .- Building `) - 16 �..� This permit is granted to the contractor or uilder named abode to construct the building or to install the equipment or device described in the appli- cation 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 pefmit is granted is the understanding that the contractor or builder named above assumes the res onsibility for a thorough knowledge o -the rdinances and regulations pertaining to the work covered hereby whether shown on the plans or dra gs or i e st a cnts or speeiiiostions and t6he sumes respon- (. Signed; / i �1 ..^� �:� . By Y � } INSPE OR In cousideeation of the issuance to me of this permit I agree to perforpi the work covered hereunder in compliance with ordinances andjoreg.pkajoions, pertainingAtereto and in strict conformit with the plans, drawings stat a is or specifications submitted to the proper authorities of Miami Sh e illage:' In acceptj'ig this permit I assume respongibility for all work done -,by er yself, my agent, servant or employee. ■ P RMIT N2 6336 sibility for work done by his agents, servants or employees. CON T •R c DE BY Subdi- vision Value of Project DATE Contractor License N . t` c /*7 f c t ( Amt. of Permit AUTHORITY = BOLDING • itLE'CTRICAL PLUIv ING/" j ',ft, i Owner, l Build • Architect k Contractor or Build.( t = .4• 4-4 Legal I,et J Description MIAMI SHORES VILLAGE, FLORIDA : PERMIT N° 6336 -1 Work tote performed under this :Permit : / ( / .'� ... 67( et.4.44 Bl. CO TO OR BUIL - Y t( z / , ONO Subdi- vision DATE Contractor License 1 o. Address of �. �' ! l ' ► Pro Value of Amt. c'C Building b, �: ,.� / ,, Permit This permit is granted to the contractor orteui1Her name abo e to construct the building or to install the equipment or device described in the appli- cation 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 1'ennit 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 furdWer condition upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of tt ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings or the sflltgnients or specifications and that he ssumes respon- sibility for work done by his agents, servants or employees. i ' Signed:A /At' / i t: ? - ' By - L ' In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance wit.14411 ordinances ani r pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Sfrotet Village. In accepting this permit I assume responsibility for a work dons,_ by either myself, my agent, servant or employee. BY AUTHORITY