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546 NE 97 St (6)• , " w a 1 7 . 11 1 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 8/16/2005 11?1141,, 1- Applicant: KENNETH KODISH Owner: KODISH KENNETH JOB ADDRESS: 546 NE 97 ST Parcel # 1132060171520 Signed: (INSPECTOR) • jp1 Permit Number: PL2005 -253 Contractor LLOYD NORTH DADE SEPTIC TANK SERVIONdhftlactor's Address: 750 NW 107 ST Local Phone: 305 - 754 -3375 Permit Status: APPROVED Permit Expiration: 2/7/2006 Construction Value: $1.200.00 Work: REPLACE DRAINFIELD Page 1 of 1 Legal Description: MIAMI SHORES SEC 4 AMD PB 15 -14 LOT 4 & LOT 5 BLK 99 LOT SIZE Fees: Description Amount FEE2005 -11229 Building Fee $175.00 FEE2005 -11230 CCF $1.20 FEE2005 -11231 Notary Fee $5.00 FEE2005 -11232 Training and Education Fee $0.40 FEE2005 -11233 Technology Fee $4.40 FEE2005 -11234 Scanning Fee $3.00 FEE2005 -11235 Builders Bond $300.00 Total Fees: $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 1 assume responisibility for all work done by either myself, my agent, servants or employes. Signed: (Contractor or Builder) BY: 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 Block: Permit Number: PL2005 -253 Permit Type: Imported Permit Inspection Type: Final Work Classification: Septic Phone Number Parcel Number 1132060171520 Lot: Phone: 305 - 754 -3375 Building Department Comments Friday, January 6, 2006 ?age 1 of 2 Passed Inspector Comments - ' �' ", � Failed Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled re- inspection fee is paid. until 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 Block: Permit Number: PL2005 -253 Permit Type: Imported Permit Inspection Type: Final Work Classification: Septic Phone Number Parcel Number 1132060171520 Lot: Phone: 305 - 754 -3375 Building Department Comments Friday, January 6, 2006 ?age 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> 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 Type: Imported Permit Inspection Type: Final Work Classification: Septic Phone Number Parcel Number 1132060171520 Lot: Phone: 305- 754 -3375 Page 2 of 2 Passed - , N spector Comments ti-,-- 7 - / :7 _ • ,-„ ,: 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> 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 Type: Imported Permit Inspection Type: Final Work Classification: Septic Phone Number Parcel Number 1132060171520 Lot: Phone: 305- 754 -3375 Page 2 of 2 Inspection Number: INSP -5384 Inspection Date: 01/06/2006 Inspector: Levrack, James Owner: KODISH, VALA Job Address: 546 97 Street NE Project: <NONE> 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 Contractor: LLOYD NORTH DADE SEPTIC TANK SERVICE INC 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 Passed y Inspelctor • J 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> 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 Contractor: LLOYD NORTH DADE SEPTIC TANK SERVICE INC 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 Inspection Number: INSP -5384 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 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 Passed , -In Pecto' Comments e , 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> 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 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 BUILDING PERMIT APPLICATION FBC 2001 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 E AUG ,A Permit Type (circle): Building Electrica ' Plumbing Mechanical Roofing Owner's Name (Fee Simple Titleholder) .+1JJULT/ A0Z /.5 F/ Phone # 7R. J _Y - // Owner's Address S c &"' 4..)-1-7- • ;7 E L T City Mill fl'1 State ,C• Zip 33/31/ Tenant/Lessee Name Phone # Permit No. ?LOS. - 26 3 Master Permit No. Job Address (where the work is being done) �." l). L • ` 72-/ r City Miami Shores Village County Miami -Dade Zip 33'. P" Is Building Historically Designated YES NO Contractor's Company Name 1-1--0Y1) rU y 77 C. Phone # : 30A - 937— 2t w, Contractor's Address '7 :) A)• frt.) • /0 7 7'4 S PEI . City rn / /7,n/ State F Zip 3.3/6 Pr Qualifier L [`.STLR L . Ci ?O eKt T <P OZrZ) Architect/Engineer's Name (if applicable) Phone # $ Value of Work For this Permit "c • C Square Footage Of Work: Type of Work: ❑Addition DAlteration ❑New [3Repair/Replace ❑ Demolition Describe Work: 1'L M01= �� / �t., /E?.D Total Fee Now Due $ 4 13c (Continued on opposite side) * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * ** * * * * * * ** Submittal Fee $ Permit Fee $ 17 . CCF $ 1 0 Notar $ 5. 00 Training/Education Fee $ 0.40 Technology :Fee $ 4 .40 Scanning $ 3.00 Radon $ Bond $ ZDO. CO Code Enforcement $ Structural Plan Review. $ AUG 11 PAID C �i4 Bonding Company's Name (if applicable) Bonding Company's Address City State Zip r " Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip 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 IMPROVEMENTS 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 WL. Owner or Agent The fore : oing instrument was acknowledged before me this n day of 0 , • )1.- 0, by kCA.MiL 7�/ SOD %ail , NOT Sign: Print: My Commission Expires: 5— Q- State Certificate or Registration No. ******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPLICATION APPROVED BY: / / L. Chc 10/14/03 who is personally known to me $11 L As ide C-. Notary Public S a e r fQtk0I My Comm t e P. es WA/ r who has produced cation and who did take an oath. (Certificate of Competency Holder) ertificate of Competency No. ************************ * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Signature Contractor The foregoing instrument was acknowledged before me this day of , 20 by 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: 1- f 2 ' Plans Examiner Engineer Zoning LOT: 4 BLOCK: 99 DATE ISSUED: 8/9/05 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM C , ,N STRUCTION PERMIT CONSTRUCTION PERMIT FOR: [ ]New System [ ]Existing System [ [ X ]Repair [ ]Abandonment ]Holding Tank [ ] Innovative Other ]Temporary [ NA ] APPLICANT: Kodish, Kenneth & Vala AGENT: SR0931123, Bryant Roland PROPERTY STREET ADDRESS: 546 NE 97 St Miami Shores FL 33138 PROPERTY ID #: 11- 3206 - 017 -1520 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 SPECIFICATIONS BY: Millan, Jorge APPROVED BY: Milian, Jorge DH 4016, 03/97 (Obsoletes previous editions which may not be used) (Stock Number: 5744- 001 - 4016 -0) Iostds cons 4016 -1] SUBDIVISION: Miami Shores Sec 4 [Section /Township /Range /Parcel No.] [OR TAX ID NUMBER] CENTRAX #: 13 -SG -26081 DATE PAID: FEE PAID : $ RECEIPT . OSTDSNBR : 05 -2650- -R 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. MULTI- CHAMBERED /IN SERIES: [Y ] MULTI- CHAMBERED /IN SERIES: [Y ] ]GALLONS @ [0 ]DOSES PER 24 HRS # PUMPS[ 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). TITLE: (":1 TITLE: Engineer I Dade CHD EXPIRATION DATE: 11/7/05 Page 1 of 2 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM ' CONSTRUCTION PERMIT 0 CONSTRUCTION PERMIT FOR: [ ]New System [ ]Existing System [ ]Holding Tank [ ] Innovative Other [ X ]Repair [ ]Abandonment [ ]Temporary [ NA ] 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 SPEC =FIC 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 MOD= FICATIONS 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 D [ 300 ]SQUARE FEET PRIMARY DRAINFIELD SYSTEM R [ 0 ]SQUARE FEET SYSTEM A TYPE SYSTEM: [+C ]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 SUBDIVISION: Miami Shores Sec 4 [Section /Township /Range /Parcel No.] [OR TAX ID NUMBER] DH 4016, 03/97 (Obsoletes previous editions which may not be used) (Stock Number: 5744- 001 - 4016 -0) (ostds_cons_4016 -1] CENTRAX #: 13 -SG -26081 DATE PAID: FEE PAID : $ RECEIPT . OSTDSNBR : 05 -2650- -R MULTI- CHAMBERED /IN SERIES: [Y ] MULTI- CHAMBERED /IN SERIES: [Y ] ] GALLONS @ [ 0 ] DOSES PER 24 HRS # PUMPS [ 0 ] TITLE: �''' TITLE: Engineer I Dade CHD EXPIRATION DATE: 11/7/05 Page 1 of 2 APPLICANT: LOT: STATE OF FLORIDA DEPARTMENT OF HEALTH $)NSITE SEWAGE DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS r.� t BLOCK: PROPERTY ID #: s ,, PROPERTY SIZE CONFORMS TO SITE PLAN: TOTAL ESTIMATED SEWAGE FLOW: AUTHORIZED SEWAGE FLOW: UNOBSTRUCTED AREA AVAILABLE: BENCHMARK /REFERENCE POINT LOCATION: SOIL PROFILE INFORMATION SITE 1 SUBDIVISION: * 'q TO BE COMPLETED BY ENGINEER, HEALTH UNIT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGItEER'S MUST PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS. ELEVATION OF PROPOSED SYSTEM SITE IS~' [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES: SURFACE WATER: .: FT DITCHES /SWALES: ` , ' FT NORMALLY WET? [ ] YES WELLS: PUBLIC: '\ FT LIMITED USE � FT PRIVATE: FT NON- POTABLE BUILDING FOUNDATIONS: f, FT PROPERTY LINES: FT POTABLE WATER LINES: SITE SUBJECT TO FREQUENT FLOODING: [ J YES ] NO 10 YEAR FLOODING? [ ] YES ( 1 NO 10 YEAR FLOOD ELEVATION FOR SITE: - „ FT MSL /NGVD SITE ELEVATION: F:: MSL /NGVD Munsell # /Color Texture Depth • .) to ^ . to I to to to to to to to USDA SOIL SERIES: [Section /Township /Range /Parcel No. or Tax ID Number) [, °] YES [ ] NO NET USABLE AREA AVAILABLE: ACRES GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2] , GALLONS PER DAY [1500 GPD /ACRE OR 2500 GPD /ACRE] SQFT UNOBSTRUCTED AREA REQUIRED: SQFT AGENT: SOIL PROFILE INFORMATION SITE 2 Munsell # /Color Texture Depth to to to USDA SOIL SERIES: SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: ! DRAINFIELD CONFIGURATION: [ ] TRENCH BED [ ] OTHER (SPECIFY) REMARKS /ADDITIONAL CRITERIA: PERMIT # to to to to to to OBSERVED WATER TABLE: INCHES [ABOVE / BELOW] EXISTING GRADE. TYPE: [PERCHED / APPARENT] ESTIMATED WET SEASON WATER TABLE ELEVATION: INCHES [ ABOVE / BELOW ] EXISTI GRADE. HIGH WATER TABLE VEGETATION: [ ] YES [;] NO MOTTLING: [ ] YES [ ] NO DEPTH: INCHES DEPTH OF EXCAVATION: INCHES SITE EVALUATED BY: A, DH 4015, 10/96 (Replaces HRS -H Form 4015 ]Page 3] which may be used) (Stock Number: 5744 - 003 - 4015 -1) DATE: [ J NO FT FT Page 3 of 3 'INSTRUCTIONS: 0• 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 IOD -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. 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 documents submitted. ELEVATION WORKSHEET ELEVATION OF BENCHMARK / REFERENCE POINT IS: BENCHMARK SITE 1 SITE 2 SITE 3 [ + ] SHOT H.I. H.1. H.I. H.1. [ - ]SHOT [ - ]SHOT [ - ]SHOT Each block represents 5 feet and 1 inch = 50 feet. otes: ly STATE OF FLORIDA DEPARTMENT OF HEALTH ,APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PE,f�MLL Permit Application Number ' J h d Pool - 1 1 -L - ' - — v i j- t + -{ 44015. 1W96 (Replaces HRS-H Rom 4015 which may be used) ,...i DJ. .we.* £IAAJvn_I111 t.C1 PART II - SITE PLAN Lot Size 3,019 Sq Ft System being replaced because drainfield failure. Roland Bryant R �, Contractor ;ite Plan submitted by: ��� Titre Signature 'Ian Approved 1 ff Not Approved Date U 6 R u��U X711 , � 1 E • c�. 16.,,, 1 \G `e County Health Department ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT Page 2 of 3 Applicant C__� ..-..st�c / �3 Permit Nber V . r j PART II ./v, YSTEM I INSPECTION AND FINAL INSTALLATION AP PROVAL Installer ?t,. c - ,c7 0. eA, Tank Manufacturer Propertank legend: Yes No Tank material C 'A Tank level: YesL Tanks watertight: Yes, No Proper tank outlet device: Yes Dralnfield Trench i.ength Width Length Width feet feet feet feet Length feet x feet= __ ft feet feet Q , 1 feet feet Proper No. drainlines: Yes f 1 _ No feet feet /V / feet feet Proper pipe separation: Yes 3- No Total = ft Total = ft Distribution box level: Yes No .4Z Systems located as permitted: Yes No Systems including plumbing stub -outs installed at proper elevation: Yes No No Average depth to drainpipe invert from finished grade: �c inches Maximum depth ,-Z Y Inches Average depth of drainfield gravel: ®3 inches Minimum depth of gravel. 4). inches Proper gravel size: Yes i� No Gravel is suitable quality: Yes , No Other findings. STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION AND INSTALLATION PERMIT 3ackfill or fill material as required: (Q ality) Yes Tank size: Inspected by: / Dates) '- � ©" 'Approved by HRS —H Form 4016, Jan 86 (Replaces Feb 85 edition which may be used) (Stock Number: 5744-002-4016-4) Manhole or marker.to grade: Yes No (Quantity) Yes No PART III - FINAL NSTALLATION APPROVAL i l -- „Z) AN APPROVED INSTALLATION DOES NOT GUARANTEE PERFORMANCE Note: Completed copies of this form will be provided to the applicant, installer and the building department. gallons gallons gallons Absorption Bed Length c2 feet x 7 feet =. 1 ft No C UBLIC HEALTH UNIT Date 1l C3 �� ' �' UNTY P Page 2 of 2 [WILDING ELECTIAL PLUMBIAGLe ! � ill Owner r° Building Architect Contractor or Builder Legal Description Address of Building Lot f L MIAMI SHORES VILLAGE, FLORIDA ,PERMIT N° 6426 Work to be performed under this Permit T' f6 �i L� 4.." �C Bl. Subdi- vision DATE e Contractor's License No._ Amt. of Permit f r; 1 " 1949 �t �/ .1 �/ / " / � a'''''4 �'+ Project Value of This permit is granted to the contractor or build r 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 anv 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 fo} a thorough knowledge ordinances and regulations pertaining to the work covered hereby whether shown on the plans or or in tlae ltat� co meYts or spe ' ' Lions, an a he scones respon- sibility for work done by his agents, servants or employees. Signed • / `` { t' (. 4 B y NSPE OR BY AUTHO. ITY In consideration of the issuance to me of this permit I agree to perforu the work covered hereunder in compliance with 44.ordinan.es and eggyyll ons pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Mimi ShoterViage. In accepting this permit I assume responsibility for all work done by either myself, my agent, servant or employee. 7 . .Lr C OONT OR BU1LD�L'R BUILDING ELECTRICAL PLUMBING Owner Builcli MIAMI SHORES VILLAGE, FLORID DATE <_ P - RMIT N2 6336 Work to in perfprmed undr this ermit t' Subdi- vision Value of Project ..,_) C1,, • t�1 tJI D SIC , t_ t t_" t a ,�fr. -� t COr N o R R l' ' BY Contractor/ License Nb. • ( </ 1 '■' 194 —� Architect Contractor or Buildek._, Legal L9( B1. Description Address of 7'0/ Building ` 4 ;' � .' ` \ rerinic This permit is granted to the contractor or Kuil er name ab 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 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 eirients or specifications end t he ; sumes respon- + k?. sibility for work done by his agents, servants or employees. 2. / ee � / Signed: .. , '. t.., C B r ( INSPE OR In consideration of the issuance to me of this permit I agree to rfo ' the work covered hereunder in compliance with} ordinances an ions: pertaining thereto and in strict conformit With the plans, drawings stat a is or specifications submitted to the proper authorities of Miami Sh e age:' In accep g this permit I assume responp�ibility for all work done . _by yself, my agent, servant or employee. / ,,,, " / AUTHORITY B LDING DATE *LECTRICAL • PLUA3ING Work to )be performed undFr thisfiermitT.- Owner +o r 7 ._...)� r,,,,,_,_.. B ' f 1,--1:4"- 1 .e '-- e 7 ��. r , �- Architect Lam' Contractor or Builder_ 44 - Legal Let Description MIAMI SHORES VILLAGE, FLORIDA PERMIT N° 6336 / ./I L ./ �: .L Bl. Subdi- vision Contract License o. • 194L.L. Building ( Address of r . �' �.... Value of 11 Amt. . r U �, d 1 /1 r Project Permit This permit is granted to the contractor or4ui er name abo e to construct the building or to install the equipment or device des cribed in the appli- cation herefor in strict compliance with all ordinances pertaining thereto and w th the understanding that the work will be performed in compliance with an) 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 pf t ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings or ' 'the syit rents or specifications and that Fie ssunws respon- sibility for work done by his agents, servants or employees.! { • "- Signed: !J Al iiidah By /'r PE R In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance wit4411 ordinances anil pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami SfitiM Village. In accepting this permit I assume responsibility for all work dons by either myself, my agent, servant or employee. CON BUIJ 9Ef�` / of' `+4fr► BY AUTHORITY