882 NE 97 St (2)MIAMI SHORES VILLA
°BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date9 [ � l'
( Pc_ 1 r l)
Permit No. C 7
Type Insp'n
Name
G(t'C lac
Address 8sz E. - ST
Company P € p+ c Tc&
— 832-0
Phone #
Inspection Date 1 S
Approved
Correction
Re- Insp'n Fee
4 MOV022005
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date 10 1 I
Type Insp'frJ l I/
Permit No. PLDS — 230
Name
Address cZ '9 7 S r
Company 14 P 7 Toni-t-4 CC)
Phone # l 306 (2 O —
Inspection Date
Approved
Correction
Re- Insp'n Fee
it
CONSTRUCTION PERMIT FOR:
[ ]New System [ ]Existing System [ ]Holding Tank [ ] Innovative Other
[ X ]Repair [ ]Abandonment [ ]Temporary [ NA ]
APPLICANT: Cleek, Ronald & Cheryl AGENT: WALLACE P, Ponder Wallace
PROPERTY STREET ADDRESS: 882 NE 97 St Miami FL 33138
LOT: 5
OTHER REMARKS:
APPROVED BY: Milian, Jorge
DATE ISSUED: 6/23/05
•
STATE OF FLORIDA
DEPARTMENT OF HEALTH L _.._ ._ _.. .w
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
BLOCK: 74 SUBDIVISION: Miami Shores
[Section /Township /Range /Parcel No.]
PROPERTY ID #: 11- 3206 - 017 -2700 [OR TAX ID NUMBER)
SYSTEM DESIGN AND SPECIFICATIONS
SPECIFICATIONS BY: Millan, Jorge
TITLE:
TITLE: Engineer I
CENTRAX #: 13 -SG -25543
DATE PAID:
FEE PAID : $
RECEIPT .
OSTDSNBR : 05 -2119- -
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.
T [ 1050 ]Gallons SEPTIC TANK MULTI - CHAMBERED /IN SERIES: [Y ]
A [ 0 ]Gallons MULTI - CHAMBERED /IN SERIES: [Y ]
N [ 0 ]GALLONS GREASE INTERCEPTOR CAPACITY
K [ 0 ]GALLONS DOSING TANK CAPACITY [ 0 ]GALLONS @ [0 ]DOSES PER 24 HRS # PUMPS[ 0 ]
D [ 300 ]SQUARE FEET PRIMARY DRAINFIELD SYSTEM
R [ 0 ]SQUARE FEET SYSTEM
A TYPE SYSTEM: [ N ]STANDARD [ N ]FILLED [ N )MOUND [ N ]
I CONFIGURATION: [ N ]TRENCH [ N ]BED [ N ]
N
F LOCATION TO BENCHMARK:
I ELEVATION OF PROPOSED SYSTEM SITE [ 0.0 ] [ FEET ] [ ]BENCHMARK /REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 0.0 ] [ FEET ] [ )BENCHMARK /REFERENCE POINT
L
D FILL REQUIRED: [ 0.0 ]INCHES EXCAVATION REQUIRED: [ 0.0 ] INCHES
[CP] Maintenance service agreement required. Install 300 sf of drainfield. Install 12" of
slightly limited soil under the bottom of drainfield. Perimeter of excavation area shall
be at least 2 ft. wider and longer than the proposed absortion bed or trench. Replaced
existing 1050 gal. septic tank.
Invert elevation of drainfield to be no less than 6.80' NGVD. Bottom of drainfield
elevation to be no less than 6.30' NGVD.
Dade CHD
EXPIRATION DATE: 9/21/05
DH 4016, 03/97 (Obsoletes previous editions which may not be used)
(Stock Number: 5794- 001 - 9016 -0) Iostds_cons_4016 -1] Page 1 of 2
I '\
�
i) r 7,
Scale: Each block represents 5 feet and 1 in
;:_..T. _...._,_,._ 'J.;
}s ,
_... 4_a.;:_i.
1 - i - . ,
f f .r -- - - - + 4 -
- -± 4 4
•
• -- - t -"-.
Notes:
By
STATE OF FLORIDA
11 :. a DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT:.: C' i r '
Permit Application'Number ! C
PART II - SITE PLAN
Site Plan submitted by:
Plan Approved
•
DH 4015, 10/96 (Replaces HRS-H Forth 4015 which may be used)
(Stock Nurrber: 5744 - 002 - 4015.6)
J) 22-4
k u ,%4 --SZ--- '-‘ M4 );) i
1 ; Signature
I_ \ Not Approved
+r !.1 (1 '
d f
g i ) "
I ,
t -.
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
aroe
Date G- 3.c) —0 5
County Health Department
Page 2 of 3
APPLICANT:
LOT:
PROPERTY ID #:
TO BE COMPLETED BY ENGINEER, HEALTH UNIT EMPLOYEE, munimaL4NIALIFIED PERSON. ENGINEER'S MUST
PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL --EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS.
PLAN: /
PROPERTY SIZE CONFORMS TO SITE P !
� �-J' YES [ ] NO NET U,SA$�rE�A��kBLE: . 2C� ACRES
TOTAL ESTIMATED SEWAGE FLOW: r' J GALLONS PER DAY j S1 DENCES -TABI r1 /"•6 )TABLE 2]
AUTHORIZED SEWAGE FLOW: 65C, GALLONS PER DAY [1500 GPD /ACRE O'R GPD/ACREJ
UNOBSTRUCTED AREA AVAILABLE: - 27 SQFT UNOBSTRUCTED AREA REQUIRED: , - SQFT
BENCHMARK /REFERENCE POINT LOCATION: _ /1/ 7 ---- / - _ ���� ( J -
ELEVATION OF PROPOSED SYSTEM SITE IS ,? �f [INCHES/ $ (ABOVEtBttb j (BENCHM R_ A�/P-EFERENCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE Q SED SYSTEM TO THE FOLLOWING FEATURES:„-
SURFACE WATER: ` FT DITCHES /SWALES: / FT NORMALLY WET? [ ] YES [ -
WELLS: PUBLIC: /1/,/it FT LIMITED USE: off FT PRIVATE: il FT NON-POTABLE: AY 2 FT
BUILDING FOUNDATIONS: FT PROPERTY LINES: /0 FT POTABLE WATER LINES: /7 FT
SITE SUBJECT TO FREQUENT FLOODING: [ ] YES [ 4- NO 10 YEAR FLOODWG ( ) YES F-1-410
FT MSL/NGVD SITE ELEVATION: 0 6 FT MSL G
10 YEAR FLOOD ELEVATION FOR SITE:
SOIL PROFILE INFORMATION SITE 1
Munsell #, /Color Texture Depth ,
'I /�Sdp.li r- 444 (9 to `I
• Ito ,;>z _
,1 • to
//
/ j to
/ _ /tot
�to
\ to /
{ to /
USDA SOIL SERIES: „
OBSERVED WATER TABLE: NA INCHES •[ABOVE / BELOW) , EXISTING GRADE. TYPE: PERCHED / APPARENT]
ESTIMATED WET SEASON WATER TABLE ELEVATION: { INCHES [ ABOVE / LOW E%I GRADE.
HIGH WATER TABLE VEGETATION: [ ] YES [9 ' MOTTLING: [ ] YES [ "-Ji 0 / DEPTH: / 'INCHES
SOIL TERTURE /LOADING RATE FOR SYSTEM SIZING: f h79 DEPTH OF EXCAVATION: ��c) INCHES
DRAINFIELD CONFIGURATION: [ ] TRENCH [ (J,,�BED [ ) OTHER (SPECIFY)
REMARKS /ADDITIONAL CRITERIA:
SITE EVALUATED BY:
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
tov 1 c (Qe fc AGENT:
• - �Gk
BLOCK:
32 c.c : 2 [[Section /Township /Range /Parcel No. or.,Tax ID Number
✓c! 3( s
DH 4015, 10/96 (Replaces HRS -H Form 4015 (Pape 3) which may be used)
(Stock Number: 5744- 003 - 4015 -1)
SUBDIVISION: I Sec 3
( f i ✓vt tAt3re:
SOIL PROFILE INFORMATION SITE 2
�-1
PERMIT i `"' - !
DATE: 1/r _. -0_ (1f,
Page 3 of 3
&mini pupa
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 7/28/2005
Applicant: CHERYL
Owner: CLEEK
JOB ADDRESS: 882
Contractor
W P SEPTIC TANK CO INC
Local Phone: 305 - 620 -6320
Parcel # 1132060142700
NE 97
Fees:
FEE2005 -10301
FEE2005 -10302
FEE2005 -10303
FEE2005 -10306
FEE2005 -10308
FEE2005 -10309
Description
Building Fee
CCF
Training and Education Fee
Technology Fee
Scanning Fee
Builders Bond
Total Fees:
Amount
$350.00
$1.80
$0.60
$8.75
$3.00
$300.00
$664.15
Total Fees: $664.15
Total Receipts: $0.00
Permit Status: APPROVED Permit Expiration: 1/21/2006 Construction Value: $2,400.00
Work: INSTALL NEW SEPTIC TANK AND DRAINFIELD
Signed: (INSPECTOR)
Plumbing Permit
Permit Number: PL2005 -230
CLEEK
CHERYL
ST
Contractor's Address: 17235 NW 12 CT
Legal Description: MIAMI SHORES SEC 3 PB 10 -37 LOT 5
Page 1 of 1
BLK 74 LOT SIZE IRREGULAR
JUL 2 8 ?AM
c_ pcs,t4
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.
Signed: (Contractor or Builder) BY:
l � aG
.4
Passed
Inspecto
omm
nts
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled
re- inspection fee is paid.
until
Owner:
•
nspection Number: I NSP- 17,290
Inspection Date: 05/16/2006
Inspector: Levrack, James
Job Address:
Project: <NONE>
CLEEK, RONALD
882 97 Street NE
Miami Shores Village, FL 33138-
Contractor: WP SEPTIC TANK CO INC
Building Department Comments
Monday, May 15, 2006
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Y "1.7 BITS
Block:
Permit Number. PL2005 -230
Permit Type: Imported Permit
Inspection Type: Landscaping
Work Classification: Plumbing
Phone Number
Parcel Number 1132060142700
Lot:
Phone: 305 -620 -6320
Page 1 of 2
''
I .-j 4(6
Inspecto Comments
Passed
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled until
re- inspection fee is paid.
•
nspection Number: INSP - 17288 y 1. 7 art Permit Number. PL2005 -230
Inspection Date: 05/16/2006
Inspector: Levrack, James
Owner: CLEEK, RONALD
Job Address: 882 97 Street NE
Project: <NONE>
Miami Shores Village, FL 33138-
Contractor: WP SEPTIC TANK CO INC
Building Department Comments
Monday, May 15, 2006
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: Plumbing
Phone Number
Parcel Number 1132060142700
Lot:
Phone: 305 -620 -6320
Page 2 of 2