Septic 20014APPLICANT:
AGENT:
LOT:
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[18]
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FILL
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[25]
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STATE OF FLORIDA.
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DIPOSAL SYSTEM
CONSTRUCTION INSPECTION AND FINAL APPROVAL
PROPERTY ADDRESS:
BLOCK:
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)
: :===mom == ===sa==ss= ==sa====s ==== = =asssa====: :tea ====:ss==sa=== == =s = = ==__
CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED.
== = a= == = =_ = = = = =s== =======
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SUBDIVISION: . % i latr` , J! / ii:'' s
TANK INSTALLATION
[01] TANK SIZE [1] [2] ;
[02] TANK MATERIAL
[03] OUTLET DEVICE
(04] MULTI- CHAM03ERED [ Y 1,N ]
[05] OUTLET FILTER ';`° ' [•1
[06] LEGEND ''' `�
[07] WATERTIGHT
[08] LEVEL
[09] DEPTH TO LID
DRAINFIELD INSTALLATION
AREA (1 ]' - r \ [ 2 ] SQFT
DISTRIBUTION BOX HEADER
NUMBER OF DRAINLINES
DRAINLINE SEPARATION
DRAINLINE SLOPE
DEPTH OF COVER
ELEVATION [ABOVE /BELOW] BM
SYSTEM LOCATION
DOSING PUMPS 1l, °r1
AGGREGATE SIZE
AGGREGATE EXCESSIVE FINES
AGGREGATE DEPTH
/ EXCAVATION MATERIAL
FILL AMOUNT I.J.
FILL TEXTURE
EXCAVATION DEPTH
AREA REPLACED
REPLACEMENT MATERIALO
EXPLANATION OF VIOLATIONS / REMARKS:
]
]
]
CONSTRUCTION`'[APPROVED /DISAPPROVED]:
FINAL SYSTEM[APPROVED /DISAPPROVED]:
DH 4016, 10/97 (Previous Editions May
ABANDONMENT
j I ,' [ ] [49] TANK PUMPED
[ ] [50] TANK CRUSHED & FILLED
Be Used)
== = === =s
r\/
Installer / Contractor
FILLED / MOUND SYSTEM
[36] DRAINFIELD COVER
[37] SHOULDERS
[38] SLOPES
[39] STABILIZATION
;'
PERMIT NO.
DATE PAID:
FEE PAID:
RECEIPT 1:
PROPERTY ID 1:
/_/
{
;1i) VI Z• tl
SETBACKS
[27] SURFACE WATER FT
[28] DITCHES FT
[29] PRIVATE WELLS FT
(30] PUBLIC WELLS FT
[31) IRRIGATION WELLS FT
[32] POTABLE WATER LINES ? FT
[33] BUILDING FOUNDATION .1 FT
[34] PROPERTY LINES , FT
[35] OTHER FT
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 j
[47] CONTRACTOR /_;',), i:C
[48] OTHER '
/_/
CHD DATE: f
CHD DATE: j % a
Pag. 2 of 3
MIAMI SHORES VILLAGE
BUILDING DEPART 1TL
305- 795 -2204
Building Inspection Request
Dat
Type Insp'n
Permit No.
Name
Approved
Correction
Re- Insp'n Fee
Per-a-J o 9 14 o
Address s ��—
Company
Phone #
Inspection Date ('�
Approved
Correction
Re- Insp'n Fee
MIAMI SHORES VJLLAGE
BUILDING DEPA
305- 795 -04
Building Inspection Requ
•
Date
Type Insp'n
Permit No.
Name f
Address Li S 4), E. 9 ��
I .
Company
Phone #
Inspection Date
.fit _ L ..
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle): Building Electrical Plumbing Mechanical Roofing
Owner's Name (Fee Simple Titleholder) c"DOE ?ok L Phone # - q(F�o- SR, F x/44
Owner's Address 4 S AJC- `� ?H cLE
City lM /R1 / .5f1,ZE State FLOZ/D14 Zip 3 5/3.?'
Tenant/Lessee Name AJ -1 . Phone # Ai /9 •
Job Address (where the work is being done) L A Ai-_• Qd '/7f 7EtEr
City Miami Shores Village County Miami -Dade Zip - 3,3/ .3(r
Is Building Historically Designated YES NO
Contractor's Company Name LL D ' Z' A. 0 7277/ - -ZYZOE e5 I Phone #
Contractor's Address /1.)• t-t) /D ?TL/
City 04 / 13 / State 1LO7? / b7
Qualifier L L c L �'' o c k 77
Architect/Engineer's Name (if applicable) Phone #
$ Value of Work For this Permit / Square Footage Of Work: 30D
Type of Work: ['Addition ❑Alteration ❑New L1 R pair/Replace ❑ Demolition
Describe Work: 7L- 7 ' 2 L 4 di.; ::
* * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Submittal Fee $ Permit Fee $ / ' LS 1 CCF $ (.% 0 CO /CC
Notary EN V 0) Training/Education Fee $ -. 0 Technology Fee $
Scanning $ Radon $ Zoning Bond
Code Enforcement $ Structural Plan Review. $
Total Fee Now Due $ ' ( S., ti CA a q &
l
(Continued on opposite side)
Miami Shores Village
Building Department
Master Permit No.
1
Zip
Permit No.PL O l ( 0
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
C °'y State Zip
,dication is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
menced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
c ruction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
V `.S, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
C . 'BIER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
a licable 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 issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature �irye ��Ufc�
Owner or Agent
The foregoing instrument was acknowledged before me this PM.
day of 744i0 , 20 U!/ , by ./Dam %/7Z
CliTho is personally known to minor who has produced
As identification and who did take an oath.
NOT
Sign:
Print:
Chc 12/15/03
APPLICATION APPROVED
7
My Commission Expires: MA _20 2 r�
**************************
LESTER E CROCKETT
MYCOMMI 14762
EXPIRES: May 20, 2005
H rvices
Signature aL,xt
Contractor
The foregoing instrument was acknowledged before me this // vvt
day of (2,0 , 2004, by LE)7 &G k19cr -rr
to is personally known to mfr who has produced
as identification and who did take an oath.
**** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
RY
S
P.riiit:
My Commissiontxl5iresx v,
(Certificate of Competency Holder)
State Certificate or Registration No. /" Certificate of Competency No.
* * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Plans Examiner
Engineer
Zoning
CONSTRUCTION PERMIT FOR:
[ ]New System [ ]Existing System [ ]Holding Tank [ ] Innovative Other
[ X ]Repair [ ]Abandonment [ ]Temporary [ NA ]
APPLICANT: Portal, Jose AGENT: SR0001343, Crockett Lester
PROPERTY STREET ADDRESS: 45 NE 98 St Miami Shores FL 33138
SUBDIVISION: Miami Shores
[Section /Township /Range /Parcel No.]
PROPERTY ID #: 11- 3206 - 013 -1130 [OR TAX ID NUMBER]
LOT: 16 BLOCK: 8
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SfWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT '
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 [ 750 ]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: [ 4]STANDARD [ N ]FILLED
I CONFIGURATION: [ N ]TRENCH [ 1t ]BED
N
F • LOCATION TO BENCHMARK: 12.6' NGVD/ FF of Residence
I ELEVATION OF PROPOSED SYSTEM SITE [ 1.5 ] [ FEET
E BOTTOM OF DRAINFIELD TO BE [ 4.0 ] [ FEET
L
D FILL REQUIRED: [ 0.0 ]INCHES
EXCAVATION REQUIRED: [ 30.0 ] INCHES
CENTRAX #: 13 -SG -20733
DATE PAID:
FEE PAID : $
RECEIPT .
OSTDSNBR : 04 -1683- -R
MULTI- CHAMBERED /IN SERIES: [Y ]
MULTI- CHAMBERED /IN SERIES: [Y ]
]DOSES PER 24 HRS # PUMPS[ 0 ]
[ N ]MOUND [ N ]
[ N ]
] [ BELOW BENCHMARK /REFERENCE POINT
] [ BELOW] BENCHMARK /REFERENCE POINT
OTHER REMARKS:
1- Install 300 sq. ft. of drainfield in bed configuration.
2- Existing 750 gals. septic tank, certified by Lloyd North Dade Septic, is to remain in
service.
3- Invert elevation of drainfield to be no less than 9.10' NGVD.
4- Bottom pf drainfield elevation to be no less than 8.60' NGVD.
5- This permit is not for additions.
SPECIFICATIONS BY:Andre, Pau .\\, TITLE: )i
APPROVED BY: Andre, Paul I,: ?• €e$ ona Sf#gin Dade CHD
THE StPT6 A ' ALL 'eel: .._..
DATE ISSUED: 5/5/04 ®F E.ECTIQN DEVICE INSTALLED ON THE d u XPIRAT ON DATE: 8/3/04
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
APPLICANT:
\1100r '7)0Z)-71:4_ AGENT: G L ow) L)/2.DE c 2.:P i G
LOT: /6, / 7
PROPERTY ID #: //. a` „ - D / 3 - // 3•o
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:
BENCHMARK /REFERENCE POINT LOCATION: / /N,i i-t/j7 4- 2. , 5Vj> /22, La
ELEVATION OF PROPOSED SYSTEM SITE IS / r ONCHES)FT] [ABOV ELO BENCHMARK /REFERENCE POINT
THE MINIMUM SETBACK WHICH
SURFACE WATER: Ad FT
WELLS: PUBLIC: A/ /4 FT
BUILDING FOUNDATIONS:
STATE OFD" FLORIDA
DEPARTMENT OF HEALTH.
ONSITE SEWAGE DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
BLOCK: SUBDIVISION: � N1i9 f (5 /p� /_55 G t�
SITE SUBJECT TO FREQUENT FLOODING: [ ] YES [-1 NO
10 YEAR FLOOD ELEVATION FOR SITE: a.() FT MSL
SOIL PROFILE INFORMATION SITE 1
Munsell # /Color
/n V R S7/
rr RC`/
//) v7? 7/2
rr xZ l_ V
1 1
Texture Depth
LOA-71-7N/ C) " to
)/ L 7 ) to //) "
OP /r, to
45 /UD to
/ to
If to
/ to
' to
0 to 7 ?!I "
USDA SOIL SERIES: (1Q? . A1it / i /:741
OBSERVED WATER TABLE: A A . INCHES [ABOVE / BELOW] EXISTING GRADE. TYPE [PERCHED / APPARENT]
ESTIMATED WET SEASON WATER TABLE ELEVATION ,S
,•j . 7-- -. INCHES' ABOVE /,,BEI.OW_...r] EXISTING GRADE.
HIGH WATER TABLE VEGETATION: [ ] YES [--(NO MOTTLING: [ ] YES [/r NO DEPTH: /04 INCHES
SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING:.-" 0 DEPTH OF EXCAVATION: D INCHES
DRAINFIELD CONFIGURATION: [ ] TRENCH ['] BED [ ] OTHER (SPECIFY)
REMARKS /ADDITIONAL CRITERIA:
5 40
.._f ' ( /
SITE EVALUATED BY: ` �• r`. J ?1i i f�� ` - `� %"�' 7;
C . (21
DH 4015, 10/96 (Replaces HRS -H Form 4015 [Page 31 which may be used)
(Stock Number: 5744- 003 - 4015 -1)
PERMIT # - �]
[Section/Township/Range/Parcel • No. or Tax ID Number]
YES [ ] NO NET USABLE AREA AVAILABLE: .-20 ACRES
GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2]
GALLONS PER DAY [1500 GPD /ACRE OR 2500 GPD /ACRE]
SQFT UNOBSTRUCTED AREA REQUIRED: 6(0) SQFT
CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES:
DITCHES /SWALES: /U FT NORMALLY WET? [ ] YES4// ] NO
LIMITED USE: f / ?. FT PRIVATE: /L FT NON - POTABLE: C) FT
S FT PROPERTY LINES: . J FT POTABLE WATER LINES: /Q FT
10 YEAR FLOODING? [ ] YES [1N0
NGVD SITE ELEVATION: //-/ ' C SL , GVD
SOIL PROFILE INFORMATION SITE 2
Munsell # /Color Texture
/D yR S / / L Di III '
6/7/= y S /141D
/0 v/ =7
G R /:_ v 51q
/I
/ '
1'
Ir
1'
USDA SOIL SERIES:
/,1
,1
'1
I !
(5FIAJz.ilniZ3
Depth
to
to
/0 t
to
to
t
to
to
to
DATE:
is _ 0L4
Page 3 of 3
Scale: Each block represents 5 feet and 1 inch = 50 feet.
t
L .
STATE OF FLORIDA •
` DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number (-(t\ 1
3
r
PART II - SITE PLAN-
//s
_ - i- _4-- -- ' t i
t
' ; L ' -
' 4— . + . 4--
-
- 'Trti Y 4 w
i w _r- - ill. {t4 + --+ i ��, r •
t - { ) j i-t - 74.12..t..4____ Y 1
t t-,, T - r J + i H1
{ } ~ � �
�-"� - - - t }- t I.� �_, i- t ,- i _� t i + rte- . -
�
y r 3 I r _1_,......i___,..4 1 '. 1 - I _ .-_f- 4 • r -+-r -_
4 t +- -. t -4- -
1:7 p
4 ,_ + - 1_.. -).74
f r
•--4 r -+- 4- ! r ,
Notes: //i--1, 6144 Oac,ct 1AJ C [ - -- 6,s,/C6Zirrr 1 (n A.J.L.
Site Plan submitte
Plan Approved
By
i
1/7 LOY
OPar_:!/< 7 T Signature
Not Approved t r,k,
ALL CHAN ES MU T BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
DH 4015, 1496 (Replaces HRS-H Form 4015 which may be used)
(Stock Number: 5744- 002. 4015-6)
3 Crc7v z,.!c
Title
Date
County Health Department
Page 2 of 3
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204 Permit Number: PL2004 -140
Printed: 5/13/2004
Applicant: JOSE
Owner: PORTAL
JOB ADDRESS: 45
Parcel # 1132060131130
NE 98
Signed: (INSPECTOR)
Plumbing Permit
PORTAL
JOSE
ST
Contractor LLOYD NORTH DADE SEPTIC TANK SERVIGGdlyttactor's Address: 750 NW 107 ST
Local Phone: 305 - 754 - 3375
Permit Status: APPROVED Permit Expiration: 11/7/2004 Construction Value: $1,400.00
Work: REPLACE DRAINFIELD
Page 1 of 1
a
Legal Description: 1 53 41 6 53 42 MIAMI SHORES SEC 1 AMD PB 10 -70 E1/2 OF LOT 16 & ALL LOT 17
Fees: Description Amount
FEE2004 -4807 Building Fee $175.00
FEE2004 -4808 CCF $1.20
FEE2004 -4809 Notary Fee $5.00
FEE2004 -4810 Technology Fee $4.37
FEE2004 -4811 Training and Education Fee $0.40
FEE2004 -4812 Builders Bond $300.00
Total Fees: $485.97
Total Fees: $485.97
Total Receipts: $485.97
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: