PL-09-2038Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INS P- 131360
Scheduled Inspection Date: December 17, 2009
Inspector: Levrock, James
Owner: DEVINE, MICHAEL & CLAUDIA
Job Address: 54 NE 102 Street
Miami Shores, FL 33138-
Permit Number: PL -12 -09 -2038
Project: <NONE>
Contractor: BOB'S SEPTIC & DRAIN INC
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Drainfield
Phone Number 305 - 759 -4883
Parcel Number 1132060131470
Phone: 305 - 558 -5818
Building Department Comments
INSTALL NEW DRAINFIELD 225 SQ FT SEPTIC TANK TO
REMAIN (750 GALLONS)
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
December 16, 2009
For Inspections please call: (305)762 -4949
Page 13 of 19
Miami Shores Villages x (om3wn
Building Department
DEC 1 1 2009 U
p
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
BY:
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949-
BUILDING Permit No .V
PERMIT APPLICATION Master Permit No.
FBC 20
Permit Type: PLUMBING
Owner's Name (Fee Simple Titleholder /c/,%paL 76v /PC
Owner's Address 67 /J f% /o 5-r,
City 1 i A , Shits, State Zi
Phone #
Tenant/Lessee Name 0006i-
Email
Job Address (where the work is being done)
City Miami Shores Village County
/oasr
Miami -Dade
3�t 38'
Phone #
,I 7 Zip J ( ?
FOLIO / PARCEL # J ' 3 p2OGj • o - t [ 0
Is Building Historically Designated YES NO Flood Zone at) ft-
4, j �C
Contractor's Company Name130 65 E c -�� j() .L4X . Phone # 33°S J 8 S� 1 Sr
Contractor's Ad Address ICJ ao 1 6 ST
City 1\1, Y t A-. State �~ I l�
' (� � � Zip � `
Bo L ` Pr2'� Phone # 11 'I
Certificate of Competency No. b U i ,c
Qualifier Name
State Certificate or Registration No. S eta (1 t
Contact Phone E -mail
Architect /Engineer's Name (if applicable)
d(Pt--
Value of Work For this Permit $
Phone #
Square / Linear Footage Of Work: 0
I
i
Type of Work: ['Addition ❑Alteration ['New A Repair/Replace
❑Demolition.
Describe Work:
SET) I P ( v-14
********* * * ** * * * * * * * * * * * * * * * * * ** * * * * * **F sir************ * * * ** * * * * * * * * * * * * * * * * * * * * *** * **
Permit Fee $ 11S•D CCF $ • CO /CC $
Submittal Fee $
Notary $ Training /Education Fee $ O' . O Technology Fee $ 0 .
Scanning $ Radon $ DPBR $ Bond $3X 4 1C113
Double Fee $ 'Violation date:
Structural Review. $ Total Fee Now Due $ 46'1 ' Ig.)
See Reverse side -
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 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 • : '.. n the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
Owner or Agent
,\"--
The foregoing instrument was c owl dged before me this `-N The fore oing instrument was acknow ed
day of�e. , 20 by \', (.\-... \- v day of , 20 c by
who is personally known to me or who has produced who is per nally known to me or who has produced
As iddntification and who did take an oath. 4 • � �' 20igtification and who did take an oath.
NO • ' Y PUBLIC:
Signature
ontractor
My Commission Expires:
* * * * * * * * **
* * * * * *XPOrxix
LI -STATE OF FLORIDA
Mike Schweiger
Commission # DD500117
Expires: JAN. 12, 2010
APPROVED B
P1sj,rea
Examiner
Engineer
(Revised 07 /10 /07)(Revised 06/10/2009)
Sign:
Print:
My Commission Expires:
Zoning
Clerk checked
Ir
STATE OF FLORIDA
DEPARTMENT OF HEALTH DATE PAID:
ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID'
SYSTEM
RECEIPT #'
PERMIT #:13 -SC- 1081575
APPLICATION #: AP944676
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Michael Devine
DOCUMENT #: PR792323
PROPERTY ADDRESS: 54 NE 102 St
LOT: 6
Miami, FL 33138
BLOCK: 11 SUBDIVISION:
PROPERTY ID #: 11- 3206- 013 -1470
[SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
[OR TAX ID NUMBER]
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION
381.0065, F.S., AND CHAPTER 64E -6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE
SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. 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 DEVELOPMENT OF THIS PROPERTY.
SYSTEM DESIGN AND SPECIFICATIONS
T [ 750 ] GALLONS / GPD SeDtic CAPACITY
A [ 0 ] GALLONS / GPD CAPACITY
N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ]
D [ 225 ] SQUARE FEET SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [X] STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [X] TRENCH [ ] BED [ ]
N
F LOCATION OF BENCHMARK: F.F.E.: 13.4' NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 29.10] [I INCHES FT ] [ ABOVE /+ BELOW bBENCHMARK /REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 59.10 ] (1 INCHES k FT ] [[ABOVE r BELOW ] BENCHMARK /REFERENCE POINT
D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: [ 30.00] INCHES
0
T
H
E
R
1— Existing 750 gal. septic tank certified by " Bob's Septic & Drain Inc." on 12/05/20 -09 to remain. 2- Install 225 sf of
drainfield in trench configuration. 3- Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed
absorption trench. 4 -Invert elevation of drainfield to be no less than 9.00' NGVD. 5. Bottom of drainfield elevation to be no
less than 8.50' NGVD.
THIS PERMIT IS NOT FOR ADDITION(s).
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED:
PA 1 11
�►t40ADE CptiWrr 1-SAL Ti i UtW.ART BEN
PE15RO N OSPINA TITLE: - Legacy
Pedro N Ospina
12/07/2009
TITLE:
Dade CHD
EXPIRATION DATE: 03/07/2010
DH 4016, 10/97 (Previous Editions May Be Used) Page 1 of 3
v 1.1.4
AP944676 SE802491
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT v ,
Permit Application Number -019'' �!
PART II - SITE PLAN
Scale: Each block represents 5 feet and 1 inch = 50 feet 0
Notes:
i'() z5F ; //c9 , '4--v - l' "1-- -"4' Y,°
Site Plan submitted by: �j
r,� — - v
,/ 7a,bc gnature 9.
Plan Approved
By
Not Approved
Title
Date
County Health Department
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
DH 4015, 10/96 (Replaces HRS-H Form 4015 which may be used) -
(Stodc Number; 5744 -002- 4015.6)
Page 2 of 3
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
PERMIT # Ce--mot T I `%.L
APPLICANT: /
LOT:
BLOCK: / SUBDIVISION:
PROPERTY ID #/f ,3�4^ j j 7o
[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.
a a = =aa == sac ===a== ==ca= == =cea=s=e= = == =______
PROPERTY SIZE CONFORMS TO SITE PLAN: [i`j YES [ ] NO NET USABLE AREA AVAILABLE:
TOTAL ESTIMATED SEWAGE FLOW:
AUTHORIZED SEWAGE FLOW: %
UNOBSTRUCTED AREA AVAILABLE:
(le-9c_, ACRES
GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2]
GALLONS PER DAY [1500 GPD /ACRE OR GiD,ACt.
SQFT UNOBSTRUCTED AREA REQUIRED: ir• SQFT
BENCHMARK /REFERENCE POINT LOCATION: ,/,.55$ � C al7Si.tt Fi1J
ELEVATION OF PROPOSED SYSTEM SITE IS -> [INCHES' J [ABOVE
Ilp 0
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PRO OSED SYSTEM TO THE FOLLOWING FEATURES:
SURFACE WATER: ,+ FT DITCHES /S$ALES: t/. " FT RMALLY WET? [ ] YES [X] NO
WELLS: PUBLIC: '''• FT LIMITED USE: _ __ FT ZVATE: FT NON- POTABLE: l; FT
BUILDING FOUNDATIONS: FT PROPE TY LINES: FT POTABLE WATER LINES: /0 FT
10 YEAR FLOODING? [ ] YES (>4 NO
10 YEAR FLOOD ELEVATION FOR SITE: 47;#1",/ T•( FT MSL /NGVD SITE ELEVATION: //,.(0 FT MSL/iOVq'
SITE SUBJECT TO FREQUENT FLOODING: [ ] YES d6] NO
SOIL PROFILE INFORMATION SITE 1
Munsell # /Color Texture
t i i2 %/� <.-4 446
Jo
Depth
G to
to /,3-
.1 10,6 _ [_to
to
to
to
to '0 f.'
USDA SOIL SERIES: (j/e 40 hl/u4
OBSERVED WATER TABLE: 737 INCHES [ABOVE /
ESTIMATED WET SEASON WATER TABLE ELEVATION:
HIGH WATER TABLE VEGETATION: [ ] YES ] NO
SOIL PROFILE INFORMATION SITE 2
Munsell # /Color Texture Depth
/O y' q/- 54‘4,7., - to
to______
Irv,( sL1 -, .e ,1; to
+ ra,. to
0
to
to
USDA SOIL SERIES:`; �-'�4 ,1/ /AAA v `'
EXISTING GRADE. TYPE: '/ APPARENT]
INCHES [ ABOVE / O ] EXISTIO GRADE.
MOTTLING: [ ] YES kj NO DEPTH: , INCHES
/
SOIL TEXTURE /LOADING RATE FOR SYSTEM SI,•J.I.NGi9,r� 1 , DEPTH OF EXCAVATION: 3 0 INCHES'
DRAINFIELD CONFIGURATION: e,TREN'CH Liii14 BED 1-1 OTHER (SPECIFY)
REMARKS /ADDITIONAL CRITERIA: r' r -: w .'• • / /''
s
SITE EVALUATED BY:
DH 4015, 10/86 (Replaces HRS -H Form 4015 (Pape 3] which may be used)
(Stock Number: 5744- 003 - 4015.1)
DATE :/c7 -
Page 3 of 3
From'Recepsanis. Fax■D•
SR :DUCER
Page 2 of 21 Date 8/24/2009 03:38 PM Page 2 of 21
CERTIFICATE OF LIABILITY INSURANCE
Augustyniak Ins & Financial Sv
8652 State Road 70 E
Bradenton FL 34202
Phone :941 -155 -9500 Fax:941 -153 -9472
NSUREC
Bob's Septic & Drain, Inc,
P. 0. Bak 612333
North Miami FL 33261
COVERAGES
CATE (MIAP_D'Y) 'r1'
OPID SSS RE 08/24/09
THIS CERTIFICATE IS ISSUED AS A MATTEZ OF INFORMATIOP'
ONLY AND CONFERS NO RIGHTS UPON THE CERTFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW
INSURERS AFFORDING COVERAGE
PIS -` =R A VW Ydutual I. :surancenhescany
r;s) C
6J <:JFtG C
P1 L.IRERE.
RATION. #
23787
THE POLICIES OR INSURANCE LISTED BELOW HAVE BEEN ,SSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED N DTLV?HS'.ANDING
ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO /RICH THIS CERTIFICATE MAY BE !SSUEO OR
MA' PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
,:SR ADD°y'_._— ._..____— _.____ —_ .__,_._.___-- _-- .__. ._ _
..TR gdSRV TYKE .F INSURANCE POLICY NUMBER - -- _r/f EFDt=CNLEiOCTE IMV.PIRATI%b -Fr ----- .'--- .'..- --- - -- --- - -----
DATE (Ri M/DD/t rrY,I I DATE (MM1DD/YY"r) LIMITS
' GENERAL UABI_ :TY
A j X - 'Mrr•F.r .;E)JEPA'- I ::Fa1' , 77PR0077560001 01/14/09 j 01/14/10
L
r■ _'.v,NPE "JCE 1, 300, 000
EisES`tEe,�!£enca) ' $ 100,000
— - -- ' ,:�n; MAP' 'r� r.,- :u I ! MED E.,-.: (An, . ra u ;: s:n, 1 $ 5,000
i PFP , \ALaAr.,h,.,0‘;r I i 300,000
I -- --! - --------'- -- -3Et/ERA1. a,a. ::E.;_ rE i 1 600 000
,
^E ', ^BATE ;'-, .44--1, r =FER �PNU ..J S- CC'MPI PA-= i_: 300,000
I
AUTOMOBILE LIABILITY
A r- J ^- 1
77BA0077560002 ; 01/14/09 01/14/10
COMBINED JINvi.E L K :'
(Eaa,c0CeM)
r 300,000
a
i
' -h '-EC n1'.AC/.:.TC: _�
B._CIL� IN.1URr
(Pe, [,EC;r,n
j .•RO
r EPT'i CAtd, -.3C ; I
TA $1.:$E LI= ,SILTY
AUTO ;_n : -'r- ER? ,_I CENT ,
A - -_
'_--, ',�TI-EPn :rp� E.,,..A <,;� 1 i.
ALI■;, ' N - -T f
EXCESS :.)MBRELLA LIAEILITr c , :, I ,G E ..
E
R 'v9'Jti $
'-
I - -- --__-
3
1�'URKoR, !Otd PE(':
r
AND Est "13ATION
EMPLOYERS' LIABILIT.
A A1• : ' : PRO= r!,ET:1^•'PeaTMFs',EaEi.__,v,_ rIM
E---
-r r1,, y "v. L CEO'
(Ma rNetorW In NH —
a:: re'
I
"t �-- vC (TAT :! -' I,.r- -I..
! I ITO"'•'/ :MMITS I _P
i .
77WC0077563001 07/01/09 , 07/01/10 ' Et EACHA•CCIDENT
1 _ - -
''Ea E•? EUP rE
f 100000
-
g 100000
F aLFP ..r,w <.e ::: 1CL.CnEAE- P,iu.:*LIMIT
.1500000
OTHER
I
I
7. ESO Ri= TIO•:.:T :,F ESA TI ✓16 r L OCATIONS 1vEH,CLES / EXCLUSIONS ADDED BY ENDORSEMENT ; SPECIAL PROVISIONS
PIGOI1C1f^A Tr ueI nLIn ___._ —. __..._. �..
Miami Shores Village Hall
10050 NE 2nd Avenue
Miami Shores FL 33138
ACORD 25 (2009/01)
SHOU..D ANY OA' THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE ExPIRAT/ON
LATE THEREO THE ISSUING INSI;RER WILL ENDFAYJR TO MA g. 10 CAYS WRITTEN
NOT/ TE TO THE CERTIFI;:ATE HOLDER NAMED TO TIE L ETT, BUT FAILURE TO DO SC SHALL
IMPOSE NO OBL;GATION OR LIABILITY OF AN/ HIND UPON THE INSURER ITS AGENTS OR
REPRESENT ATI/'ES.
AUT�IZED REPRE
0
F11788-2 2 . All rights reserved.
The ACORD name and logo are registered marks of ACORD
9 ACO COR
STATE OF FLORIDA:: •
DEPARTMENT OF HEALTH • DATE PAID' .
ONSITE SEWAGE TREATMENZrAND,,DISFOSAUS?;SEEM: ' • • • ',FEE PAID' '•, ' -
CONSTRICTION INSPECTION AND FINAL APPROVAL . .RECEIPT:11:
•-• • . ... •:. •ii :t•i;,•• • ' • *.:: • -.
APPLICANT: —di( 11 4 et -.4)e4ft v*.....,.., ...,..-k, . . - -.: 0.--:, •
,
--•
,•.•••••.. • .
4 p. 44 6 74
PERMIT NO.13- S(-1Q'1 S rs•
;1••• ;:„?
AGENT:
PROPERTY.ADDRESS:,
. '•
• • • .• • . *. *;•' , .
......,
LOT: 49_ .. BLOCK: ;". • ,••••=,• „ f!FIQFPWTY:. IP,1414-WA.
.',•:;•12; Lox: •
mz mm mm mu.me mm == mm mm em ma me me mm ma mm mm um me mm mm mm me em mm'mm eM mu mm mm mm mm mm me um mm me Ms Ds mm mm ms mm m
CHECKED • [X] ITEMS ARE NOT INI.:COMR1.1A1400.:NSIffed.STATItie. •,01:( RULE ' AND .* MUST
=I; IRE = =. SRC Ds teem Bs
= = =
TANK INSTALLATION
[01] TANK SIZE (13 7S [2]
102j TANK MATERIAL CO r_fir "le
(03] OUTLET DEVICE
[04] MULTI-CHAMBEFIED [Y / N
[05]
E081
OUTLET FILTER
LEGEND
[07] WATERTIGHT
(08] LEVEL
[09] DEPTH TO LID .; .
DRAINFIELD INSTALLATI N, :,?t•:••
[10] AREA [1] Z [21—SOFT 40,
[11] DISTRIBUTION BOX—HEADER —le
(121 NUMBER OF
[131 DRAINLINE SEPARATION,
[14] DRAINLINE SLOPE
(1`5] DEPTH OF COVER •
[18) ELEVATION [ABOVE/BELOW] BM
[17] SYSTEM LOCATION
[18) DOSING PUMPS
[19] AGGREGATE SIZE •
[20] AGGREGATE EXCESSIVE FINES
[211 AGGREGATE DEPTH
FILL / EXCAVATION MATERIAL.'
[22] FILL AMOUNT
[23] FILL TEXTURE':
[24] .
1253
126)
••1'. . • . •..:
EXCAVATION DEPTH
AREA REPLACED"e' -1.11AI•iVY
REPLACEMENT, MATERIAL .. • , : •
. . • .1.;/••ii that 4;7+,0' •
SE CORRECTED'• •
mu um mm mM Mm um am me
sEraKS'•" '.".: •• • ". • •:
[21. St/ttFISCsE , •(28]
[291 ' PRIVATE WELLS__ Fr
[30] • PUBLIC WELLS • FT
t 1 [31] IRRIGATION / . ' •:„ • • , • $ • ,
[ 1 [32] • POTABLE WATER LINES tO FT
( ] •'•-i..BUII:1311,1d:FOUNDATION ;1' • r.*: :FT
P130P.g!lre yln,P , .k,t) - FT
] I [3:53:'' •• • •••' • • ---'",!'“•'/A.: •FT •
• [381 D1/17C1IP-P g9Yq!"..
.•; •,•151•';; • ;
;•1:••• ;,1.3
• ]. • 1371 • • SHO-LDEOI§ • * • .* • •
t 1 •• (33] • tAinclf104.3;k2,4- 1:A..0:141.••••••;:gali
[ 3 (39] . , STABILIZATION
• • • . s..sal I r./ • %. •
' ,. • • -ADDITIONAL INFORMATION
I I (40) •.• UNOBSTRUCTED AREA :./.1;;:.; t:i
] • (411. STORMWATER RUNOFF
[ 1 [421' • j''-•ALik)ips'ils'‘. • . ' . •
1 [43] iYINNTNANCE .
[ 3 [44] 13011.DING XREA " • ' • •'• ••••
1 [44 •APAY,91)1, .99N PLAN
. .
[ [48] . • FINAL SITE GRADING
-t -1 [44 OcINTRACT.OB.:'
) [481. • OTHER
• . . •
•••■•:$•!) 141% • • : • •::•• ,;
• • ABANDONMENT
rvIlrtql,(419141;''. • TANK PUMPED," '";./ ' •• ' ••=•:.;
• [ . J. . 459 . • • . TANK CRUSHED & FILLED —/
-*•`; :73'0 . •
EXPLANATION OFVIOI.ATIONS'i RiMAFIZilri'1141":.7 '‘) ."‘•••• 's • . ":
• •.;:..: •' • : ) • • ••• : •••
1 I
•1. 3
-1 I
• I, I
; • • . • ,•••,A.) -• • • • • • • •••
CONSTRUCTION [
. . .
0/DISAPPROVED):
' • ; :
FINAL SYSTEM [AP O D/DISAPPROVED]:••
.- • • • -•
T
DH 4010 (Pape 2), 10/07 (Previous Editions May So Used
Stock Number: S744.002140164
CHD,
ogg:12 Ariol
_ CHO DATE 4X",/42,141
PT 1; ApplAconi
P1 2: insiallsoconesstor
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