PL-18-1833P)C 18 -1171
(
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
-b -eat(
Inspection Number: INSP-307925
Permit Number: PL-7-18-1833
Scheduled Inspection Date: July 09, 2018
Inspector: Hernandez, Rafael
Owner: RODRIGUEZ, CLAUDIO
Job Address: 1263 NE 101 Street
Miami Shores, FL
Project: <NONE>
Contractor: STATEWIDE SEPTIC CONNECTIONS
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Septic
Phone Number
Parcel Number 1132050250040
Phone: (954)963-0082
Building Department Comments
INSTALL NEW 1350 TANK AND 750 DRAINFIELD
REPLACED PL-4-15-986
Infractio
Passed Comments
INSPECTOR COMMENTS
False
Passed
Failed
Correction
Needed
Re -Inspection
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
Inspector Comments
HRS APPROVAL ON FILE
July 06, 2018
For Inspections please call: (305)762-4949
Page 23 of 34
Office
From: Torres, Diana <Diana.Torres@flhealth.gov>
Sent: Thursday, July 05, 2018 12:39 PM
To: Office
Subject: FW: OSTDS_PDF.aspx.pdf
Attachments: OSTDS_PDF.aspx.pdf
Follow Up Flag: Follow up
Flag Status: Completed
Categories: RECEIVED
Hello,
Please see inspection results attached.
Thanks,
Diana Torres
Florida Department of Health in Miami -Dade County
Administrative Assistant I
Email: Diana.Torrest flhealth.gov
Phone: 786-315-2444
Mailing Address: 11805 SW 26 STREET Floor: 01 Room: 120
MIAMI, FL 33175
How is my customer service? Please let me know by taking our
survey: htto://www.survevmonkev.com/r/dohmdsurvev
Our Mission is to protect, promote & improve the health of all people
in Florida through integrated state, county, & community efforts.
Please note: Florida has very broad public records law. Most written
communication to or from state officials regarding state business are
public records available to the public and media upon request. Your
e-mail communications may therefore be subject to public disclosure.
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION INSPECTION AND FINAL APPROVAL
APPLICANT: Claudio Rodriguez
APPLICATION #:AP1181930
PERMIT #: 13-SC-1595797
DOCUMENT # : FI 1000789
DATE PAID:05/14/2015
FEE PAID:100.00
RECEIPT #:13-PID-2662595
AGENT: Statewide Septic
PROPERTY ADDRESS: 1263 NE 101 St Miami, FL 33138
LOT: 5
SUBDIVISION:
Bay Breeze
BLOCK: 185
ID#: 11-3205-025-0040
CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED.
TANK INSTALLATION
[01]
[02]
[03]
[04]
[05]
[06]
[07]
[08]
[09]
TANK SIZE [1] 1500.00 [2]
TANK MATERIAL Polyethylene
OUTLET DEVICE
MULTI -CHAMBERED [ Y / N ]
OUTLET FILTER Tuf-Tite EF-4
LEGEND 1. 70-109-23DC3 2.
WATERTIGHT
LEVEL
DEPTH TO LID
DRAINFIELD INSTALLATION
[10]
[11]
[12]
[13]
[14]
[15]
[16]
[17]
[18]
[19]
[20]
[21]
FILL
[22]
[23]
[24]
[25]
[26]
AREA [1] 675 [2]
DISTRIBUTION BOX
NUMBER OF DRAINLINES
DRAINLINE SEPARATION
DRAINLINE SLOPE
DEPTH OF COVER
ELEVATION [ ABOVE /
SYSTEM LOCATION
DOSING PUMPS
HEADER
1. 3.00 2.
BELOW
SQFT
X
]BM 12.12
AGGREGATE SIZE
AGGREGATE EXCESSIVE FINES
AGGREGATE DEPTH
/ EXCAVATION MATERIAL
FILL AMOUNT
FILL TEXTURE
EXCAVATION DEPTH
AREA REPLACED
REPLACEMENT MATERIAL
Comments: Comments are on page 2.
SETBACKS
[27]
[28]
[29]
[30]
[31]
[32]
[33]
[34]
[35]
SURFACE WATER
DITCHES
PRIVATE WELLS
PUBLIC WELLS
IRRIGATION WELLS
POTABLE WATER
FT
FT
FT
FT
FT
55 FT
BUILDING FOUNDATIONS
PROPERTY LINES
OTHER
FILLED / MOUND SYSTEM
[36]
[37]
[38]
[39]
14 FT
6 FT
DRAINFIELD COVER
SHOULDERS
SLOPES
STABILIZATION
ADDITIONAL INFORMATION
FT
[40] UNOBSTRUCTED AREA
[41] STORMWATER RUNOFF
[42] ALARMS
[43] MAINTENANCE AGREEMENT
[44] BUILDING AREA
[45] LOCATION CONFORMS WITH SITE PLAN
[46] FINAL SITE GRADING
[47] CONTRACTOR Teresa J Solomon (Statewide
[ 48 ] OTHER ADS ARC 24
ABANDONMENT
[49] TANK PUMPED
[50] TANK CRUSHED & FILLED
CONSTRUCTION [
FINAL SYSTEM (
APPROVED
APPROVED
/ Dade CHD
DISAPPROVED ) ' Engineering Specialist II Erlande Omisca (Department of Health in Dade
/ DISAPPROVE i
DATE : 05/14/2015
Dade CHD DATE: 05/14/2015
Engineering Specialist II Erlande Omisca (Department of Health in Dad
(Explanation of Violations on following page)
DH 4016, 08/09 (Obsoletes all rrevious editions which
Incorporated: 64E-6.003, FAC
E.HDaalmvi.0.1
API
may not be used)
0
Pago 2 of 3
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION INSPECTION AND FINAL APPROVAL
APPLICATION #:AP1181930
PERMIT # 13-SC-1595797
DOCUMENT #: FI1000789
DATE PAID :05/14/2015
FEE PAID:100.00
RECEIPT #:13-PID-2662595
Violation Number
Comment
Comments
- Septic system information, setbacks, drainfield size and chambers were taken during previous inspections by previous
inspectors.
- 42" inches of sand provided below drainfield.
- 45 ARC24 chambers DF- 675 sf trench
The system is sized for 5 bedrooms with a maximum occupancy of 10 persons (2 per bedroom), for a total estimated flow of 520
gpd.
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated.: C4E-6.003, FAC
EH CaB v1,0,1
Page 2 of 3
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Permit
■
Parcel Number
Permit NO. PL-7-18-1833
Permit Type: Plumbing - Residential
Work Classification: Septic
Permit Status: APPROVED
Expiration: 01/01/2019
Applicant
1263 NE 101 Street
Miami Shores, FL
1132050250040
Block: Lot:
CLAUDIO RODRIGUEZ
Owner Information
Address
Phone
Cell
CLAUDIO RODRIGUEZ
1263 101 Street
MIAMI SHORES FL 33138-
1263 101 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone
STATEWIDE SEPTIC CONNECTIONS (954)963-0082
Cell Phone
Valuation:
Total Sq Feet:
$ 7,500.00
0
Type of Work: INSTALL NEW 1350 TANK AND 750 DRAIN
Type of Piping:
Additional Info:
Bond Return :
Classification: Residential
Scanning: 1
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$0.00
$0.00
$o.00
$0.00
$300.00
$0.00
$0.00
$300.00
Pay Date Pay Type
Invoice # PL-7-18-68152
07/05/2018 Check #: 1543
Amt Paid Amt Due
$ 300.00 $ 0.00
Available Inspections:
Inspection Type:
HRS Approval
Final
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 responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing information is
construction and zoning. Futhermore, I authorize the above -nary d cc5ntrator to do the work stated.
rate and that all work will be done in compliance with all applicable laws regulating
July 05, 2018
Authorized Signature: Owner / Applicant Contrac / Agent Date
Building Department Copy 1 �� ` o f< \
July 05, 2018 1
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
BUILDING
PERMIT APPLICATION
BUILDING ❑ ELECTRIC ❑ ROOFING
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS
JOB ADDRESS:
❑ REVISION
CHANGE OF
CONTRACTOR
1263
City: Miami Shores
Folio/Parcel#:
Occupancy Type:
County:
Load:
RECEIVED.
JUL 0 5 2016
FBC 2014
Master Permit No. C •- (o — (2 - %?-
Sub Permit No. p 1 18- 1:333
❑ EXTENSION RENEWAL
❑ CANCELLATION ❑ SHOP
DRAWINGS
Miami Dade Zip:
Is the Building Historically Designated: Yes
Construction Type: _ Flood Zone:
NO
BFE: FFE:
OWNER: Name (Fee Simple Titleholder): (.i 1 a. 'C 0 .g (r•� ? Phone#: 37S , Z ) Z Z 2. 4
Address: 1 2 �i !kJ C,
City: I t _ / • State:
Tenant/Lessee Name: Phone#:
Email:
Zip: ( 3 g
CONTRACTOR: Company Name: V `lr eVe/L 546 (! �K 6%Tot. ,a 7' Phone#: ',.
Address::/ t-7(L tp O.5( 7
city:(- ' teo¢ <1' State: f J . Zip: 30/ g
Qualifier Name��G' '( .t "Cc'A Phone#: ' f, i2.fo ClC/ct9-
State Certification or Registration #��G eireZ $ yoZ / Certificate of Competency #:,
DESIGNER: Architect/Engineer: 14 S f `'1 co_r Phone#:* ? 6 6- Sz✓ ?'► -?'-s 5 S
p
Address: IC' ✓ % / v tC._ ( ( 'y S t' City: I. ? T Y State: ti Zip: 1 j 1 iP .
Value of Work for this Permit: $
Type of Work: ❑ Addition
Description of Work:
n Alteration
Square/Linear Footage of Work:
❑ New ❑ Repair/Replace n Demolition
ww
t)?rcv'v .
Specify color of co,. lor. thru..tile: {
Submittal Fee $'*"Permit•Fee $...
Scanning Fee $ Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
CCF $ CO/CC $
DBPR $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE$
(Revised02/24/2014)
Bonding' Company's,Name (if applicable)
Bonding Company's Address
.Tv. r 6
City
A
Mortgage Lender's Name (if applicable)
State Zip
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 thata separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES, BOILERS, HEATERS, TANKS, 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, issued. In the absence of such posted notice, the
n: inspection will not be approved an einspection fee will be charged.
Signature
OWNER4IENT
The foregoing instrument was acknowledged before me this
,20 18 ,by
nn,,, ' C.t ,1� o r w o is e3nally�konown to
ff
me or who has produced 41 I t1
identification and who did take an oath.
NOTARY PUBLIC:
S
Print:
Seal:
" day of U\
od
MY COMMISSION # GG 044602
EXPIRES: November 2, 2020
Bonded Thru Notary Public Underwriters
**********************************
APPROVE BY
14
(Revised02/24/20 )
`as
CONTRACTOR
' :P 1'y, , s
The foregoing instrument was acknowledged before me this
�/� day of h e , 20 / 0 , by
)1'9G1`Lej ..0—'` < ?who is personally known to
me or who has produced as
'identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print L t, erect' /.LLAr '
Seal:
************************
t! Utz;; i'liU. State of Florida
r: I. wdoh Maria Rivera
My Commission GG 124638
of A, cfPExpires 07/18/2021
Plans Examiner Zoning
Structural Revie Clerk