PL-10-820 Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 143014 Permit Number: PL -5 -10 -820
Scheduled Inspection Date: May 17, 2010 Permit Type: Plumbing - Residential
Inspector: Hernandez, Rafael Inspection Type: Final
Owner: HAND, MARION Work Classification: Septic
Job Address: 878 NE 91 Terrace
Miami Shores, FL Phone Number
Parcel Number 113206005032
Project: <NONE>
Contractor: MIAMI DADE ENVIROMENTAL Phone: 786- 251 -4099
Building Department Comments
INSTALL A NEW 1050 GALLON SEPTIC TANK AND 300
SQ FT DRAINFIELD IN BED CONFIGURATION
Inspector Comments
Passed HRS APPROVAL IN FILE
Failed
Correction ❑
Needed
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
May 14, 2010 For Inspections please call: (305)762 -4949 Page 25 of 32
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 143013 Permit Number: PL -5 -10 -820
Scheduled Inspection Date: May 17, 2010 Permit Type: Plumbing - Residential
Inspector: Hernandez, Rafael Inspection Type: HRS Approval
Owner: HAND, MARION Work Classification: Septic
Job Address: 878 NE 91 Terrace
Miami Shores, FL Phone Number
Parcel Number 1132060050320
Project: <NONE>
Contractor: MIAMI DADE ENVIROMENTAL Phone: 786- 251 -4099
Building Department Comments
INSTALL A NEW 1050 GALLON SEPTIC TANK AND 300
SQ FT DRAINFIELD IN BED CONFIGURATION
Inspector Comments
Passed
Failed
7
Correction ❑
Needed
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
May 14, 2010 For Inspections please call: (305)762 -4949 Page 24 of 32
Miami Shores Village /t Ty Plmbin l+slt+t>i�l(
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
r s
Phone: (305)795 -2204 li•
' Expiration: 1110812010
Project Address Parcel Number Applicant
878 NE 91 Terrace 1132060050320
MARION HAND
Miami Shores, FL Block: Lot:
Owner Information Address Phone Cell
MARION HAND 878 NE 91 TERR
MIAMI SHORES FL 33138 -3218
Contractor(s) Phone Cell Phone Valuation: $ 6,000.00
MIAMI DADE E NVIROMENTAL 786 - 251 -4099
Total Sq Feet: 300
Type of Work: PLUMBING Available Inspections:
Type of Piping: SEPTIC & DRAINFIELD Inspection Type:
Additional Info: HRS Approval
Bond Return: Abandonment
Classification: Residential Final
Rough
Landscaping
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
Bond Type - Contractors Bond $300.00 Invoice # PL -5-10 -37856
CCF $3.00 05/12/2010 Check #: 2589 $ 611.00 $ 0.00
Education Surcharge $1.00
Permit Fee - Additions/Alterabons $300.00 Bond #: 1966
Scanning Fee $3.00
Technology Fee $4.0
Total: $611.00
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 accurate and that all work will be done in compliance with all applicable taws regulating
construction and zoning. Futhermore, I authorize the above -named contractor to do the work stated
May 12, 2010
Authorized Signature: Owner / Applicant / Contractor / Agent Date
Building Department Copy
May 12, 2010 1
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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 1, 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.
"WARMNG TO OWNER: YOUR FAILURE TO RECORD A NOTICE . OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
IMPROVEMEN S TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN
INANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT."
Notice to Applicant. As 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 roe is subject attachment. Also, a certified co o the recorded notice o commencement must be posted at the job P P �y J PY f f P J ob 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 �(J� Signatur
Owner or Agent f,��. Contractor
The foregoing instrument was acknowledged before me this The fore instrument was ackno led ed before e s
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day of $° , 20 h, by day of , 2010 b
who is personally known to me or who has produced who is p rsonall kno o e or who has produced
As''denti cation and who did take an oath.
Jose Bolanos
NOTARY PUBLIC: , °'� ' ''s N TAR PUBLIC:
Commission # DD603343
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APPROVED BY � - � � ` Plans Examiner Zoning''
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Engineer Clerk checked
(Revised 07 /10 /07)(Revised 06/10/2009)
PERMIT # : 13 -SC- 1135421
STATE OF FLORIDA APPLICATION #: AP964600
DEPARTMENT OF HEALTH DATE PAID:
ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID:
SYSTEM
RECEIPT #:
DocUMENT #: PR809713
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Marion Hand
PROPERTY ADDRESS: 878 NE 91 Ter Miami, FL 33138
LOT: 3 BLOCK: 2 SUBDIVISION: Golden Gate
PROPERTY ID #: 11- 3206 - 005 -0370 [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 [ 900 ] GALLONS / GPD Seotic CAPACITY
A [ 0 j 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 [ 7
D [ 300 ] SQUARE FEET SYSTEM
R I 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [X] STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [X] TRENCH [ ] BED [ ]
N
F LOCATION OF BENCHMARK: F.F.E: 15.90' NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 24.00][ INCHES FT ][ABOVE BELOW BENCHMARK /REFERENCE POINT
E BOTTOM OF DRAINFIELD TO HE [ 52.00][ INCHE3 FT ][ABOVE iBELOW BENCHMARK /REFERENCE POINT
L
D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: [ 13.501 INCHES
0 1— Install 1050 gal. category -3 septic tank equippdd 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)(0. 3- Install 300 sf of
T drainfield in bed configuration. 4- Perimeter of excavation area shall be at least 2 It wider and logger than the proposed
H absorption bed. 5 -Invert elevation of drainfield to be no less than 11.66' NGVD 6. Bottom of drainfield elevation to be no
E less than 11.16' NGVD. P, I It
R THIS PEMIT IS NOT FOR ADDITION s . __._. of-P PSM I
SPECIFICATIONS BY;,,- N OSPINA T TLE:
ABPROVED BY:( /*
esaina TITLE: Dade CHD
DATE ISSUED: 05/10/2010 EXPIRATION DATE: 08/08/2010
DH 4016, 10/97 (Previous Editions May Be Used) Page 1 of 3
v 1.1 4 AP964600 3X816634
_ STATE OF FLORIDA
s
DEPARTMENT OF HEALTH f
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT`
VWME
Permit Application Number
----------- - - - - -- PART II - SITE PLAN------------- - - - - --
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Site Plan submitte
Sign Title
Flan Approved a -�°` .. ---�-- Not Approved Date
By %� County Health Department
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH gEPARTMENT
ON 4015. 10196 eplaces HRS-H Form 4015 which may be used)
(Stock Number: 5744- M- 40154Q
Page 2 of 3
PERMIT #:13 -SC- 1135427
STATE OF FLORIDA APPLICATION #: AP964605
DEPARTMENT OF HEALTH DATE PAID:
ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAM:
4D SYSTEM
RECEIPT #:
DocuMENT #: PR809819
CONSTRUCTION PERMIT FOR: OSTDS Abandonment
APPLICANT: Marion Hands
PROPERTY ADDRESS: 878 NE 91 Ter Miami, FL 33158
LOT: 3 BLOCK: 2 SUBDIVISION: Golden Gate
PROPERTY ID #: 11- 3206 - 005-0320 [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 I ] GALLONS / GPD CAPACITY
A I I GALLONS / GPD CAPACITY
N I ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K I ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ]
D I ] SQUARE FEET SYSTEM
R I ] SQUARE FEET SYSTEM
A TYPE SYSTEM: I l STANDARD [ ] FILLED I ] MOUND [ ]
I CONFIGURATION: [ ] TRENCH [ ] BED [ ]
N
F LOCATION OF BENCHMARK:
I ELEVATION OF PROPOSED SYSTEM SITE I ]I / ] DOVE/ BELOW] BENCHMARK /REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ ][ / ][ABOVE/ BELOW] BENCHMARK /REFERENCE POINT
L
D FILL REQUIRED: [ 0.001 INCHES EXCAVATION REQUIRED: [ ] INCHES
o Have the tank abandoned in accordance with the following procedures:(a) The tank shall be pumped out.(b) The bottom of
the tank shall be opened or ruptured, or the entire tank collapsed so as to prevent the tank from retaining water, and(c) The
T tank shall be filled with clean sand or other suitable material, and completely covered with soil.Have the system inspected
H by the health department after it has been pumped and ruptured but before it is filled with sand and covered.
E
R
3PECIFICATI PED"N06VTNA ITLE:
APPROVED BY: TITLE: Dade CHD
afro N Ospina
DATE ISSUED: 05/11/2010 EXPIRATION DATE: 08/09/2010
DH 4016, 10/97 (Previous Editions May Be Used) Page 1 of 3
V 1.1.4 AP964605 SL -1
t " a • � �� ^ r, . raur d �f'.�u�6�7.,., a'. �. ^4'YY� . + i'tT'ilm''1 . 77, "" r °�, . � -; r`. � •;�'.. { r� ',� �#. A ` qR
'V J a .:•1s4 a `M'N ..a _ ...al, 1 .. ., v ,.rT�, a. 1.
. _ STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PER
WS
Permit Application Number
----------- - - - - -- PART II - SITE PLAN-- - - - - -
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Site Plan sub mie - `# °'�� � cd ° �Alld1 A( 0
_. _ - Signature Cdr y` Title
Plan Approved pproved
Date 0:5 a-
By
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{ County Health Department
ALL CHANGES MUST BE APPROVED BY THE COUNTY EALTH DEPARTMENT
OH 4015,10M (Reple m HR8-H Foos 4015 which may be uaed) Page 2 of 3
(Slodc Numbet:8744 002�W18