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DRAINFIELDVillage of Miami Shores N9 4614 JOB 11 S : r AD 3,,,,,, ,., ,:. , ,, , .(; INSPECTION 6 0 7 . TIME READY 1 v/4 # 7-2 5 REMARKS 6. kf. INSPECTOR DATE C p .. , ) 6 1 --r- 6 (9 Passed Ins ec qr o e is Failed Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled re- inspection fee is paid . until ::. �ii:vvvi }i :.. ....... ..............:. ............................... \ . i/. �..... Ilv:.# I.. �. *IFv:..Y,:Y,.ii:•i�.:w.�}14:Yi: ::.:: :....... .. :::v::. �::::::::::::: :.:::::::.:..::: i:h:•i }iiiii:4i iii:9iiiiiii;.; y::::::. .... �......................... .:.�::.. .:::.......................................................................................... ............................... .. Inspection Date: 06/19/2006 Inspector: Levrack, James Owner: VALMOCINA, MARIBEL Job Address: 685 93 Street NE Miami Shores Village, FL 33138- Project: <NONE> Contractor: STATEWIDE SEPTIC CONNECTIONS Building Department Comments Friday, June 16, 2006 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Block: r:hrti w Permit Type: Plumbing - Residential Inspection Type: Landscaping Work Classification: Drainfield Phone Number (305)758 -7829 Parcel Number 1132060141750 Lot: Phone: 305 - 661 -6633 Page 1 of 2 AGENT: APPLICANT: PROPE11TY.ADDRESS:' -5 BLOCK: b S 1 STATE OF FLORIDA DEPARTMENT OF HEALTH =t "' . ONSITE SEWAGE TREATMENT:AND DISPOSAL SYSTEM CONSTRUCTION INSPECTION FINAL APPROVAL CHECKED [X] ITEMS : ARE NOT IN TANK INSTALLATION ' [ ]• [01] TANK SIZE [1]/0 0 [2] [ , ]. [02] .TANK.MATERIALc . 1: -e•/t b [ ] [03] OUTLET DEVICE [ ] [04] MULTI- CHAMBERED [ i ] [05] OUTLET FILTER ,/ [ ] [06] LEGEND 7• [ ] [07] WATERTIGHT [.i ] [08] LEVEL,yirct [' ] [09] DEPTH TO'LID JCj ' • DRAINFIELD INSTALLATION- , [10] AREA? x2 [ 3 C� 0 SOFT . . "' ` " DISTRIBUTION BOX= HEADER [12] NUMBER OF,DRAINLINES Y [ ; ] • [93] DRAINLINE SEPARATION [ ] [14] DRAINLINE SLOPE [ ] [15] DEPTH OF COVER jf 7 [ ] [16] ELEVATION: [ABOtt1;tt3ErO,BM [ : ] [17] SYSTEM LOCATION. [ ] [18] DOSING PUMPS - [ ] [19] AGGREGATE SIZE S ',© [ ] _ [20] ` "AGGREGATE EXCESSIVE - FINES [21] AGGREGATE DEPTH / FILL / EXCAVATION MATERIAL [22] - FILL AMOUNT'=' J2 [23] FILL TEXTURE [24 ] EXCA V4 + O N D x ',l •f c 'a ti t ` 1'' ) , ea =, ABANDONM E NT - • l t '' '' '151i.: t, i ') 1' " ' 1 "14 1 11 ( 1 . ° c '' 1 t tf it t '{ f e [ 2 5 j ARE .REPL M [ , ] . [ TA { N K PUMP J t' [26] REPLACEMENT MATERIAL • [ ] ' [50]' "TANK CRUSH D & FILLED_ . EXPLANATION OF VIOLATIONS' /'REMARIS: [I ] • III • . - CONS]'RUCTION__ [APPROVED /RISAPPRO_VED] FINAL SYSTEM [APPROVED /DISAPPROVED]: DH 4016 (Page 2); 10/97 (Previous Editions May Be Used) Stock Number: 5744- 002- 4016 -4 ,rr SUBDIVISION:i�'4 c - COMPLIANCE WITH STATUTE' . OR RULE AND MUST BE : CORRECTED. ill; 3 % Jac- [ • [ ] [ a ; A.x 'EL ..,.c „ ,- PERMIT NO tom(' " - - DATE PAID: FEE PAID RECEIPT #• • PROPERTY ID #. ; • _ SETBACKS ' [271 SURFACE WATER N /4- ] [28] s DITGHE$ ] [29] '✓ PRIVATE WELLS ] • [30j : 'PUBLIC WELLS' [31] -` IRRIGATION WELLS A/ /' [32] ' POTABLE WATERLINES [33]` • BUILDING FOUNDATION r 1 [34] PROPERTY LINES : ] [35] OTHER FILLED /: MOOD •SYSTEM.: [36] DRAINFIELD COVER ] [37] ; ,SHOULDERS - - - : ] i [38] :SLOPES 1. • [39] STABILIZATION • t ADDIT)O FORMAI'IdN [40] :`UNOBSTRUCTED AREA [41] STORMWATER RUNOFF CONTRACTOR PT 1:' Applicant • • PT 2: Installer /Contractor • PT 3:' Building Department.. PT 4i Health Department ti?` i [ ] ' [42] , ALARMS:, ? t [ I; [43] MAINTENANCE AGREEMENT [44] BUILDING AREA [ ] [45] LOCATION CONFORMS WITH SITE PLAN 1•: -• 446] _r' FINAL' SITE GRADI • CHD DATE. - / CHD DATE' /‘" FT . FT FT FT FT FT FT FT -.FT Page 2 of 3 Inspec • • • ertril • Inspection Date: 06/19/2006 Inspector: Levrack, James Owner: VALMOCINA, MARIBEL Job Address: 685 93 Street NE Miami Shores Village, FL 33138- Project: <NONE> Contractor: STATEWIDE SEPTIC CONNECTIONS Building Department Comments Friday, June 16, 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: Plumbing - Residential Inspection Type: Final Work Classification: Drainfield Phone Number (305)758-7829 Parcel Number 1132060141750 Lot: Phone: 305-661-6633 Page 1 of 2 Passed Inspector Comments Failed Correction Needed Re-Inspection Fee ($75) No Additional Inspections can be scheduled re-inspection fee is paid . until Inspec • • • ertril • Inspection Date: 06/19/2006 Inspector: Levrack, James Owner: VALMOCINA, MARIBEL Job Address: 685 93 Street NE Miami Shores Village, FL 33138- Project: <NONE> Contractor: STATEWIDE SEPTIC CONNECTIONS Building Department Comments Friday, June 16, 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: Plumbing - Residential Inspection Type: Final Work Classification: Drainfield Phone Number (305)758-7829 Parcel Number 1132060141750 Lot: Phone: 305-661-6633 Page 1 of 2 E BUILDING PERMIT APPLICATIO FBC 2004 13y Job Address (where the work is being done) FOLIO / PARCEL # ) ' 3 2 p c4 0 1 , Is Building Historically Designated YES NO Architect/Engineer's Name (if applicable) NA Value of Work For this Permit $ Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 RECFT \TFID MAY 0 Permit No. P1 O 125 Master Permit No. Permit Type (circle): Building Electrical tA Plumbing Mechanical Roofing r (Fee Simple Titleholder) O n � O r -. � �Y, Owner's Name Fee Sim le Titleholder \ �-. P h one # 3 ' 1 0 Owner's Address CQ Q City k JC■k gN7j State Zip Tenant/Lessee Name Phone # G5 NE c3 S City Miami Shores Village County Miami -Dade Zip - 33 ( 'A' (3os) Contractor's Company Name 5-iG *wl de, G (J' v s C Phone # G Contractor's Address 3590 S- $'t Act 26 City M' l Q w\A r State ft- Zip 3 ? 13 Qualifier Name Te-re S 4' so 1 Oi ' q.-- Phone # State Certificate or Registration No. SA'1 1( 2(o 2 Certificate of Competency No. Phone # Square / Linear Footage Of Work: 30d ******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** F * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Type of Work: ['Addition DAlteration ['New Repair/Replace ❑ Demolition Describe Work: r 11 Ni-e. w D,' 4 I &Q d Submittal Fee $ Permit Fee $ CCF $ 1 • Uu CO /CC Notary $ Z) CO Training/Education Fee $ ' GO Technology Fee $ 3' 1S Scanning $ y�j-, CO Radon $ DPBR $ Zoning $3 � Bond $ CC.,) ,GC.) Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ 48"1 . IS See Reverse side -* cy, 5V6 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 issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature )%nA 4 � `v r \ k aMi , no\ Owner or Agent The foregoing instrument was acknowledged before me this day of a 200G , by Mf ibL 1 JAI YrNO e — who is persona y known to me or who has produced ' v. U Ci` ration and who did take . oath. NOTARY PUBLPC:�`� T �.ovtO I G, 2007 �5 FL Notary Discount Assoc. Co. Sign: Print: ? OF D ¢ 04 6 8 4 3-N , . s ir 'Illa'■•• T- eeese. My Commission Expires: 1 ****** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPLICATION APPROVED BY: (Revised 02/08/06) Signature < `•' Q 4e'Yvt` ` Contractor The for o ng instrument was acknowledged before me this day day of , 20a2by who is personally known to me or who has produced L ci NOTARY PUB Sign: Print: My as identification and who did take an oath. RRY PUBLIC - ,STATE OF FLORIDA Y or1 • ny Hernandez asst, # DD476455 E? 27, 2009 ' . Y - .•7ili• :s s• - _ 1". Warlai " r l atM r iallb �• ssion Expires: —` ****** / ******************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** e i Plans Examiner Engineer Zoning STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: [ ]New System [ )Existing System [ [ X ]Repair [ ]Abandonment APPLICANT: Valmocina, Maribel PROPERTY STREET ADDRESS: 685 NE 93 St Miami Shores FL 33138 LOT: 19 BLOCK: 65 PROPERTY ID #: 11- 3206 - 014 -1750 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 [ 900 ]Gallons SEPTIC TANK A [ 0 ]Gallons N [ 0 ]GALLONS GREASE INTERCEPTOR CAPACITY K [ 0 ]GALLONS DOSING TANK CAPACITY [ 0 ]GALLONS @ D [ 300 ]SQUARE FEET PRIMARY DRAINFIELD SYSTEM R [ 0 ]SQUARE FEET SYSTEM A TYPE SYSTEM: [ ]STANDARD [ N ]FILLED I CONFIGURATION: [ N ]TRENCH [ ]BED N F LOCATION TO BENCHMARK: F.F.E.: 13.9' NGVD I ELEVATION OF PROPOSED SYSTEM SITE [ 1.6 ] [ FEET E BOTTOM OF DRAINFIELD TO BE [ 4.1 ] [ FEET L D FILL REQUIRED: [ 0.0 ]INCHES OTHER REMARKS: 1.- Install 300 sf of drainfield in bed configur 2.- Existing 900 gal. septic tank, certified by 05/05/2006" to remain. 3.- Invert elevation of drainfield to be no less 4.- Bottom of drainfield elevation to be no less THIS PERMIT IS NOT FOR "ADDITION(s) ". SPECIFICATIONS APPROVED BY: DATE ISSUED: 5/5/06 PEDRO DH 4016, 03/97 (Obsoletes previous editions which may not be used) (Stock Number: 5744- 001 - 4016 -0) [ostds_cons_4016 -1] CENTRAX #: 13 -SG -28993 DATE PAID: FEE PAID : $ RECEIPT . OSTDSNBR : 06 -1425- -R ]Holding Tank [ ] Innovative Other ]Temporary [ NA ] AGENT: SA0021074, Solomon Teresa SUBDIVISION: Miami Shores Sec 3 [Section /Township /Range /Parcel No.] [OR TAX ID NUMBER] EXCAVATION REQUIRED: [ 30.0 ] INCHES TITLE: TITLE: than 10.30' NGVD. than 9.80' NGVD. MULTI - CHAMBERED /IN SERIES: [Y MULTI - CHAMBERED /IN SERIES: [Y ] [0 ]DOSES PER 24 HRS # PUMPS[ 0 ] [ N ]MOUND [ N ] [ N ] [ BELOW BENCHMARK /REFERENCE POINT ] [ BELOW BENCHMARK /REFERENCE POINT ation. "Statewide Septic Connections Inc. on i Dade EXPIRATION DATE: 8/3/06 CHD Page 1 of 2 Scale: Each block represents 5 feet and 1 inch = 50 feet. CA t , t r I t � , Site Plan submitted by' Plan A• • • ed By 014 4015, 1098 (Replaces HRS-H Forth 4015 which may be used) (Stock Number: 5744- 002.40156) STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PER !T r s r Permit Application NumbeL J4 6 C PART II - SITE PLAN Not Approved 0 • ( Notes: WrnOCono o ( Grb ocik‘ v d R n) Crakrr) -e! cii Signature Title ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT iPj Date 1 1° 7 County Health Department Page 2 of 3 Issue Date: 5/11/2006 Owner's Name: MARIBEL VALMOCINA Permit Type: Plumbing - Residential Work Classification: Drainfield Job Address: 685 93 Street NE Comments: INSTALL NEW DRAINFIELD Additional Information Miami Shores Village, FL 33138- Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 Permit Expires: 11/05/2006 Contractor(s) Phone STATEWIDE SEPTIC CONNECTION 305 - 661 - 6633 Yes Primary Contractor Type of Work: DRAINFIELD Additional Info: 300 SQ FT Classification: Residential Type of Piping: Bond Return : 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 laws regulating construction and zoning. Futhermore, I authorize the above -named contractor to do the work stated. Fees Due Bond Type - Contractors Bond CCF Education Surcharge Notary Fee Permit Fee - Additions /Alterations Scanning Fee Technology Fee Total: Amount $300.00 $1.80 $0.60 $5.00 $175.00 $3.00 $3.75 $489.15 Building Department File Copy Applicant Signature Parcel #: Block: Section: Permit Status: APPROVED Permit Number: PL -5-06 -1205 Phone: (305)758 -7829 1132060141750 Lot: PB: Total Square Feet: 0 Total Valuation: $ 2,400.00 Required Inspections Rough Landscaping Final Invoice Number PL - 5 - 06 - 24785 Total: - sS Amt Due $489.15 Amt Paid $489.15 $489.15 NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county. AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES.