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PL-08-185 y Inspection Worksheet Miami Shores Village -- 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP -73459 Permit Number: PL -2 -08 -185 Scheduled Inspection Date: June 25, 2009 Permit Type: Plumbing - Residential Inspector: Levrock, James Inspection Type: Final Owner: GERHARDT, ELIZABETH Work Classification: Drainfield Job Address: 42 NE 106 Street Miami Shores, FL Phone Number Parcel Number 112136006005 Project: <NONE> Contractor: A AARON SUPER ROOTER Phone: 305 - 944 -8886 Building Department Comments P A Comments Passed OVAL IN FILE Failed Correction ❑ Needed Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. AaK- I 6s - STATE OF FLORIDA PERMIT NO. DEPARTMENT OF HEALTH DATE PAID: ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID: CONSTRUCTION INSPECTION AND FINAL APPROVAL RECEIPT #: APPLICANT: / ` �` r'1 f� P C AGENT: PROPERTY ADDRESS: 14 Z_ LOT: BLOCK: 7 - 0 4 SUBDIVISION." i v e4 /1 4`10 N PROPERTY ID #: _ 02j3 s>OV CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED. TANK INSTALLATION SETBACKS [ ] [01] TANK SIZE [i] 0 0 [2] [ ] [27] SURFACE WATER FT [ ] [02] TANK MATERIAL �'"-- [ ] [28] DITCHES a j e4% ;- FT [ ] [03] OUTLET DEVICE [ ] [29] PRIVATE WELLS _FT [ ] [04] MULTI - CHAMBERED [Y / [ ] [30] PUBLIC WELLS FT [ ] [05] OUTLET FILTER [ ] [311. IRRIGATION WELLS FT [ J [06 LEGEND �.�'e ` [ ] [32] POTABLE WATER LINES i ® FT [ ] [07] - WATERTIGHT [ ] [33 BUILDING FOUNDATION FT [ ] [08] LEVEL [ ] [34] PROPERTY LINES FT [ ] (09] DEPTH TO LID [ ] [35] PTHER FT DRAINFtELD INSTALLATION- ] X- FILLED ! MOUND SYSTE [ ] [10] AREA [1] {2] SQFT [ ] [36] DRAINFIEL OVER [ ] [ii] DISTRIBUTION, BOX HEADER [ ] [37] SHOU RS [ J [12],, NUMBER OF DRAINLINES S" [ ] [38] SL ES I - 1. 1131 DRAINLINE SEPARATION [ ] [39] STABILIZATION [ ] [14] DRAINLINE SLOPE d [ ] [15] DEPTH OF COVER �►� N ADDITIONAL INFORMATION [ ] [16] ELEVATION [ABOVE/( ELO BM �`! 1 ' 1t ' [ I [40] UNOBSTRUCTED AREA [ ] [17] SYSTEM LOCATION ` [ J [41] STORMWATER RUNOFF [ ] [18] DOSING PUMPS rL s [ ] [42] ALARMS M-t [ ] [19] AGGREGATE SIZE k [ ] [43 MAINTENANCE AGREEMENT 4 [ ] [20] AGGREGATE EXCESSIVE FINES ' t. [ ] [44 BUILDING AREA [ ] [21] AGGREGATE DEPTH [ ] [45] LOCATION CONFORMS WITH SITE PLAN [ J [46] FINAL SITE GRADINfp FILL !EXCAVATION MATERIAL [ ] [47] CONTRACTOR IT [ ] [22] FILL AMOUNT [ ] [48] OTHER [ ] [23] FILL TEXTURE c� [ ] [24 EXCAVATION DEPTH 3­0 ABANDONMENT [ ] [25] AREA REPLACED [ ] [491 TANK PUMPED [ ] [26] REPLACEMENT MATERIAL [ ] [50] TANK CRUSHED & FILLED EXPLANATION OF VIOLATIONS / REMARKS: CONSTRUCTIO [APPROV /DISAPPROVED]: CHD DATE: FINAL SYSTE "[APPROVE ISAPPROVED]: CHD DATE: �- DH 4016 (Page 2), 10/97 (Previous Edttions•May Be Used) Page 2 of 3 Stock Number. 5744 - 002 - 4016 -4 PT t. Applk*M PT 2: Insta w/contractor PT 3: Building Deparbnent PT d• NnoeN rt—h -0 .�- Miami Shores Village - -•' is � ::. >? .. ,« 10050 N.E. 2n d Avenue X. 97 �. . Miami Shores, FL 33138 -0000 o?- 1 Phone: (305)795-2204 795- a 2204 0 Exp iration: 07130120 8 Project Address Parcel Number Applicant _:...... ......,.... ....... ...... ...,, ,, ...... ......_.. ................ 42 NE 106 Street 1121360060050 Miami Shores Village, FL Block: Lot: ELIZABETH GERHARDT !Y!!g!.Iflf4[R}atlQ!1 ......,,. .......... Address.,,,, ..... Phone Celi ....... ELIZABETH GERHARDT 42 NE 106 ST MIAMI SHORES FL 33138-2035 .............. .K SSSO KKd•4 " N .K Contractor(s) Phone Cell Phone ;Valuation: $ 150.00 A AARON SUPER ROOTER 305- 944 -8886 >" ...................................................... ............................... ;Total Sq Feet: 3000 • <sss��xx ...:..........,...,., sass; �...,,»..•...•.,, ..a:�.:�,,.,.....,.,.......::. Type of Work: PLUMBING Available Inspections: Type of Piping: DRAINFIELD Inspection Type: Additional Info: Landscaping Bond Return: Final Classification: Residential Rough i i Fees Due Amount Total Amt Paid Amt Due Bond Type - Contractors Bond $300.00 T CCF $0.60 $ 0.00 $ 0.00 $ 0.00 Education Surcharge $0.20 l.. .... Permit Fee - New Construction $175.00 Payment Type: Scanning Fee $3.00 Technology Fee $4,37 Total: $483.17 � i rn o i PAID 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 . February 01, 2008 Authorized Signature: Owner J Applicant ! Contractor t Agent Date Building Department Copy Friday, February 1, 2008 1 M Cc' b ]1[1 ! �_ ' Miami Shores Village FEB 0 1 2008 Building Department ' 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING Permit No. &106_ 1 2_ PERMIT APPLICATION Master Permit N o. FBC 2004 Permit Type: Plumbi11Q Owner's Name (Fee Simple Titleholder) Glt 2G 6e+r l Ge A a rd + Phone # Owner's Address (SA f" ?) City State Zip Tenant/Lessee Name Phone # E- MAIL: Job Address (where the work is being done) 42 N t 4r0 City Miami Miami Shores Village County Miami -Dade Zip X 3312) P FOLIO /PARCEL# � � OO6 - QOSO Is Building Historically Designated YES NO Contractor's Company Name R An r-"*x c kc & 4e, Phone Contractor's Address Cit L Vy,_0el State 'FL Zip Z3 . Qualifier Name n T Phone # State Certificate or Registration No. -7 Certificate of Competency No. E -MAIL: Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ Square / Linear Footage Of Work: Type of Work: ❑Addition ❑Alteration E]New � Repair/Replace ❑Demolition Describe Work: .e.�l a � d�ra ►Y, Submittal Fee $ Permit Fee $ q VJ d CtF CO /CC Notary $ Training /Education Fee $ -�lJ Technology Fee $ 4 - L Scanning $ , 6 . to Radon $ DPBR $ Zoning $ dMI Bond $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ -4ffl -44 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. 1 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, TANIgS anal 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 exce 'ng $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochu will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commence ent 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. s' Signature J U Signature Owner or Agent T Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this s?f' day of 3 7-1 0 1 ' 2008, by day of , 1*1 , 20 'd b I,,i ' j �, who is personally known to me or who has produced i +w • who is personally known tome or who has produced O✓lv, l ��h As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLI NOTARY PUBLIC: Y C MM SA J. S OLOA?prr Z Sign: A of o _ E SS/ON � Db 26 #V � ar �� Sign: � h. Print: o�rnAm Print: y, �!1 tli fr My Commission Expires: My Com '' xpires: 4r %r.i;x &iie *e ae is ie *at atr t ak ae 4c ie 9C ie >e 9e ae aYx xx *xde xX',F,}; x *X'aexie 'e 9:r]Y aF r. �xn: is at at' a'e 4t d: *ic ie t i:a'; a % %XxiCXa:aFa: *acxaF a': ee is 9; r. xiez *a;-xt e:xr, r. APPLICATION APPROVED B ` ©� Plans Examiner Engineer Zoning (Revised 02/08/06) PERMIT #: 13SG- 901117 STATE OF FLORIDA APPLICATION #: AP843842 a DEPARTMERT OF HEALTH DATE PAID: 1/1/1899 ONSITE SEWAGE TREAT ENT AND DISPOSAL FEE PAID: $15.00 SYSTEM RECEIPT #: 13 -PID- 986807 DOCUMENT #• PR703957 CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: Elizabeth Gerhardt PROPERTY ADDRESS: 42 NE 106 St MIAMI, FL 33138 LOT: 5 BLOCK: 202 SUBDIVISION: Dunnings Miami Shores PROPERTY ID " #: 11- 2136-006 -0050 [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 PE RMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY. SYSTEM DESIGN AND SPECIFICATIONS T [ 900 ] GALLONS / GPD Sentic 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 Trench Configuration SYSTEM R [ 0 ] SQUARE FEET SYSTEM A TYPE SYSTEM: [ ] STANDARD [ ] FILLED [ ] MOUND [ 7 I CONFIGURATION: [s] TRENCH I ] BED [ ] N I . F LOCATION OF BENCHMARK: FFE ....... Ell.:11.80 "" NGVD I ELEVATION OF PROPOSED SYSTEM SITE [ 22.807[ INCHE3 FT ][ABOVE BELOW BENCHMARK /REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 40.80][CHEg FT ][ABOVE BELOW BENCHMARK /REFERENCE POINT L D FILL REQUIRED: [ 0.40] INCHES EXCAVATION REQUIRED: [ 30.00] INCHES 0 1.- Existing 900 gal. septic tank to remain. 2.- Install 225 sf of drainfield in trench configuration. T 3. -Invert elevation of drainfield to be no less than 7.90 ft NGVD. H 6. -Bottom of drainfield elevation to be no less than 7.40 ft NGVD. E THIS PERMIT IS NOT FOR " ADDITION(s) ". R SPECIFICATIONS BY: Oeral Phil' are TITLE: APPROVED BY: TITLE: Engineer Specialist II Dade CHD PaITph R - ' DATE ISSUED: 008 EXPIRATION DATE: 04129/2008 DH 4016, 10/9 (Previous Editions May Be Used) Page 1 of 3 v 1.1.4 AP843842 SE721225 STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERM T Permit Application Number -- • PART 11- SITE PLAN - -- -- — — — -- Scale: Each block represents 5 feet and 1_inch = 50 feet, ,n } P s { x b } 4 x x 1 ' E A t � » n r x. } » E £ £ 3 d x x } d x x l rrr £ y , > L Notes: Ccr tom' lM 33t 2 A' lam o z-z Site Plan submitted by:. / Signature Title Plan Approved '✓ Not Approved Date `� > By 1 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) (st«* Number: 5744 -0W- 4015.6) Page 2 of 3 v .k