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PL-09-1261 � Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FIL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Nu INSP 120421 Permit Number: PL -7 -09 -1261 Scheduled Inspection Date: February 01 2010 Permit Type: Plumbing - Residential Inspector: Bruhn, Norman Inspection Type: Final Owner: RUSHFELDT, JAMES Work Classification: Drainfield Job Address: 540 NW 113 Street Miami Shores, FL 33168 - Phone Number Parcel Number 3021360210841 Project: <NONE> Contractor: JOE LEWIS SPECIALTY SEPTIC Phone: (305)662 -7979 Building Department Comments INSTALL NEW 400 SQ DRAINFIELD Inspector Comments Passed HRS APPROVAL FINAL INSPECTION IN FILE Failed � C Correction ❑ Needed ` Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. January 29, 2010 For Inspections please call: (305)762 -4949 Page 1 of 18 07/08/09 09:19P �1 STATE SEPTIC CONNECTIONS INCS 9549630085 p.03 ,SN �' 00fiP itt'I f 1't WiN «w ` E j NZ rlr r , t�� F �f�jxf`+"'f `�� , {r�!.a1kMR"'�.5�.�4{t�s°` k'; r ! I � ' r '` - ., r t t ` 4 -.r t :4R I '•� �dtE i l�t� t��y m�db; Co 0'1 #t� � 061*'t, to �db t1tir, VubPlt .akt"'t! fnstttl�. latibns.$S. irttlicated. a?td that ail work'wtt1. Ee peifotm�o td meet :the standards of al! Iw ,f s retstft(Ig co tt G A It ir+'tha jt�i'Ps IteElan I underistarld IHat: *ppars.e hermit mustlbt securgd 1`or fL ACTRUlk . W jkkI 0.1.,UM 'I kl�ftl>l, t(LER; tlA if5,1Al�llt and r4lt CC�7N.C['tCJNE�t, E t'L:,... � 1�� 1t `. ;1 c�rttfy that a)'f the foregoing WorMkion is accurate aild that ail wnrk will be done in eotrtp`(tanec with ai! a�af��la�'t�r�s regrlating c�rnstKUCtion and: zoning, t'C� tR >F'A�r °r, iwORD A NOTICE OF �OM1�1 } LNCl 1t1 N" 14IAY!k l t'I` Il i 3N I" " C9lr 'Kx l f$ If Y+l�'Cl t�tTEI��J► �(!r tJ�")<'A4IN . Ci'I�t��t!G"�1��. ,r ;, •, � � v t ' YO B �1fi1 ". � >�Y At �1w C lE rii 'Wt 1l , , I i VrMl' •'W" 4 , 44 , e}srtnrrrY d valit ceadl�r 23't ; r � ti td t nrrxsRd tt <t r # Cr o t�tst itti �r,rattm a�/t�rtxrutrian• idarr !aw' 6rokture .�vlft be derv // y y� E �J:rS(r2. ttxX `� i`tdGXtttt sv, 4rtft'cI'a r�etred ritrce o�trmrrrerrararmusr.be �a;r.tc 'gib aril p � r,�s` e r rla brr w#r �t b Ct f$ s av N /f yl k r r ze br cot hermit � Fssued I� the abs�rro� d� sueh pQ� �d' nt�trce the rrrsactrorr rlt ` p�aproved acrd a retnspecrrgrr fee wr1 s &argad, L \ C WIWI or A.0 i OL ; ' Contractor ' #I& i�t 4ir[gE�t tr�tt pthw aclEnowled td leifott tr►e this, this,IC The Foregayng.if-Istruinetit was acknowledged bafote me thys nt `2tls b of 20 � ��., by , w+�; frsQha y rro meJor who has prod(co whq, �s personally known to mo or wh'a Eaas,ptatc _ �, 'dri =t qth �s rtl�rttiitccxttgn end wilds t tlr� 4tt#t ' z t 3JEFW "Own; st t t tgrT. �f t ' t �' .'� }ff$49 >p�>Y i�utk� ',YYr *:�E�r�ret��' #�+��T!� • ',�,4�,v *Wi�rt�>t,� *;��t�a + 4*: �Y�v, ���r��* �k� .w,ar,vuE,���nk�t�ti * #�1�� #��'� • C1 I , l2pq r +• R�t��f E� '+' )v�' 4 1 S I � i F l L l V ``hi i 2 \ x 1 7F 11 Y'S�` 44 A I.I L / l- h� y }p t, tr A ;j � t .F'lfJ X11 }1t Y i) Z �� j� t y xIV.� + F 1 M1TE. d A� t "a.l l � l, j f (f' A � f {gt �;S .I }.ii '.t4Pr:il�l yj f �i f 1. i� �,, f}, tr'� +q: ° t j ,., fasf �i.it . �� E . .I �.. J t ,? .•<<' , v Ito 07/08/09 09:19 PH STATEWIDE SEPTIC CONNECTIONS INCS 9549630085 "i �(�� �� 2� mi 8 Vi uL 54 SUt it t t+d AWOW l t tt�t h res, ffiin�dctl 3'3!3& t } a•, y� 1 lW tster Pow No. +tl vn�r'fi I tr � 'ee rrh fe t'itt hottte�') J cX S ItO Phone # M_ 1 p e sctrs ti / x.e H :1 .t i t W l IY d g 1�StQ �� t1�? t3 si r it+�d, ' S NO 4 y �1� 1 5 � fly me �raerqP's � �;�.�,...,�,::�� Phone f# t c e i St E 6r R gist tt h , . G�rt'i gate of Cornpetbney No,_, T {littrt ter) Pticrt� #_ t�t'VV�7r�r:�� Aga -dw6tt Attt ri ttdh Now pair /R pfa e ] ©t iitton k t Wild uj fee lYowi?uie , t t .8 tt8 Pis " A � t t o i t l f ! _ Miami Shores Village y � S 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Pet ft tafua A . ED Phone: (305)795-2204 Expiration: 01241201 Project Address Pa rcel Number Applic 540 113 Street 3021360210841 Miami Shores, FL 33168 Block: Lot: JAMES RUSHFELDT Owner In __ Address Phone Cell � JAMES RUSHFELDT 750 190 Street DRESSER WI 54009 - Contractor(s) Phone Cell Phone Valuation: $ 3,000.00 JOE LEWIS SPECIALTY SEPTIC (305)662 -7979 Total Sq Feet: 400 Type of Work: PLUMBING For Inspections please call: Type of Piping: DRAINFIELD (305)762-3949 Additional Info: Available Inspections: Bond Return : Inspection Type: Classification: Residential Final Rough Landscaping Fees Due Amount Invoice # Total Amt Paid Amt Due CCF $1.60 PL -7 -09 -35502 $ 189.78 $ 189.78 $ 0.00 Education Surcharge $0.60 Notary Fee $5.00 Check #: 439 Permit Fee - Additions /Alterations $175.00 Scanning Fee $3.00 Technology Fee $4.38 Total: $189.78 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. July 28, 2009 Authorized Signature: Owner / Applicant / Contractor / Agent Date Building Department Copy Julv 28, 2009 _... 1 STATE OF FLORIDA PERMIT NQ. DEPARTMENT OF HEALTH DATE PAID: ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID: � CONSTRUCTION INSPECTION AND FINAL APPROVAL RECEIPT #: goo aa��` APPLICANT: AGENT: PROPERTY ADDRESS: LOT: BLOCK: SUBDIVISION: PROPERTY ID # : 11- -91i ,' � CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED. TANK INSTALLATION SETBACKS [ ] 1011 TANK SIZE [1] 21 1 ] [27] SURFACE WATER FT [ ) [021 TANK MATERIAL`'" [ ] [28] DITCHES FT [ 1 [03] OUTLET DEVICE [ ] [29] PRIVATE WELLS FT [ 1 [04] MULTI- CHAMBERED [Y / N ] [ ] [30) PUBLIC WELLS FT [ 1 1051 OUTLET FILTER [ ] [31] IRRIGATION WELLS FT [ ] [06] LEGEND [ 1 [321 POTABLE WATER LINES FT [ ] [07] WATERTIGHT ` [ ] [331 BUILDING FOUNDATION FT [ 1 1081 LEVEL [ ) [341 PROPERTY LINES FT [ ] [09) DEPTH TO LID [ 1 [35] OTHER FT DRAINFIELD INSTALLATION FILLED / MOUND SYSTEM [ 1 1101 AREA [1] [2] . %" SQF [ ] [36] DRAINFIELD COVER ( ] [111 DISTRIBUTION BOX HEA ER [ ] [37] SHOULDERS [ 1 [12] NUMBER OF DRAINLINES ] [38] SLOPES [ ' [131 DRAINLINE SEPARATION 'j` I [ ] 1391 STABILIZATION [ 1 [141 DRAINLINE SLOPE [ ] [15] DEPTH OF COVER 1 /�,} ADDITIONAL INFORMATION [ ] [16] ELEVATION [ABOVE /BELOW] BM _, � [ ] [40] UNOBSTRUCTED AREA [ 1 1171 SYSTEM LOCATION :j [ ] [41 STORMWATER RUNOFF [ 1 [181 DOSING PUMPS { ] (42] ALARMS [ 1 1191 AGGREGATE SIZE [ ] [43] MAINTENANCE AGREEMENT [ ] [20] AGGREGATE EXCESSIVE FINES [ ] [44] BUILDING AREA [ ) [21] AGGREGATE DEPTH [ ] [45] LOCATION CONFORMS WITH SITE PLAN [ ] [46) FINAL SITE GRADING FILL / EXCAVATION MATERIAL [ ] [47] CONTRACTOR [ ] [22] FILL AMOUNT t �� [ 1 [48] OTHER [ ) [23] FILL TEXTURE [ 1 [24] EXCAVATION DEPTH ABANDONMENT [ ] [251 AREA REPLACED [ ] [49] TANK PUMPED_ [ 1 [261 REPLACEMENT MATERIAL [ ] [50] TANK CRUSHED & FILLED_ EXPLANATION OF VIOLATIONS / REMARKS: ( ] YY [ 1 ( ) CONSTRUCTION APPROVED /D APPROVED): �� CHID DATE: V 1 FINAL SYSTEM [ PPROVED/ ISAPPROVED]: k"j __� CHD DATE: 10 )IM Dt 40 Gage 2 ), 10197 {Previous Editions May Be used} Page 2 of 3 Stock Number: 5744 - 002 - 4016 -4 PT 1: Applicant PT 2: Installer /Contractor PT 3: Building Department I r ro � ,.�t� f��`" � a r � 3 -rk�^ �r�J � � w�rr'�e✓ �k �^'fix��f t ;� �. � $ , „✓�i + ! `n � �' `� h � � r v ��C' t - `�' �"��? "k' �'� i � � r' �, i rr� '�", i� � �, r � � � ; ✓ ,� a r �'"� r " l � t � �� y{ drt k Cx �,yl � � . , N u j' � +t S eta AN 1 f q