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PL-08-678Project Address 9495 N MIAMI Avenue LMiami Shores, FL 33150- Owner information CECILE & REJIM SALAMEDA Type of Work: PLUMBING Type of Piping: SEPTIC Additional Info: Bond Retum : Classification: Residential Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Address P E1 4-8 78 Type; Plumbir>Ig - l Idential 9e pti 4117 APPROVED Expiration: 1 /1 / Fees Due Amount Bond Type - Contractors Bond $300.00 CCF $1.80 Education Surcharge $0.60 Permit Fee - Additions/Alterations $175.00 Permit Fee - Additions/Alterations $175.00 Scanning Fee $3.00 Technology Fee $8.75 Total: $664.15 Building Department Copy Parcel Number 1132060130500 Block: Lot 9495 N MIAMI Avenue MIAMI SHORES FL 33150 Contractor(s) Phone CeII Phone A AMERICAN SEPTIC & PLUMBING (305)866 -5600 (786)236 -5599 Authorized Signature: Owner / Applicant / Contractor / Agent Phone Total I Amt Paid I Amt Due $ 664.15 $ 664.15 Payment Type: Check / Number 3180 Applicant CECILE & REJIM SALAMEDA Available Inspections: CeII MOMS' MBEVROMORIMPIMMIEW' Valuation: Total Sq Feet $ 3,000.00 WAKINOWANOMMANNANSSIMMOMMAIMMINIMOM Inspection Type: Abandonment Final HRS Approval Rough Landscaping 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. May 06, 2008 Date Tuesday, May 6, 2008 1 Arki 'Tr BUILDING PERMIT APPLICATION FBC 2004 Permit Type: Plumbing Owner's Name (Fee Simple Titleholder) R) c - CSC I �� wt) c Phon`� e #� °' 3 / - 1 S — 8 l Owner's Address G( "1 G lJ µ1\81 cwt Aven v e Cit K u gifliare3 State Zip 3 i GO Tenant/Lessee Name Phone # E -MAIL: Job Address (where the work is being done) I T"l G i\ G m A City Miami Shores Village County Miami -Dade Zip 3 3ISo FOLIO / PARCEL # tt— ��O�C-- (.9 ('2 0500 Is Building Historically Designated YES NO 4 _ et u r f-bin Contractor's Company Name Ar eji CD n C - Phone ' 7841 — Z 3C — S Sqq Contractor's Address tz,GG 5 SSG dk4d cil t) City T'11 Ql ►-,r 1 State a. Zip '3 3 IV Qualifier Name lk ( i r % tp) co Gli Cr C Phone # State Certificate orRegistration No. Certificate of Competency No. E -MAIL: Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ 2® Type of Work: ['Addition Describe Work: Miami Shores Village Building D epartment 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 ['Alteration Square / Linear Footage Of Work: 9°Q 5a(tor f rl K ['New Permit No. PL,O ' (ol K Master Permit No. J. Repair /Replace ' e-2f—S '•-•= ''--;:- 0 Demolition Submittal Fee $ Permit Fee $ 1 ( CCF $ 1 - � CO /CC Notary $ Training /Education Fee $ V Technology Fee $ 4• (°� ' Scanning $ qq Radon $ DPBR $ Zoning $ Bond $ 9 1 / Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ 434 •16 See Reverse side --> Bonding Company's Name (if applicable) Bonding Company's Address City State 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. l 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: 1 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 s sted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Owner or Agen r Signature Zip Contractor The foregoing instrument was acknowledged before me this K The foregoing instrument was acknowledged before me this d S day of Apd , 20 DB, by ttry-1 kientd L; , day of l , 20 Ogby \PS 11 i orn vvb QeXe who is personally known to me or who has produced ham- who is personally known to me or who has produced (AV . As identification and who did take an oath. f R ( � t' o�►er►d.+�A,�jd.�ke an oath. NOTARY PUBLIC: SOLOMON NOTARt I , C: Comm* DD0733346 • " Expires 11/8/2011 Comm# DD0733346 °�•o'.• Si" •41 ..... Sign: Print: My Commission Expires: xxxxxxxxxxxxx xxxxxxxxxxxxxxxx APPLICATION APPROVED (Revised 02/08/06) 'TERESA J. SOLOMON Na u - 4 yaeeill10, sn My Commission Expires: x xxx xxara :xxxxxxxxxxxxxxxxxxxxxxxxxxxx xxxxxxxxxx xxxxxxxxxxxxxxxxx Plans Examiner Engineer Zoning 05/06/2008 14:56 FAX 3058916905 SIMIOS� t�1lP'1� O>l' MH OZi1SITJt; 3» TEMATMENT X11® DI3POSi L SWOT= 002orreber2o r witeam To*: QSTDS a►trrssrsur: Retire $ Cade Selamsda =on= aoroou E 1 9495 N Mipml Ave ins s 10 sect 4 n OPITI T JD 6: 1142084134500 Sari .0096, 1.9., AMA CEO 6 8nts iSPACToaz mulroIOQAir0E roe sJ U NION MAMA AS A ■419 =8 101 bZaael2T &VPLZCia'Z001. • 5QCE MC= allau agce or Teas . MUM bees alms, Roos LOCATN PAfQ'!TZEQ Repair MIAMI, FL 331130 XIDT IX DX66 E AND 9PE0z x 0ioO9 R [ 000 ] onrz19 / are PPABL CAPACITY A [ 0 1 =memo / GAD cemparrr •M [ 0 3 PAL' "I ate tiammeariVa CAPaCZ' T [ NM:1 94 XMAIRC2TeminAIM TINe11280 oelr.LOrai] 9 [ • 1 oniz.ORa ammo means dIPkCZtT , [ 16+►.L0169 0 [ 3DOal$ ma 24 awls Irmo* [ ] D t 226 ] 0260011 EMT X [ 0 ] KRA1E 1UT a T:!PE smolt [s] REAPPASO a COXITG AATI09: [E] T9ms0r ( 1 U [ 1 . E 0 T. FFE:11. " NGVO s gear arenpoam aroma mire E Soma 4P .DIELV TO s3 L D > : E [ 1 PEEWEE [ 0.00 j xal tEn EECSVEZEOa 1110EZE ea: [ 30.001 lecEan 1 .- E:dstIng 900 gal septic tank. carted Ip° A Amy Sap[Ic on 034 5108" tm rerneln. 2.-Install 225 M at drainfeld In trench cor?lguration. 3. -Invert elevation of *Enfield to be no leas than 6.60' NOVD. 4: Oottorn 0f drakrflsld elevation to be no less then 8.10' NGVD. """""THIS PERMIT IS Nov FOR ADATION(ar"" m VOA V Edon :d. TITLE: Zwinmay 9p.eielast !I 46 ITTLA: t gross. spabislist x x aesc1Pxcs ST: EMPIROvis Mr: 00&17 MOM: 03202008 o8 4016, 10/97 (Previews Editions nn Y 9s Q..d) V 1.. , a4lpaysaa aw: v Qaml Shona Sec 1 Amd AwaSZO5% 10 'd 2800£961756 SNOI,LOHNNOO OIJ,d3S Ma= 11 Errafte '1'209 a s DATE reso s in PEED: aaeG711P0 As oacuezor 6 AP852061 1nilese 555.00 13- PtD.10D5137 PR7114O6 189011 �T, mama iii, ihiai, 89B CPT, mama] tom Tai ID iiiaiael EGCaSOiwCS Iwo apicz `X 9TZosta a2ID 6'T6*1e OP 910010* E -6, E'.i.C, DVPamaorr EP99QPAL or ai6'y'aaa D00a NOT z mom= seance 9P =me . ester 09191 Zal MATRil8L la 711, Issiaura9 or =II PL as ED= 141E arias a*1 TO al em us manic= MY =ME IN TIM PElolaT NEIJRri woe sW.i. APE VOID. 11101' FEET fie aPl LIOMMT ltE1011 COMPLEANCE EITE MACE MIME, NOR nsv LOMa0P1' 07 PI= PEOPEE 1. TIMTM MITCH [ ] ream 1 1 [ 9.80 311.131121111k f r ] [ ABOVE gialionSesNOWDEPAIMEE011 90191 [ 39.801 ti viarrael Pr ] 1 ASCVE illiiisaugonaieriezuraeuall Rolla PAIR CbL� �� 38129499 la 001 /001 Dads. CED •, pas. 1 ea 1 . Wd 8E:2i 8002 -EE -�d8 CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANTT: Rejim & Cecile Salameda PROPERTY ADDRESS 9495 N Miami Ave MIAMI, FL 33150 LOT: 10 BLOCK: 4 SUBDIVISION: Miami Shores Section # 1 PROPERTY ID #: 11- 3206 - 013 -0500 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 [ A [ N [ K [ 0 T H E STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM 900 ] GALLONS / GPD 0 ] GALLONS / GPD 0 ] GALLONS GREASE INTERCEPTOR CAPACITY ] GALLONS DOSING TANK CAPACITY [ 300 ] SQUARE FEET 0 ] SQUARE FEET [X] STANDARD [ ] TRENCH D [ R [ A TYPE SYSTEM: I CONFIGURATION: Bed configuration Septic Tank [x] BED N F LOCATION OF BENCHMARK: FFE eI:11.40 "" NGVD 1 ELEVATION OF PROPOSED SYSTEM SITE [ 9.60 E BOTTOM OF DRAINFIELD TO BE L D FILL REQUIRED: [ 0.00 ] INCHES 1.- Install 900 gal. category-3 septic tank equipped with an approved filter. 2. -The Iicenced contractor is responsible for installing the minimum category of tank sec. 64E- 6.013(3)(f). 3.-Existing 150 sf of drainfield in bed configuration to remain. .THIS PERMIT IS NOT FOR "ADDITION(s) ". R SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: DH 4016, 10/97 (Prey / us Editions May Be Used) v 1.1.4 SYSTEM SYSTEM [ ] FILLED [ ] [ ] EXCAVATION REQUIRED: [ 30.00] INCHES AP855003 SE'731300 PERMIT #: 13-SG-912739 APPLICATION #: AP855003 DATE PAID: 04/14/2008 FEE PAID: $55.00 RECEIPT #: 13- PID- 1004822 DOCUMENT #: PR713927 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] [OR TAX ID NUMBER] CAPACITY CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] ]GALLONS 01 ]DOSES PER 24 HRS #Pumps [ ] ] [I INCHES r FT ] [ ABOVE A BELOW h BENCHMARK /REFERENCE POINT [ 27.60 ] [ I INCHES FT ] [ ABOVE /) BELOW II BENCHMARK /REFERENCE POINT EXPIRATION DATE: Page 1 of 3 STATE OF FLORIDA DEPARTIVIENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPosAL RUCTION PERMIT Permit Application Number PART II PLAN 50 feet. Notes: Site Plan submitted by: Plan Approved By Sigma Not Approved Date Counter Health Department ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT DH4015.10/96 (Replaces 'FIRS- 14ftna4015whchnay be used) (Stock Number:5744- 002-4M 8j= Page of 3 ..ter. sr— • s — Y I "' em u` • A Ede i ).., _.. r-•i x 3- - �" -- -- ". 'w: °: El ^' ' • . rt it — • S Q � "x• t • e _ ,. e. .- ..._. ., �— e- Sew"*. Y 4n'. robA. e HEW Y fff a' { P ^... ...>.... >: 99 .- G - -a._- -., ..Ea. — S_ }'p,..% .'�__'S -y .y,. - F-"' ".° £" d""'4•-- $: - iT " 3 ^^ r ..,5 ...+. a "' S^' 1 #.. ._. _i'� : ■ee� ':� ;may ■ '� _ F__ ..- ir k... € � � ;at } ..... -+x... - 8.— c+--- � . r "> , �, _�....e Y_'ti I +g. t - &...o...,>.- 1 I •-�. i t.+..- Is...„.,.. ., ' P g s t ii i r; z a y � r : ' __ i ^ "'-'^ ^c 1 .. #`af 'y b ti tl .«- � a� c S t ° . R° e t�d £ — s E ? Y 3.. STATE OF FLORIDA DEPARTIVIENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPosAL RUCTION PERMIT Permit Application Number PART II PLAN 50 feet. Notes: Site Plan submitted by: Plan Approved By Sigma Not Approved Date Counter Health Department ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT DH4015.10/96 (Replaces 'FIRS- 14ftna4015whchnay be used) (Stock Number:5744- 002-4M 8j= Page of 3 08/18/2008 08:14 FAX 3058816905 • STATE OF FLORIDA a(W 2' 0 2008 DEPARTMENt OF HEALTH • k ONS['?'E SEWAGE TFI'EATME ! s ' 'CONSTRUCTION INSPECTION AIS113CRNAL AP RO APPLICANT: AGENT: PROPI;R'IY AD 1 1 4 i • .LOT;. ElLocKir '.'' 7seerIi/1S1011L [ ] [011 • TANK SIZE [11 4 ' 4 " - [23 - [Og] [ ' • 1 1071 WATERMGHr 1 [ ] ' [ 1. • ' ;[091 DEPTH T LI . • • may DRAINFIELD• INSTALLATION [ ) [10] AREA (1] 12l SQFF [ • ] [11] ' . • DISTAIBLRTON BOX ' • ' • HEADER [ .1 •' 1 ' ' NUMSER1OF DRAINL11 _' • [ ] •11.S ' DRAII4JNE''SEPARAT [ ' '1' [a 14] DRAINLINE SLOPE [• 1 [151' ' DEPT}} OF COV N 1 ' 1 ' tiel , ELEVA?1CN.[AeOve8EI OW1 [ I [17] SYSTEM LOQ1aTION [„ ] 111:1] 111:1] • DOSING,•PIAMPS • • • • t ] [19] AGOREG!)'TE SIZE • ' [ 1: ' [20] AGGREGATE EXCESSIVE FINES: [ .1 ' [21) AGGREGATE DEPTH • nil EXCAVATION MATERIAL .,' • [ ' 1 [22] ALL AMOUIfl [ " .1 [23] FILL TEXTURE [ • • 1' • •[24] EXCAV61 ON DEPTH • •[ 1 • [25J ARE n,, P LA¢ED I ] [281 REPL EAI>EIIIT•M • °•" ..;,_ e, DH 4010 (Peue •2),1x187 (Previous motions May Ea,1Jsaa) Stock Numbakr 5744-0021010.4 • { ] • Imo] . TANK RAATERI'AL ' d`" -1.-c. ,y [ ]' ' [ 1.i_SURFACE WATER [ ; '1 • '1031 • OuTLET DEVICE [ j' ' [28 '' DITCHEa' ' • • ' [20] ' PAIVATE [ . j : • [ 0 4 ) ' ' M U 1 T I [V i r • • h s [' ' 1' " fobl OUTLET AILTEA ►�� a /r [ T [3 0j " F'UULIC WEL ''' E(VD pig ; • 'IRRIGATION'. WELLS l PLANATION OF VIOLATIONSI / REMARKS: • [ •] • [• I ' 1..1 If 1 CON97A TIO a : •.',� 6 .,a ^ ' V y+�i .'•r mvl.Lma° 'rjdt.•.,. . : FINAL.SYSTEM [ PRO•„V •• ° '•o„ -67 WI 002 / 004 • I [ ]' . ' „ 1323 ; ',',POTABLE WATER LINES PERM1,7'' 4 ' ,] 773 . DATE PAID: FESPAID :. - RECEIPT ° --• — CHECKED ' = ITEMS. •ARE NOT • IN = = = = _ = _ = _ = = Me" .= :x = •' ' ^ _ _ COMPLIANCE WITH. 'SEA 4''' _ -- p eo = -.. _ — a _ . TIPfE = R RULE~ • °ANI:1' 'MUST BE ' CORRECTED. ' TANK INST = � >= ,_ � = =a `we _ >� .c..- 4r � = .moo _ - AUATION = _ =..: a • rI I .;1" [331; "BUILDING FOUNDATION • - -� • FT [ ] [34] " PROPERTY LINES ' FT .] ' MS1 ° OTHER • [ 1 ' [301 DRAINFIEVY:COVER . 'I 1 171' SHOUL s ' , , [' ] [k8) ' . SLOP . • . '[ I , Ill ' ' STABILIZATION ' '° a]ID(IIONAL 'INFORMATION •[[• -1 ,[44 . ' • UNOSSr'RUCTro (Apes STORMWATER, RUNOFF' ti [ 4, " 'ALARMS ' ; ' ' • [ ] '1:021 MAINTENANCE AGREEMENT [ ] RR; r ' BUILDING AREA' [ 1 [44' LOCATION CONFORMS,WjTH9 SATE NA [ ] ' [ ' ' FINAL SITE GRAOI • a [ 1 14 CQNTRACToj', n.' : s 4 cq [ ] [4 • OTHER ' I . FT Fr FT 5 . PT • AitAq#0Niviih [ ] L501 ' •' 7:41NIC :CRUSHED, BI;,FILLE4, • ° "CF'lA .:DATE: "� `:�? =,� = •,''�' CHD • DAT& 4.4.7..110„17 z Page 2 of 3 • ar, :'4011 ' PR2- bseaer ' • ' P'T•A enma;k Rr aspwaNaaaaanmeuy'' 08/18/2008 09:15 FAX 3058816805 utPARTMENT OF HEALTH , QNSITE SEWAGE TREATMENT AND DISPOSAL;SY•STEIV1 ' CONSTRUCTION INSPECTION. AND FINAL APPROVAL , r • APPLICANT- AGENT PROPERTY * ADDRESS • LOT: BLOCK: ' ' XI ITEMS ARE NOT' IN • COMPLIANCE 'W1111 STA LII ' OR = L: = = = == = =¢ = = = = == DRAJNRELD, INSTALLATION ' • TANK INSTALLATION [ ] [01] TANK SIZE [1] 7° 'G .,[21 [ 1 Io21 TANK MATERIALC - s.•,, -,- s - • [` ' 1. [031 ' OUTLET DEVICE [ 1 [ MULTI-CHAMBERED [Y /,mod [ ] [051 OUTLET FrLTER • [ 1 [08] LEGSND . [ ] • [07] • ' WATERTIGHT [ 1 [081 1.08. [ 1 - L0Sj DEPV TO IUD a i . [ ] 11II}.,.., AI EA [ij� d2] ` r+ r;r , S SQFT' • [' ' ] . 1111• DISTRJ8UT1oN box HE ADER ' • ' [. 7 [12] NUMBER'OF DRAM..INES' • °x [ ] 1131. MAINLINE sEPARAT1oN,. �.� t 3,, [ ] [14] •DRNNLINE SLOPE ' ' „ ' . • t 1 1151 DEPTH OF COVER i.5' `' [ 1 [161 ' ' ELEVATION [AS T= 911- .• ' [ ] , [17] ;YSTFM LOCATION [ •] [18] .I . , . ► [18] `] I201 AGGREGATE EXCESSIVE FINES' [ 1 • 21] AGGREGATE DEPTH , • bowie PUMPS • • AGGREGATE SIZE ,-'r 'FILL'/ EXCAVATION -MATERIAL , [ ] • 122] FILL AMOUNT 4 • • 1 • 'I 1 •FILI.IEXTURE • [ ] 1241 EXCAVATION DEPTH [ 1 ' [ AREA REPLACED [ 1' [2E]' REPLACEMENT MATERIAL ' EXPLANATION OF / REMARKS: [ [ -1 [ 1 [• ] DI4 4018 (Pape 21,1019'7 (Pirditue Myna Muy Be Stock Number 6744.002-40164 SUBDIVISION: = = = . = = = 2' = = = = = = = = = = = = = = S = = = ' • RULE • AND MUST' BE 'CORREOTED. 'ILLS'/ MOUND SYSTEM •r-.'N • • ' ' [AP EU /UISAPPROVEDJ . rp .ir'-:L:: ?- • •E -:�' . P� FINAL SYSSrE 4APPROVEoSAPPROV®]: 4.1:.•,9`;0 ::fP ,!. _. , %' �.., �, i • DATE PAID: FEE PAID: RECEIPT.& PROPERTY ID $:, =2 "•••• • = M.11 a7c =ate= =a•p =c SE I • • 1 1272 SURFACE: WATER [ ] [26] • DI'rCHES [ .3.. • [29] . PRIVATE WELLS [ 1 L30 , .PUBLIC WELLS 131] ' • IRRIGATION VIY, LLS .1 PM POTABLE WATER LINES t ] • '1 ] ' ' '$1iJIU IN`G FIOUIVDAT1oN L ] [542, • • PROPERTY L1N [ 1 • , [a5]. ": O`rkEA' .' ' .I , 1 • [ 1' [37] SJIOULDERS ' ,[as] SLoRrG.,;,,,., �f ' [301 STABILIZATION" _- • iDDI INFOFIMATI0; .?; ' • [ 1'• .14o " "0146i}^S RUGZ°ED;.J 3'EA, [ 1 t4 ' 'ST iMI1v*TER, FpliNo F, ' "•' ° 0 ° I ' A i ° Y�H • 4 ' I H /r / , 'i'u. ,4 I 1 [43l ;y ; MAINTENANCEJMEEMENti ]' [44]! ' Al 1 • [45 4 LOCATJON � RMS it s ,P, AN L . 1 ,1461 FINAL" 19R NG' ' ° +' rs' • p . 1 •;[ 7' , CONTRACT R 1 [481 OTHER ABANDONMENT [ '] .' [4s1. • :'TANK • PUMF'Eo [ • 1 , ' [so] ',TANK cRuaJ4 • [361: DRAINFIELD COVER `' }-mo irowtterr . �'k, • RI 003/004 4 . = FT i=r FT Fr • ox-.61 DIVISION OF E nvironmental Health Florida Department of Heath Miami -Dade County Health Department OSTDS /Septic Tank Division 7769 NW 48 St. Suite 175 fa. MiaL 3 Inspectorj c'S < h rV y3166 im(` Date 1 1 i 2 Z Address c 4 'IT K ,. 44t a / tJ OSTDS # 13 "S (r , itr* vo3. Comments: Signature AO. APPLICANT: AGENT: - PROPERTY ADDRESS LOT: STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION INSPECTION AND FINAL APPROVAL BLOCK: t , SUBDIVISION: PROPERTY ID #• CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED. TANK INSTALLATION [01] TANK SIZE [1] r " [2] [02] TANK MATERIAL = >- [03] OUTLET DEVICE [04] MULTI - CHAMBERED [05] OUTLET FILTER [06] LEGEND [07] WATERTIGHT [08] LEVEL [09] DEPTH TO LID /C DRAINFIELD INSTALLATION [10] AREA [1] [2] " -- SQFT [11] DISTRIBUTION BOX HEADER [12] NUMBER OF DRAINLINES [13] DRAINLINE SEPARATION _ i [14] DRAINLINE SLOPE [15] DEPTH OF COVER [16] ELEVATION [ABOVE/BELOWf°BM [17] SYSTEM LOCATION [18] DOSING PUMPS [19] AGGREGATE SIZE ?"' [20] AGGREGATE EXCESSIVE FINES [21] AGGREGATE DEPTH FILL / EXCAVATION MATERIAL [22] FILL AMOUNT k c [23] FILL TEXTURE [24] EXCAVATION DEPTH [25] AREA REPLACED [26] REPLACEMENT MATERIAL EXPLANATION OF VIOLATIONS / REMARKS: FINAL SYSTEM [APPROVEDLDISAPPROVED]: DH 4016 (Page 2), 10/97 (Previous Editions May Be Used) Stock Number. 5744 - 002 - 4016 -4 CONSTRUCTION [APPROVED/DISAPPROVED]. PT 1: Applicant PT 2: Installer /Contractor PT 3: Building Department PT 4: Health Department PERMIT NO"� b DATE PAID FEE PAID RECEIPT #. SETBACKS [27] SURFACE WATER FT [28] DITCHES FT [29] PRIVATE WELLS FT [30] PUBLIC WELLS FT [31] IRRIGATION WELLS FT [32] POTABLE WATER LINES '- ' FT [33] BUILDING FOUNDATION__ FT [34] PROPERTY LINES FT [35] OTHER FT FILLED / MOUND SYSTEM [36] DRAINFIELD COVER [37] SHOULDERS [38] SLOPES [39] STABILIZATION ADDITIONAL INFORMATION [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 [48] OTHER CHD DATE CHD DATE: ABANDONMENT [49] TANK PUMPED__/ [50] TANK CRUSHED & FILLED . 1! Page 2 of 3 APPLIG AGENT-` PROPERTY ADDRESS'. LOT : - STATE OF FLORIDA DEPARTMENT OF HEALTH = =01�151TE SEWAGE TKATMEissrr AND DISPOSAL SYSTI CONSTRUCTION INSPECTION "AND APPROVAL BLOCK•. _ DIV CHECKED [X) ITEMS ARE NGT 1N COMPLIANCE: WITH STATUTE OR AULE;.- AND : CORRECT TANK INSTALLATION [ I [41] TANK SIZE [11 I 9° 12 [ 1 _ 1021 - TANK MATERIAL . f = 1031 OUTLET DEVICE [ ; 1- [04) MULTI- CHAMaE ED [V / N '. [ - 1 [05] OUTLET FILTER 1 [ 1 1061 LEGEND " [ ) 107] WATERTIGHT [: 1 [081 LEVEL 1 [09] DEPTH TO LID: =' 1 0RAINFIEL.D INSTALLATION [ l [10] AREA [1] [ ] - [11] DISTRIBUTION BOX [ 1 1121 NUMBER OF DRAINLIN l [131 DRAtNLINE_SEPARAT1 [ ) [14] DRAINLINE StPE f ] [15) DEPTH OF COVE [ ] [16] ELEVATION [AVE/BELOW] -BM _ [17] SYSTEM LOCATION [181 DOSING PUMP [19] AGGREGATE SIZE [201 AGGRFCGATE. EXCESSIVE FINES [21] AGGREGATE DEPTH �1 FILL / EXCAVATION [221 FILL AMOUT [231 FILL TEXTURE" �UR [24] EXCAVATION DEPTH [ 1 1 .1 1251 AREA, IEPLAG [ 1 [26] REPLACEMENT MATERIAL EXPLANATION OF VIOLATIONS / REMARKS: SOFT DER - - [ 1 SETBACKS _ [27j SURFACE WATER .FT [2$ _ DITCHES F7 [291 d : " `PRIVATE VYELLS FT- [30} . PUE3UG WELLS _ y FZ 1311 IRRIGATION WELLS FT [32] POTABLE =WATER LINES • FT [33F .. , BUILOINS FOUNDATION FT ] [34l ..' PROPERTY LINES - - FT ] 1351. °' OTHER == FT FILLED -1 MOUND SYST [301. DRAINFIEWCOVEF ] [371 - SHOULQERS 1 1381 SLORES ] [ STABILIZATION= ADOITJONAL INFORMATION 1 ? [40J UNOBSTRUL 1 EU ARC [41] = STORMWATER -FRUN H ALARMs ] _ ; MAINTENANCE AGREEMENT ' ) [44] BUILDING AREA l [ LOCATION CONFORMS WITH SITE PLAN ] [ 4 6 1 FINAL S, ITE GRADI 1 CONTRACTOR ] 1481 OTHER PROP Eft. CID ABAI D ONMEN ' ..ANK. PUMPED [50] TANK CRUSHED &.FILLED - i CHD PT 1: Applicant PT 2: tnstaleriContrector PT &' Building Deparinfe 1 PT 4:,HBa1th De u neat 2 of 3 [ 1 CONSTRUCTION [APPROVED/DISAPPROVED} FINAL SYSTEM (APPROVE©/DISAPPROVED1. DH 4016 (Page 2), 10/97 (Previous Editions May Be U Stock Number. 5744.002- 4016 -4 [ i - >pERMIT NO DATE PAID -- 1Att RECEIPT ' #' REPLACE BROKEN SEPTIC TANK AND DRAINFIELD ATTACHED TO PERMIT ON05/06/2008 Passed q Inspecto 1) Comments Failed Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled re- inspection fee is paid . until Inspection Date: 08/21/2008 Inspector: Levrock, James Owner: SALAMEDA, CECILE & REJIM Job Address: 9495 MIAMI Avenue N Miami Shores, FL 33150- Project: <NONE> Contractor: A AMERICAN SEPTIC & PLUMBING Building Department Comments Wednesday, August 20, 2008 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: Septic Phone Number Parcel Number 1132060130500 Lot: Phone: (305)866 -5600 Page 1 of 2