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PL-06-1206Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 spew Inspection Date: 06/19/2006 Inspector: Levrack, James Owner: PASQUALIN, AIMONE Job Address: 253 94 Street NE Miami Shores Village, FL 33138- Project: <NONE> Block: Contractor: STATEWIDE SEPTIC CONNECTIONS Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Septic Phone Number Parcel Number 1132060133820 Lot: Phone: 305 -661 -6633 Building Department Comments 6,0....,___0,4 P° 7 le Passed �� iComments i Failed Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled re- inspection fee is paid . until Friday, June 16, 2006 Page 2 of 2 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305 795 V .8972 MAY 0 91"6. BUILDING PERMIT APPLICATION FBC 2004 Permit Type (circle): Building Electrical MAY 09 PAID Permit No. PI 06 I Wic ter Permit No. Mechanical Roofing Owner's Name (Fee Simple Titleholder) N' "'O P 5 9 uo " Phone # Owner's Address 2S Nvr L%' S"--t- County City S iNo 5 State R° Zip r" Tenant/Lessee Name Phone # Job Address (where the work is being done) City Miami Shores Village FOLIO / PARCEL # 2'93 pse 00+ . Miami -Dade Zip 5-3 t Is Building Historically Designated YES NO Contractor's Company Name F A it %n ac Co CXAvA Phone # CZO &1 33 Contractor's Address 35�0 c-t \ Ui 1 2C, City j■kk f t"^ a l State Qualifier Name t O re urt Zip # State Certificate or Registration No. ch10 ci 7 0-(02- Certificate of Competency No. Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ C`0 Type of Work: ['Addition ['Alteration Describe Work: Square / Linear Footage Of Work: J� [New iNb4 .near) Repair/Replace ❑ Demolition Y ld * * * * * * ** * *, * * * * * * * ****x * * * * * * * * * * * * * * ** Fees** ** * ** ****** *** * * * * * * * * * ****** * * * * * * * * * *** Submittal Fee $ Permit Fee $ 1754- 115 't2aJCCF $ I CO /CC Notary $ Training/Education Fee $ , COO Technology Fee $ 8 075 Scanning $ 3 °CX-3 Radon $ DPBR $ Zoning $ Bond $ .®0 Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ 6,cf „ See Reverse sid�t_S 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 sub» t to attachment. Als a certified copy of the recorded notice of commencement must be posted at the job site for the first inspectio f which occurs seven days after the building permit is issued. In the absence of such posted notice, the inspection will not be pproved and • reins - . ion fee will be charged. Owner or Agent The foregoing instrument was acknow dged before me this .5 The foregoing instrument was acknowledged 'before e this day of 20Ce by NiS QviSzv, , day of who is personal known to me or who has produced airW, (4-11—"___A§Acivati.ficationand who did tak- an oath. Contractor NOTARY PURL Ce 'PEOF b,`. 4 1 .cTARY i 16.1'/1 . _ —...: '- ..i r1 Sign: Print: TFP ` A. J. SOLOMON :,1437 J7 Discount Assoc. Co. My Commission Expires: 20 by who is personall known to me or who has produced as identification and who did take an oath. NOTARY P ' c-s 0? Ptp r � Hernandez is ission Expires: **** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPLICATION APPROVED BY: (Revised 02/08/06) rirr Plans Examiner Engineer Zoning STATE OF FLORIDA PERMIT NC ' U 1 V DEPARTMENT OF HEALTH DATE PAID. ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID. CONSTRUCTION INSPECTION AND FINAL APPROVAL RECEIPT #: r APPLICANT. AGENT: PROPERTY ADDRESS ,C 3 Al 7V LOT: 20 BLOCK:Z.K SUBDIVISION* PROPERTY ID #. CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED. TANK INSTALLATION ee7,� [01] TANK SIZE [1]/C9 [2] [02] TANK MATERIAL [03] OUTLET DEVICE- --Q-- [041 o MULTI - CHAMBERED \ " N [05] OUTLET FILTER 7 vo4:7,e‘ L. [06] LEGEND QJ- ' —U 71 3 [07] WATERTIGHT 3,. [08] LEVEL ,> [09] DEPTH TO LID DRAINFIELD INSTALLATION [10] AREA [1 ...,X -Z 5[2] -70 C) SOFT [11] DISTRIBUTION BOX HEADER NUMBER OF DRAINLINES [13] DRAINLINE SEPARATION 3 ,, [14] DRAINLINE SLOPE [15] DEPTH OF COVER.? [16] ELEVATION [ABOVIM Y. (3 [17] SYSTEM LOCATION t [18] DOSING PUMPS [19] AGGREGATE SIZgt 4. [20] AGGREGATE EXCESSIVE FINES [21] AGGREGATE DEPTH L ji FILL / EXCAVATION MATERIAL [22] FILL AMOUNT ) [23] FILL TEXTURE [24] EXCAVATION DEPTH [25] AREA REPLACED [26] REPLACEMENT MATERIAL EXPLANATION OF VIOLATIONS / REMARKS: [ [ ] [ SETBACKS [27] SURFACE WATER N )1<1 FT [28] DITCHES FT [29] PRIVATE WELLS FT [30] PUBLIC WELLS FT [31] IRRIGATION WELLS Ai", 14 FT [32] POTABLE WATER LINES 6 FT [33] BUILDING FOUNDATION -S"" FT [34] PROPERTY LINES - FT [35] OTHER FT FILLED / MOUND SYSTEM [36] DRAINFIELD COVER [37] SHOULDERS [38] SLOPES [39] STABILIZATION 1 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 GRAD [47] CONTRACTOR [48] OTHER ABANDONMENT [49] TANK PUMPED /7-/ 9 [50] TANK CRUSHED & FILLED P•// [ [ l [ l CONSTRUCTI APPROVED /D PPROVED]• 1-'7 C CHD DATE j - t a_C 1'12 CHD DATE. DH 4016 (Page 2), 10/97 (Previous Editions May Be Used) Stock Number: 5744 - 002 - 4016 -4 PT 1: Applicant PT 2: Installer /Contractor PT 3: Building Department Page 2 of 3 STATE OF .FLORIDA DEPARTMENT OF HEALTH" g ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM vc °-j CONSTRUCTION, INSPECTION' AND FINAL APPROVAL APPLICANT' •.c J A -CSENT PROPERTY ADDRESS* LO'f C • PERMIT NO t.1 / / 2 DATE PAI FEE PAID RECEIPT f BLOCK: SU136VISIdN QHECKED [-X1 `ITEMS ARE . NOT IN E OMPLIANCE WITH 'STATUTE OR •RULE AND MUST TANK INSTALLATION [01] TANK SIZE [1]f c _ [2] [02] TANK MATERIALC f^ --'--r . [03] OUTLET DEVICE. [0;4] MULTI - CHAMBERED V)Lq [05] OUTLET FILTER l • WATERTIGHT:. ':LEVEL + .• • • [Q9] . 'DEPTH TO:LID... DRAINFIELD INSTALLATION I [ ] ,11;01 [ , :] [t•1] ;'[:141..' [ ] •[1l1 11'81 [! :1 [.i ] ..._ .r.. 12Q1. [ ] • [2i1.• AREA [1 AX DISTRIBUTION BOX HEADER" :NUMBER OF DRAINLINES'-... Fc RAINLINE SEPARATION; :D,( r. ;QRAINLINE SLOPE ,DEPTH -OF ELEVATION [ABOV 3Z. SYSTEM LOCATION��:. DOSING PUMPS AGGREGATE SIZE p.GGREGATE EXCESSIVEFINES`T AGGREGATE DEPTH`' ,.,FILL / EXCAVATION MATERIAL [2�] FILL AMOUNT'' [231 - FILL TEXTU [24] - . EXCAVATIO i PTH ,[25] AREA REPLACED .REPLACEMENT MATERIAL XPLANATI' CirVI L SETBACKS £•15'; ':f`) ?G ^`.{ 1. [27 SURFACE WATER • .r: DITCHES • [29 PRIVATE WELLS ]' :j30 PUBLIC WELLS_ - -_ [31 IRRIGATION WELLS ;[32 POTABLE WATER LINES :[ .1; [ 1 :.j BUILDING FOUNDATION PROPERTY LINES • :.•:'bT`HER •'PI{ LE` :Ri'"MC UNC :°SYSTEIU:.' ... 136] . "DRAINFIELD COVER ^[37] ��OU,LI�ERS $] . `SLOPES 4 RfABIL0 1QM.r `.' ADDITIONAL 'INFORMATION `}'1 [ ]' '.40] UNOBSTRUCTED AREA 41] 1 STORMWATER RUNOFF i ..' 42] ALARMS. ' 1431 ' MAINTENANCE AGREEMENIT BUILDING - AREA'. :e; ,= . r�A `•' h 45] LOCATION CONFORMS Vd1TH SITE PLAN ?;: r ' FINAL SITE GRADING- - FT 47] CONTRACTOR -* 4$j'` `i OTHER ABANDONMENT 49] TANK PUMPED • 14 :: 501 TANK CRUSHED& 'FILLED' CIS :WIMMIS >s, r!`na.'t8.�tiM' 7), :9• CONSTRUTI PP OVEQfD 1 APPF_3QVEQ]_ ✓�_ FIiVAL sYPROVED1SAPP130V0o1 DH 4016.(PSge 2) '10/9/ :(Preyious Editions May Be Used) Stock .Numtier: $74402-401614 . . '.. CHD DATE • 1. r L • .PT:1 `,. 41A0ant • '.: 2:- Iristaaor,IC °Fitractor_ • *p7 3: ©u l Id Dopartmetlt' PI 1: HeaiU 9eea;traeclt. DATE • .Page2.of 3,. . 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: Pasqualin, Aimone ]Holding Tank ] Temporary [ NA ] CENTRAX #: 13-SG-28996 DATE PAID: FEE PAID : $ RECEIPT . OSTDSNBR : 06 -1428- -R [ ] Innovative Other AGENT: SA0021074, Solomon Teresa PROPERTY STREET ADDRESS: 253 NE 94 St Miami Shores FL 33138 LOT: 20 BLOCK: 28 SUBDIVISION: Miami Shores Sec 1 A [Section /Township /Range /Parcel No.] [OR TAX ID NUMBER] PROPERTY ID #: 11- 3206 - 013 -3820 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 MULTI - CHAMBERED /IN SERIES: [Y ] MULTI - CHAMBERED /IN SERIES: [Y ] ]GALLONS @ [0 ]DOSES PER 24 HRS # PUMPS[ 0 ] 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.: 12.3' NGVD [ N ]MOUND [ N ] [ N ] I ELEVATION OF PROPOSED SYSTEM SITE [ 2.2 ] [ FEET E BOTTOM OF DRAINFIELD TO BE [ 4.7 ] [ FEET L D FILL REQUIRED: [ 0.0 ] INC'HE5 OTHER REMARKS: EXCAVATION REQUIRED: ] [ BELOW] BENCHMARK /REFERENCE POINT ] [ BELOW BENCHMARK /REFERENCE POINT [ 30.0 ] INCHES 1.- Install_900- -gal. category -3 septic tank equipped 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)(f), FAC. 3.- Install 300 sf of drainfield in bed configuration. 4.- Invert elevation of drainfield to be no less than 8..10' NGVD. 5.- Bottom of drainfield elevation to be no less than 7.60' NGVD. THIS PERMIT IS NOT FOR "ADDITION(s) ". SPECIFICATI APPROVED BY: DATE ISSUED: BY: OSPINA,' PEDRO TITLE: •sp n=. -'_. 5/5/06 TITLE: DH 4016, 03/97 (Obsoletes previous editions which may not be used) (Stock Number: 5744- 001 - 4016 -0) [ostds_cons_4016 -1] Dade EXPIRATION DATE: 8/3/06 CHD Page 1 of 2 STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PE Permit Application Number PART II SITE PLAN -? 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SrSm1REssMSsSearNrlflNalrsrlrssrs uSSerssuura ssssr.SSSNiNIIr rseesstr°s..a-. tl i .liNINsriLI asi lI iC;iirst rrraNM0.11%SNtr INImis■ssm. 11111 srrSSSMINI M Mill r slue■ (MINI MsrssssOs�sssSMINSIM ■NSE SESSISHISSINE.NlSfltrrinsaa 11 mmiswal■rammu e�i°iarr�smimr airrilr ■rrr■es�li�iiarrssrll■rlrassr iSNamassaNrii�NalNlirrrraalr .MaaE I11111mmuslaIaaimmaalummi► simmer srat4rla►ssMmmumMiswsamssimum MMsumennismummamum rlreemslMlN; s. Notes: t{. �s. S. 331 do reto 11°144" Site Plan submitted by: Plan A; B ignature Not Approved 6 corsItir Tide Date �d,�_• �� County Health Department ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT OH 4015.10/98 (Replaces HRS•H Farm4018 which may be wed) (Stock amber: 6744-00240184) Page 2 of 3