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PL-06-529
Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Date: 05/15/2008 Inspector: Levrock, James Owner: JADALLAH, AMANI Job Address: 100 96 Street NE Miami Shores Village, FL 33138- Project: <NONE> Contractor: MIAMI DADE ENVIROMENTAL Building Department Comments Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Drainfield Block: e Number Parcel Number 1132060132700 Lot: Phone: 786- 251 -4099 DRIANFIELD OK 16 70 ®0 Passed ector Comments Failed Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled re- inspection fee is paid. until Wednesday, May 14, 2008 Page 1 of 2 A,„ STATE OF FLORIDA EPARTI4ENT OF HEAL' ONSITE SEWAGE TTT CONSTRUCTION INSPITION PROPERTY ADDRESS: LOT: 1 BLOCK: SUBDIVISION: saa °aacaaasasas CKED [X) ITEMS ARE NOT IN COMPLIANCE WITS STATUTE OR RULE AND MUST BE CORRECTED. - :=:sw=ig= sa=saa TANK INSTALLATION SETBACKS [01] TANK SIZE [1] [t; .[02] TANK MATERIAL [ -'' [ 03 ] OUTLET DEVICE [ ] [04] MULTI -CUMBERED [ Y / N)] 14 - 1 [OSr" "OUTIAT FILTER [ ] [061 p urailiND x,] [On WATERTIGHT [ ....J` [©$ [ ] [09] DEPTH TO LID DRAINiIELD INSTAL LATIONQ 110] AREA [1] 3: [2] SQPT • [ ) [ 27) SURFACE WATER [ ] [28] DITCHES [ ] [29] PRIVATE [ ] [30) PUBLIC WELLS [ ] [31] IRRIGATION"i [ 1`"° [32 ] POTABLE WAIIER [ _) °' j 3 3 ) BUILDING.., F*UNDA` [ : ._) . -_[34] PROPERTY LIKES `:� OTHER [ 221- [231 [241 [25] [26] DISTRIBUTION B01 a,,- BEAD= — ER OF DRAINLINES, f t-... DRAT INN 'SEPARATION w DRAT INE SLOPE DEPTH -OF COVER ELEVATION '[ ABOVE/ BELOW_] BN SYSTEM LOCATION DOSING PUMPS AGGREGATE SIZE AGG1]EGRTE EXCESSIVE FINES AGGREGATE DEPTH ExCAAVATL031 MATERIAL FILL AMOUNT FILL TEXTURE EXCAVATION DEPTH AREA REPLACED REPLACEMENT, MATERIAL FILLED (36) [37) [38 [391 / ..gS + STABILIZATION ADDITIONAL INFFORMATION 1 [ 40 ] UNOBSTRUCTED AREA [ 1 -[41] STORMWATER RUNOFF ( ) [ 42] ALARMS ( 1 [ 431 MAINTtCE &GREENEST ( ] (44 ] BUILDING AREA ( ) -145 LOCATION CONFORMS WI' [ ] (46 ] FINAL SITE . WASHING [ ,fir [47 ] CONTRACTOR [ ) [ 4S ] OTHER ABANDONMENT [ 49] TANK [50) EXPLANATION OF VIOLATIONS / REMARKS: CONSTRUCTI FINAL SYSTEM DISAPPRO ISAPPAOVED HEALTH DEPARTMENT er PT 3: Buikeng Department PT 4: Health Department PERMIT NUMBER: APPLICANT: AGENT: MAILING ADDRESS: LOT, BLOCK, SUBDIVISION PROPERTY ID#: Permit tracking numlow4issigned triy CHD. Property owners fuf name..' Property owner's legrilly authorized representative. P.O. box or street mailing address„ for applicant or alter Lot, Block and Subdivision for lot or 27 character number for property. (property appraiser 1 COUNTY HEALTH DEPARTMENT CHECKS [X] ITEMS NO IN COMPLIANCE WITH CONSTR STATUTE OR RULE. INFORMATION IS COMPLETED BY CHD ON 'FOLLOWING ITEMS: TANK SIZE (gallons) AS BUILT* INSTALLATION SKETCH TANK MATERIAL (concrete, fiberglass, etc) OUTLET FILTER (manufacturer, make, model) LEGEND (manufacturer code) DRAINFIELD AREA (square feet) DISTRIBUTION BOX / HEADER (check box) NUMBER OF DRAINLINES (number installed) SYSTEM ELEVATION On relation to BM) DOSING PUMPS (number installed) SETBACKS (record actual setbacks in ft) SETBACKS OTHER (as required) STABILIZATION (date stabilized); CONTRACTOR (contractor installing system) ADDITIONAL INFORMATION (as required) ABANDONMENT TANK PUMPED (date) TANK CRUSHED AND FILLED (date) EXPLANATION OF VIOLATIONS: CONSTRUCTION APPROVAL. FINAL APPROVAL; Record item number explanation of violation, and requi Circle approved or disapproved, CHD signature and dat Circle approved or disapproved. CHD signature and da Final approval shall not be granted unit the CHD has confirmed that building construction and lot compliance with plans and specifications submitted with the pplermit'application. e of'pproval. radirtg are in stibstantial ELEVATION OF BENCHMARK OR REFERENCE POINT: f EXISTING GROUND TOP OF AGGREGATE H.1. H.l. H.I. [ -] SHOT [ -]. SHOT a-. [-] SHOT I Miami Shores Village • Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 9 ; 0 ,A ri '7 / ocr, Tel: 3 S 5) 756.8972 tee BUILDING PERMIT APPLICATIO FBC 2004 MAR 0 2 A000 Permit No. P10 la 5Z41 Master Permit No. Permit Type (circle): Building Electrical Mechanical Roofing Owner's Name (Fee Simple Titleholder) 1(A.h &\\h )„.,Y (t(.— Phone # City$ /pa. tvtl State Aft Owner's Address /OO? i' -9'6 sr Tenant/Lessee Name Plumbing Zip /3 Phone # Job Address (where the work is being done) / ®O L/6-0/6 r City Miami Shores Village County FOLIO / P A R C E L # - 3 7 0 ( e - 0 6 - 7 - 7 0 0 Is Building Historically Designated YES Miami -Dade zip g1sg-" NO GS Contractor's Company Name fl (044 ( 0 e i`d l (t_.ey A Contractor's Address f S 9( I0 A.- -t Vl,e ct, R 1 v o S a 20 City PI / 4 et4 . State R19- Zip S 331 7 7 Qualifier Name ,10*. R 0 160-4-fi Phone # -786, 257 --C10 9 7 State Certificate or Registration No.S 01,C1r1 1,• L7 r Certificate of Competency No. S Orr) 101'7 Phone# 7E6 . ( -Z/c 9% Architect/Engineer's Name (if applicable) v (A- Value of Work For this Permit $ 9 -)_0(-) Phone # Square / Linear Footage Of Work: , 00 Type of Work: QAddition DAlteration flNew Describe Work: U; f ! A l t \ .\ P Ficsln Repair/Replace 0 Demolition * * * * * * * * * * * * * ** Submittal Fee $ Permit Fee $ * ,i** Fees* *********** * ** * * * * * * * * * * * * * * * * * * * * * * * * * * ** Notaiy $ Training/Education Fee $ 00 ccF $1 -7S( ) a L(U Technology Fee S Scanning $ 7 , 00 Radon '$ DPBR $ Bond $ 00 , e'c) Code Enforcement $ Double Fee $ CO /CC Zoning $ Structural Review. $ Total Fee Now Due $ See Reverse side -a 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 ►��' A a �_ !!(t+7��:�►� Signature �' /.�►��. Owner'. Agent The foregoing instrument was ac owledged before_me this The foreg ►'1 day o , 20 , by I"�l l i .jC l J� C 1 Y of 0� �' who personally known to me or who has produced who s personally known to me or who has produced as identificatitt o did take an oath. NOT P LIC A°. •.:'. «. Si 1 ` '1.."-- -_ • �. . 984 Print: 4 / ®?? tP 7 My t,. mmission Expires .n tification and who did take an oath. Contractor g instrument was acknowledged before me this Z- YC 2 by Vn OrT . NOTARY P ®00611/, Sign: Print: My Co ion* / argue 98 t1 lion Expires: >k *1>< * * * * * * * * * * * * * * * * * * * ** /ne * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPLICATION APPROVED BY: (Revised 02108/06) ✓ �� Plans Examiner Engineer Zoning STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL `. STEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: [ ]New System [ ]Existing System [ [ X ]Repair [ ]Abandonment APPLICANT: Jadallah, Ayman & Amani CENTRAX #: 13 -SG -27954 DATE PAID: FEE PAID : $ RECEIPT . OSTDSNBR : 06- 0399 --R ]Holding Tank [ ] Innovative Other ]Temporary [ NA ] AGENT: SA0021077, Bolanos Jose PROPERTY STREET ADDRESS: 100 NE 96 St Miami FL 33138 LOT: 14 BLOCK: 20 SUBDIVISION: Miami Shores Section [Section /Township /Range /Parcel No.] [OR TAX ID NUMBER] PROPERTY ID #: 11- 3206 - 013 -2700 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 [ 1 ]BED N F LOCATION TO BENCHMARK: F.F.E.: 11.7' NGVD I ELEVATION OF PROPOSED SYSTEM SITE [ 1.3 ] [ FEET E BOTTOM OF DRAINFIELD TO BE [ 3.3 ] [ FEET L D FILL REQUIRED: [ 0.0 ]INCHES 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 EXCAVATION REQUIRED: [ 24.0 ] INCHES OTHER REMARKS: 1.- Install 300 sf of drainfield in bed configuration. 2.- Existing 900 gal. septic tank, certified by "Miami Dade Environmental Services Inc. on 02/08/2006" to remain. 3.- Invert elevation of drainfield to be no less than 8.90' NGVD. 4.- Bottom of drainfield elevation to be no less than 8.40' NGVD. THIS PERMIT IS NOT FOR "ADDITION(s) ". SPECIFICATIONS BY: Heybeck,�holas TITLE: APPROVED BY: Heyback, Nic]f TITLE: DATE ISSUED: 2/10/06 DH 4016, 03/97 (Obsoletes previous editions which may not be used) Dade CHD EXPIRATION DATE: 5/11/06 3i2 -6130- t1508 STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT. 6 3 Permit Application Number Scale: Each block represents 5 feet and 1 inch = 50 feet. i-T—g;—gt 3 tit+3-4, I ; ; , PART !"-t- 1 IRIIUIII Ha maim ° a II SITE PLAN 1-1 4 31-1-1 r ÷- ,r—rt r . • li mg mon Jos imaa a alit - sum iew susaisus shOis•ell111 11111mall 11.21111M MUM SOMINSIMISHISHISSIR •uuuusuua s.u.uuum uuussuauauusuuuuuua.. 111 1111111 UM INS IRUUINIII ea ..s.uauuue is •u.ssuausa •s '111111111111111111MSM MI USW HSHHqammanana SIMI • SISVIIIIimansa SSW= SMIMISISIS musmines sum S6I01115 11111i 1ira8n.1it1 $ 1.S....U, 0. we. ..N.amS I w . 4 s am m SNRUSI SS ssie$1 WSSIS 1 I OSRNN •Wi11111 NSII 1, 111.111 MS NUM ISISSO s imi " 1 ce aana mman n 15s aaa 6m_ / — IP. S US anainagaaaliamminiarifiserm itamma allimilliinlifallaniaissanim JEW MI 11115*1 111 l..lIIulSIu$IllII1flpWLI5I 115 mistmOrP simillimaiiiiinamwmairuNWISIMM/M s millifeellimicommom fillisiMielimill IS SIIIIIIIIIIII•IIIII: isillallrn_ 1 ill INISISSIS 1111111. amemene in alma ma mum a a maranal assaiminut aa minana anutanim 0" ' 1 21111111181 faliallintil was simmommiminiownimmumm a m • masain aanananaisamaas ilainai ____allia saallia OWRIONSISIMMISIN•ONIN iiimeas Notes: t , g 3 4,..Ht ■ _ it' It t: i ' i;;11-:„,3-13 iliTilliiiii iiiiiiii 1.11-,1114,;:i!tliiiiiii ,----t---,r-T-1-33-3-1 4- i -+-4-1.-- t .: 4. t_., i f,,_ i_ii,._ rl , 1 1-1 , ..E '' _ 4_4 4 i L 1- -1-1.---t-t-' t----t-c- 4 • •13-3333;c33:4 -4,--4,-,,i,:-L-' 1 f t.1 1 lc i„..1, i_H f,. ,- : ' ',...1:41:1 11 ,-----,--41,444-4:44-4 4_4, -2 T-1--t-i 1 1-333 40 Arr tA8Ai ;3I32 Site Plan submitted br: Plan Approved X By 3;1 Signature Not Approved ,_:10L.01‘) W0-0,tk eNflifer Title Date 0, 2, e.) A.17 County Health Department ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT DH 4015, 10/96 (Replaces HRS-14 Form 4015 which may be used) Mock Nun: 5744-0024015-6) Page 2 of 3