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PL-07-1608Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 • Inspection Date: 06/26/2008 Inspector: Levrock, James Owner: ROSS, RALPH Job Address: 501 96 Street NE Miami Shores Village, FL Project: <NONE> Block: Contractor: A AARON SUPER ROOTER Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Drainfield Phone Number Parcel Number 1132060171550 Lot: Phone: 305 -944 -8886 Building Department Comments REPLACE DRAINFIELD eiar"1" Passed In ,• - • r Comments Failed Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled re- inspection fee is paid . until Wednesday, June 25, 2008 Page 1 of 2 Environmentaj Heaith Florida Department of Heath i ®Dade County Health Department OSTDS /Sept Tank Division 7769 NW 48t St. Suite 175 Miami, FL 33166 tns ec... p ate Andress Corn mens: Signature'`; rl;� STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION INSPECTION AND FINAL APPROVAL APPLICANT: AGENT: - PERMIT NO DATE PAID FEE PAID RECEIPT #: PROPERTY ADDRESS. ¶ © l v. LOT•llO 12 BLOCK:. SUBDIVISION: PROPERTY ID / J203 b '0474% CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED. TANK INSTALLATION q [01] TANK SIZE [1]! (70 [2] [02] TANK MATERIAL C`�. [03] OUTLET DEVICE [04] MULTI - CHAMBERED [Y /0 [05] OUTLET FILTER 1Y/ pit [06] LEGEND At % A [07] WATERTIGHT [08] LEVEL [09] DEPTH TO LID DRAINFIELD INSTALLATION [10] AREA [1]/YX ?2].AZ,CSOFT [11] DISTRIBUTION BOX HEADER [12] NUMBER OF DRAINLINES.�'�'�:,,� [13] DRAINUNE SEPARATION -34 s.• [14] DRAINUNE SLOPE [15] DEPTH OF COVER /.� 1/ [16] ELEVATION [ABOVE/BELOW] BM [17] SYSTEM LOCATION [18] DOSING PUMPS [19] AGGREGATE SIZE AI 1 [20] AGGREGATE EXCESSIVE FINES [21] AGGREGATE DEPTH FILL / EXCAVATION MATERIAL [22] FILL AMOUNT I „2 " [23] FILL TEXTURE [24] EXCAVATION DEPTH [25] AREA REPLACED [26] REPLACEMENT MATERIAL EXPLANATION OF VIOLATIONS / REMARKS: I l I l I ] SETBACKS [27] SURFACE WATER FT [28] DITCHES FT [29] PRIVATE WELLS FT [30] PUBLIC WELLS FT [31] IRRIGATION WELLS FT [32] POTABLE WATER LINES / 3' FT [33] BUILDING FOUNDATION FT [34] PROPERTY LINES 7 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 GRADING [47] CONTRACTOR [48] OTHER ABANDONMENT % [49] TANK PUMPED 5 / ? /0% [50] TANK CRUSHED & FILLED / L i l I I COMM ION [APPROVED APPROVED]ter FINAL SY ISAPPROVED]: DH 4016 (Page 2). 10197 (Previous Editions May Be Used) Stock Number: 5744- 002 - 4016 -4 CHD DATE: O "" 7-6 7 CHD DATE 6 7- Ul Page 2 of 3 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspec on Number: INSP -57294 Perm Number:; PL-7-07- 608 Inspection Date: 10/04/2007 Inspector: Levrock, James Owner: ROSS, RALPH Job Address: 501 96 Street NE Miami Shores Village, FL Project: <NONE> Contractor: A AARON SUPER ROOTER Block: Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Drainfield Phone Number Parcel Number 1132060171550 Lot: Phone: 305 - 944 -8886 REPLACE DRAINFIELD c‘''4\ Passed Ir , or Comments Failed Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled re- inspection fee is paid. until Wednesday, October 3, 2007 Page 2 of 2 DIVISION OF Environmental Health Florida Department di Reath Miami -Dade County Flealth Department OSTDS /Septie Tank Division 7769 NW 4V St. Suite 175 Miami, FL 33166 Inspector Date .mm onDs # 7 c°72 Address 5-0- / Al Comments: Signature DIVISION OF Environmental Health Florida Department of Heath t Miami-Dade County Health Department OSTDS /Septic Tank Division 7769 NW 48th St. Suite 175 Miami, FL 33166 — a Date 0 —" Address'a ; j dett.."7. ,F‘ ®SIDS Comments: Signature Miami Shores Village JUL 31 2007 J f Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Big __ Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING Permit No. PL 1 w i6 O S PERMIT APPLICATION Master Permit No. FBC 2004 Permit Type: Plumbing goSS Owner's Name (Fee Simple Titleholder) ""'Ral h a- Ger -Tru Ae Phone # Owner's Address 50( NE (A& S City 1 \. S :Ice State F1.. Zip 33138 Tenant /Lessee Name Phone # E -MAIL: Job Address (where the work is being done) 501 NE R G STEE City Miami Shores Village County Miami -Dade Zip 331 -'8 FOLIO / PARCEL # 32o6 -0 i-7 -165° Is Building Historically Designated YES NO n A nn (3s Contractor's Company Name A AO rO ' S � eoo- ( Phone # a 4 4 -dam Contractor's Address 60 22_. 3S C+ City MI,rarr\O o' Qualifier Name ja ^ Tv State Certificate or Registration No. S€Po0064-' Certificate of Competency No. E -MAIL: Architect /Engineer's Name (if applicable) State FE- Zip 55023 Phone # Phone # Value of Work For this Permit $ 2Q" Square / Linear Footage Of Work: Type of Work: ❑Addition Alteration New )c Repair /Replace ❑ Demolition Describe Work: 2,5 zt jT ******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees***,********** * * * * * * * **** **** * * * * * * * * * ** * * * ** Submittal Fee $ el Permit Fee $ I/5 C!3 CCF $ i.I0 CO /CC Notary $ 0 Training /Education Fee $ .6d Technology Fee $ 4. 3-t 7 1 IF.Scanning $ .93 = 0) Radon $ DPBR $ Zoning $ Bond $ 300.00 Code Enforcement $ Double Fee $ // L Structural Review. $ Total Fee Now Due $ 4 g4 `T 1 � ��k� See Reverse side „rim 31 pa 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 exceedin• ;250, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure w be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commenceme mu '- be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the a enc -'of such posted notice, the inspection will not be approved and a reinspection fee will be charged. $inatu .Signature_ Contractor The foregoing instrument was acknowledged before me this 24 The foregoing instrument was acknowledged before me this 24f day of , 20 ti. by gc Ross , day of u 20 1)7 by who is personal' nown to me or who has produced brtv• L. (trick (FLA) As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: 41c SQ1-41rN%-t. T)24-41141L&Ig n-1-42'1 My Commission Expires 4.1/41'G TERESA J. SOLOM * * * * * * % % % % % % % % %* MY COMMISSION # DD 41134N0TAPY FL N a yy4 • 044q APPLICATION APPROVED BY: (Revised 02 /08/06) who is personally known to me or who has produced W +� identification and who did take an oath. NOTARY PUBLIC: lf4 Sig Print: My Com i1L t r • (' - ^t1 OMMISSION # OD 250437 Oriv EXPIRES: September 16, 2007 Plans Examiner Engineer Zoning P,ermitCommentsFirst STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND SYSTEM CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: Ralph & Gertrude Ross PROPERTY ADDRESS: 501 NE 96 St MIAMI, FL 33138 LOT: 11 & 12 " coP PERMIT # : 13 -SG- 305531 APPLICATION #: AP298526 DATE PAID: 07/27/2007 FEE PAID: $200.00 RECEIPT #: 13 -PID- 246714 DOCUMENT #: PR232235 JUL 3 1 2007 114' lj BLOCK: 99 SUBDIVISION: Miami Shores PROPERTY ID #: 11- 3206- 017 -1550 [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 PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY. SYSTEM DESIGN AND SPECIFICATIONS T [ 900 ] GALLONS / GPD Seotic CAPACITY A [ 0 ] GALLONS / GPD CAPACITY N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPAC K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS D ( 225 ] SQUARE FEET Trench Confiauration SYSTEM R [ 0 ] SQUARE FEET SYSTEM A TYPE SYSTEM: [x] STANDARD [ ] FILLED [] MOUND I CONFIGURATION: [x] TRENCH [ ] BED [ ] N F LOCATION OF BENCHMARK: FFE EI.:11.40" NGVD I ELEVATION OF PROPOSED SYSTEM SITE E BOTTOM OF DRAINFIELD TO BE L D FILL REQUIRED: 0 T H E [ 0.00 ] INCHES ITFN2 7250 GALLONS] ■ ]livs�sN 1i h Viilac 'mps [ APPROVED BY DATE [Zm ING DEPT [ 2.60 ] [ INCHES 4 FT [ A [ 5.10 ] [ INCHES 1 FT 11 ( A OVE BELOWIBENCHMARK /REFERENCE POINT UNTY RULES AND REGULATIONS EXCAVATION REQUIRED: [ 30.001 INCHES Existing tank OK for use. Required drainfield area based on rule 64E- 6.015(6)(c)2. Install a new 225 drainfield in trench configuration to achieve Drainfield size requirement. The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance with s. 64E- 6.013(3)(f), FAC. Invert elevation of the drainfield to be no less than 6.80" NGVD. Bottom of drainfield elevation to be no less than 6.30" NGVD. THIS IS NOT FOR ANY "ADDITION(s) ". SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: 1 cVe-#— TITLE: Dade CHD EXPIRATION DATE: 10/28/2007 STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Number ;. PART II - SITE PLAN = Scale: Each block represents 5 feet and 1 inch = 50 feet. mi B• t iiiiiWi MAIM In MOM IMWMOU USOOMMO NOMMUS SOOSIBM IMUMMOR MUMUSS MOUSO WOUSSMOUSI BOUNUSUMNUMMISSUROMMOSMOni SMOHNOSOMMOMMOSSIBUMOSSIMOR ■ 11111111111111111 iguntrommim assUISOUNImmill is win nusommina..........semomm sainsionSIMOSENOSOSIOnsmial mommenessimmummormagen IIOURROMSIOUSSOMMOM Moms assimi mosommi mummis inOmoss nammemumnwassamess Notes: CZ o SS -- Site Plan submitted by:' ., Plan Approved I/ By kr :CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT DH 4015.10/98 (Replaces HR$H Form 4015 Will may be used) (stoat Renter: 5744-012 -4015-0) Page 2 of 3