PL-08-421i 1�
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Date: 03/31/2008
Inspector: Levrock, James
Owner: BROWN, JAY
Job Address: 302 97 Street NE
Miami Shores Village, FL
Project: <NONE>
Contractor: MR C'S PLUMBING SEPTIC INC
Block:
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Drainfield
Phone Number
Parcel Number 1132060135870
Lot:
Phone: (305)651 -7859
Building Department Comments
Repair drainfield
0312
Passed
Insp. tor Comments
u C REEN CARD IN FILE
II
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled
re- inspection fee is paid .
until
Thursday, March 27, 2008
Page 1 of 2
Inspector
Addres
DIVISION OF
Environmental Health
Florida Department of Heath
Miami -Dade County Health Department
OSTDS /Septic Tank Division
ty NW 48t St Suite 175
�FL
j IM 33166
Date
3 0 aE OSTDS # ofg
Comments:
PL 0z-42(
5oD, Nc- 91
10050 N.E. SECOND AVENUE
MIAMI SHORES, FLORIDA 33138 -2382
TELEPHONE (305) 795 -2207
FAX, (305) 756 -8972
COURTESY NOTICE
Date 3 \\0���
Address t '� �1
Dear Property Owner / Occupant
In an effort to maintain the appearance and property value of your home, Miami Shores
Village has various codes for the upkeep and maintenance of the homes and properties
within the community. We are sure that you will agree that a well- maintained home
enhances the appeal of the entire neighborhood.
Occasionally, a deficiency may be noted at an individual residence. We have found that
in most cases, residents were not aware that a problem existed. In this case, it was noted
that the following item(s) require your attention:
❑ Property is in need of mowing /cleaning ❑ Vehicle parking areas must be paved
❑ Trash on site ❑ Vessel / boat not properly stored
❑ Exterior of structure requires maintenance Interior / exterior work requires permits
❑ Trees/bushes/hedges need trimming ❑ Prohibited signs on property
❑ Commercial vehicle in residential zone ❑ Non - domestic animals on property
❑ Inoperable vehicle on property ❑ Other:
❑ Vehicle parked in landscaped area ..�
Please correct the above noted item(s) by 3 tiS L�
(Date)
Ri•• e— L'-N-k£,- --
If you feel that you may require additional time or assistance in this matter, please con-
tact me at 305- 795 -2207 so that we can discuss your options for bringing the property
into compliance.
Sincerely, C i �' cS
Code Enforcement Officer
Miami Shores Village
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING
PERMIT APPLICATION
FBC 2004
Permit Type: Plumbing fifi
Owner's Narne (Fee Simple Titleholder)
Owner's Address
City lan
Tenant/Lessee Name
E -MAIL:
61,6-7,0
Permit No. I L o 4z1
Master Permit No.
Phone # 0 `P (p - 4-1
State Zip 3 ) o3
Phone #
Job Address (where the work is being done)
3oa 17 S-1' ,
City Miami Shores Village County Miami -Dade Zip j •581'
FOLIO / PARCEL # I I ° - 6 3 -
Is Building Historically Designated YES NO
Contractor's Company Name ill �G 2-1-A ) T 1p #
Contractor's Address 1 62Y7t ? j\D jN a
City ��
r� , State � Zip 3 1
Qualifier Name V o k r I c(.. n Ley Phone # &)5- 6) - Bel
State Certificate or Registration No. GFL '-r' „ (o—] S 1 Certificate of Competency No.
E -MAIL:
305 G,5/—'7951
Architect /Engineer's Name (if applicable)
Value of Work For this Permit $ O
Type of Work: ['Addition ❑Alteration
Describe Work:
Phone #
Square / Linear Footage Of Work:
['New
)- QP ZS'C.l ( (\
Repair /Replace Demolition
******** * * * * * * * * * * * ** ** * * * * *** *** ****** Fees************:** *:xxxxw *,: * * ** ** ****** * *** *****
'
Submittal Fee$ Permit Fee$ /7S� CCF$ tad CO /CC
Notary $ 5.0 O Training /Education Fee $ 0.4-6 Technology Fee $ 413
Scanning $ 3.0° Radon $ DPBR $ Zoning $ 766•N ►1 dS.
Bond $ '
•� Code Enforcement $ ,,. __ Double Fee $ Q,,ii
Structural Review. $ Total Fee Now Due $ 43460
See Reverse side
MAR 1 Q 208- t 844 • t: 6
c� 41 it
Bonding Comany'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. 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. 1 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."
Zip
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
Signature
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this I C
M
day of , 20 , by day of 1 .") Q(,rr)k, 2001 rb v0h'✓� Hqh L--ca
who is personally known to me or who has produced by
p who is personally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUB
ouS=21___
Sign: Sign:
Print:
Print:
My Commission Expires: ' My Com
+ tic* *** * ***** * ** * * *** *** **
APPLICATION APPROVED B:
(Revised 02/08/06)
i •— '.:�ireSCOMMtSSION #DD471903
OF EXPIRES: Sept. 14.2009
* *,{ 114140e* * *IF***Nttedy' **
4,1d
* * * ** * **
Plans Examiner
Engineer
Zoning
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Jay & Dana Brown
PERMIT #: 13-SG- 906353
APPLICATION #: AP848906
DATE PAID: 1/1/1899
FEE PAID: $55.00
RECEIPT #: 13 -PID- 995020
DOCUMENT #: PR708637
PROPERTY ADDRESS: 302 NE 97 St MIAMI, FL 33138
LOT: 1/2 11 & 12
BLOCK: 43 SUBDIVISION: Miami Shores Section # 1
PROPERTY ID #: 11- 3206 - 013 -5870
[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 [
A [
N [
K [
900 ] GALLONS / GPD Septic
0 ] GALLONS / GPD
0 ] GALLONS GREASE INTERCEPTOR CAPACITY
] GALLONS DOSING TANK CAPACITY
D [ 300 ] SQUARE FEET
R [ 0 ] SQUARE FEET
A TYPE SYSTEM:
I CONFIGURATION:
N
F LOCATION OF BENCHMARK:
[X] STANDARD
[ ] TRENCH
CAPACITY
CAPACITY
[MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ]
SYSTEM
SYSTEM
[]
[ ] FILLED
[X] BED [ ]
FFE:11.8" NGVD
MOUND
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE
L
D FILL REQUIRED:
0
T
E
R
SPECIFICATIONS BY:
APPROVED BY:
[ 0.00 ] INCHES
[ 19.20 ] [I INCHES / FT ] [ ABOVE/ BELOW U BENCHMARK /REFERENCE
[ 47.20 ] [I INCHES I FT ] [ ABOVE)LBELOW h BENCHMARK /REFERENCE
EXCAVATION REQUIRED: [ 28.00] INCHES
POINT
POINT
1.- Existing 900 gal. septic tank, certified by " Mr. C's Plumbing on 02/27/08" to remain.
2.- Install 300 sf of drainfield in bed configuration.
3. -Invert elevation of drainfield to be no less than 8.37 NGVD.
4. -Bottom of drainfield elevation to be no Tess than 7.87' NGVD.
? NI
******* *****THIS PERMIT IS NOT FOR ADDITION(s) * * * * * * * * * * * * ** �E. CO
'd V Edwards
Astrid V Edwards
DATE ISSUED: 03/05/2008
TITLE: Engineer Specialist II
TITLE: Engineer Specialist II
DH 4016, 10/97 (Previous Editions May Be Used)
v 1.1.4
AP84890€
Dade
EXPIRATION DATE: 06/03/2008
SE725968
CBD
Page 1 of 3
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PE IT Vtgq66
Permit Application Number
PART II - SITEPLAN
Scale: Each block represents 10 feet and 1 inch = 40 feet.
1
ef
be
).e
r°3
k
►n
Notes: oa N' `� 1 e+ ,may 33)
eat S+ i 1 d i v " 1'42p -t be rl c_4.
& �* i u .. c card 2ep#Lo fit- ° ase. w«, �.
Site Plan submitte
Plan AFL,. -d
By 151 ocg
Not Approved
Date 31310'
M-t el-m —PSI ;ounty Health Department
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
DH 4015,10!96 (Replaces HRS-H Form 4016 which maybe used)
(Stock Number: 5744- 002 - 4015 -6)
Page 2 of 4
4
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATION
APPLICANT: Jay & Dana Brown
APPLICATION # AP848906
PERMIT # 13-SG- 906353
DOCUMENT # SE725968
CONTRACTOR / AGENT: Mr. C's Plumbing & Septic, Inc
LOT : 1/2 11 & 12 BLOCK: 43
SUBDIVISION: Miami Shores Section # 1 ID #: 11- 3206 - 013 -5870
TO BE COMPLETED BY ENGINEER, HEALTH DEPARTMENT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEERS MUST PROVIDE
REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS.
PROPERTY SIZE CONFORMS TO SITE PLAN: [X]YES [ ]NO NET USABLE AREA AVAILABLE • 0.19 ACRES
TOTAL ESTIMATED SEWAGE FLOW: 400 GALLONS PER DAY [ RESIDENCES— TABLE1 / OTHER —TABLE 2 ]
AUTHORIZED SEWAGE FLOW: 474.98 GALLONS PER DAY [ 1500 GPD /ACRE OR 2500 GPD /ACRE ]
UNOBSTRUCTED AREA AVAILABLE: 300.00 SQFT
BENCHMARK /REFERENCE POINT LOCATION:
ELEVATION OF PROPOSED SYSTEM SITE
FFE:11.8' NGVD
19.20 [
UNOBSTRUCTED AREA REQUIRED: 1000.00 SQS°1'
INCHES
/ FT ] [ ABOVE /
BELOW
] BENCHMARK /REFERENCE POINT
TBE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES
SURFACE WATER: N/A FT DITCHES /SWALES: N/A FT NORMALLY WET: [ ]YES [X]NO
WELLS: PUBLIC: N/A FT LIMITED USE: N/A FT PRIVATE: N/A FT NON— POTABLE: N/A FT
BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: 5 FT POTABLE WATER LINES: 10 FT
SITE SUBJECT TO FREQUENT FLOODING?
10 YEAR FLOOD ELEVATION FOR SITE:
SOIL PROFILE INFORMATION SITE 1
[ ]YES [X]NO
FT [ MSL /
USDA SOIL SERIES:
Munsell #/Color
Urban land
Texture
Depth
10YR 5/1
Sand
0 To 12
10YR 6/4
Sand
12 To 72
OBSERVED WATER TABLE:
80.40 INCHES [ ABOVE /
ESTIMATED WET SEASON WATER TABLE ELEVATION:
BELOW
80
HIGH WATER TABLE VEGETATION: [ ]YES [X]NO
NGVD
10 YEAR FLOODING? [ ]YES [X]N01
] SITE ELEVATION: 10.20 FT [ MSL /
NFORMATION SITE 2
NGVD
USDA SOIL SERIES:
Munsell # /Color
Urban land
Texture
Depth
10YR 5/1
Sand
0 To 12
10YR 6/4
Sand
12 To 72
] EXISTING GRADE TYPE:
INCHES [ABOVE /
MOTTLING: [ ]YES [X]NO
BELOW
SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: Sand
[ PERCHED /
EXISTING GRADE
DEPTH: INCHES
APPARENT
DEPTH OF EXCAVATION: 28 INCHES
DRAINFIELD CONFIGURATION: [ ] TRENCH [X] BED. [ ] OTHER (SPECIFY)
REMARKS /ADDITIONAL CRITERIA
SITE EVALUATED BY:
Hanley, John (Title: - Legacy) (Mr. C's Plumbing & Septic, Inc)
DH 4015, 09/2006 (Previous Editions May Be Used)
DATE: 03/03/2008
Page 3 of 4
AP848906 EID906353 v 1,0.2