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PL-09-1757Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: I NSP- 127787 Scheduled Inspection Date: December 22, 2009 Inspector: Levrock, James Owner: BAIOFF, ELSIE Job Address: 336 NE 98 Street Miami Shores, FL 33138- Project: <NONE> Contractor: A AARON SUPER ROOTER Permit Number: PL -10 -09 -1757 Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Septic Phone Number Parcel Number 1132060135700 Phone: 305 - 944 -8886 Building Department Comments REPLACE SEPTIC AND DRAINFIELD WITH NEW SEPTIC (900 GALLON) AND NEW DRAINFIELD (225 SF ) Passed Failed ector Comments PPROVAL IN FILE Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. December 21, 2009 For Inspections please call: (305)762 -4949 Page 7 of 27 Miami Shores Villa e D E� � g OCT z � zoo9 Building Department By:� 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 f BUILDING PERMIT APPLICATION FBC 200$ Permit Type: Plumbing Permit Nog' ^' (fl Master Permit No. joky, SG(yPeiCK. Owner's Name (Fee Simple Titleholder) €I 5.I . OCA Phone # Owner's Address ?G NC ST City M SC'iO reS State h. Zip 3 3438 Tenant /Lessee Name Phone # E -MAIL: Job Address (where the work is being done) ,3 , )■; ¶ rreC City Miami Shores Village County Miami -Dade Zip 3 3i FOLIO / PARCEL # ((- ?il_.(ac._ i;i 3- -c-;-i Is Building Historically Designated YES NO Contractor's Company Name Pt k ci ro 5 ! C +-t'_- Phone # 5 c s 9 4 4—?C Contractor's Address . C-c 22 - S - -D. CI-- City j'- c - CI. r-v' ' v State FL Zip '33o L3 Qualifier Name co 7 Phone # State Certificate or Registration No. ) Sit5410 C''C °C'4 S' 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: Square / Linear Footage Of Work: ['Alteration ['New Repair /Replace [' Demolition R( )v\ce St p' , +c =r1 iv- D'eai?) 4° e N- w D i 't t a m -e(Ci (22-C +?-6701) ******************* * * * * * * * ** * ******* ***Feesicit*** ; ***** *** * ****wwwww c*wwww9cxxx *xxxxxxxxx Submittal Fee $ Permit. Fee $ (' C CCF $ 1- 160 CO /CC Notary $ Training /Education Fee $ 0400 Technology Fee $ )'1S Scanning $ 3.00 Radon $ DPBR $ Zoning $ Bond $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ (A021-11/4S • See Reverse side -* 'ding Company's Name (if applicable) ding Company's Address y State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City Zip 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 _ promise in good faith that a copy of the notice of commencement and construction lien law bri whose property is subject to attachment. Also, a certified copy of the recorded notice of comet for the first inspection which occurs seven (7) days after the building permit is issued. In inspection will not be approved and a reinspectlon, fee will be charged. Signature Owner Agent The foregoing instrument was acknowledged before me this 2'3 day of tCl , 20C r) , by Jo kr, �t�. c'( Signature ceeding $2500, the applicant must ure will be delivered to the person ment must be posted at the job site absence of such posted notice, the Contractor The foregoing instrument was acknowledged before me this 23 day of 0( 1- , 20 el, by JAI who is personally known to me or who has produced Jn v 4 062,1 , who is personally known to me or who has produced 1I ✓ 1.'66'1 As identification and who did take an oath. 6-1-$.C) as identification and who did take an oath. ( SI) NOTARY PUB Sign: LIC: I SOLOMON Print: ` � l�''�54 8,,,,i14440 My Commission Expires: ExPi ` ,110201I * * * * * * * * * * * * * * * * * * * * * * * * * ** APPLICATION APPROVED (Revised 02/08/06) NOTARY PUBLIC: Sign: Print: ..4,,e,fe — ,.aira: ?l. 11 t;«'''''u TEriESS+A.1. SOLOMON fires: es: Comm# �y3(�3]346 N0rYAssn., Inc ■n.ua.u.b.nnntnN 0 7 Plans Examiner My Commisisi ** * ** * * *d: * * *** * * *i4' Engineer Zoning PERMIT 4: 13-SC-1007024 APPLICATION #: AP940280 STATE OF FLORIDA DEPARTMENT OF HEALTH DATE PAID: ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID* SYSTEM RECEIPT #. CONSTRUCTION PERMIT FOR: OSTDS Abandonment APPLICANT: Elsie Baioff & John Saypack PROPERTY ADDRESS: 336 NE 98 St Miami, FL 33138 LOT: 7 &8 DOCUMENT #: PR788666 BLOCK: 42 SUBDIVISION: Miami Shores Sec 1 Amd PROPERTY ID #: 11- 3206 -013 -5700 [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 MAX 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 [ ] GALLONS / GPD CAPACITY A [ ] GALLONS / GPD CAPACITY N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ D R A I N F I E L D O T H E R SPECIFICATIONS BY: - =EDRO N OSPINA TITLE: - Legacy [ ] SQUARE FEET SYSTEM [ ] SQUARE FEET SYSTEM TYPE SYSTEM: [ ] STANDARD [ ] FILLED [ ] MOUND [ ] CONFIGURATION: [ ] TRENCH [ ] BED [ ] LOCATION OF BENCHMARK: ELEVATION OF PROPOSED SYSTEM SITE BOTTOM OF DRAINFIELD TO BE FILL REQUIRED: ][ / ][ABOVE / BELOW ]BENCHMARK /REFERENCE POINT [ ][ / ][ABOVE/ BELOW]BENCHMARK /REFERENCE POINT [ 0.00] INCHES EXCAVATION REQUIRED: [ ] INCHES Have the tank abandoned in accordance with the following procedures:(a) The tank shall be pumped out.(b) The bottom of the tank shall be opened or ruptured, or the entire tank collapsed so as to prevent the tank from retaining water, and(c) The tank shall be filled with clean sand or other suitable material, and completely covered with soil.Have the system inspected by the health department after it has been pumped and ruptured but before it is filled with sand and covered. APPROVED BY: / TITLE: Pedr. N Ospina DATE ISSUED: 10/26/2009 Dade CHD EXPIRATION DATE: 01/24/2010 DH 4016, 10/97 (Previous Editions May Be Used) Page 1 of 3 v 1.1.4 A13940280 SE -1 STATE OF FLORIDA DEPARTMENT OF HEALTH DATE PAID: ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID: SYSTEM RECEIPT #: DOCUMENT #: PR788693 PERMIT # :13 -SC- 1007025 APPLICATION #: AP940281 CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: Elsie Baioff & John Saypack PROPERTY ADDRESS: 336 NE 98 St Miami, FL 33138 LOT: 7 &8 BLOCK: 42 SUBDIVISION: Miami Shores Sec 1 Amd PROPERTY ID #: 11- 3206 - 013 -5700 [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 SeDtiC CAPACITY A [ 0 ] GALLONS / GPD CAPACITY N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @( ]DOSES PER 24 HRS #Pumps [ l D [ 225 ] SQUARE FEET SYSTEM R [ 0 ] SQUARE FEET SYSTEM A TYPE SYSTEM: [X] STANDARD [ ] FILLED [ ] MOUND [ ] I CONFIGURATION: [X] TRENCH [ ] BED [ ] N F LOCATION OF BENCHMARK: F.F.E.: 12.0' NGVD I ELEVATION OF PROPOSED SYSTEM SITE E BOTTOM OF DRAINFIELD TO BE L D FILL REQUIRED: 0 T H E R [ 0.00 ] INCHES [ 25.20 ] [I INCHES 1 FT ] [ ABOVE /) BELOW U BENCHMARK /REFERENCE POINT [ 55.20 ] ii INCHES I FT ] [ ABOVE /) BELOW fi BENCHMARK /REFERENCE POINT EXCAVATION REQUIRED: [ 30.00] INCHES 1— Install 1050 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). 3- Install 225 sf of drainfield in trench configuration. 4- Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed. 5 -Invert elevation of drainfield to be no less than 7.90' NGVD. 6. Bottom of drainfield elevation to be no less than 7.40' NGVD. THIS PERMIT IS NOT FOR AD M1411 .41, a► SPECIFICATIONS APPROVED BY: DATE ISSUED: Pedro N Ospina 10/26/2009 DH 4016, 10/97 (Previous Editions May Be Used) v 1,1.4 A1,940281 HEAL DEPARNEW Dade CHD EXPIRATION DATE: 01/24/2010 6E799638 Page 1 of 3 STATE OF FLORIDA DEPARTMENT OF :HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL= SYSTEM CONSTRUCTIONf Permit Application Nun1'lor, , - - . PART II - SITEPLAN Scale: Each block re • resents 10 feet and 1 inch = 40 feet. ®11M111®® ®1 ®1®®MME®®■®®® ®1® ®11®®®1®11® ® ®1111i ®111® ®■ ®11®. ®111.111 MMINIMEMMEMMOOMMEMMEMMEMMMOMM MMINIMMIMMEMMEWMMEMMMEMMEMMEM MEMINIMUMMIIMMIMMINIMEMBSIMMEM MINIMINIMMMENNMEEMMINIMMEMEMERM MOMMINMEMEMMEMMMUMMIMMIMMOMME ■■ ®1®®111111�1!�'!'�l'i+ i�i®® ®i Ill 1 1®II1®I1i I iI 1II®II ®11 1®i5 MINIMMIMMEMMMODEMNIMMEMMEMMEM MMEMEMMEMENNIMMEMMINIMMEMMEM 1111111111111111111111111111111Mr 1112 111111111111111111111111111 MMINIMMUMMUMUMPNWAMMMINIMOMMINM IMINIMENNEEMNIIMMUNNIMMENNINEMI MEINIMMUMMEEEMEERMIIMMINIMMIN MMINIMMIIMMOMMEMMMEMMENOMMEM 111111 INIMMIMMIIMMENUMMINIMMUMMINIMMINI MOMMEMMEMMINIMMEMOMMEMMEMOM M■1 IMINIM MN®1111®®11® ®1® ® ®i1 ®1 Notes: 1 a t V 33G ,sF °` )3 1 c 4r eo-, At Site Plan submitted by: Plan Approved By Signature 2-4 Title Date County Health Department ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT DH 4015, 10/96 (Replaces HRS -H Form 4016 which may used) (Stock Number: 5744- 002 - 4015 -6) Page 2 of 4 STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERIVII Permit Application Number - PART II - SITEPLAN - Scale: Each block re • resents 10 feet. and 1. inch = 40 feet. ®®111® 1 ® ®M ® ® ®111111® ®1111® ■ ®11 ®1INE. NFIE!! E2MPN 111® ®111 ■11111® ®111®1"611111111 ®® ®® 1111111111111111111111MIPMEIMILMENENI11111111111111 1111111111.1111111111MIELMINIIIIIIMMENEEMIIMI 111111111111111111111111111B11111111111111111111111111111111111111111111 ■ ��® �s!!.�.�.� #111® ®ail ® ® ® ®® 111116511111111111111LIMEMIPICHIMMINIIIIIIIIIIIMMEI 111111111111111111111111111,0 ICIIMEEM111111111111111111111111111 11111 11111111111111111111110111B11111111111111111111111111111111111111 1111111111111111111011111111111111111111111111111111111111111111116 111111111111111111111111111111111111111111111111111111111111111111111111 1111111111iiiiiiiiniiiiiiiitnitill11111111111111111111111111111 11111111111101111521111111111111111111111111111111111111111111111111111 Notes: 8 'a 00 On kin T e n Site Plan submitted by: Plan Approved By 240-o% Approved—i_ Title Date County Health 'Department ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT DH 4015, 10/96 (Replaces HRS -H Form 4016 which may be used) (Stock Number: 5744-002- 4015 -6)