PL-06-844Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Date: 02/13/2007
Inspector: Levrack, James
Owner: KATTOURA, CAROLINA
Job Address: 798 98 Street NE
Miami Shores Village, FL 33138-
Project: <NONE>
Contractor: A AARON SUPER ROOTER
Block:
Pemit
.W.W.V.WAV
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Drainfield
Phone Number (305)754-3213
Parcel Number 1132060142290
Lot:
Phone: 305-944-8886
Building Department Comments
INSTALL NEW DRAINFIELD
FEB 1 5 200?
( 12 /WS
C'e
...-7
Passed
- r Comments
Failed
Correction
Needed
Re-Inspection
Fee
($75)
No Additional Inspections can be scheduled
re-inspection fee is paid .
until
Monday, February 12, 2007
Page 1 of 1
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DI 'SP 3SAL SYSTEM
CONSTRUCTION INSPECTION AND FINAL APPROVAL
APPLICANT:
444
PERMIT NO. JG`CF 9oL -?
DATE PAID:
FEE PAID'
RECEI #:
t --- 0-7�e'?
AGENT: d
PROPERTY ADDRESS:
LOT: 1_ BLOCK: .
SUBDIVISION: ✓ rvt. \ JVI SE'S C-0-3 PROPERTY ID #:
CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED.
TANK INSTALLATION
[ .4 [01] TANK SIZE [1] [2]
[ [02] TANK MATERIAL C°0 C (e-Fe
[ 1,j/ [Op] OUTLET DEVICE
[ ] [014] MULTI - CHAMBERED [Y /10
[ • ] [05] OUTLET FILTER
[ 1 [06] LEGEND 6!r
[ 1� � 1 07] WATERTIGHT
[ 1.1./.108] J08] LEVEL
[ [09] DEPTH TO LID
DRAINFIELD INSTALLATIOJ
[ t.]''s [10] AREA [1] .2. [2] SOFT
[ r [11] DISTRIBUTION BOX HEADER
1 [12] NUMBER OF DRAINUNES 4j * 1405
[ I.J' [13] DRAINUNE SEPARATION
[ 41 DRAINUNE SLOPE 'mil ` r
[ 1�"� 51 DEPTH OF COVER
t [16] ELEVATION [ABOVE/B�j26 BM
[ +J, [17] SYSTEM LOCATION
[ ] [18] DOSING PUMPS
j ] j19] AGGREGATE SIZE
] [20] AGGREGATE EXCESSIVE FINES
[ 1 [21] AGGREGATE DEPTH
C` (,) :,)S ,
FILL / EXCAVATION MATERIAL
[ ] [221
[ l [23]
[ ' [24]
1 te 1251
[261
FILL AMOUNT
ALL TEXTURE
EXCAVATION DEPTH
AREA REPLACED
REPLACEMENT MATERIAL
EXPLANATION OF VIOLATIONS / REMARKS:
SETBACKS
1 1 [271
[ 1 [281
[ 1 [29]
[ 1 [301
[ 1 [31]
[ 14Y'[321
[ 331
[ �Y1341
[ l [351
SURFACE WATER FT
DITCHES FT
PRIVATE WELLS • FT
PUBUC WELLS FT
IRRIGATION WELLS A FT
POTABLE WATER LINES AP FT
BUILDING FOUNDATION / FT
PROPERTY LINES Q. FT
OTHER FT
FILLED./ MOUND SYS
DRAINFIELD ,' • ER
SHOUL
ES
ABILIZATION
[361
[371
138]
[39]
ADDITIONAL INFORMATION
UNOBSTRUCTED AREA
STORMWATER RUNOFF
ALARMS
MAINTENANCE AGREEMENT, -
BUILDING AREA
LOCATION CONFORMS WITH SITE PLAN
FINAL SITE GRADI
CONTRACTOR 1-1.40
'
OTHER
[
[
441
[45]
[ l [4$]
[ x[471
[ 1 1481
ABANDONMENT
[49] TANK PUMP
[50] TANK SHED & FILLED if L
CONSTRUCTION
FINAL SYSTE
/DISAPPROVED]:
/'? 2 CHD DATE:
ISAPPROVED]:
DH 4016 (Page 2)4 10/97 (Previous Editions May Be Used)
Stock. Number_ 5744 -002- 40164
'7 CHD DATE:
PT 1: Applicant
• 2: InstalleeCoAtrader
PT 3 Buitcling Department
Page 2 013
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DI P 3SAL SYSTEM
CONSTRUCTION INSPECTION AND FINAL APPROVAL
APPLICANT:
6 taC A. rel.url
AGENT: 6VIY u
PERMIT NO Uc -c `7'a)
DATE PAID-
FEE PAID-
RECEIPT #:
13�5� 05349x'7
Va0(0 ° '44
PROPERTY ADDRESS: 01
LOT: r BLOCK: 2
NE
&w'l,
SUBDIVISION: ✓"t t +n t l BPS �� PROPERTY ID #: eft Cl/ 6
CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED.
TANK INSTALLATION
[ A [01] TANK SIZE [1] /�� [2]
[ ,Y [02] TANK MATERIAL + °'^ c.G@.
[ V [03] OUTLET DEVICE
[ ] [04] MULTI- CHAMBERED
[" ] [05] OUTLET FILTER
[ ] [06] LEGEND &'4
[ 07j WATERTIGHT
[ �08] LEVEL
[t.�'� [09] DEPTH TO LID
DRAINFIELD INSTALLATIOJ
[ i�}''f [10] AREA [1] .= ' [2] SOFT
[ j' [11] DISTRIBUTION BOX HEADER t�
[ [12] NUMBER OF DRAINLINES)/ 11o'5
[ V [13] DRAINLINE SEPARATION
[4] DRAINLINE SLOPE ,057( [ 5] DEPTH OF COVER ��
[ [16] ELEVATION [ABOVE/1311/1 5• '>
[ 1j7 [17] SYSTEM LOCATION
] [18] DOSING PUMPS
1 [19] AGGREGATE SIZE
] [20] AGGREGATE EXCESSIVE FINES
] [21] AGGREGATE DEPTH
FILL / EXCAVATION MATERIAL
[ 1 [22]
[ ] [23]
[ Lk-4 [24]
[ t [25]
[ [26]
FILL AMOUNT
FILL TEXTURE
EXCAVATION DEPTH
AREA. REPLACED
REPLACEMENT MATERIAL
EXPLANATION OF VIOLATIONS / REMARKS:
[
SETBACKS
[ ] [27] SURFACE WATER 1/ FT
[ ] [28] DITCHES FT
[ ] [29] PRIVATE WELLS FT
[ ] [30] PUBLIC WELLS FT
[ ] [31] IRRIGATION WELLS FT
[ U/' [32] POTABLE WATER LINES /a FT
[ V33] BUILDING FOUNDATION g FT
[34] PROPERTY LINES c ,'S FT
[ ] [35] OTHER FT
FILLED / MOUND SYSTE
DRAINFIELD ` VER
SHOUL ra ` S
[36]
[37]
[38] SL ' ES
[39] ABILIZATION
ADDITIONAL INFORMATION
[ c -3 - " [40] UNOBSTRUCTED AREA
[ x[41] STORMWATER RUNOFF
[ ] [42] ALARMS �J
[ ] [43] MAINTENANCE AGREEMENT 01-
[ �44] BUILDING AREA
[ [45] LOCATION CONFORMS WITH SITE PLAN
[ ] [46] FINAL SITE GRADI G
[ L...10/1471 [47] CONTRACTOR 11 f k
[ ] [48] OTHER
[ ]
ABANDONMENT
[49] TANK PUMP
[50] TANK C SHED & FILLED
CONSTRUCTION A PROV ./DISAPPROVED]:
FINAL SYSTE
/DISAPPROVED]:
DH 4016 (Page 2), 10/97 (Previous Editions May Bo Used)
Stock Number. 5744 - 002 - 4016 -4
CHD DATE.
CHD DATE'
PT 1: Applicant
PT 2: Installer /Contractor
PT 3: Building Department
PT 4: Health Department
Page 2 of 3
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING ilECMEIVM Permit NoPUJ -"
PERMIT APPLICATION ffP 0 3 °h6 aster Permit No.
FBC 2004 BY
Permit Type (circle): Building Electric '''C Plumbing) Mechanical Roofing
Owner's Name (Fee Simple Titleholder) l j ri G. �1 r , Phone # 3:::15" % 51-e 3 L--13
Owner's Address '79 ,lJ E G7 g
CityMkOI cS'i-tiV' ? State Pic) «J'Ot Zip 3.31 3 g
Tenant/Lessee Name
Job Address (where the work is being done) �y
City Miami Shores Village County . Miami -Dade Zip 3 313 O
FOLIO /PARCEL# (d ® 'zap 6° Ok4- 22iO
Is Building Historically Designated YES NO l7
Phone #
16$ NE 9g 5tr e�--
(;5)
Contractor's Company Name r IrCe 11 P:362° Phone # C? � E�lta
Contractor's Address 60 ti.t 3S C
City /" if 4 rgi v' State Zip 3 30-2.
Qualifier Name On Phone #
State Certificate or Registration No. SRO l a 2 Certificate of Competency No.
Architect/Engineer's Name (if applicable) 4 4
Value of Work For this Permit $
Phone #
Square / Linear Footage Of Work. 22S
-
Type of Work: ['Addition ['Alteration ❑New la Repair/Replace ❑ Demolition
Describe Work: k 6i . orcA,trq, t �
* * * * * * * *1 * * * *** ** ** * * *** * * * *** * * *** * ** Fees * * * * * * * * *** * * *** * * ** ***** * *** * *** * * * * *** **
Submittal Fee $ - 60Permit Fee $ 1-75- CCF $ 1 .
Notary $ Training/Education Fee $ 0'.J " Technology Fee $
CO /CC
Scanning Saco Radon $ DPBR $ Zoning $
Bond $(. Code Enforcement $ Double Fee $
Structural Review. $ Total Fee Now Due $ 4et4 —c
APR 0 3 PAID
See Reverse side -->
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 brochu - will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of comme ent must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued In �, /absence of such posted notice, the
inspection will not be approved and a reinssection ee will be charged
Signature
Owner or Agent
The foregoing instrument was acknowledged before me this
day of /k 4-PCL, 20 f6 by Cctec`� 0
who is personally known to me or who has produced
6 As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
t 1� ()s-V‘eoi-
etie.4-es. o
My Commission Expires:
* * * * * * * * * * * * * * **
Contractor
The foregoing instrument was acknowledged before me this
day of 1 C ,20 6, by 34 -0--
who is personally known to me or who has produced
1..c<es,x, as identification and who did take an oath.
**
* **
NOTARY PUBLIC:
Sign:
Print:
v; y Comm
MYCONi 1`s'ON #Di250437
S to'F' XlreocPIRES: September 16, 2007
,tr n* * *1 _ FF.: I D scount Assoc. Co.
APPLICATION AP
(Revised 02/08/06)
t: FL Notary Discount Assoc. C
5/-o 0.6
Plans Examiner
Engineer
Zoning
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CENTRAX #: 13 -SG -28487
DATE PAID:
FEE PAID : $
RECEIPT .
OSTDSNBR : 06-0927--R
:ONSTRUCTION PERMIT FOR:
]New System [ ]Existing System [ ]Holding Tank [ ] Innovative Other
X ]Repair [ ]Abandonment [ ]Temporary [ NA ]
IPPLICANT: Kattoura, Carolina
AGENT: SR091112, Tuffy John
'ROPERTY STREET ADDRESS: 798 NE 98 St Miami Shores FL 33138
,OT: 1 BLOCK: 70 SUBDIVISION: Miami Shores Sec 3
[Section /Township /Range /Parcel No.]
'ROPERTY ID #: 11- 3206 - 014 -2290 [OR TAX ID NUMBER]
,YSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 64E -6,FAC
) EPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC TIME
'ERIOD. ANY CHANGE IN MATERIAL FACTS WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT,
.SQUIRE THE APPLICANT TO MODIFY THE PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS
ERMIT BEING MADE NULL AND VOID. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM
OMPLIANCE WITH OTHER FEDERAL, STATE OR LOCAL PERMITTING REQUIRED FOR PROPERTY DEVELOPMENT.
YSTEM DESIGN AND SPECIFICATIONS
[ 900 ]Gallons SEPTIC TANK MULTI- CHAMBERED /IN SERIES: [Y ]
[ 0 ]Gallons MULTI- CHAMBERED /IN SERIES: [Y ]
[ 0 ]GALLONS GREASE INTERCEPTOR CAPACITY
[ 0 ]GALLONS DOSING TANK CAPACITY [ 0 ]GALLONS @ [0 ]DOSES PER 24 HRS # PUMPS[ 0 ]
[ 225 ]SQUARE FEET PRIMARY DRAINFIELD SYSTEM
[ 0 ]SQUARE FEET SYSTEM
TYPE SYSTEM: [ ]STANDARD [ N ]FILLED [ N ]MOUND [ N ]
CONFIGURATION: [(j ]TRENCH [ N ]BED [ N ]
LOCATION TO BENCHMARK: F.F.E.: 11.5' NGVD
ELEVATION OF PROPOSED SYSTEM SITE [ 2.0 ] [ FEET
] [ BELOW] BENCHMARK /REFERENCE POINT
BOTTOM OF DRAINFIELD TO BE [ 5.0 ] [ FEET ] [ BELOW] BENCHMARK /REFERENCE POINT
FILL REQUIRED:[ 0.0 ]INCHES EXCAVATION REQUIRED: [ 36.0 ] INCHES
THER REMARKS:
1.- Install 225 sf of drainfield in trench configuration.
2.- Existing 900 gal. septic tank, certified by "A Aaron Super Rooter on 03/20/2006" to
remain.
3.- Invert elevation of drainfield to be no less than 7.00' NGVD.
4.- Bottom of drainfield elevation to be no less than 6.50' NGVD.
THIS PERMIT IS NOT FOR "ADDITION(s) ".
PECIFICATIONS : OSP •EDR
PPROVED Osp' na, '•e•o
ATE ISSUED: 3/29/06
TITLE:
TITLE:
4016, 03/97 (Obsoletes previous editions which may not be used)
Stock Number: 5744- 001 - 4016 -0) :ostds_cons_4o16 -1)
Dade
EXPIRATION DATE: 6/27/06
CHD
Page 1 of 2
5 IAI L 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.
MOON..,,•• Ismo
Dotes: t�C {iU Qv c i�'
Site Plan submitted by:
'Ian App
Aie
Signature Title
Not Approved Date
3y 4 / b County Health Department
CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
444015. 10198 (Replaces HRS-H Rem 4015 WO may be used)
a'todt Number: 6144-002-4015-e)
Page 2 of 3