PL-07-1480Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Date: 08/21/2007
Inspector: Levrock, James
Owner: CHRISTIE, GWENDOLYN
Job Address: 844 98 Street NE
Miami Shores Village, FL 33138-
Project: <NONE>
Contractor: BOBS SEPTIC & DRAIN INC
Block:
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Septic
Phone Number 305 - 757-4852
Parcel Number 1132060142560
Lot:
Phone: 305 -558 -5818
Building Department Comments
SEPTIC TANK AND DRAINFIELD
AUG 22 2001
Passed
p-
- r Comments
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled
re- inspection fee is paid.
until
Tuesday, August 21, 2007
Page 1 of 2
ao
APPLICANT:
AGENT: j /
6 (!
STATE OF FLORIDA PERMIT 'NO.
V
DEPARTMENT OF HEALTH DATE PAID*
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID: ;.
CONSTRUCTION INSPECTION AND FINAL APPROVAL R EIPT
PROPERTY ADDRESS: y le ! • i
LOT:
CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND - MUST . BE CORRECTED.;
— — — — —
BLOCK: 3'3 SUBDIVISION:
s-t-
(41,," Si
4/9
V E/ PROPERTY ID #:
[ ]
TANK INSTALLATION
[01] TANKSIZE[1]
[021 TANK MATERIAL
[03] OUTLET DEVICE
[04] MULTI- CHAMBERED
[05] OUTLET FILTER
[06] LEGEND 70-
[07] WATERTIGHT
[08] LEVEL
[09] DEPTH TO LID
[2]
N
DRAINFIELD INSTALLATION raj
[10] AREA [1] [2] ✓ b SQFT
[11] DISTRIBUTION BOX HEADER
[12] NUMBER OF DRAINLINES Yet'
[13] DRAINLINE SEPARATION
6/. [14] DRAINLINE SLOPE . � .L'7 I
[15] DEPTH OF COVER
[16] ELEVATION [ABOVE /BELOW] BM
[17] SYSTEM LOCATION ,ptf<
[18] DOSING PUMPS �/Y" f1
[19] AGGREGATE SIZE
[20] AGGREGATE EXCESSIVE FINES
[21] AGGREGATE DEPTH
FILL / EXCAVATION MATERIAL
[22] FILL AMOUNT
[23] FILL TEXTURE
[24] EXCAVATION DEPTH
[25] AREA REPLACED
[26] REPLACEMENT MATERIAL
4
SETBACKS
[27] SURFACE WATER
[28] DITCHES FT
[29] PRIVATE WELLS FT
[30] PUBLIC WELLS FT
[31] IRRIGATION WELLS FT
[32] POTABLE WATER LINES FT
[33] BUILDING FOUNDATION FT
[34] PROPERTY LINES FT
[35] OTHER , FT
FILLED / MOUND SYSTEM
] [36] DRAINFIELD.COVER
] [37] SHOULDERS
] [38] SLOPES
] [39] STABILIZATION
ADDITIONAL INFORMATION
[40] UNOBSTRUCTED AREA
[41] STORMWATER RUNOFF
[42] ALARMS
[43] MAINTENANCE AGREEMENT
[44] BUILDING AREA
[45] LOCATION CONFORMS ;WI"i
[46] FINAL SITE GRADING
[47] CONTRACTOR
[48] OTHER
SITE PLAN
ABANDONMENT
[49] TANK PUMPED .;
[50] TANK CRUSHED;
1 /
FILLED
EXPLANATION OF VIOLATIONS / REMARKS:
[ },
[ ]
[ ]
}
CONSTRUCTION APPROVED :ISAPPROVED]:- l L CHD` DATI
FINAL SYSTEM PPROVE®'iiSAPPFIOVED] :: + " Doi/le CH0 OATTEE# �`
// ,
11 ► MT
DH 4016 (Page 2), 10197 (Previous Be Used)
Stock Number: 5744 -002- 4016 -4
PT 1: Applicant
PT 2: Installer/Contractor
PT 3: Building DepartDvtent -
PT 4: 11 Departn3ent-
Page 2 of a
PERMIT NUMBER: Permit tracking number assigned by CHD.
APPLICANT: Property owners full name.
AGENT: Property owner's legally authorized representative.
MAILING ADDRESS: P.O. box or street mailing address for applicant Dr agent.
LOT, BLOCK, SUBDIVISION Lot, Block and Subdivision for lot or
PROPERTY ID #: 27 character number for property. (property appraiser ID It or GIS location)
COUNTY HEALTH DEPARTMENT CHECKS [X] ITEMS NOT IN COMPLIANCE WITH CONSTRUCTION PERMIT AND
STATUTE OR RULE. INFORMATION IS COMPLETED BY CHD ON FOLLOWING ITEMS:
TANK SIZE (gallons):
TANK MATERIAL (concrete, fiberglass, etc)
OUTLET FILTER (manufacturer, make, model)
LEGEND (manufacturer code)
DRAINFIELD AREA (square feet)
DISTRIBUTION BOX / HEADER (check box)
NUMBER Ot= DRAINLUNES (number installed)
SYSTEM ELEVATION (in 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:
AS BUILT INSTALLATIgN SKETCH
Record item number, explanation of violation, and required
Circle approved or disapproved, CHD signature and date.
FINAL APPROVAL: Circle approved or disapproved. CHO signature and dale of approval.
Final approval shall not be granted until the CHD has confirmed that building 4zonXruction and •lot <grading are in substantial
compliance with plans and specifications submitted with the permit application.
ELEVATION WORKSHEET ELEVATION OF BENCHMARK OR REFERENCE POINT
EXISTING GROUND TOP OF AGGREGATE
[ +] SHOT H.I. H.I. 11.t.
H.I. [ -] SHOT 1-1 SHOT [ -) .SHOT
ELEVATION
Cl
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING 011i61c *-- ()LT A-%o
Permit No.
PERMIT APPLICATION
Master Permit No.
FBC 2004
Permit Type: Plumbing
id),
1,01 Owner's Narne (Fee Simple Titlehdlder) 1 G�j f} C L n/� f}� Phone #
Owner's�Address 0 44 0 ,� vL O 5--y
Citymi, Pt., S j, #__.5 E State tt ,
Tenant /Lessee Name V W krE g
E -MAIL:
CD 7c-9 -R X 90
Zip 3 c ��
Phone #
Job Address (where the work is being done) 44 'LIE , -I FS"T;
City Miami Shores Village County Miami -Dade
FOLIO / PARCEL # ) 1- '3 .. l-(7.
Is Building Historically Designated YES NO X
Zip 3 J / 3V
Contractor's Company Narne i� • t} Phone #
Contractor' Address 10 ac) /3. 1 ._ ;
,�
City i State �C s. 2 Zip 3 �J l ,,D.
Qualifier Name l Ob .2�gt Lt-ft Phone #vs 53 S O
State Certificate or Registration No. S�" 4,--1. I 1 (�
Certificate of Competency No. Ott) "F.; /g-
E-MAIL:
Architect /Engineer's Name (if applicable) N 79--- Phone #
Value of Work For this Permit $ 5001 -'
Square / Linear Footage Of Work:
N/A
Type of Work: ❑Addition ❑Alteration [New Repair /Replace ❑ Demolition
Describe Work: .,
Submittal Fee $ Permit Fee $ i15t t //11�15. = 356. CCF $ 110 CO /CC
Notary $ 55.5 Training /Education Fee $ r�V Technology Fee $ "CM-
Scanning $ .3-92 Radon $ DPBR $ Zoning $
Bond $ ° Code Enforcement $ Double Fee $
Structural Review. $
Total Fee Now Due $ 66. * 14 CI1��
See Reverse side -4 JUL 1 7 PAID
Bonding Company's Name (if applicable)
Bonding Cbmpany'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. 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: 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."
/11/49—
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 rein jpection, fee will be charged.
Owner or Agent
The foregoing instrument was acknowledged before me this
day of 20 0_1_, by ilid tt( k //,dms / ,
who is personally known to me or who has produced fl pnifets
LcC . (^job
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Signature
ntractor
The foregoing instrument was acknowledge efore me this
day of ]u,,,k( , 20 61, by l T '4crillk
who is personally known to me or who has produced 1. "Dlvd'5
Lit` -[ as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
* * * * * * * * * * * * * * * * * * * * * * * * * * ** *TS
APPLICATION APPROVED BY:
(Revised 02/08/06)
My Commission Expir
*** * **** * * * * * * * * * * * * * * * * * * * *tx * ** z * * * * * * * *** * * * * * * * * * **
Plans Examiner
Engineer
Zoning
A,3 1
STATE OF FLORIDA g . ••• • • • •••
DFEARTMENT OF HEALTH %41 : i : :•••i
ONE ITE SEWAGE TREATMENT: AN1 D :SP• "A4 SYyrTE
COrSTRUCTION .PERMIT • • 0400 •. • • • • • •
• ••• • ••• • ••-
• • • •• • • • •
• • • • • • • • • •
�, F� • • • • • • • • -
CONSTRUCTION PERMIT OR: • • • • • • • •
X ;New System • r • • • •. •
' y�_�. ]Existing System i ]Iio�dzng Tank [ j
Repair lAoandonment [ }Temporary
[ NA
s AGN; :: OWl7E i • • ' • APPLICANT: Lognmar , Michael • •
SROPERT: STREET ACDRESS: 844 NE 98 St Miami Shores FL 33138 cFi 3 *
CENTRAX 4: 13 -SG -33238
DATE PAID:
FEE PAID : $
RECEIPT • •
T -a ' ® i 1753-N
L0T: 8 :BLOC);: 73 SUBDIVISION: Miami Shores Village /\ 0/1,1, (2.9-^' 7- 1g7g8
[Section /Township /Range /Parcel No.]
PROPERTY i:: 11- 3206 -014 -2560 OR TAX ID NUMBER]
SYSTEM :=.: SE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 64E i,FAC
DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC TIME
PERIOD. ANY OH:ANi3E IN N',ATERIAL FACTS WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT,
REQUIRE THE APPLICANT TO MODIFY THE PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN PHIS
PERMIT BEING MATE NULL AND VOID. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM
COMPL ANCF ..__.: O':iER FEDERAL, STATE OR k0cA.L PF IlT QUIRED FOR PROPERTY DEVELOPMENT.
YSTEM DESIGN AND SPECIFICATIONS
JUL 1 7 MR
1050 a. 1s SEPTIC TANK MULTI-CHAMBERED/IN SERIES: :Y
0 ons RR MULTI- CHAMBERED /IN SERIES:
.. Y
0 - JLLJ:eS GREASE INTERCEPTOR CI rA(Cr f7 •'�' ®°"'°'
0 riLLONS DOSING TANK CAPACITY [ 0 ]GALLONS 2 [0 ]DOSES PER 24 HRS 4 PUMPS 0
571 .SiUARE FEET PRIMARY GRAINFIELD SYSTEM
0 ;SQUARE FEET SYSTEM
TYPE SYSTEM: [ Y ]STANDARD [ N ]FILLED
CON iOR .T'ION: [ N ] TRENCH [ Y 'BED
1,OC TI ': IC 3 ?:NCHMARK: C/L NE 98 St : 9.21'NGVD
ELEVATION DF )'ROPOSED SYSTEM SITE : 7.3 ] [ INCHES
BOTTOM 7,:F . RA INFIELD TO BE [ 37.3 ] [ INCHES
[ N ]MOUND [ N ]
N 1
1 [
1 [
BELOW J BENCHMARK /REF ERENCE POINT
BELOW] BENCHMARK /REFERENCE. POINT
t= :E, UIREC [ 0.0 ;INCHES EXCAVATION REQUIRED: [ 72.0 j INCHES
OTHER REMARKS:
:
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 tan): in accordance with sec. 64E- 6.013(3)(f), FAC.
3, Install 571 :3f of drainfield.
4. Install 42" of slightly limited soil under the bottom of drainfield.
5. Perimeter of excavation area shall be at least 2 ft. wider and longer than the propo.sad
absortion bed o.- trench.
6. Invert elevation of drainfield to be no less than 6.60' NGVD.
7. Bottom of drainfield elevation to be no less than 6.10' NGVD.
__E____..- ___ :NS 3 . Piver•er, Jose •h
AFRC,VED Piverger, Jose -h
u ..: 7/2/07
diN5 F - -.s -
VII A
L DG DEPT
':hb tes prev :sous editio which may not be .sedi'E3JECT TO COM IANCE WITH ALL FEDERAL
=
°, ND COUNTY RULES AND REGULATIONS
CHD
e
t
STATE OF FLORIDA
DEPARTMENT OF HEALTH
• • ••• • • • •••
ONSITE SEWAGE DISPOSAIMMTEr • , ••••;
SITE EVALUATION AND SYpTE11 S„EOICATIjjN4
• • ••• • • • • •••
APPLICANT: Lognmarz, Michael
AGENT: , OWNER
• ••• •
• • • •ti
• • • • •
• • • •
• • • •
••• • •••
• •
• • • • •
• • • •
• • • •
CENTRAX #: 13 -SG -33238
OSTDSNBR : 07- 01753 -N
OWNER
LOT: 8 BLOCK: 73 SUBDIVISION: Miami Shores Village ID #: 11- 3206- 014 -2560
•• • • • •• ••• ••
•
• • • •
•-•-•--11--0-19 •
TO BE COMPLETED BY ENGINEER, HEALTH DIARtIvitg'B•EIPZO"i'•BEpoOR OTHER QUALIFIED PERSON. ENGINEER'S
PROPERTY SIZE CONFORMS TO SITE PLAN:[X]YES [ INC NET USABLE AREA AVAILABLE:
TOTAL ESTIMATED SEWAGE FLOW: 400 GALLONS PER DAY [64E -6, TABLE 1]
AUTHORIZED SEWAGE FLOW: 575 GALLONS PER DAY [1500GPD /ACRE OR 2500GPD /ACRE]
UNOBSTRUCTED AREA AVAILABLE: 1300 SQFT UNOBSTRUCTED AREA REQUIRED: 1143 SQFT
BENCHMARK /REFERENCE POINT LOCATION: C/L NE 98 St : 9.21'NGVD
ELEVATION OF PROPOSED SYSTEM SITE IS 7.32 [ INCHES ] [
0.23 ACRES
BELOW ]BENCHMARK /REFERENCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES:
SURFACE WATER: 100 FT DITCHES /SWALES: 100 FT NORMALLY WET? [ ]YES [ X ]NO
WELLS: PUBLIC: N/A FT LIMITED USE: N/A FT PRIVATE: 100 FT NON - POTABLE: 50 FT
BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: 5 FT POTABLE WATER LINES: 10 FT
SITE SUBJECT TO FREQUENT FLOODING: [ ]YES [ X ]NO 10 YEAR FLOODING?
10 YEAR FLOOD ELEVATION FOR SITE: 0 FT NGVD SITE ELEVATION:
SOIL PROFILE INFORMATION SITE 1
Mansell # /Color Texture
1 n'R -S /9 -a 73N Rand
10YR -9/9 -n RN Sand
USDA SOIL SERIES: 15 Urban land
Depth
0 to 94
94 to 79
to
to
to
to
to
to
]YES [ X ]N0
9 FT NGVD
SOIL PROFILE INFORMATION SITE 2
Mansell # /Color Texture
1OYR -9/9 -( RN Rand
10YR -S/9 -M RN Sant
10YR -S /9 -a RM
Oolitic! T,i maa,
USDA SOIL SERIES: 15 Urban land
Depth
0 t 10
10 to 79
79 to R4
to
to
to
to
to
OBSERVED WATER TABLE67.00 INCHES [ BELOW ] EXISTING GRADE TYPE: [APPARENT
ESTIMATED WET SEASON WATER TABLE ELEVATION:67.00 INCHES [ BELOW ] EXISTING GRADE.
HIGH WATER TABLE VEGETATION: [ ]YES [X]NO MOTTLING: [ ]YES [X]NO DEPTH: 0.0
SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING:Replacement/0.70 DEPTH OF EXCAVATION:72.0
DRAINFIELD CONFIGURATION: [ ]TRENCH [ X ]BED [ ]OTHER (SPECIFY)
REMARKS /ADDITIONAL CRITERIA:
]
INCHES
INCHES
SITE EVALUATED BY: Hai
DH 4015, 03/97 (Obsoletes previous editions which may not be used)
(Stock Number: 5744 - 003 - 4015 -1) [ostds_eval_4015 -3]
DATE: 6/27/07
Page 3 of 3