PL-08-293Inspection Date: 07/16/2008
Inspector: Levrock, James
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Owner: Sims/ Haldeman, Mark & Gail
Job Address: 1077 98 Street NE
Miami Shores, FL 33138-
Project: <NONE>
Block:
Contractor: STATEWIDE SEPTIC CONNECTIONS
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Septic
Phone Number (305)757 -6697
Parcel Number 1132050180240
Lot:
Phone: 305 -661 -6633
Building Department Comments
abandon tank
install tank and new drainfield
4 1 2®®0 CLIN0
/
T 1
ct- r 1 omments
I�
f•
Passed
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled until
re- inspection fee is paid .
Tuesday, July 15, 2008
Page 1 of 2
PL ot-Zn
d r r DIVISION CF
Environmental Health
Florida Department of Heath
iami -Dade County Health Department
OSTDS /Septic Tank Division
7769„TpA, 48' St, sure 175
Inspector
Address /,
Comments:
2.11141 A f r`lJ
0.4's yotc "iL
Miami Shores Village 91'
`� !a
is FE3 2 0 2008
Building Department Y: �----
10050 N.E.2nd Avenue, Miami Shores, Horida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING
PERMIT APPLICATION
FBC 2004
Permit Type: Plumbing
Permit No. 910Y-215
Master Permit No.
M. AiLK St MS S �F Owner's Name (Fee Simple Titleholder) 4,A .IL ( t_l�E- 11MA�e�J Phone # boa ' i( O
Owner's Address 1,077 cib ' 5 r
City tout4.44,t th:eraLe.5 State L Zip 3313
Tenant/Lessee Name Phone #
E -MAIL: REVMA -12k i t t,4-C. Ca. 0411
1.1711 ‘J6 brI Si
Job Address (where the work is being done)
City Miami Shores Village County Miami -Dade Zip `3i 38
FOLIO / PARCEL #. L( 32o so 'aO't- 40
Is Building Historically Designated YES NO
Contractor's Company Name S ''}e--mil de, �y 1 C 'i f 15 Phone # " 6G .'J
Contractor's Address 0 S. (t- Pci °i 4 ? �J
tn'- (,$)
City ` -iVC ►'rt Gl f' State F 320 2 3 / Zip
Qualifier Name St i .:r(O �'Yl o?I Phone #
State Certificate or Rggistration No. M x`11 l Z. 2.
E -MAIL: 5 1 c€ C vc ). c.o4
Architect /Engineer's Name (if applicable) Phone #
Certificate of Competency No.
Value of Work For this Permit $3t`
Square / Linear Footage Of Work:
Type of Work: ❑Addition ❑Alteration ❑New In Repair /Replace ❑ Demolition
Describe Work: bCAv 1ViC) () } q
1Y1 'S'ir41 jjl'\i
*xxnxxx,:xxxrxx * * * * *xx r rxxrxr
)flCwtF pep ** *** * *** * * * * * * *XXY.XX *ww rrrrrr.XrrXXY.XXXYXYX
Submittal Fee $ Permit Fee $, .�J CCF $ �. CO /CC
Notary $ S •W Training /Education Fee $ 0.(190 Technology Fee $ S
Scanning $49.00 Radon $ DPBR $
Bond WO '04f !(4
Zoning $
Code Enforcement $ Double Fee $
Structural Review. $ Total Fee Now Due $ 612 -15
4-ccAveol
v,,y,Ad fcb aa(ov
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: 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 RECORI1 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 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 seve (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a rein. %ection fee will be charged.
Signature
The fore
day of
who is personally
Owner or Agent
Signature
Contractor
o QQ ii � n �� g i n s t r w n e nn tt was aAcknnoowlel dged b, foor�emjey,ttlljis0 1 The foregoing instrument was acknowledged before me this 1 8-
VII.U�'Z%, 200, by IV LU�I`' Y U&jU�li► Jl )S day of F-e--(0 20 dc by 1erfAc a 0isn:.'"
nown to me or who has produced( who is personally known to me or who has produced ' w
"" as identification and who did take an oath.
. NOTARY PUBLIC:
As identification and who did take an oath.
N Y TARY ' UBLIC:
Sign:
Print:
My Commission Expires:
xx* *r. xx** *x * *xrxxxxx * * * * ** *r
iAPPLICATION APPROVED BY
(Revised 02/08/06)
Sign:
Print:
My Com
xxr,r.xxxx
.+ , Y
Illw
•
irRatary ublic State ofFlorida
* * *A4 91aPAO*V1 * *,
Expires 12/19/2008
xx* *r. r.r,*
Plans Examiner
Engineer
Zoning
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Gail Haldeman & Mark Sims
PROPERTY ADDRESS: 1077 NE 98 St MIAMI, FL 33138
LOT: 15
PERMIT #: 13-SG- 902939
APPLICATION #: AP845596
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #:
1/1/1899
$55.00
13- PID- 989654
PR706263
BLOCK: 179 SUBDIVISION: Miami Shores Sec 8 Rev
PROPERTY ID #: 11- 3205 - 018 -0240
[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 [
D
R
A
I
N
F
I
E
L
D
0
T
H
E
R
900 ] GALLONS / GPD
0 ] GALLONS / GPD
0 ] GALLONS GREASE INTERCEPTOR CAPACITY
] GALLONS DOSING TANK CAPACITY
Septic Tank
[ 150 ] SQUARE
[ 0 ] SQUARE
TYPE SYSTEM:
CONFIGURATION:
FEET
FEET
[K] STANDARD
[X] TRENCH
CAPACITY
CAPACITY
[MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
]GALLONS @[ ]DOSES PER 24 HRS #Pumps [
Trench Confiauration SYSTEM
SYSTEM
[ ] FILLED [ ] MOUND [ ]
[ ] BED [ ]
LOCATION OF BENCHMARK:
FFE EI.:9.40 "" NGVD
ELEVATION OF PROPOSED SYSTEM SITE [ 19.20 ] [1 INCHES f FT ] [ ABOVE /) BELOW U BENCHMARK /REFERENCE POINT
BOTTOM OF DRAINFIELD TO BE [ 49.20 ] [) INCHES I FT 3 [ ABOVE /) BELOW h BENCHMARK /REFERENCE POINT
FILL REQUIRED:
[ 0.00 ) INCHES EXCAVATION REQUIRED: [ 30.00] INCHES
1.- Install 900 gal. category-3 septic tank equipped with an approved filter.
2. -The licenced contractor is responsible for installing the minimum category of tank sec. 64E- 6.013(3)(f).
3.- Install 150 sf of drainfield in trench configuration.
4. -Invert elevation of drainfield to be no less than 5.80 ft NGVD.
5. -Bottom of drainfield elevation to be no less than 5.30 ft NGVD.
THIS PERMIT IS NOT FOR " ADDITION(s) ".
SPECIFICATIONS BY: Gerald L i1iz = -'e TITLE:
APPROVED BY:
DATE ISSUED:
Piverger
8/ I12 EXPIRATION DATE:
TITLE:
Dade
05/18/2008
CHD
DH 4016, 10/97 (Previous Editions May Be Used) Page 1 of 3
v 1.1.4
AP845596 SE722869
STATE OF FLORIDA
DEPARTMENT OF HEAI_TH
APPLICATION FORONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERIVIILAO
If 2ry- 3 W
,•,,--.
Permit ApplicationNumber
— — — — PART II - SITE PLAN —
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Site Plan submitted by:
Plan Approved
By e---f)
Signature
Not Approved
Date
County Health Department
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
DH 4015, 10/96 (Replaces HRS-H Forte 4015 which may be msed)
(Stock Number: 5744-002-4015-6)
-
Page 2 of 3