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PL-08-180-4► Inspection Date: 03/04/2008 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: SELZER, ALEXANDRA Job Address: 271 101 Street NE Miami Shores, FL 33138- Project: <NONE> Contractor: BOBS SEPTIC & DRAIN INC Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Septic ellAmoggir hone Number 305/446 -0500 Block: Parcel Number 1132060134810 Lot: Phone: 305- 558 -5818 Building Department Comments SEPTIC TANK AND DRAINFIELD aR ®510 Passed 1 °s ector Comments 0 Failed Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled re- inspection fee is paid . until Monday, March 3, 2008 Page 2 of 2 APPLICANT: AGENT' STATE OF FLORIDA DEPARTMENT OF HEALTH • ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION 'INSPECTION AND FINAL APPROVAL �} Ie X GI in ruk PROPERTY ADDRESS' LOT: 19 -L0 BLOCK- 3 elf 3 PERMIT NO. f r +S . : 9 3 DATE PAID. FEE PAID' RECEIPT #• SUBDIVISIONa wit �f alas • ��N Z PROPERTY' ID #: 143206 013 7 i1.10 CHECKED [X) ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE. AND MUST BE CORRECTED. TANK [01] [02] [03] [04] [05] [06] [07] [08] [09] INSTALLATION TANK SIZE [1] 9 p 0 [2] TANK MATERIAL P 1.y P 4 Le. OUTLET DEVICE 4' MULTICHAMBERED 89/ N ] OUTLET FILTER 11 LEGEND % O 11 t - p't G 3 WATERTIGHT I/ LEVEL DEPTH TO LID DRAINFIELD INSTALLATION L. [10] AREA [1] 1 [ 0 (2] SOFT [11] DISTRIBUTION BOX- - __HEADER (12) NUMBER OF DRAINLINES [13J DRAINLINE SEPARATION ! / [14] DRAINLINE SLOPE /C v g Isr.3 [15] DEPTH OF COVER [18] ELEVATION [ABOV [17] SYSTEM LOCATION [16) DOSING PUMPS [19) AGGREGATE SIZE [20) AGGREGATE EXCESSIVE FINES [21] AGGREGATE DEPTH BM 6 a. 7 2 `. h/� FILL / EXCAVATION MATERIAL [221 FILL AMOUNT . [23) FILL TEXTURE [241 • EXCAV T •' „, •• • ■ [25) AREA REPLACED [26] REPLACEMENT MATERIAL EXPLANATION OF VIOLATIONS / REMARKS::: • 1 ] ISAPPROVED): CHD DATE' L / 8V OF SETBACKS (27] SURFACE WATER � FT 1 [28] DITCHES . v7 /sQ 'FT 1 [291 PRIVATE WELLS _I./4 FT ] [301 PUBLIC. WELLS ''' �a FT 1 [31] IRRIGATION WELLS t(`'lr- ] [32] POTABLE WATER LINES so'' • FT 1 [33J BUILDING FOUNDATION' 5' FT ] [34] PROPERTY LINES S FT 1 [35] OTHER ,FT t"." .�,. .«ti,; • FILLED'/ MOUND YSTE . . 'n'i...• •: \i,' • ,.•.16. .• .. • [36) DRAINFIELD OVER [37) SHOULD - S •••' [36] SLOB [391 STABILIZATION ADDITIONAL INFORMATION [40] UNOBSTRUCTED AREA• [41] STORMWATER RUNOFF N /4- [42] ALARMS : y+• �0. ,:.:•. [43] MAINTENANCE AGREEMENT [44] BUILDING AREA [451 LOCATION CONFORMS WITH SITE PLAN [46] FINAL SITE GRADING [47] CONTRACTOR �p <Az p ,c. [48] OTHER •- . • ABANDOJ MENT [ ] [4$],• TANK PUMPED [ ] [50] TANK CRUSHED & FILLED CONSTRUCTION FINAL SYSTEM ISAPPROVED]: CHD DATE. DH 4016 (Page 2). 10/97 (Pravtous Editions. May Ba Used) StQOk Number: 5744 - 002 -4016 -4 PT 1: Applingrq • PT 2: MstaIteNCOnlfactor PT S: Wading Dapwtmant PT 4: Haalth Dapasma t 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 Owner's Name (Fee Simple Titleholder/ Owner's Address c City /i t° t✓i( State Tenant /Lessee Name E- MAIL: JAN > T 2008 �/jj LI V. �: Master Permit No. 1— Phone # ? Giv•-) Zip z Phone # Job Address (where the work is being done) l / A >0 / S / 404 City Miami Shores Village County Miami -Dade Zip FOLIO / PARCEL # -• u : ` :" Is Building Historically Designated YES } C .. Contractor's Company Name ��j ,� � � / 2A j/ ' Phon NO Contractor's Address . City Qualifier Name �� -- State 7 :///: State Certificate or Registration No. E -MAIL: — Architect /Engineer's Name (if applicable) Value of Work For this Permit $ Zip Phone # Certificate of Competency No.j , Type of Work: ❑Addition ['Alteration Describe Work: -- # Square / Linear Footage Of Work: ❑New XRepair/Replace ❑ Demolition xxxxr *Yxxrxx rxrrxxxxxxrxxrr x xr Yrxr Fees***** ******* *** *********** ************ ** * ** " CCF $ (L CO /CC Submittal Fee $ Notary $ k'( Scanning$ Bond $ w, Permit Fee $ Training /Education Fee $ Structural Review. $ Radon $ Code Enforcement $ DPBR $ Technology Fee $ • Double Fee $ Zoning $ Total Fee Now Due $ See Reverse side --* Bonding Company's Name (if applicable) Bonding Company's Address City 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. 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: 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 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. —fn .he absence of such posted notice, the inspection will not be approvedd a reinspection fee will be charged. + Owner or Agent The foregoing instrument was acknowledged before me this , ) ljO') dayof'('1'� ,20 t`i b ,who is personally known to the or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: y `- Print: GI My Commission Expires: at�"Y`6e4, Dawn ******************* x y Commipisson ;N,;• rBo idot # '9OF FLOP' Bonded gulo D345711 0;166 x Yr x Y Signature Coast actor The foregoing instrument was acknowledged beflore me this ? day of(_1 bLU ' L L, 20; . t -` , by who is personally known to me or who has produced •Yf(``: as identification and who did take an o NOTARY PUBLIC: ru g Co., Inc. Sign: Print: My Commission Expires: APPLICATION APPROVED By /: (Revised 02/08/06) 07 -I Plans Examiner Engineer Zoning STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: Alexandra Selzer PERMIT # : 13-SG- 900932 APPLICATION #: AP843664 DATE PAID: 1/1/1899 FEE PAID: $15.00 RECEIPT #: 13- PID- 986554 DOCUMENT #: PR703976 PROPERTY ADDRESS: 271 NE 101 St MIAMI, FL 33138 LOT: 19 -20 BLOCK: 35 SUBDIVISION: Miami Shores Section 1 PROPERTY ID #: 11- 3206 - 013 -4810 [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 [ 200 ] SQUARE FEET R [ 0 ] SQUARE FEET A I N TYPE SYSTEM: [ ] STANDARD CONFIGURATION: [ ] TRENCH CAPACITY CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]. ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ] SYSTEM SYSTEM [ ] FILLED [ ] MOUND [ ] [u] BED [ ] LOCATION OF BENCHMARK: FFE: 12.5" NGVD I ELEVATION OF PROPOSED SYSTEM SITE E BOTTOM OF DRAINFIELD TO BE L D 0 T H E R FILL REQUIRED: [ 0.00 ] INCHES 32.40 ] [I INCHES if FT ] [ ABOVE a BELOW b BENCHMARK /REFERENCE POINT 62.40 ] [I INCHES I FT ] [ ABOVE /) BELOW b BENCHMARK /REFERENCE POINT EXCAVATION REQUIRED: [ 30.00] INCHES 1.-Install a 900 gal min. category-3 septic tank with an approved filter. 2. -The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance with s. 64E- 6.013(3)(f), FAC. 3.-Install 200 sf of drainfield in bed configuration. 4. -Invert elevation of drainfield to be no less than 7.80' NGVD. 5. -Bottom of drainfield elevation to be no less than 7.30' NGVD. ************"THIS PERMIT IS NOT FOR ADDITION(s)************** SPECIFICATIONS BY: trid V Edwards APPROVED BY: DATE ISSUED: Astrid V Edwards 01/30/2008 TITLE: Engineer Specialist II TITLE: Engineer Specialist II DE 4016, 10/97 (Previous Editions May Be Used) v 1.1.4 AP843664 Dade EXPIRATION DATE: 04/29/2008 5E721241 CHD Page 1 of 3 Scale: Each block represe s 5 feet and 1 inch = 50 feet. 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