PL-08-1074-
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Date: 07/11/2008
Inspector: Levrock, James
Owner: BOLTON, JOHN AND JENNIFER
Job Address: 1202 101 Street NE
Miami Shores Village, FL
Project: <NONE>
Contractor: A AARON SUPER ROOTER
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Drainfield
Block:
Phone Number (305)754 -2136
Parcel Number 1132050210030
Lot:
Phone: 305 - 944 -8886
Building Department Comments
REPLACE DRAINFIELD
n 63
Insp �or
cc
I!�
•�: ments
Passed
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Thursday, July 10, 2008
Page 2 of 2
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 No. 11,0‘6 -)(J14
Master Permit No.
Permit Type: Plumbing
Owner's Name (Fee Simple Titleholder) BC h7 f I 1" t tiv't" -Phone #
Owner's Address ‘ZCZ JueT i 0
City 44 .Shp 5 State FL
Tenant/Lessee Name
E -MAIL:
Job Address (where the work is being done) c202 NE 10' S -
City Miami Shores Village County Miami-Dade
zip 3,3138
Phone #
FOLIO / PARCEL # i) —2)20 5 -02A .spy
Zip 3 3 [ 3 ft
Is Building Historically Designated YES NO
Contractor's Company Name O 4 Aq ron 9-00+2.0 Phone # 'bps 1 y-'4 - gt vp
Contractor's Address CO2.2- 61.4 ?j5 C
City j't tV4rv,4 , State Ft Zip 3-502,3
Qualifier Name aO T\ Phone #
State Certificate or Registration No.
E -MAIL:
Architect /Engineer's Name (if applicable)
Certificate of Competency No.
Phone #
Value of Work For this Permit $
Square / Linear Footage Of Work: 22. S
Type of Work: ['Addition ['Alteration ❑New Repair /Replace ❑ Demolition
Describe Work:
* **** ******** * * *** * * ** ***************** Fee s x xrx x **
Submittal Fee $
Permit Fee $
Notary $ / Training /Education Fee $ U ✓Ga
Scanning $ '� l�u Radon $ DPBR $
ov
Bond $ #I1 lb Code Enforcement $ Double Fee $
CC F$ 14 O V CO /CC
Technology Fee $ �Y37/
Zoning $
Structural Review. $
Total Fee Now Due $
See Reverse side —>
Bondi>
rt,'eiFiat,if applicable)
•
Bolding 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. 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
PAYING TWICE FOR IMPROVEMENTS TO
CONSULT WITH YOUR LENDER OR
COMMENCEMENT."
RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING,
AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
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 bro re will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of comm : ment must be posted at the job site
for the first inspec '.n hich occurs seven (7) days after the building permit is issued. In absence of such posted notice, the
inspection will ' . t be a. pro, d and a reinspection fee will be charged.
Signatur Signature
Owner or Agent
The forego' instrument was acknowledged before me this 9
i
Contractor
~�' The foregoing instrument was acknowledged before me this
day of r 20 by ()1)h b-. ( day of Tiro{, , 20 a, by 3 cj �.r.
�a■■■1 ■Uqq ■ , )
who is personally known to me or wtlo hasp ' t.. I■■tt••■■■■.......... y ho is personally knownaa me,q
As identificati „o o d — ? It tcc.
+ l ea
a id oath .
Expires 11/812011 a 8J2011 NOTARY PUB !'r Expires 11,3i2011
Ai � •
"���s�iivr
baaae.■■anuutttt■ta IS p "a7AS8n.atnc :
Florida WIT r o:., inc 3
C!a nnnn■■.■■.■■■■i x'.'�,,
Ya a99a 0 ■. ■tpp■■■.pp ■lY ■ ■a all aa.a Fi ` ;.ala ■n9
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
x xxr, xx x x *r. r. Y. WXxx x * * * ** * * *Xx xxr
APPLICATION APPROVED BY:
(Revised 02/08/06)
Sign:
Print:
My Commission Expires:
* * *r. '� *xr. *r.xxr.rxxrxx * * * *** * *at* * *x xrxxxx *xx
;xr.xr. w x * *x xxxxxx*
08 Plans Examiner
Engineer
Zoning
IAPPROVED I
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION INSPECTION AND FINAL APPROVAL
APPLICANT: John & Jennifer Bolton
AGENT: A Aaron Super Rooter
PROPERTY ADDRESS: 1202 NE 101St MIAMI, FL 33138
LOT: 6 BLOCK: 184
SUBDIVISION: Miami Shores Sec 8 Rev
APPLICATION #
PERMIT NO.
DOCUMENT #:
DATE PAID:
FEE PAID:
RECEIPT #:
AP884040
13- SG- 942338
FI712326
06/13/2008
55.00
13- PID- 1040915
ID# : 113205 -021 -0030
knr-1014-
CHECKED fX] ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED.
TANK INSTALLATION
[01] TANK SIZE [1]
[02] TANK MATERIAL
[03] OUTLET DEVICE
[04] MULTI- CHAMBERED
1050.00 [2]
Polyethylene
IFYI/N1
[05] OUTLET FILTER Zabel
(06] LEGEND 1. 70- 109 -11DC3
[07] WATERTIGHT
[08] LEVEL
[09] DEPTH TO LID
DRAINFIELD INSTALLATION
[10] AREA [1] 375 [2]
[11] DISTRIBUTION BOX
[12] NUMBER OF DRAINLINES
[13] DRAINLINE SEPARATION
[14] DRAINLINE SLOPE
[15] DEPTH OF COVER
[16] ELEVATION [ ABOVE /
[17] SYSTEM LOCATION
[18] DOSING PUMPS
[19] AGGREGATE SIZE
[20] AGGREGATE EXCESSIVE FINES
[21] AGGREGATE DEPTH
2.
SQFT
_ HEADER X
1 5.00 2.
IBELOW I
]BM 19.20
FILL
[22]
[23]
[24]
[25]
[26]
/ EXCAVATION MATERIAL
FILL AMOUNT
FILL TEXTURE
EXCAVATION DEPTH
AREA REPLACED
REPLACEMENT MATERIAL
Comments are on page 2.
CONSTRUCTION [
IAPPROVED I
FINAL SYSTEM [
/ DISAPPROVED 3:
SETBACKS
[27]
[28]
[29]
[30]
[31]
[32]
[33]
[34]
[35]
SURFACE WATER
DITCHES
PRIVATE WELLS
PUBLIC WELLS
IRRIGATION WELLS
POTABLE WATER
10
BUILDING FOUNDATIONS
PROPERTY LINES
OTHER
FILLED / MOUND SYSTEM
[36]
[37]
[38]
[39]
FT
FT
FT
FT
FT
FT
7 FT
FT
FT
DRAINFIELD COVER
SHOULDERS
SLOPES
STABILIZATION
ADDITIONAL INFORMATION
[40] UNOBSTRUCTED AREA
[41] STORMWATER RUNOFF
[42] ALARMS
[43] MAINTENANCE AGREEMENT
[44] BUILDING AREA
[45] LOCATION CONFORMS WITH SITE PLAN
[46] FINAL SITE GRADING
[47] CONTRACTOR A Aaron S.Roote (A Aaron S
[48] OTHER ARDS ARC 24
ABANDONMENT
[49] TANK PUMPED
[50] TANK CRUSHED & FILLED
Ronald E Cave
/ DISAPPROVED ] :
Ronald E Cave
DH 4016, 10/97 (Previous Editions May Be Used)
EH Database v 1.0.1
AP884040
Dade
Dade
CHD DATE 06/17/2008
CHD DATE: 07/10/2008
E1D942338
Page 2 of 3
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL �, - 1Y t
SYSTEM
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT:
John & Jennifer Bolton
PERMIT #:
ICATION #:
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #:
13SG- 942338
AP884040
06/06/2008
$55.00
13 -PID- 1039415
PR741262
PROPERTY ADDRESS: 1202 NE 101 St MIAMI, FL 33138
LOT: 6
BLOCK: 184 SUBDIVISION: Miami Shores Sec 8 Rev
PROPERTY ID #: 11- 3205 - 021 -0030
[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
0 ] GALLONS / GPD
Septic Tank
0 ] GALLONS GREASE INTERCEPTOR CAPACITY
] GALLONS DOSING TANK CAPACITY
CAPACITY
CAPACITY
[MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
[ ]GALLONS @[ IDOSES PER 24 HRS #Pumps [ ]
D [ 225 ] SQUARE FEET Trench Confiauration SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [X] TRENCH [ ] BED [ ]
N
F LOCATION OF BENCHMARK: FFE EI.:9.40 "" NGVD
I ELEVATION OFPROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE
L
D FILL REQUIRED:
O
T
H
E
R
SPECIFICATIONS BY:
APPROVED BY:
[ 0.00 ] INCHES
[ 2.40 ] [I INCHES / FT ] [I ABOVE c BELOW ] BENCHMARK /REFERENCE POINT
[ 15.60 ] [) INCHES k FT 1 [ ABOVE 4 BELOW BENCHMARK /REFERENCE POINT
EXCAVATION REQUIRED: [ 30.00] INCHES
1.- Existing 900 gal. septic tank to remain.
2.-Install 225 sf of drainfield in trench configuration.
3. -Invert elevation of drainfield to be no less than 7.60 ft NGVD.
6. -Bottom of drainfield elevation to be no Tess than 7.10 ft NGVD.
THIS PERMIT IS NOT FOR " ADDITION(s) ".
Philizaire
trid V Edwards
DATE ISSUED: 06/09/2008
TITLE:
ITLE: Engineer Specialist II
DH 4016, 10/97 (Previous Editions May Be Used)
v 1.1.4
AP884040
Dade CHD
EXPIRATION DATE: 09/07/2008
SE758441
Page 1 of 3
STATE OF FLORIDA `'046 -0
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERkT
Permit Application Number,- A f
-- -- —=-- PART II -SITE PLAN-
Scale ::. Each block represents 5 feet and 1 inch = 50 feet.-
o o ‘207._ �`
Plan App' ` -d
C (,1-0,3
Signature Title
Not Approved ; Date le / 10,--01
By 4'0 County Health Department
ALL CHANGES MUST BE APPROVED BY1HE COUNTY HEALTH DEPARTMENT
DH 4015, 10196 (Replaces HRS-H Fomi 4015 which may be used}
(Stock Number: 5744 -002- 4015.6)