PL-08-1723Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL .,
Phone: (305)795 -2204 Fax: (305)756 -8972
tip?. �u:. '•:_:iL•f:__:'4±6�i:k:3:�'ad:L::
Inspection Date: 10/03/2008
Inspector: Levrock, James
Owner: CARVALHO, ANNELI DE
Job Address: 356 102 Street NE
Miami Shores, FL 33138 -2429
Project: <NONE>
Contractor: BOB'S SEPTIC & DRAIN INC
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Septic
Block:
e Number
Parcel Number 1132060135120
Lot:
Phone: 305 - 558 -5818
Building Department Comments
DRAINFEILD AND SEPTIC
CO
Passed
;
.p
Inspect r Comments
i
Failed
Correction
Needed
Re- Inspection
Fee
0075)
No Additional Inspections can be scheduled
re- inspection fee is paid .
until
Thursday, October 2, 2008
Page 2of2
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Inspecter
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Comments:
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Signature
APPLICANT'
AGENT:
PROPERTY ADDRESS:
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION INSPECTION AND FINAL APPROVAL
,43
LOT3 4/ BLOCK` SUBDIVISION:
PERMIT NO 19''l .5' "-
` %iL
DATE PAID' ..
FEE PAID. .
RECEIPT #-
•PROPERTY. 19 4)).--?..20c< -Ql C41-%
CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITH
TANK INSTALLATION
TANK SIZE [1] 9e5 e) [2)
TANK MATERIALJ‘
OUTLET DEVICE .✓4-
MULTI - CHAMBERED / N J
OUT]_EI FILPr�•�,=';0'••"'
LEG ND F9rJ - /O2 —Oi' '(.
WA1IERTIGHT
LEVEL
DEPtrH TO LID
STALLATION !C (-0(1,,....„4.
[01]
(02]
[03]
1041
[051
[06]
[07]
[081
[09]
DRAINFIELD
[10] AREA
114 AfB'U'tION B
[12] NUMBER OF DRAI
[ DRA
[
11
[1
[1
[18]
(19]
STATUTE OR RULE
AND MUST BE CORRECTFp.y ---
1m.—
DRAINLINIr• SLQ
DEPTH OF COVE
M
SYSTEM LO aN
D 171IG PUMPS
AGGREGATE SIZE 11./',.4 AGGREGATE EXCESSIVE FINES
AGGREGATE DEPTH /y
X-. HEADER
ES
RATION Z y
\1
I
FILL / EXCAVATION MATERIAL
[22] FILL AMOUNT A Y
[23] FILL TEXTURE
[24] EXCAVATION DEPTH
[25] AREA REPLACED
[26] REPLACEMENT MATERIAL
EXPLANATION OF VIOLATIONS/ REMARKS:
[ 1
[ 1
[ J
1 1
SETBACKS
[27] SURFACE WATER
[28) DITCHES
--- - FT
FT
[29] PRIVATE WELLS FT
[30] PUBLIC WELLS FT
[31] IRRIGATION WELLS ` FT
[32] POTABLE WATER LINES _ lei FT
[33] BUILDING FOUNDATION • • 57 • FT
[34] PROPERTY LINES / r" FT
[351 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 A4 REEMENT
[44] BUILDING AREA
[45] 11OCATION CONFORM& WITH. SITE PLAN
[46] FINAL SITE GRAD 1p ,, G'
[47] CONTRACTOf3,
[48] OTHER
ABANDONMENT
[49] ' TANK PUMPED
[50] TANK CRUSHED & FILLED L—L
CONSTRUC N [A131 /DISAPPROVED)L -a .
FINAL SYSTEM [APPROVE DISAPPROVED]:i
OH 4016 (Page 2), 10/97 (Previou$ Editions May Be UBBd)
Stock Number, 5744- 002 -4016 -4
C'>
CHD DATE. — `
iy
CHD DATE'
PT 1: Applic8nt
PT 2: mower/Contractor
PT 3: Building Onpanmem
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
PERMIT APPLICATION
FBC 2004
p2CLE.---Em.:3-771-1
SEP 2 3 208
BY
Permit No. Pi.--19-08---/E573
Master Permit No.
Permit Type: Numbing
Owner's Name (Fee Simple Titleholder)GUt%6 /( - (cal vna0
Owner's,Address 31512 ,U6
I d9 S l y
City r I P' Sts,jL5 State,
Tenant/Lessee Name On--
E- MAIL: il/M'
35- NE
Job Address (where the work is being done)
City Miami Shores Village
FOLIO / PARCEL #
Is Building Historically Designated YES NO ie
+—D ,^iL)�Dt, Phone (3� 557 5 'f
-/9'�
l
Phone #
Zip
Phone #
100 � s'r
County Miami -Dade Zip
Contractor's Company Name
Contractor's A,/ddrreyss�
City 10 . / 1 y 14-...
Qualifier Name B 6 Y6 'Pit
State Certificate or Regis ration NoS'
)tt
6
State
E -MAIL:
Architect/Engineer's Name (if applicable)
Value of Work For this Permit $
Type of Work: ['Addition
Describe Work:
p/R
(9-5-0 0,
❑Alte rat ion
.53 Zip 12 t
Phone # /I
Certificate of Competency No. OA,/ -7-3411-":
Phone #
Square / Linear Footage Of Work:
['New
Repair /Replace ❑ Demolition
gy
Submittal Fee $ Permit Fee
Notary $ 6: 60 Training /Education
GY` V (- t Scanning $ ,� .00 Radon $
PXP b Bond $ 0
Structural
ew. $
xx xxxx,C, r.,c WIC
CCF $ CO /CC
Technology Fee $ E3.7
Zoning $
Code $
Enforcement$ ' SHO ES Q t
lfl!!fll Gl V >a ( e
Total Fee Now Due $
�1�
V
See Reverse side
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
/4
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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued In the absence of such posted notice, the
inspection will no e approved and a reins pection fee will be charged.
Owner or Agent
The foregoing instrument was acknowledged before me this
day of
�Z , 20 cam$, by Ti^u,..c� b c4Qr
who is personally known to Tor wlio has produced
�r Nt .r 5 L- 1c�LngAs identifcationland who did hake an Oath
NOTARY PUBLIC: E ). •1 Z•& t
Sign:
Print:
My Commission Expires:
,er
The foregoing instrument was ackno
day of , 20 _, by
X x xx WU* x xx x x x xx
t
APPLICATION APPROVED BY:
(Revised 02/08/06)
tr
i � e
who is personally known to me or who has produced jZL
as identification and who did take a
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires.
xxx xxxx xxxtxxxxxxxtxxxxxtoe 4e ** xx x xrx xr. x 'ex
txxxxxxxxxxxxxrx
Plans Examiner
Engineer
Zoning
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number0
PART II - SITE PLAN
Scale: Each block represents 5 feet and 1 inch = 50 feet.
Notes:
, <^
o
" J r T , ! ,� :� 1,° ` ",G1- X
Site Plan submitted by:
Plan Approved f/
By
d -4 ;; fry,,,,,:, J f� --" r ry /`Signature --` v ,- 2
Tide
Not Approved Date
County Health Department
ALL CMANCES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
DH 4015, 10196 (Replaces HRS-H Form 4015 which may be used)
(Stock Number: 5744-002-4015-6)
Page 2 of 3
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Anneli Decarvalho
PERMIT #: 13 -SG- 945990
APPLICATION #: AP887542
DATE PAID: 07/07/2008
FEE PAID: $55.00
RECEIPT #: 13 -PID -10456
DOCUMENT #: PR744142
PROPERTY ADDRESS: 356 NE 102 St MIAMI, FL 33138
LOT: 3 & 4
BLOCK: SUBDIVISION: Miami Shores
PROPERTY ID #: 11- 3206 - 013 -5120
[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
O ] GALLONS / GPD
O ] GALLONS GREASE INTERCEPTOR CAPACITY
] GALLONS DOSING TANK CAPACITY [
Septic Tank
CAPACITY
CAPACITY
[MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ]
D ( 150 1 SQUARE FEET Trench Configuration SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [x] TRENCH [ ] BED [ ]
N
F LOCATION OF BENCHMARK: FFE el .11.70 NGVD
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE
L
D FILL REQUIRED:
0
T
H
E
R
SPECIFICATIONS•BY:
APPROVED BY:
DATE ISSUED:
[ 0.00 ] INCHES
[ 21.60 ] [1 INCHES 1 FT ] [ ABOVE a BELOW U BENCHMARK /REFERENCE POINT
( 39.60 ] [) INCHES 1 FT ] [ ABOVE A BELOW h BENCHMARK /REFERENCE POINT
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 7.90' ft NGVD. ° p''3
5. -Bottom of drainfield elevation to be no less than 7.40 ft NGVD.
THIS PERMIT IS NOT FOR " ADDITION(s) ".
TITLE:
TITLE: Engineer Specialist II
DH 4016, 10/97 (P'evious tions May Be Used)
v 1.1.4
Dade
EXPIRATION DATE:
AP887542 3E761261
10/06/2008
CHD
Page 1 of 3