PL-11-1540Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 163624
Scheduled Inspection Date: August 24, 2011
Inspector: Hernandez, Rafael
Owner:
Permit Number: PL -8 -11 -1540
Job Address: 102 NE 109 Street
Miami Shores, FL 33161 -7042
Project: <NONE>
Contractor: A SUPER SEPTIC TANK, INC.
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Drainfield
Phone Number
Parcel Number 1121360090160
Phone: (05)364 -0113
Building Department Comments
DRAINFIELD INSTALLATION
Passed
IT
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
HRS IN FILE
August 23, 2011
For Inspections please call: (305)762 -4949
Page 18 of 23
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING
PERMIT APPLICATION
FBC 20
Permit Ne.
Tipawrg7
AUG 2 2011
.a
BY: ► ......................
-p1 N—IS9O
Master Permit Na.
Permit Type: PLUMBING /�
OWNER: Name (Fee Simple Titleholder): Z a G / e, / g i / l 4 i e ° / /2 f i Phone# 0S i7 3 �7 7
Address: 0 2 t /.e C
City: ice/ lei fro/ i 5',) cvr G f._ State: ' /v1-• j 4 Zip: "7 3 /h
Tenant/Lessee Name: Phone #:
Email:
/ Jam° �
JOB ADDRESS: / G )t/ /_ / r0"-,e — 7�
City: Miami Shores County:
Folio/Parcel #: (/ - 2 /3 6 p 9 U / 6. Ci
Is the Building Historically Designated: Yes
Miami Dade
Zip: 77/ 6 /
NO Flood Zone: lilt'
CONTRACTOR: Company Name: / /2.@6 r°0077G `re, 4,17: c Phone #: 3as 369- 0 / 13
Address: T7 O / t,t/ l r
City: /-4 rR A State: (0",-, r �9 Zip: 530 I
Qualifier Name: fL, e-4- 2 g
State Certification or Registration #:
Phone #: -76-'6 7 £f- 6) /
Certificate of Competency #:
Contact Phone #: 7, SLV- J 7 1 $ Email Address:
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: Address ❑Alteration
Description of Work:
?Am ye
UNew epair/Replace
UDemolition
* * * * * * * * *** * *** *+x******** :** * *** * *,x**** Fees **** ******** *** ** : ****u:* x:***a:*******+x*x::xx ***
Submittal Fee $ Permit Fee $ /57, — CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $
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: 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 occur/ seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspect will not be approved reinspection fee will be charged.
r Agent
The foregoing instrument was acknowledged before me thi
who is per4 nail
own to me or w Q has produced
As identification and who did take an oath.
•
NOTARY PUBLI
My Commission Expires:
actor
The fore • oing instrument was acknowledged before me this
day of '1 i m.∎ , 20 _4, by APIWAVO L ;--�
frd
who is personally known to me or who has produced 11
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Ex
o 1!" O '.
s lam'' 4,
*** * *** ** ***** **x:* ********+ x*: xx: ***** *********************** **x:: x* *****+x*************a spm4i`ih k*************
APPROVED BY if 2 4 it /// Plans Examiner
Zoning
Structural Review Clerk
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
AUG, 22. 2011
12:06PM piElg=-7(3).5)--756), Bc1-7
STATE OF' FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: (Federal National Mortgage)
PROPERTY ADDRESS:
102 NE 109 St
)N0U791/j(
y `PERMIT #: 13- SC- 1364064
APPLICATION #: AP1044319
BATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR852031
Miami, FL 33161
LOT: 6 BLOCK: 216
PROPERTY ID #: 11 -2136- 009.0160
SUBDIVISION:
[SECTION, TOWNSSI?, RANGE PARCEL NomBER]
(OR TAR ID NUMBER]
SYSTEM MUST HE CONSTRUCTED IN ACCORDANCE MITE 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 x6s ANCE OF THIS PERMIT, REQUIRE TEE APPLICANT TO MODIFY THE
PERMIT APPLICATION. SUCH MODIFICAYxoNS MOAT RESULT 7N THIS PERMIT BEING MADE NULL AND VOID,
ISSUANCE OF THIS PERMIT DOES NOT E]tfmPT THE APPLICANT FROM COMPLIANCE MITE OTHER FEDERAL,
STATE, OR LOCAL PERMtTTIPIG REQUIRED FOR DEVELOPMENT OF THIS PROPERTY.
SYSTEM DESIGN AND SPECIFICATIONS
T [
A [
N [
x [
900 ] GALLONS / Gpb
0 ] GALLONS / GPD
0 ] GALLONS GREASE INTERCEPTOR CAPACITY
3 GALLONS DOSING TANK CAPACITY [
Septic
D [ 150 ] am= FEET
R [ 0 ] SQUARE FEET
A TYPE SYSTEM: [x] STANDARD
I CONFIGDRATION: [x] TRENCH
N
F LOCATION OF BENCHMARK: F.F.E.: 13.2' NGVD.
1 L"LL',VATIQN OF PROPOSED SYSTEM SITE
E SOTTOm2 OF DRAINFIELD TO BE
CAPACITY
CAPACITY
[MAXIMUM CAPACITY SINGLE TANK :1230 GALLONS]
JGALLONB or ]DOSES PER 24 MRS #Pumps [ 3
SYSTEM
SYSTEM
pIT.T rn [ ]
[]am
L
D FILL REQUIRED: [ 0.00 3 INCHES
0
E
[3
MOUND
[ 24.00 3 [) x=CMEs t FT ] [ ABOVE A sEL0w b sENCHHssx/REFERENCE Poxsm
[ 48.00 ] [LIrTCass r FT 3 [ ABOVE 4 BELOW P stwcaM:aRE REFERENCE DOxx
EXCAVATION REQUIRED: [ 24.003 INCHES
1— Existing 900 gal. septic tank certified by " A Super Septic Tank Inc." on 08/1/2011 to remain. 2- Install 150 of of
dralnfleld in trench configuration. 3- Install 12° of slightly limited soil under the bottom of drainfield. 4- Perimeter of
excavation area shall be at least 2 ft wider and longer than the proposed absorption trench. 5 -Invert elevation of
dralnfleld to be no less than 9.70' NGVD, 6. Bottom of drainfield elevation to be no less than 9.20' NGVD
114I8 PERMIT IS NOT FOR ADDITION(8).
SPECIFICATION$ BY: PEDRO At OSPINA
APPROVED BY:
-avciro P vsozas
DATE ISSUED: 08/15/2011
DE 4016, 08/09 (Chaplet**, all Previous
Incorporated; 64E - 6,003, FAC
v1.1.4
editions which may not be used)
EXPIRA • • ■ATE: 11/13/2011
Ap1044910 Ss4501$$
cis
Page 1 of 3
ApPRovED I
APPROVED f
AUG, 22. 2011 12: 07PM DERM
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITL SEWAGE TREATMENT AND DISPOSAL. SYSTEM
CONSTRUCTION INSPECTION AND FINAL APPROVAL
APPLICANT: Federal National Mortgage
AGF11T: A Super Septic Tank
NO. 179 P. 2
APPLICATION #:AP1044319
me= #:13 -SC- 136406. 4
uocaMEin # :F1842472
DATE PAID:08 /12/2011
PEE PtbID :200.00
RECEIPT #:13 -PID- 1690557
PROPERTY ADDRESS:
LOT: $
SUBDIVISION:
102 NE 109 St Miami, FL 33161
BLOCH: 216
ID #: 11 -2136- 009 -0100
3
3
OEECHED [8] ITEMS ARE NOT IN COMPLIANCE WITH STATUE OR RULE AND MOST EE CORRECTED.
TANK INSTALLATION
[01]
[023
(031
[04]
[05]
[06]
[07]
[08]
[09]
TANK SIZE [1] 900,00 [23
TANIt MATERIAY. Concrete
OUTLET DEVICE
MULTI - CHAMBERED
OUTLET FILTER
LEGEND 1.
WATERTIGHT
LEVEL
DEPTH TO LID
[ Y IN)
DRAINFIELD INSTALLATION
[ 3 [3.01
[ 3 (11]
( ] [123
[ 3 [13]
[ ] [14]
[ ] (1S]
[ ] (16]
C ] [17]
[ 3 [18]
[ ] [19]
[ ] [203
[ 3 [21]
.ILL
] [22]
3 [23]
1 [24]
3 [253
] [26]
commentS ;
2.
AREA [1] 150 [2] son'
DISTRIBUTION SOX HEADER X
N msER OF DRAINLINES 1. 3.00 2,
DI(A.TNLINE SEPARATION
DRAINLINE SLOPE
DEPTH O1:" COVER
ELEVATION [ ABOVE /
SYSSTPm LOCATION
DOSING PUMPS
BELOW
rad 42.00
AGGREGATE STsE
AGGREGATE EXCESSIVE W NES
AGGREGATE DEPTH
/ EXCAVATION MATERIAL
FILL AMOUNT
FILL TEXTURE
EXCAVATION DEPTH
AREA REPLACED
REPLACEMENT MATE
[
[ 3
r1
[ 3
[
( 3
[ 3
( 3
[
[ 3
( 1
[
( 1
( ]
[
[ 3
[ 3
[
[ 1
[ 3
( 3
[ 3
1 3
( 1
CONSTRUCTION [
i NAL SYSTEM
[
DISAPPROVED ]:
/ bISmPPROVED 3:
(E pianaeson of Violatioaa an tet. awing Sage)
DE 4016, 08/09 (Ohsolotee Ala previous
Inaorp4zstOd: 64E- 6.003, PAC
EH Database v 1.0.1
SETBACKS
[27] SURFACE WATER
[28] LATCHES
[29] PRIVATE WELLS
[30] PUBLIC WELLS
(31] IRRIGATION WELLS
[321 POTAB AnaTER
(333 BUILDING FOUNDATIONS
35
10
10 tank
[34] PROPERTY LAS 5
[35] OTHER
FIT,AED / MOUND SYSTEM
0.63 DRAINFI5i.n cOVSR
[37] SHOULDERS
[38] SLOPES
[39] STABILIZATION
FT
FT
FT
FT
rT
FT
FT
FT
FT
ADDITIONAL =roman=
[40] UNOBSTRUCTED AREA
[41] SToRmwATER RUNOFF
[42] ALARMS
(43] MAINTENANCE AGREEMENT
[44] Stl'ILDING AREA
[45] LOCATION CONFORMS KITE SITE PLAN
[463 PXk x. SITE GRADING
[471 CONTRACTOR Zero Andrew (a super septic
ADS ARC 24
[4e] OTHER
ABANDONMENT
[69] TANK PUMPED
[50] TANK CRUSHED 6 PI
Ronald E Cave (Dade County Environmental Health)
Ronald 6 Gave (Dada County Environmental He
editjOrts which
may net be Used)
AP1044310
712011
•
EID13t 4.64
ge 2 ef 3
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE THE aMENT AND DISPOSAL SYS• TEM
CONSTRUCTION INSPECTION AND FINAL APPROVAL
PERMIT NO.
DATE PAID:
FEE PAID:
RECEIPT #:
APPLICANT:
AGENT:
PROPERTY ADDRESS:
[Xl
BLOCK:
SUBDIVISION:
PROPERTY D
ITEMS ARE NOT _IN COMPLIANCE. WITH STATUTE OR RULE AND MUST BE CORRECTED.
TANK INSTALLATION
[01] TANK SIZE [1]----- -1--(2]
[02] TANK MATERIAL;
OUTLET DEVICE
MULTI- CHAMMBERED °6) N 1 }
OUTLET FILTERS
4 z�
LEGEND
WATEF TIGHT _ ▪ .
LEVEL
DEPTH TOKLID
1031
[04]
[05]
[061
[07]
[081
[09]
DRAINFIELD INS4ALLATION1
t 2] SQFT .
1101 . ' ARTEAi [11 r
[11] DISTRIBUTION
BOX HF_ADER
g a
[12] NUMBER OF DRAINUNES � -a-- =-
[13] DRAINUNE SEPARATION
[141 OFI'id UNE SLOPE'
[i5] DEPTH OF COVERS / . ti
(16 =- -ECEVATiON (ABOVELOlM • •
[17] SYSTEM LOCATION
[1 g] DOSING PUMPS
[19] AGGREGATE SIZES
[201 AGGREGATE E)(CE6SIVE FINES
[21] AGGREGATE DEPTH .T4;
FILL / EXCAVATION MATERIAL
[22] FILL AMOUNT: t
[23] FILL TEXTURE
[24] EXCAVATION DEPTH
[25] AREA REPLACED
[26] REPLACEMENT MATERIAL
EXPLANATION OF VIOLATIONS/ REMARKS:'
[, 1
[' 1
[ 1
[ ] ��.
CONSTRUCTION [APE' /DISAPPROVED]:
FINAL SYSTEM [APPROVI DIDISAPPROVED]: ;
01-14016 (Page 2), 10197 (Previous Editions May Be Used)
Stock Number. 5744-002-40164
SETBACKS
[27] SURFACE WATER FT
[28] DITCHES F.I.
[291 PRIVATE WELLS - FT
[30] PUBLIC WELLS F
[311 IRRIGATION WELLS
[32] POTABLE WATER LINES FT
[33] BUILDING FOUNDATION__- -- -- FT
[34] • PROPERTY LINES FT
[351 OTHER
FILLED / MOUND SYSTEM
[361 DRAINFIELD COVER -,'
[371 SHOULDERS*
[381 _- _SLOPES_
[39] STABILIZATIQN
ADDITIONAL INFORMATION
( ,1 ' [40] UNOBSTRUCTED AREA
[ ] [41] STORMWATER RUNOFF
[ 1 [421 ALARMS
[ 1 [43] ' MAINTENANCE AGREEMENT
( [44] BUILDING AREA
[ [45] LOCATION CONFORMS WITH SITE PLAN
[ [A6] FINAL SITE(GRADIIG
I 1 [47] CONTRACTOR
[ 1 [48] OTHER
ABANDONMENT
] {49] TANK PUMPED
] : [501 TANK CRUSHED & FILLED
PT 1: Applicant
PT 2: installer/Contractor
PT 3: 'Building 'Department
PT 4: Wealth Department
DATE:".. ,r
DATE: