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PL-11-1544Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 163971 Permit Number: PL -8 -11 -1544 Scheduled Inspection Date: September 02, 2011 Inspector: Hernandez, Rafael Owner: IDA, ETHEL, Job Address: 511 NE 94 Street Miami Shores, FL 33138- Project: <NONE> Contractor: STATEWIDE SEPTIC CONNECTIONS Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Septic Phone Number Parcel Number 1132060140855 Phone: (954)963 -0082 Building Department Comments REPLACE DRAINFIELD Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments CREATED AS REINSPECTION FOR INSP- 163630. HRS APPROVAL IN FILE missing sod in front September 01, 2011 For Inspections please call: (305)762 -4949 Page 5 of 7 STATE OF FLORIDA PERMIT NO. DEPARTMENT OF HEALTH DATE PAID: ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID: CONSTRUCTION INSPECTION AND FINAL APPROVAL RECEIPT #: APPLICANT: AGENT:. PROPERTY ADDRESS- LOT: BLOCK: SUBDIVISION: PROPERTY ID 4: CHECKED [X) ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED. TANK INSTALLATION [01] TANK SIZE [1] [2] [02] TANK MATERIAL [03] OUTLET DEVICE [04] MULTI - CHAMBERED [Y / N [05] OUTLET FILTER [06] LEGEND [07] WATERTIGHT [08] LEVEL [09] DEPTH TO LID DRAINFIELD INSTALLATION [10] [11] [12] [13] [14] [15] [16] [17] [18] [19] [20] [21] AREA [1] [2] SQFT DISTRIBUTION BOX HEADER NUMBER OF DRAINLIN DRAINLIN DEPTH Of ELEVATIO SYSTEM 1 DOSING P AGGREGA AGGREGA AGGREGA FILL / EXCAVATION [22] [23] [24] [25] [26) FILL AMOL FILL TEXTI EXCAVATII AREA REP REPLACEN EXPLANATION OF VIOLATIOf DRAINLINES SETBACKS [27] SURFACE WATER FT [28] DITCHES FT [29] PRIVATE WELLS FT [30] PUBLIC WELLS FT [31) IRRIGATION WELLS FT [32] POTABLE WATER LINES FT [33) BUILDING FOUNDATION FT [34] PROPERTY LINES FT [35] OTHER FT FILLED / MOUND SYSTEM [36) DRAINFIELD COVER [37] SHOULDERS f381 SLOPES DIVISION OF Environmental Health Florida Department of Health Miami -Dade County Health Department OSTDS /Well Division 11805 SW 26 St. • Miami, FI. 33175 Inspector Address S 91 ,J- 57 14., Comments: YV Date -_2c -)1 '$OSTDS #/ /0 Signature • CONSTRUCTION [APPROVED /DISAPPROVED]: CHD DATE: FINAL SYSTEM [APPROVED /DISAPPROVED]: CHD DATE. DH 4016 (Page 2), 10/97 (Previous Editions May Be Used) Stock Number: 5744- 002- 4016 -4 PT 1: Applicant PT 2: Installer /Contractor PT 3: Building Department PT 4: Health Department Page 2 of 3 NenxleJ Paper 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 RECETIT7D AUG 2 2 011 BY: C' Permit No Master Permit No. Permit Type: PLUMBING y / OWNER: Name (Fee Simple Titleholder): ` Phone#: Address: ,!\1L77.- @., City: &lam C� 9� a State: Tenant/Lessee Name: Phone #: Zip: 303 Email: JOB ADDRESS: CI City: Miami Shores County: Folio/Parcel #: _ ��ei Miami Dade Zip: . Z3 Ls the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: ,� P Y �.��u �s� Phone #:t— E' Address: <`-» Ce i (> T F4-74 �' C „ 1® City: bre , State: Qualifier Name: . —,,, (c; �� °,r ,� r p Phone #: State Certification or9 Registration #: Certificate of Competency #: Contact Phone #: Email Address: DESIGNER: Architect/Engineer: Phone #: Zip: �9 2 p: Value of Work for this Permit: $ cRie.D0 a 03 Square/Linear Footage of Work: 22 Type of Work: Address ❑Alteration ❑New epair/Replace Description of Work: �`' 4 Ca C '- Cr) . d ❑Demolition ******** * * * * * * * * * ** * * * * * * * * * * * * * * * * * * ** Fees***************** ** *x:** *** *x:*****:x********** Submittal Fee $ Permit Fee $ /4-0 CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ J,, TOTAL FEE NOW DUE $ 6 IN2. SD 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 ich occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be a inspee tion fee will be charged. Signature ( . Owner or Agent _.,"' Contractor The foregoing instrument was acknowledged before me this The fore oing instrument was acknowledged before me this rd— day of , 20 L, by S-ru t' day of L} 4 , 201( , by , wilt or who has produced o is personally knownli�ne or who has produced ) P as identification and who did take an oath. As identification and who did take an oath. NOTARY PUBLIC: \`�� \111 111l11/lI /'i \\\0\ \ \``eilllsll / / / / /,�i //i \, .�' 1 s �'ii �',� ��• �'••... .. Sift •% Sign: / • . es '• Sign: �°> °° _�-- -, _���,� /�s/ • o� Print: �orAR = Prim. _ d %q�pypU Qmmis9 0/, My Commission Expires: ;�� Q7sf p • or: D7 9 1 **************************************4% '1 t ** * * * *** * ******** * * *** * * * * * *** * * * *** * * * * ********4 4 * NOTARY PUBLIC: My Commission Expires: APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) ho aflci, bi Q (54)3W- 5 Lp STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: (Esthel Ida & Sol Stohl) PROPERTY ADDRESS: 511 NE 94 St Miami, FL 33138 LOT: 14,15 ,.• • PERMIT # :13 -SC- 1363868 APPLICATION #:API044193 DATE PAID: FEE PAID: RECEIPT #: DOCUMENT #: PR851923 BLOCK: 55 PROPERTY ID #: 11- 3206 - 014 -0855 SUBDIVISION: Miami Shores [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 [ 900 ] GALLONS / GPD Septic CAPACITY A [ 0 ] GALLONS / GPD CAPACITY N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ] D [ 300 ] SQUARE FEET SYSTEM R [ 0 ] SQUARE FEET SYSTEM A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ] I CONFIGURATION: [ ] TRENCH [s] BED [ ] N F LOCATION OF BENCHMARK: F.F.E.: 10.62' NGVD. I ELEVATION OF PROPOSED SYSTEM SITE E BOTTOM OF DRAINFIELD TO BE L D FILL REQUIRED: 0 T H E R [ 0.00 ] INCHES [ 15.30 ] [I INCHES FT ] [ ABOVE A BELOW b BENCHMARK /REFERENCE POINT [ 41.30 ] [I INCHES I/ FT ] [ ABOVE 4 BELOW I BENCHMARK /REFERENCE POINT EXCAVATION REQUIRED: [ 26.00] INCHES 1— Existing 900 gal. septic tank certified by" Rolando V. Nryant Septic. " on 07/12/2011 to remain. 2- Install 300 sf of drainfield in bed configuration. 3- Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed. 4 -Invert elevation of drainfield to be no less than 7.67' NGVD. 7. Bottom of drainfield elevation to be no Tess than 7.17' NGVD. THIS PERMIT IS NOT FOR ADDITION(s),_________._ SPECIFICA • S BY: PEDRO N OSPINA TITLE: APPR BY : LE: o N Ospina DATE ISSUED: 08/12/2011 DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E- 6.003, CO11.1i iispoptor. CHD EXPIRATION DATE: FAC v 1.1. the contractor (or destfiEfePrequired to perform a esaaas soil boring adjacent to the draintieid excavation at the time of final inspection. Prior to Final Approval, the DOH Inspector shale witness the soil boring and compare the results to the original site evaluation submitted. A reinspection fee will be assessed it the contractor is not at the johstte at the arranged time 11/10/2011 Page 1 of 3 NOTICE OF RIGHTS A party whose substantial interest is affected by this order may petition for an administrative hearing pursuant to sections 120.569 and 120.57, Florida Statutes. Such proceedings are governed by Rule 28 -106, Florida Administrative Code. A petition for administrative hearing must be in writing and must be received by the Agency Clerk for the Department, within twenty-one (21) days from the receipt of this order. The address of the Agency Clerk is 4052 Bald Cypress Way, BIN # A02, Tallahassee, Florida 32399 -1703. The Agency Clerk's facsimile number is 850 -410 -1448. Mediation is not available as an alternative remedy. Your failure to submit a petition for hearing within 21 days from receipt of this order will constitute a waiver of your right to an administrative hearing, and this order shall become a 'final order'. Should this order become a final order, a party who is adversely affected by it is entitled to judicial review pursuant to Section 120.68, Florida Statutes. Review proceedings are governed by the Florida Rules of Appellate Procedure. Such proceedings may be commenced by filing one copy of a Notice of Appeal with the Agency Clerk of the Department of Health and a second copy, accompanied by the filing fees required by law, with the Court of Appeal in the appropriate District Court. The notice must be filed within 30 days of rendition of the final order.