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PL-11-230Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 155923 Permit Number: PL -2 -11 -230 Scheduled Inspection Date: July 13, 2011 Inspector: Hernandez, Rafael Owner: BERROUET, EMMANUEL Job Address: 50 NW 108 Street Miami Shores, FL Project: <NONE> Contractor: A AMERICAN SEPTIC & PLUMBING Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Drainfield Phone Number (305)758 -6727 Parcel Number 1121360110130 Phone: (305)866 -5600 Building Department Comments EXITING 900 GALON SEPTIC TANK AND 150 SQ FT DRAINFIELD INSTALLATION Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments HRS IN FLIE July 12, 2011 For Inspections please call: (305)762 -4949 Page 1 of 26 STATE OF FLORIDA DEPARTMENT OF HEALTH O NSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION INSPECTION AND FINAL APPROVAL APPLICANT: Maglie Berouet APPLICATION #:AP992376 PERMIT #:13 -SC- 1298993 DOCEMENT #: F1826645 DATE Piaci:02/02/2011 FEE PAID :200.00 RECEIPT 8:13-PI D-1560034 AGENT: A American Plumbing PROPERTY ADDRESS: 50 NW 108 St Miami, FL 33168 LOT: 8 SUBDIVISION: BLOCK: 211 ID#: 11- 2136 - 011 -0130 CHECKED [X] 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 -CHAS [ Y I N p [05] OUTLET FILTER [06] LEGEND 1. 2. [07] WATERTIGHT 900.00 [2] Concrete [08] LEVEL [09] DEPTH TO LID DRAINFIELD INSTALLATION [10] AREA [1] 225 [11] DISTRIBUTION BOX [12] NUMBER OF DRAINLINES [13] DRAINLINE SEPARATION [14] DRAINLLINE SLOPE [15] DEPTH OF COVER [16] ELEVATION [ ABOVE [17] SYSTEM LOCATION [18] DOSING PUMPS [19] AGGREGATE SIZE [20] AGGREGATE EXCESSIVE [21] AGGREGATE DEPTH FILL [22] [23] [24] [25] [26] Comments: [2] SQFT HEADER X 1. 3.00 2. BELOW IBM 45.60 FINKS / EXCAVATION MATERIAL FILL AMOUNT FILL TEXTURE EXCAVATION DEPTH AREA REPLACED REPLACEMMIT MATERIAL SETRA KS [27] SURFACE WATER [28] DITCHES [29] PRIVATE WELLS [30] PUBLIC WELLS [31] IRRIGATION WELLS [32] POTABLE WATER [33] BUILDING FOUNDATIONS [34] PROPERTY LINES [35] OTHER FT FT FT FT FT 20 FT 5 tank FT 20 FT FT FILLED / MOUND SYSTEM [36] DRAINFIELD COVER [37] SHOULDERS [38] SLOPES [39] STABILIZATION ADDITIONAL INFORMATION [40] UNOBSTRUCTED AREA (41] STORM hTER 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 ADS ARC 24 ABANDONMENT [49] TANK PUMPED [50 ] TANK CRUSHED & FILLED CONSTRUCTION [ FINAL SYSTEM [ APPROVED APPROVED DISAPPROVED 1: DISAPPROVED 1: (Explanation of Violations on following page) Dade CHD DATE: 02/10/2011 Ronald E Cave (Dade County Environmental Health) E County DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E- 6.003, FAC EH Database v 1.0.1 AP992376 Dade Clio DATE: 02/10/2011 E1D1298993 Page 2 of 3 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION INSPECTION AND FINAL APPROVAL APPLICATION #:AP992376 PERMIT #:13 -SC- 1298993 DOCUMENT #: F1826645 DATE PAID: 02/02/2011 FEE pATD :200.00 RECEIPT #:13-PI D-1560034 Violation Number Comment DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E- 6.003, FAC EH Database v 1.0.1 AP992376 EID1298993 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 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION FBC 20 Permit Type: PLUMBING OWNER: Name (Fee Simple ple Titleholder): 011146- � l Address: V) /OW l 03 4 Permit No. stvgin 1)1 \)--- 2:50 Master Permit No. S1✓f rOU-e- Phone#: ($ o5)33(O City: J/ l; Ii /VC/ State: F C, Tenant/Lessee Name: Phone#: Email: Zip: 33L ( B JOB ADDRESS: CO 4 C t i l a S 4. City: Miami Shores County: 7 ;, Miami Dade Zip: • (Deb Folio/Parcel #: Ls the Building Historically Designated: Yes CONTRACTOR: Company Name: NO X Flood Zone: Q a1nie1; etfrt p( ��-.. Phone#: 9/4°'� Address: 1.7S-3' CG- ' . '' Q City: AA, i ANCI State: F lr Zip: 3 3 ( K Qualifier Name: / 5, (1 f Phone#: 3 v T° 96-6 - S60c) . State Certification or Registration #: e Cle ('-(1-3 ({Ili. Certificate of Competency #: Contact Phone#: 3047-V:4 - 5-600. Email Address: DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ VS-O(,k Square/Linear Footage of Work: Type of Work: DAddress DA� l/teration DNew 92epair/Replace DDemolition Description of Work: a ,A 4e(cL 11241.4--, ******* ******* **** ** ***** ***o * * ****** *Fees * *** * *a * *** ******axe* * ** *** * *** x ****** x* Submittal Fee $ Permit Fee $ 1 CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEIN: NOW DUE $ Bonding Company's Name (if applicable) dBondi* 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 be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued In e' of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Owner or Agent The forego instrument was acknowledged before me this n day of // , 20 ((, by 1. N, )v4 ( S zeki who is personally known to me or who has produced B f D 3 100- F3 k -3(8 %'identification and who did take an oath. NOTARY PUBLIC: Signature . Contractor The foregoing instrument was acknowledged before me this tb day of r , 20 P 1 , by ��',.a r/ej%`� S who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: �� `\��tt lNtpt�ii, luuut J .•.:.boo 1� Sign �9�o •-MiSSr0\‘‘. N'�� Print: 4 (C,., -' l' 1� �C7A'g,�1,� �. a� °0, p�� q� Print 6"-if (((.� (IA a. Ito �'�• •30.apcA� 99p • : =My Commission Expires: mst 2.: #DD 896557 :4:7, °�� 'y �nded�� '�0 �Qa °` #DD 896557 Q • j9'9`•�; Plr6ficUnd.•'ttQ�'� Sip *.4 BondedihN �:•p�� lII111� ✓Paj! �/C STAB %'tlliI11111 O °'� Zoning My Commission Expires: APPROVED BY Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06/10/2009)(Revised 3/15/09) Clerk PERMIT #: 13-SC-1298993 STATE OF FLORIDA APPLICATION #: AP992376 DEPARTMENT OF HEALTH DATE PAID: ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID' SYSTEM RECEIPT #: DOCUMENT #: PR834164 CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: Maglie Berouet PROPERTY ADDRESS: 50 NW 108 St Miami, FL 33168 LOT: 5 BLOCK: 211 PROPERTY ID #: 11- 2136 - 011 -0130 SUBDIVISION: [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 Seotic CAPACITY A [ 0 ] GALLONS / GPD CAPACITY N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMIDI CAPACITY SINGLE TANK :1250 GALLONS] K [ ] GALLONS DOSING .TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ] D [ 150 ] SQUARE FEET SYSTEM R [ 0 ] SQUARE FEET SYSTEM [ ] FILLED [ ] MOUND [ ] [ ] BED [ ] A TYPE SYSTEM: [X] STANDARD I CONFIGURATION: [X] TRENCH N F LOCATION OF BENCHMARK: F.F.E.: 13.10' NGVD I ELEVATION OF PROPOSED SYSTEM SITE E BOTTOM OF DRAINFIELD TO BE L D FILL RE.UIRED: 0 T E THIS PERMIT IS NOT FOR ADDITIO(s). [ 0.00] INCHES [ 21.60 ] [ I CHES FT 7 [ ABOVE == LOW I BENCHMARK /REFERENCE POINT [ 46.60 ] d INCHES 1 FT ] [ ABOVE A BELOW li BENCHMARK /REFERENCE POINT EXCAVATION RE•UIRED: [ 25.00] INCHES 1- Existing 900 gal. septic tank certified by " A American Septic & Plumbing " on 01/17/2011 to remain. 2- Install 150 sf of drainfield in trench configuration. 3- Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption trench. 4 -Invert elevation of drainfield to be no less than 9.72' NGVD. 5. Bottom of drainfield elevation to be no less than 9.22' NGVD. R • SPECIFICATIONS APPROVED awry' 14EA1,Th TITLE: Pedro N Ospina DATE ISSUED: 02/08/2011 DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E - 6.003, FAC v 1.1.4 AP992376 EXPIRATION DATE: 05/09/2011 3E835510 CND Page 1 of 3 A if' CERTIFICATE OF LIABILITY INSURANCE DATE ( IOMYYT ) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and condltlons of the policy, certain policies may 'squire an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PAD 954 -318 -2469 954 -31 8-2474 INFINITY INSURANCE SOLUTIONS 6412 N UNIVERSITY DRIVE SUITE 132 TAMARAC. FL 33321 INFINITY INSURANCE SOLUTIONS MINE o. Ea* 954 - 318 -2469 1 iAIC,Not:954 -318 -2474 ADDRESS: INFO @IISFL.COM PRODUCER ID #: INSURER(s) AFFORDING COVERAGE NAIL ll INSURED 305 - 919 -9514 305 -891 -6905 A AMERICAN PLUMBING, INC. 12555 BISCAYNE BOULEVARD, #970 NORTH MIAMI, FL 33181 INSURER A: SEMINOLE CASUALTY INS. CO INSURERS: SUA INSURANCE COMPANY SCL- 000309708 -0 INSURER C: 08/10/11 INSURER D : $ 1,000,000 $ 100,000 $ 5,000 INSURERE: PREMISES (Ea TO INSURER F • CLAIMS -MADE COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDrf1ON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS WEIR LTR TYPE OF INSURANCE IVs WR POLICY NUMBER GOIMWYYYTY1 (MMIDDIYYYY) LINTS A GENERAL LIABI IT' COMMERCIAL GENERAL LIABILITY OCCUR SCL- 000309708 -0 08/10/10 08/10/11 EACH OCCURRENCE $ 1,000,000 $ 100,000 $ 5,000 q PREMISES (Ea TO CLAIMS -MADE f MED EXP (Any one person) PERSONAL & ADV INJURY $1,000,000 $ 2,000,000 $ 2,000,000 $ GENERAL AGGREGATE GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG 71 POLICY F JEC - I— LOC AUTDMOBII.E LIABILnY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS . COMBINED SINGLE UMIT (Ea aotldent) $ BODILY INJURY (Per person) $ BODILY INJURY (Per ambient) $ PROPERTY DAMAGE (Per accident) $ $ $ UMBRELLA LI1B EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ B EMPLOYERS' WORKERS COMPENSATION AND ANY PROPRIETORIPARTNER/E)ECUTIVE Y / N N / A WSAUIEC12193901 02/03/11 02/03/12 ( I TORY LAMITS I I ER EL EACH ACCIDENT $ 100,000 I (Mandatory y BERG EXCLUDED? DESCRIPTIdON OF OPERATIONS EL DISEASE - EA EMPLOYEE $ 100,000 below EL DISEASE -POLICY OMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, AddItIoaaI Remarks Schedule, U Hare awe Is ns{Wred) 98482- PLUMBING, COMMERCIAL & INDUSTRIAL 98483- PLUMBING, RESIDENTIAL OR DOMESTIC 91585 - SUBCONTRACTOR CONSTRUCTION, ERECTION, REPAIR OF BUILDINGS 5183- PLUMBING NOC AND DRIVES (WC) CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE 10050 NE 2ND AVENUE MIAMI SHORES, FL 33138 ACORD 25 (2009109) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE @ 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD