PL-11-765sio
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 158998
Scheduled Inspection Date: November 04, 2011
Inspector: Hernandez, Rafael
Owner: PEARSON, LEONARD
Permit Number: PL -5 -11 -765
Job Address: 246 NE 103 Street
Miami Shores, FL 33138 -2431
Project: <NONE>
Contractor: MR C'S PLUMBING SEPTIC INC
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Drainfield
Phone Number
Parcel Number 1132060134880
Phone: (305)651 -7859
Building Department Comments
REPAIR DRAINFIELD
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
November 03, 2011
For Inspections please call: (305)762 -4949
Page 1 of 8
ci locos
rr
Miami Shores Village
Building Department
egt`
SAY, 0 2.2011
10050 N.E2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING Permit No. 1 I —
PERMIT APPLICATION Master Permit No.
FBC 20
Permit Type: PLUMBING
OWNER: Name (Fee Siml, Titleholder):
Address: /r 1p� .bd7 �± , j it �f
City: 1" {� 1I M I , E A C H
Tenant/Lessee Name:N
Email:
Sow Phone#: (3031S g8 1
State: FLoRrpti
JOB ADDRESS: U-(0 WE 103 51-;
City:
Folio/Parcel#:
zip: 33l
Phone #:
Miami Shores
County:
Is the Building Historically Designated: Yes
Miami Dade
Zip: 33/3 S
CONTRACTOR: Company Name: /i 1 T d 4,J £, Phone #: 368 6$ /7 ni
QZ Nca a's)
Address:
City: State:
Qualifier Name: 02v __ wt. 1–(o
State Certification or Registration #: <ft (`td -6 `? S(
FL_
zip: 33 /c
Phone #: 3o 65' J 7S;C`►
Certificate of Competency #:
Contact Phone #: Email Address:
DESIGNER: Architect/Engineer. Phone #:
1 TOO. 00
Value of Work for this Permit: $ Square/Linear Footage of Work: —f " t
Type of Work: ❑Address DAlteration DNew E i�epair/Replace Demolition
Description of Work: ke pe“:4-- 4 J. r- A:v1 Ike
**** * **** * **** * *** ** ** ******** * * * * * ** *Fees ** * * * ** * * * **** * ***** ** *a: * * * * *** ***** *awe * * **
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 $ l l.L ( ' 0
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 El ACTRICAL 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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be appro and a reinspection fee will be charged.
Signature
Qff
Owner or Agent
The fore oing Instrument
aJ
was acknowledged before me this The foregoing instrument was acknowledged before me this
day of � , 20( I , by , day of OA 20 I l , by `00k r Ha I, Pe v
uhais personally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
who is personally known to me or who has produced
NOTARY PUBLIC:
Sign:
Print:
My Commission Exp
MY EXPIRES: Sept Pa "`e 14.
o BondedThruNotary
NOTARY-PUBLIC
Sign: igi
Print
My Commiss
KEMBLE E. TRICK
we:: MY COMMISSIP' • 0 891'.4
q EXPIRES: Sept�i•" �:-
5 • Bonded Thru Notary Put rs
* ***>s;ee *** SAN=$ i= kE++ FdsH +*6=+P*s3laR+rP****** ***a.*** . *44'..: ****fk+k*k.^ * ***skBses. * ******V.t*8s****: *** +skA+" **** **** ****-A4SF * ***$:aie3+$+** ***
APPROVED BY H. J Plans Examiner
Structural Review
(Revised 07 /10 /07)(Revised 06/10/2009)(Revised 3/15/09)
KEMBLE TPtCit
MY COMMISSION it _
EXPIRES: Sepiembet -a. 2013 , •
Bonded Thru Notary Public Uncler. !terc
Zoning
Clerk
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Fabio Correa
PERMIT #: 13-SC-1314830
APPLICATION # : AP 1002905
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR843223
PROPERTY ADDRESS: 246 NE 103 St Miami, FL 33138
LOT: 7
BLOCK: 36 SUBDIVISION:
PROPERTY ID #: 11- 3206- 013 -4880
[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 [ 1,050 ] 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
R
A
I
N
F
I
E
L
D
O
T
H
E
R
[ 400 ] SQUARE FEET SYSTEM
[ 0 ] SQUARE FEET SYSTEM
TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ]
CONFIGURATION: [ ] TRENCH [x] BED [ ]
LOCATION OF BENCHMARK: FFE: 12.8' NGVD
ELEVATION OF PROPOSED SYSTEM SITE [ 27.60 ] E INCHES If FT ] [ ABOVE /I BELOW 6 BENCHMARK /REFERENCE FWVIBP
BOTTOM OF DRAINFIELD TO BE [ 55.60 ] [I INCHES I' FT ] [ ABOVE /I BELOW i BENCHMARK /REFERENCE POINT
FILL REQUIRED:
[ 0.00] INCHES EXCAVATION REQUIRED: [ 40.00] INCHES
1.- Install a 1050 gal min. category-3 septic tank with an approved filter. 2. -The lic. contractor installi -th si
responsible for installing the min.category of tank in accordance with s. 64E- 6.013(3)(f), H 0,0sP
3.- Install 400 sf of drainfield in bed configuration. t,pi
4.- Install 12" of slightly limited soil at the bottom of the drainfield. WO°
5.- Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed.
6. -Invert el. of drainfield to be no less than 8.67' NGVD. 7. -Bottom of drainfield el. to be no less than 8.16' NGVD.
** * *** ** *THIS PERMIT IS NOT FOR ADDITION(s) *** * * * * ***'* * **
SPECIFICATIONS BY:
APPROVED BY:
V Edwar.
SENAPIR
Astr'. - Edwards
DATE ISSUED: 04/28/2011 nee � � 07/27/2011
The contractor (or designee) on at the
DH 4016, 08/09 (Obsoletes all previous editions whit* je tg rair�field excavation DOH
Incorporated: 64E -6.003 , FAC time of final inspection, Prior to Rnal Approval, fe the Page 1 of 3
v 2 . s . a APiasp r shall witness the borin and comps
anal site Wubmitted. A
results ct the original if the contractor is not
reinspectlon fee will be assessed'
at the jobsite at the arranged time.
TITLE: Engineer Specialist II
TITLE: Engineer Specialist II
Dade CHD
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 govemed 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 govemed 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.
•
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATION
APPLICANT: Fabio Correa
CONTRACTOR / AGENT:
LOT: 7
SUBDIVISION:
APPLICATION # AP1002905
PERMIT # 13 -SC- 1314830
DOCUMENT # SE842915
Mr C "s
BLOCK: 36
TD#: 11-3206-013-4880
TO BE COMPLETED BY ENGINEER, HEALTH DEPARTMENT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEERS MUST
PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS.
PROPERTY SIZE CONFORMS TO SITE PLAN: [X ]YES [ ]NO
TOTAL ESTIMATED SEWAGE FLOW: 400 GALLONS PER DAY [
AUTHORIZED SEWAGE FLOW: 549.99 GALLONS PER DAY [ 1500 GPD /ACRE OR
UNOBSTRUCTED AREA AVAILABLE: 600.00 SQFT
NET USABLE AREA AVAILABLE: 0.22 ACRES
1 RESIDENCES- TABLE1 1
BENCHMARK /REFERENCE POINT LOCATION: FFE: 12.8' NGVD
UNOBSTRUCTED AREA REQUIRED:
/
OTHER -TABLE 2 ]
SQFT
2500 GPD /ACRE
600.00
ELEVATION OF PROPOSED SYSTEM SITE 27.60
[ I INCHES
/ FT ] [ ABOVE /
BELOW
] BENCHMARK /REFERENCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES
SURFACE WATER: NA FT
WELLS: PUBLIC: NA FT LIMITED USE: NA FT PRIVATE:
BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: 5 FT
DITCHES /SWALES: NA FT NORMALLY WET: [ ]YES [X]NO
FT NON- POTABLE: NA FT
POTABLE WATER LINES: 10 FT
SITE SUBJECT TO FREQUENT FLOODING?
10 YEAR FLOOD ELEVATION FOR SITE:
SOIL PROFILE INFORMATION SITE 1
[ ]YES [X]NO
FT( MSL /
USDA SOIL SERIES:
Munsell #/Color
Urban land
Texture
Depth
10YR 3/1
Sand
0 To 10
10YR 6/6
Sand
10 To 20
10YR 7/4
Oolitic Limestone
20 To 72
OBSERVED WATER TABLE: 84.00
ESTIMATED WET SEASON WATER TABLE
HIGH WATER TABLE VEGETATION:
INCHES [ ABOVE /
ELEVATION:
[ ]YES
BELOW
84
[ X 'NO
NGVD
10 YEAR FLOODING? [ ]YES [X]NO)
] SITE ELEVATION: 10.50 FT [ MSL /
FILE INFORMATION SITE 2
NGVD
USDA SOIL SERIES:
Munsell # /Color
Urban land
Texture
l
Depth
10YR 3/1
Sand
0 To 10
10YR 6/6
Sand
10 To 20
10YR 7/4
Oolitic Limestone
20 To 72
] EXISTING GRADE TYPE:
INCHES [ ABOVE /
MOTTLING: [ ]YES [X]NO
BELOW
/ PERCHED /
EXISTING GRADE
DEPTH: INCHES
APPARENT
]
SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: Replacement4 -S, CS, LCS/O DEPTH OF EXCAVATION: 40 INCHES
DRAINFIELD CONFIGURATION: [ ] TRENCH
REMARKS /ADDITIONAL CRITERIA
[X] BED [ ] OTHER (SPECIFY)
SITE EVALUATED BY:
Ettrick, Womble (Title: ) (Mr. Max Septic Service)
DH 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated: 64E- 6.001, FAC
AP1002905 E1D1314830
DATE: 04/21/2011
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