PL-11-1786Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 164928
Permit Number: PL -9 -11 -1786
Scheduled Inspection Date: October 26, 2011
Inspector: Hernandez, Rafael
Owner: VAIL, GEORGE & ASHLEY
Job Address: 325 NE 95 Street
Miami Shores, FL
Project: <NONE>
Contractor: STATEWIDE SEPTIC CONNECTIONS
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Drainfield
Phone Number
Parcel Number 1132060136020
Phone: (954)963 -0082
Building Department Comments
REPLACE DRAINFIELD . EXISTING 750 SEPTIC TANK TO
REMAIN. NEW 150 SQ DRAINFIELD IN TRENCH
CONFIGURATION
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
GREEN TAG IN FILE.
October 25, 2011
For Inspections please call: (305)762 -4949
Page 10 of 33
DIVISION OF
Environmental Health
Florida Department of Health
Miami -Dade County Health Department
OSTDS/Well Division
11805 SW 26 St. • Miami, FL 33175
Inspector
Address s -
Comments:
Date
OSTDS
Signature
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
Permit No.o
BUILDING
PERMIT APPLICATION
FBC 20
Permit Type: PLUMBING
OWNER: Name (Fee Simple Titleholder):
Address: 36L5 t g s
Master Permit No.
Phone #: 3 f 788-1+-93 it
City: L'1 ►Qr0 01 -es
State:
Zip: 3o2 3
Tenant/Lessee Name: Phone#:
Email:
JOB ADDRESS: 1 re e "
City: Miami Shores County: rAtipe. Miami Dade Zip: 331736
Folio/Parcel #: 11— 32 0 6 a> -° L-20 2-
Is the Building Historically Designated: Yes i NO Flood Zone:
I Inc 3(6 61- 66 ,3"
CONTRACTOR: Company Name:' '�� �� t k Phone #:
Address: ,,K 3 s
p
City: C t sd VJOQd State: Zip: 3302.3
Qualifier Name: ¶ tea' LT. c.pc_3 I C +"'10`) Phone #:
State Certification or Registration #: s .) ®P ) P2-6 2.- Certificate of Competency #:
Contact Phone #: Email Address:
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ * 2.000 g79 Square/Linear Footage of Work: 1. '°
Type of Work: ❑Address ❑Alteration i ❑New epair/Replace
Description of Work: f 1 oC €. aro r) - e
❑Demolition
***** ********+ x****** **:x:x********* ****** Fees ***:x**** : **** ********************* * **** x****
Submittal Fee $ Permit Fee $ (,® °— 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 CONDmONERS, 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 approved and a reinspection fee will be charged.
� Q
Signature Signatures°
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this 2 % The foregoing instrument was acknowledged before me this
day ofS , 20 1 ! , by A-Sk l \ c , day of
who is personally known to me or who has produced who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
,20_,by
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
Sign:
Print:
My Commission Expires:
* * * * * * * * * * * * * * * * * * * * * * * * ***** **************** **** ****** * * ******* **** **** ***a ** ** ** ** *** * * * ** ** ** **** *******
APPROVED BY —3 -1% Plans Examiner Zoning
Structural Review Clerk
(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: George Vail
PERMIT #: 13-SC- 1370745
APPLICATION #: AP 1048134
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR855276
PROPERTY ADDRESS: 325 NE 95 St Miami, FL 33138
LOT: 13
BLOCK: 44 SUBDIVISION:
PROPERTY ID #: 11- 3206 -013 -6020
[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 [
D
R
A
I
N
F
I
E
L
D
O
T
H
E
R
750 ] GALLONS / GPD Septic existing
0 ] GALLONS / GPD
0 ] GALLONS GREASE INTERCEPTOR CAPACITY
] GALLONS DOSING TANK CAPACITY [
[ 150 ] SQUARE FEET
0 ] SQUARE FEET
TYPE SYSTEM: [x] STANDARD
CONFIGURATION: [x] TRENCH
CAPACITY
CAPACITY
[MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ]
in trench configuration SYSTEM
SYSTEM
[ ] FILLED [ ] MOUND
[ ] BED [ ]
LOCATION OF BENCHMARK: FFE 12.6' NGVD
ELEVATION OF PROPOSED SYSTEM SITE
BOTTOM OF DRAINFIELD TO BE
FILL REQUIRED:
[ 0.00] INCHES
[ 31.20 ] [i INCHEsT FT ] [ ABOVE 4 BELOW b BENCHMARK /REFERENCE POINT
[ 61.20 ] [I INCHES if FT ] [ABOVE/ BELOW li BENCHMARK /REFERENCE POINT
EXCAVATION REQUIRED: [ 30.00] INCHES
- Install 150 sq ft drainfield in trench configuration.
- Elevation of bottom of drainfield to be no less than 7.50' NGVD.
- Existing 750 g septic tank, to remain.
- Not for additions
The contractor (or designee) is required to perform a
soil boring adjacent to the drainfield excavation at the
time of final inspection. Prior to Final Approval, the DOH
inspector shall witness the soil boring and compare the
results to the original site evaluation submitted. A
reinspection fee will be assessed if the contractor is not
at the jobsite at the arranged time.
SPECIFICATIONS BY: Teresa J Solomo
APPROVED BY:
DATE ISSUED: 09/27/2011
DH 4016, 08/09 ( bsoletes all previous
Incorporated: 64E- 6.003, FAC
v 1.1.4
TI
TITLE: Master Septic Tank Contractor
Engineer Specialist II Dade
editions which may not be used)
AP1048134
EXPIRATION DATE: 12/26/2011
8E852889
CHD
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