PL-11-2194/
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: I NSP- 167067
Permit Number: PL -11 -11 -2194
Scheduled Inspection Date: December 14, 2011
Inspector: Hernandez, Rafael
Owner: , CK PROPERTY SOLUTIONS, LLC
Job Address: 10618 NE 11 Avenue
Miami Shores, FL 33138-
Project: <NONE>
Contractor: STATEWIDE SEPTIC CONNECTIONS
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Septic
Phone Number
Parcel Number 1122320280630
Phone: (954)963 -0082
Building Department Comments
REPLACE DRAINFIELD AND INSTALL DOSING TANK
WITH PUMP ALARM
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
HRS IN FILE
December 13, 2011
For Inspections please call: (305)762 -4949
Page 23 of 53
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
NM@MEWM
LE NOV 2 8 2011
B Y:
Permit NeVu —a194
Master Permit No.
Owner's Name (Fee Simple Titleholder) CA; Po cq'e Cr °fie , r/c. --&* Phone #
Owner's Address 2 f .9e- r
City 6
State
c
755 3/??
Zip 33
Tenant/Lessee Name Phone #
Email
Job Address (where the work is being done) 1A' tee iS/ "V /1 /91"/-E
City Miami Shores Villa • e County Miami -Dade Zip 331 3
FOLIO /PARCEL# I(`22 3Z — ® 2- - cG
NO
Is Building Historically Designated YES
Contractor's Company Name t ' t' aA..; i 0,1e.
Contractor's Address PO e" x. 3 8G.
City State
Qualifier Name ((. 5 i ' l Dr
State Certificate or Registration No.
Contact Phone
rt
Phone #
Zip
Phone #
Architect/Engineer's Name (if applicable)
Value of Work For this Permit $ SS
Type of Work:
Describe Work:
['Addition
E -mail
Flood Zone
3661- 6633
3
Certificate of Competency No.
Phone #
Square / Linear Footage Of Work:
tip.
DAlteration [JNew :1 Repair/Replace
p t vice Drc c fir` (d d- I Stc i)
Si r
❑ Demolition
cf" iitet13 4+ � �� J
Ilr��'�� w�� �rtc�,i ,f; p
YAf rp9` FFC
tae o:t 4Ye�liil i0,1?"*4t 4�
e aoomr ,gr f {
Submittal Fee
Notary $
Scanning $ Radon $
Double Fee $
Structural Review. $ Total Fee Now Due $
* * * ** * *** * * * * * ** *Fees * *** * *** * * *** * * *
mit Fee $ 3 °0
Training/Education Fee $
CCF $ CO /CC $
DPBR $
Violation date:
Technology Fee $
Bond $
See Reverse side -->
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 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.
Signature
Signa
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this 25 The fore:. 1 g in, i ment was acknowledged befo
day of (4 c.)," , 20 11 , by (1,1 f r O day of /' , 2cJ1 , by
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. as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
�, ?e"`•':i�;: TERESA J SOLOMON
'? MY COMMISSION # EE131935
EXPIRES November 08, 2015
•Iill `
( 407) 398 -0153 Fledda1491Irrervh e.ean
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *, * * * * * * * * * * * * * ** ** *'fie * * * * * * * * * * * * * * * * * * * * * **
Sign:
Print:
My Commission
APPROVED BY
��� ` ✓� Plans Examiner
Engineer
(Revised 07 /10 /07)(Revised 06/10/2009)
Zoning
Clerk checked
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: (CK Property Solutions LLC)
PROPERTY ADDRESS: 10618 NE 11 Ave Miami, FL 33138
LOT: 13
PERMIT # :13 -SC- 1379707
APPLICATION #:API053382 -
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #:PR859700
BLOCK: 4 SUBDIVISION:
PROPERTY ID #: 11- 2232 - 028 -0630
[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 1 GALLONS / GPD SeptiC CAPACITY
A [ 0 ] GALLONS / GPD CAPACITY
N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ 225 1 GALLONS DOSING TANK CAPACITY (37.50 ]GALLONS @[ 6 ]DOSES PER 24 HAS #Pumps [ 1 ]
D [ 300 ] SQUARE FEET SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [ ] STANDARD [x] FILLED [] MOUND [ ]
I CONFIGURATION: [ ] TRENCH [x] BED [ ]
N
F LOCATION OF BENCHMARK: F.F.E.: 6.5' NGVD.
I ELEVATION OF PROPOSED SYSTEM SITE [ 22.801 El INCHES I/ FT 1[ ABOVE 4 BELOWbBENCHMARK /REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 29.80 ] [f INCHES If FT ] [ ABOVE 4 BELOW b BENCHMARK /REFERENCE POINT
D FILL REQUIRED:
0
T
H
E
R
[ 11.00] INCHES EXCAVATION REQUIRED: [ 7.20 1 INCHES
1— Exiisting 9090 gal. septic tank certified by " Dtatewide Septic Connections Inc." on 11/15/2011 to remain. 2- Install 300
sf of drainfield in bed configuration or .maximum available space. 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 4.38' NGVD. 5.
Bottom of drainfield elevation to be n4 less than 3.88' NGVD. 6. Install a 225 gal.lift/dosing tank and all the requirements
foir an alarm system installation.
THIS PERMIT IS NOT FOR ADDITION(s
:18 alIsgo( ag11e
ns uogerij i( I I;,u`'.34102 sllnsai
Suuoq llos aql ss?UtM ii H adsul
SPECIFICATIONS - OSPINA a.
IBMICIdV le;n j of iopd •uoilaadsu; i •'� .
APPROVED B TITLE:
OW lau0ileAeOxa plallule�p a4i of wealthy? Pi�i)inq lin Dade CND
P= o N ospina I aluupus of moos; si (aaut!,:::ap 10) !01 l
DATE ISSUED: 11/2 011 EXPIRI�TIQ i�JKI 02/20/2012
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E- 6.003, FAC
v 1.1.4
AP1053382
8E856660
Page 1 of 3
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number ‘1 '').-1
PART II - SITEPLAN
Scale: Each block re • resents 10 feet and 1 inch = 40 feet.
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Notes:
CK ro 1 - I 1& NO I Q AV . 3313
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Site Plan submitted by:
Plan Approved
By
Signature
it I CO 0°‘6(,3,0°
Title
Date
County Health Department
//
1/
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
DH 4015, 10/96 (Replaces HRS -H Form 4016 which may be used)
(Stock Number: 5744-002-4015-6)
Page 2 of 4