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PL-12-1Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 168343 Permit Number: PL- 1 -12 -1 Scheduled Inspection Date: January 13, 2012 Permit Type: Plumbing - Residential Inspector: Hernandez, Rafael Inspection Type: Final Owner: GARRET, ROBERT & SYEDA Work Classification: Drainfield Job Address: 465 NE 96 Street Miami Shores, FL Project: <NONE> Contractor: STATEWIDE SEPTIC CONNECTIONS Phone Number Parcel Number 1132060170120 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 A-49 " 1� January 13, 2012 For Inspections please call: (305)762 -4949 Page 5 of 9 DIVISION OF Environmental Health Florida Department of Health Miami-Dade County Health Department OSTDS/WeIl Division 11805 SW 26 St. • Miami, FL 33175 Inspector -P„ Address 96 f#7. 'as Date I — OSTDS = CI 7— 6 6-3 Comments; , Signature - STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAG., TPEAYI-JMENT AND DISPOSAL SYSTEM CONSTRUCTION INSPECTION AND FINAL APPROVAL APPLICANT:X0-42-4---/ AGENT: PROPERTY ADDRESS: PEFIMIT NOP DATE PAID* FEE PAID* RECEIPT #: L01-127 BLOCK' SUBDIVISION*. PROPERTY ID , • 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 /el) [05] OUTLET FILTER [06] LEGEND [07] WATERTIGHT [08] LEVEL .• [09] DEPTH TO LID , DRAINFIELD -INSTALLATION [ I [10] AREA [1] j_c,,Y,,-(2] 7..4- (111 DISTRIBUTION -,HEADER2.,./ [ ] [12] NUMBER OF DFIAINEINES [ ] [13] DRAINLINE SEPARATION • • [ 1 [14] DRAINLINE SLOPE: • -., - [ ] [15] DEPTH OF COVER [ ] [16] ELEVATION [ABOVagEmeM [ ] [17] SYSTEM LOCATION [ ] [18] DOSING PUMPS . ,•"'S [ ] [19] AGGREGATE SIZE [ ] [20] AGGREGATE EXCESSIVE FINES • ( ] [21] AGGREGATE DEPTH . FILL1 EXCAVATION MATERIAL [ ] [22] PILL AMOUNT [ 3 [23] FILL , •., [ ] [24] EXCAVATION DEPTH [ ]- .[25] AREA REPLACED r•- [ ] [26], REPLACEMENT MATERIAL . • . EXPLANATION' OF VIOLATIONtifIEMARIKS:'-'- I CONSTRUCTI AP-PFIOV /DISAPPROVED]: FINAL SYSTEAPTiiDISAPPROVEDI - . SETBACKS • [27] SURFACE WATER FT [28] DITCHES FT [29] q PRIVATE WELLS FT , [30] PUBLIC WELLS FT [31] IRRIGATION WELLS --- FT [32] POTABLE WATER LINES 7-At [33] BUILDING-FOUNDATJON,„24.- [34] PROPERTY LINES [351. - 'OTIAER. Fr FILLEI,VV#OUND.SYSTENI [36] DRAINFIELD COVER [37] SHOULDERS [38] SLOPES [39] STABILIZATION. FT Fr FT ADDITIONALINFORMATION I [40] UNOBSTRUCTED AREA ] (41] ' STORMWATE R RUNOFF ] [42] 'ALARMS - ] [43] MAINTENANCE AGREEMENT [ ] [44] ' ,BUILDING AREA ( 1 [45] LOCATION CONFORM WITH SITE PLAN [ ] 146] FINAL SITE GRADI [ [47] • CONTRACTOR ( 1 [48] OCHER ....*ABANDONMENT [ ] - 'TANK PUlyIPED [ ] [50] TANK CRUSHED & FILLED , / OH 4016 (Page 2), 10/97 (Previous Editions May Be Used) Stock Number. 5744-0024016-4 tj■4 ld {V' CHD DATE. / 4-- I c_ CHD DATE*/ ) -2-- Page 2-of 3 PT 1: Applicant PT 2: Installer/Contractor PT B: Building Department PT 4. Health.Dapartment iireyard Pope . r 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 12-1 BUILDING Permit No. P 1 PERMIT APPLICATION Master Permit No. FBC 20 Permit Type: PLUMBING OWNER: Name (Fee Simple Titleholder): Yo -er-� y lek. Gc r r--cetr Phone #: 305 -Th y' 3 2 7c) Address: `7 U 5 ,& 76 141k I City: "�/' �' t j ©�'2 S State: F L Zip: 33/3 F Tenant/Lessee Name: �J G� q p Phone #: Email: �d� jc rre f I'QAG4Th�1 1 t,i A()� c�riGl s ecick @ ko+01.4.; ), CO )4-‘ JOB ADDRESS: '�' �, �E c) G st l' e t''� City: Miami Shores County: Miami Dade zip: 3� Folio/Parcel #: it- - .7_ 01-7 - 0! 2 0 Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: S�G * ems\ c e C. s r.'( #: : G. 66 33 Phone (" Address: Po $C ? 3 8 6 p City: 1 C d State: Ft- Zip: ',C) p 3 Qualifier Name: Tetedg LT 10 o -C),-, Phone#: State Certification or Registration #: M-091 t Z ( 2- Certificate of Competency #: Contact Phone #: Email Address: DESIGNER: Architect/Engineer: Phone#: g'Y Value of Work for this Permit: $ 28 o 0 Square/Linear Footage of Work: ,Type of Work: ❑Address < , UAlteration ❑New Repair/Replace ❑Demolition Description of Work: ' Re e( ACC D' col i Submittal Fee $ Permit Fee $ ire 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 x 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 MR 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 reinspection fee will be charged. it Signature ���" or Agent The foregoing instrument was acknowledged before me this Z3 day O2C n ' , 20 (� , by �1 YT V q--YY --'Zt- who is personally known t me or who has produced �� i Yi�g t As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: o,�1TSt tlq ''�i''i 11 wrCSAlik*i My Commission Expires: APPROVED BY • „„o� #EE26515• „QO °O °o��� �BCIC, STA��o ���``\� FP • j\/, Signature Contractor The fo oing instru ent , s acknc , day of �1 . 0 11, by iVtv $vho is personally known to mn or who has produced as identification and who did take an oath. NOTA • Y PUBLIC: Sign: Print: My Commission Exp ! �3r�' 81LtoS . I I I �4 � ifil itt t of Ft p�15 ., ws c, r.: ( My Comm. Ex4 . �1.aEnE 128810 �,V�1"',� Natl°12 i da s -1 „oo aged Through Plans Examiner Zoning Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) do- STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: Robert Garret PERMIT 8:13 -SC- 1384359 APPLICATION 8: AP 1056363 DATE PAID: FEE PAID: RECEIPT 8: DOCUMENT #: PR862287 PROPERTY ADDRESS: 465 NE 96 St Miami, FL 33138 LOT: 1718 BLOCK: 86 PROPERTY ID 4: 11- 3206-017 -0120 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 [ 750 ] GALLONS / GPD Septic CAPACITY A [ 0 ] GALLONS / GPD CAPACITY N [ 0 l GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ] D [ 225 I SQUARE FEET SYSTEM R [ 0 l SQUARE FEET SYSTEM A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ] I CONFIGURATION: [x] TRENCH [ ] BED [ N F LOCATION OF BENCHMARK: F.F.E.: 11.20' NGVD I ELEVATION OF PROPOSED SYSTEM SITE [ 21.601 I) INCHES ' FT ] [ ABOVE BENCF84ARK /REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 57.60 I [I INCHES I FT ] [ ABOVE 4 BELOW BENCHMARK /REFERENCE POINT L D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: [ 36.001 INCHES 1- Existing 750 gal. septic tank certified by " Statewide Septic Connections Inc." on12/18/2011 to remain. 2- Install 225 sf • of drainfleld in trench configuration. 3- Perimeter of excavation area shall be at least 2 ft wider and longer than the T proposed absorption trench. 4 -Invert elevation of drainfield to be no less than 6.90' NGVD. 5. Bottom of drainfield • elevation to be no less than 6.40' NGVD. E THIS PERMIT IS NOT FOR ADDITION(s). R APPROVED BY I.1 N t �q T 0 /en 'uS o q II� E I4t aa� °I 7N 4 e d] DE 4016, 08/09 Osolet es. all iDATE ISSUED: Incorporated: 64E- 6.003, PAM okplg a • IL/4 n 12/27 0 a1 o v 1.17r 1 Pemlb ue °4lold � 8P1 /9 o A EXPIRATION DATE: 03/26/2012 Dade CHD Page 1 of 3 88858798 DEPARTMENT OF HEALTH ON FOR,()NSITE SEWAGE DISPOSAL SYSTEM QE NSTRUCTJON PERMIT Permit Application Number ! trot: AMOMMOK M IMF t- "e 4 1 �MI lin *a 1 Slte Plan submitted by: bate County Health Department j COUNTY 14 ALTH DEPARTMENT Page 2 of 3 1 Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Permi' Permit NO. PL- 1 -12 -1` Permit Type: Plumbing - Residential!. Work Classification: Drainfield Permit Status: APPROVED Issue Date: 1 /4/2012: Expiration: 07/02/2012 Parcel Number Applicant 465 NE 96 Street Miami Shores, FL 1132060170120 Block: Lot: ROBERT & SYEDA GARRET Owner Information Address Phone Cell ROBERT & SYEDA GARRET 465 NE 96 Street MIAMI SHORES FL 33138 -2733 Contractor(s) Phone STATEWIDE SEPTIC CONNECTIONS (954)963 -0082 Cell Phone Type of Work: Type of Piping: Additional Info: Bond Retum : Classification: Residential Scanning: 1 Fees Due Bond Type - Owners Bond CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $500.00 $1.80 $2.25 $2.25 $0.60 $150.00 $3.00 $2.40 $662.30 Pay Date Pay Type Invoice # PL -1 -12 -43048 01/04/2012 Check #: 132 $ 662.30 $ 0.00 Bond #: 2092 Amt Paid Amt Due Available Inspections: Inspection Type: Final Rough In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS 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. Futhermore, I authorize the above -named contractor to do the work stated. January 04, 2012 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date January 04, 2012 1