PL-12-68Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 171434
Permit Number: PL- 1 -12 -68
Scheduled Inspection Date: March 26, 2012
Inspector: Hernandez, Rafael
Owner: DAKOTA, MICHAEL
Job Address: 515 NE 96 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: STATEWIDE SEPTIC CONNECTIONS
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Drainfield
Phone Number
Parcel Number 1132060171560
Phone: (954)963 -0082
Building Department Comments
REPALCE DRAINFIELD
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
CREATED AS REINSPECTION FOR INSP- 168788. HRS IN FILE missing
sod
March 23, 2012
For Inspections please call: (305)762 -4949
Page 29 of 37
pLii--cgo-
lLj^,
TMENT AND DISPOSAL SYSTEM
CTION AND FINAL APPROVAL
•
PERMIT NO, t L. fi ;`; c-
DATE PAID:
FEE PAID:
RECEIPT #•
ION:
PROPERTY ID #:
N
OLIANCE WITH TATUTE OR RULE AND MUST BE CORRECTED.
l
SETBACKS
[ ] [27] SURFACE WATER FT
[ j [28] DITCHES FT
[ ] [29] PRIVATE WELLS FT •
[ 1 [30] PUBLIC WELLS •FT
[ ] [31] IRRIGATION WELLS FT
[i----1 [32] /POTABLE WATER LINES ("°) FT
[..-.1 [33] BUILDING FOUNDATION 'S FT
[�]"" [34] PROPERTY LINES —. FT
[ . j [35] " OTHER FT
[171
[18] t DOSING 43
1191 AGGREG
PO] AGGREG
[211 AGGRE E DEPTH
• FILL I AVATI MATERIAL
[ [22] u FILL AMOUNT,Y'
FILL TEXTURE
J4J \.• '41 EXCAVATION
5] AREM EPLACED
REPLACEMENT MATER 'h(L
E RI ANATIO VIOLATIONS / REMARKS
VE FINes -
FILLED / MOUNC SYSTEM
[36] DRAINFIELD COVER
[37] SHOULDERS
[38] SLOPES
[39] STABILIZATION •
ADDITIONAL INFORMATION
[40] UNOBSTRUCTED AREA
[41] STORMWATER RUNOFF
[42]
[43]
[44]
[4Sl
[46]
:> - -" - [471
ALARMS
MAINTENANCE AGREEMENT
BUILDING 'AREA
WGAT -fin S /TEPLAN
FINAL SITE GRA y _
CONTRACTOR
HE`S .
_ As. yr
ABANDCSNI h T
X49] TANiC\PUMPED'
-1[50] ." _TANK CRUSHED••
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 No. `Y 1(2-:-.
PERMIT APPLICATION Master Permit No.
FBC 20
Permit Type: PLUMBING
OWNER: Name (Fee Simple Titleholder):
Address: C
7 1r
Phone#:
City: State: Zip:
Tenant/Lessee Name: Phone#:
Email:
JOB ADDRESS: t
c'-t
City: Miami Shores County: Miami Dade
Folio/Parcel #:
Zip: _s.
Is the Building Historically Designated: Yes
NO A Flood Zone:
CONTRACTOR: Company Name: ) 6 a- f: a ° L ' � q N` a `,L ° ' fa Phone#:
A=�
Address: ;;�9` 5
City: V-,01
Qualifier Name:, e,, 01. � Phone#:
State Certification or Registration #: Certificate of Competency #:
Contact Phone#: Email Address:
DESIGNER: Architect/Engineer: Phone#:
State:
zip: '' ,
Value of Work for this Permit:
Type of Work: ❑Address
Description of Work:
$a= Square/Linear Footage of Work:
❑Alteration
❑New t Repair/Replace
❑Demolition
.-- Submittal Fee $ Permit Fee $ ice CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL 1411'. NOW DUE $ ( (_( d %�'
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
.4),( r fa' )2- 11
Contractor
The foregoing instrument was ac �. � wledged before me this 12 The fore _ . ingyinstrument was ackno ledged before
day of �7cf1, 201 Z,, by L' i°?I° CC'ef< lf- � , day of � 4 ���� 1 `� t ' 20 1 '2-;by
w ho is personally known to me or who has produced ' who is personally kno to me or who has produced
I) r V li.' (1 As identification and who did take an oath. as dentification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: t.
My Commission Expires:
APPROVED BY
•► 'P: TERESA .i SOLOMON
.;;,„",d;, EXPIRES November 08, 2(115
(407) 399-0153 Florida NotaryService.com
NOT Y ?UBLIC:
Sign:
Print:
My Commiss
- • E My Comm. Expires Sep 23, 2015
%9:f o�ec Commission # EE 128810
�•,,,,, , " Bonded Through Natio.,al Notary Assn.
FM?, /2-- 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: Michael & Irene Dakota
PERMIT #: 13-SC- 1386726
APPLICATION #: AP 1057865
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR863687
PROPERTY ADDRESS: 515 NE 96 St
Miami, FL 33138
LOT: 13 &amp; 1 BLOCK: 99 SUBDIVISION: Miami Shores Sec4
PROPERTY ID #: 11- 3206 -017 -1560
[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 [
900 ] GALLONS / GPD Septic existing CAPACITY
0 ] GALLONS / GPD CAPACITY
0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ]
D [ 225 ] SQUARE FEET in trench configuration SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [x] TRENCH [ ] BED [ 7
N
F LOCATION OF BENCHMARK: FFE : 10.6' NGVD
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE
L
D FILL REQUIRED:
O
T
H
E
R
SPECIFICATIONS BY:
APPROVED BY:
[ 0.00 ] INCHES
1 21.60 ] [) INCHES I FT ] [ ABOVE 4 BELOW (I BENCHMARK /REFERENCE POINT
[ 59.60 ] II INCHES f FT 1 [ ABOVE BELOW BENCHMARK /REFERENCE POINT
EXCAVATION REQUIRED: [ 38.00] INCHES
- Install 225 sq ft drainfield in trench configuration.
- Elevation of bottom of drainfield to be no less than 5.63' NGVD.
- Existing 900 g septic tank, to remain.
- Not for additions
DATE ISSUED:
Teresa J Solomon
Joseph R Piverger
01/12/2012
TITLE: Master Septic Tank Contractor
TITLE: Engineer Specialist II
Dade CND
EXPIRATION DATE: 04/11/2012
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E- 6.003, FAC SE860090
V' 1.1.4 AP1057865
Page 1 of 3
STATE LORIDA
,
DEPARTMENT OF HEALTH
PP14ICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PvflT, •q
Permit Application Number,
,1 r •
PART II SITE PLAN-
Scale: Each block represents 5 feet and 1 inch = 50 feet.
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Site Plan submitted by: Aoc JtX14,11,1 ) 12- (-16 is-irol-f
Plan Approved,
By
11 7 ?
ALL CHANGES MUST BE APPROVED BY 'THE COUNTY HEALTH DEPARTMENT
''Signature
Title
Not Approved Date
County Health Department
DH 4015, 10/06 (Replaces HRS-H Form 4015 which may be used)
(Stock Number: 5744-002-4015-6)
Page 2 of 3 1-9