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PL-12-274Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 170070 Permit Number: PL -2 -12 -274 Scheduled Inspection Date: March 26, 2012 Inspector: Hernandez, Rafael Owner: CASEY, LIONEL & CHARATSRI Job Address: 10610 NE 11 Avenue Miami Shores, FL 33138- Project: <NONE> Contractor: A AARON SUPER ROOTER Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Drainfield Phone Number Parcel Number 1122320280620 Phone: 305 -944 -8886 Building Department Comments REPLACE DRAINFIELD AND INSTALL DOSING TANK WITH PUMP Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments HRS IN FILE March 23, 2012 For Inspections please call: (305)762 -4949 Page 17 of 37 Snvi�i Tm ntal Health Florida Department of Health MI Dade County eeetth Department OSTDS/Wet1 Division nos SW 26 St. • %glint, FL 33175 Signa 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 OWNER: Name (Fee Simple Titleholder): Address: 1 0610 PJ E \ l A.,Q, Permit No. 1 () Master Permit No. 1.1 or)et i. ChC 4scl done #: City: M S k o re State: FL Zip: 38 Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: ©G1 O NE l Av-e- City: Miami Shores County: Miami Dade Folio/Parcel #: t t ' 21'2 " 0 2 - ®E"'Zo zip: 33 l Is the Building Historically Designated: Yes CONTRACTOR: Company Name: IN- Address: 6O2Z 3S C.1' City: a-'■ i a✓ Qualifier Name: do h'n NO Flood Zone: ci ron S\V.Q -d q00,1 Phone #: al State: FL. Zip: 3)23 Phone #: State Certification or Registration #: Certificate of Competency #: Contact Phone#: Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ 2140 O 11 Square/Linear Footage of Work: Zo Type of Work: ❑Address DAlteration ❑New DRepair/Replace Description of Work: ,, .1 • ,. Ref) 1 c� c� J� �►'� 4■( oSI 'O DDemolition W I etk.,p • * , x* *** ***** ** ** C** ** * * * * * *** **** Fees************* * **** **** ** *** ** ** ****** ** * **** Submittal Fee $ Permit Fee $ 0(7)4 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 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 excee ng $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commence i t must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the a Bence of such posted notice, the inspection will not b„ 'proved and a reinspection fee will be charged. Owner or Agent The foregoing instrument was acknowledged before me this day of Feb , 20°2- , by 1-3\c' who is personally known to me or who has produced V. As identification and who did take an oath. NOTARY PUBLIC: Sign: 3A_Loc Print: (S` My Commission Expires: z Lei' T RESA J SOLOMON ''' +� MY COMMISSION # EE 131935 EXPIgES Nove mbar x: �x+ x�xx: **�x*�x+ x**�x�x�x�x�x*�x�x*+ x*�x*�x�x�xx�u :x�a�x:�x�x�x*A... >, .. • , ,:, +x +� �� Signature Contractor The foregoing instrument was acknowledged before me this 13 day of _ Ce 5 , 20 t2 , by \31i1..-, ra► who is personally known to me or who has produced QS, as identification and who did take an oath. NOTARY PUBLIC: APPROVED BY 217- /-2- Plans Examiner (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Structural Review Zoning Clerk STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: Lionel Casey PROPERTY ADDRESS: 10610 NE 11 Ave Miami, FL 33138 LOT: 12 PERMIT #:13 -SC- 1393096 APPLICATION #: AP 1061889 DATE PAID: FEE PAID: RECEIPT 0: DOCUMENT 5: PR866863 BLOCK: 4 PROPERTY ID #: 11- 2232 -028 -0620 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 TEE 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 ] GALLONS GREASE INTERCEPTOR CAPACITY Lummox CAPACITY SINGLE TANK:1250 GALLONS] K [ 300 1 GALLONS DOSING TANK CAPACITY 150.00 GGALLONS 111 6 ]DOSES PER 24 BRS #Pumps [ 1 1 D [ 200 1 SQUARE FEET SYSTEM R [ 0 ] SQUARE FEET SYSTEM A TYPE SYSTEM: [ ] STANDARD [x1 FILLED [ ] MOOND [ ] I CONFIGURATION: [ ] TRENCH [X] BED ( 1 N F LOCATION OF BENCHMARK: F.F.E.: 6.10' NGVD. I ELEVATION OF PROPOSED SYSTEM SITE [ 25.20 1 proms FT 1 [ ABOVE E BOTTOM OF DRAINFIELD TO BE L D FILL: FIRED: 112.00] INCHES EXCAVATION REQUIRED: [ 6.00 1 INCHES 1 —Exist ling 750 gal. septic tank certified by " A Aaron Super Rooter " n 02/09/2012 to remain. 2- Install 200 sf of drainfield • in bed configuration. 3- Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption T bed. 4 -Invert elevation of drainfield to be no less than 400' NGVD. 5. Bottom of drainfield elevation to be no Tess than 3.50' NGVD.6. Install a rift/dosing tank with all the requirements for an alalrm system nstallation. BENCHMARK /REFERENCE POINT [ 31.20 1 [) INCH88 Y FT 1 [ ABOVE ' BELOW + BENCHMARK /REFERENCE POINT E R THIS PERMIT IS NOT FOR = ' • N(s). STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION Permit Application Number PART 1I - SITEPLAN Scale: Each block r : • esents 10 feet and 1 inch = 40 feet. ■UlUlUl112 /�111•[R111..1 F111111!S1111il11. �� ■■�11��11 X111/101111111I1Z VAINI1IIIIIIMMI r IN0INI■ 11111111111111121WILTRIENdaiiiiiii•MEZO11.1111111M11111 ■ ■11111111111111r1 ■l ,i 111192'',. !1l1111111110Mi�.'�ii iii �i !!MITI■ 1111111iNoliroltitionigit 1 ••••••Limpilimummusom 0 Notes: ‘12_119 C►5' 1 °C AC w it p1,r� MCCShores 3313' 010..1 204 D (p 1`, Zl d i d (.gird) 6.)1rk '"fiY 02�eE toiir-v. 501 ytov-% Site Plan submitted by: Plan Approved By' County Health Department ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT DH 4015,10/98 (Replaces HRS -H Form 4016 which may be used) (Stock Number 5744 -2- 4015-6) Page 2 of 4