PL-12-1511Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 177166 Permit Number: PL -8 -12 -1511
Scheduled Inspection Date: August 22, 2012
Inspector: Hernandez, Rafael
Owner: CARR, HEIDI
Job Address: 150 NE 111 Street
Miami Shores, FL
Project: <NONE>
Contractor: CHAPMAN SEPTIC SERVICE, INC.
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Septic
Phone Number
Parcel Number 1121360040120
Phone: (305)815 -9901
Building Department Comments
ABANDON EXISTING SEPTIC TANK AND INSTALL 900
GALLON WITH 300 SQ FT DRAINFIELD IN BED
CONFIGURATION
Passed
IN
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
HRS IN FILE
August 22, 2012
For Inspections please call: (305)762 -4949
Page 24 of 38
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DIPOSAL SYSTEM
CONSTRUCTION INSPECTION AND FINAL APPROVAL
APPLICANT:
AGENT:
PERMIT NO. / ?PAY 7Y/P42)'
DATE PAID:
FEE PAID:
RECEIPT #:
PROPERTY ADDRESS: //3--
/ 3 c "41'r Lr • 1 / J Z7
LOT:
BLOCK:
SUBDIVISION:
PROPERTY ID #:
CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED.
TANK INSTALLATION
[ i-1" [01] TANK SIZE [1] 0..r [2]
[,-.1°' [02] TANK MATERIAL
[ A' [03] OUTLET DEVICE
[ [04] MULTI- CHAMBERE, [ Y / N
[ [05] OUTLET FILTER
[ [06] LEGEND PST
'[ j, [07] WATERTIGHT
[ [08] LEVEL [ i
[ r] [09] DEPTH TO •Lti? I ]
DRAINFIELD INSTALLATION
(,...1- [10] AREA [1] /„2A: [2]4p, SQFT [
[---.' [11] DISTRIBUTION B X HEADER __ [
[' [12] NUMBER OF DRAINLINES f
[ [13] DRAINLINE SEPARATION %A i, [
[......1- [14] DRAINLINE SLOPE
[./" [15] DEPTH OF COVER / .2 it
[.- [16] ELEVATION [ABO /BELO " BM
[ - [17] SYSTEM LOCATION
[ ] [18] DOSING PUMPS
[ ] [19] AGGREGATE SIZE
[ ] [20] AGGREGATE EXCESSIVE FINES
[ ] [21] AGGREGATE DEPTH
/ FILL
[•d'] [22]
[ 4 [23]
[ -o]' [24]
[ -( [25]
[ ] [26]
/ EXCAVATION MATERIAL
FILL AMOUNT of
FILL TEXTURE
EXCAVATION DEPTH
AREA REPLACED
REPLACEMENT MATERIAL.
EXPLANATION OF VIOLATIONS / REMARKS:
[ ]
[
[ ]
[ ]
SETBACKS
[27] SURFACE WATER
[28] DITCHES
[29] PRIVATE WELLS
[30] PUBLIC WELLS
[31] IRRIGATION WELLS
[32] POTABLE WATER LINES
[33] BUILDING FOUNDATION
[34] PROPERTY LINES
[35] OTHER
FILLED. %.MOUND SYSTEM
[36) DRAINFIELU COVER
[37] SHOULDERS.
[38] SLOPES
[39] STABILIZATION
FT
FT
FT
FT
6g" FT
FT
FT
FT
FT
ADDITIONAL INFORMATION
[40] UNOBSTRUCTED AREA
[41] STORMWATER RUNOFF
[42] ALARMS
[43] MAINTENANCE AGREEMENT
[44] BUILDING AREA
[45] LOCATION CONFORMS WITH SITE PLAN
[46] FINAL SITE GRRAADIIN
[47] CONTRACTOR �`+•
[48] OTHER
ABANDONMENT
[49] TANK PUMPED
[50] TANK CRUSHED & FILLED //-Cy/ I
CONSTRUCT APPROVE ISAPPROVED] D
FINAL SYST [APPRO D /DISAPPROVED] . ` �....ec Q
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E- 6.003, FAC
CHD DATE: 8' 1 4 _0•
CHD DATE: e /2
Page 2 of 3
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DING
PERMIT APPLICATION
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
FBC 20
ING
RR, go'
Permit No. )ZR - \
Master Permit No.
OWNER: Name (Fee Simple Titleholder): 144. Odirc Phone#:
Address: 1 SO rt‘e.
City: 1ittel.4461
Tenant/Lessee Name:
Email:
state:6
Zip: 33
Phone#: • .-• 1.
,
JOB ADDRESS: 1 6-0 il) i UST
City: Miami Shores County: Miami Dade zip: 3 3
Folio/Parcel#: It -213(0.1)19-q **0 120
Is the Bidding Historleally Designated Yes NO ■,47
CONTRACTOR: Company Name:
Address: P-0 60K,..) Eisie3(1
City: state: ri
- -Zip: 33 2,43
g
Qualifier Name:0 Phone*:
State Certihcation Criletistration*: 6nto'4"t" vlAr? Ceriifieete Okinniitifook `14 (91 te9 57Lp
Contact Phone# )13-eiG3901 Email Address:
DESIGNElii. Architect/Engineer: I.
Flood Zone:
6.eirkt, 0--ed rut Phone*: cet
Phone#:
Value of Work for this Permit: $ Square/Linear Footage of Work:
°Alteration • ew &repair/Replace °Demolition
Descripdo of ork: Li Al 441 Spiep
Type of Work: °Address
***************************************Fees********************************************
Submittal Fee $ Permit Fee $ 36° — CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $
Bond L.500
Notary $ 'Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DU--WlicP—Sb-4
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 CONDTTIONERS, 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 properly is subject to attachment. Also, a certified -copy of the recorded notice of commencement must be pasted 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 wi(l not be approved and a reinspection fee will be charged.
,1:(\k
Signature
Owner or Agent
The fore : o„ . g instrument was acknowledged before me this
day of :�:. 201,y(;t7-
who is personally own to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:`
Sign:
Print: 4
VANESA CANTRELL
tar u c - State of Florida
Aires Jun 15, 2013 a
is,y�m"DNcaaaryAssa)
My Commitsi31i Licp1 es'T. "
* * * * * * * * * * * * * * * * * * * * * * * * * **
APPROVED BY
Signature
Contractor
The foregoing instrument was acknowledged before me thisl
day of , 20 _, by
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Prin'
My
VANE ANTRELL
i(, r led iJ�bjS.4
r Aga,
Alf
•
'48i ■J`' jsmisit Through National Notary Assn.
* ** ***************** * * * * * * * * * * * * * * * * * * * * * * *s ** * ** ** *a* *wry *** * * * * * * *** * ***** *** *
Plans Examiner
Structural Review
(Revised 07 /10/07)(Revised 06/10/2009)(Revised 3/15/09)
Zoning
Clerk
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR OSTDS Repair
APPLICANT: Heidi Carr
PERMIT # :13 -SC- 1422625
APPLICATION 0: AP 1078901
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR881356
PROPERTY ADDRESS: 150 NE 111 St Miami, FL 33161
LOT: 13
BLOCK: 1 SUBDIVISION:
PROPERTY ID #: 11- 2136 - 004 -0120
[SECTION, TOWNSHIP, RANGE, PARCEL HUMBER]
[OR MAX 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
0
T
H
E
R
900 ] GALLONS / GPD Septic CAPACITY
0 1 GALLONS / GPD CAPACITY
0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
] GALLONS DOSING TANK CAPACITY [ 1GALLONS @[ ]DOSES PER 24 HRS *Pumps [
[, 200 ] SQUARE FEET
[ 0 ] SQUARE FEET
TYPE SYSTEM: [x] STANDARD
CONFIGURATION: [ ] TRENCH
SYSTEM
SYSTEM
[ ] FILLED [ ] MOUND
[x] BED [
LOCATION OF BENCHMARK: F.F.E.: 14.0' NGVD.
ELEVATION OF PROPOSED SYSTEM SITE
BOTTOM OF DRAINFIELD TO BE
FILL REQUIRED:
[ 0.00 ] INCHES
[ 32.40 1 [ INCHES FT ] [ ABOVE A BELOW b BENCHMARK/REFERENCE POINT
[ 62.40 ] [' INCHES 1 FT ] [ ABOVE BELOW BENCHMARK /REFERENCE POINT
EXCAVATION REQUIRED: [ 42.00] INCHES
1— Install 900 gal septic tank equipped with an approved filter. 2 -The licensed contractor installing the system is
responsible for installing the minimum category of tank in accordance with sec. 64E- 6.013(3)(f). 3- Install 200 sf of
drainfield in bed configuration. 4- Install 12" of slightly limited soil under the bottom of drainfield. 5- Perimeter of
excavation area shall be at least 2 ft wider and longer than the proposed absorption bed. 6 -Invert elevation of drainfield
to be no less than 9.30' NGVD. 7. Bottom of drainfield elevation to be no less than 8.80' NGVD. 8: This permit includes
the Abandonment of the existing septic tank.
THIS PERMIT IS NOT FOR ADDITION(s).
SPECIFICATIONS
APP `• c BY:
DATE ISSUED:
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DH 4016, 08/09 (Obsoletes all previous
Incorporated: 64E- 6.003, FAC
v 1.1.4
EXPIRATION DATE: 10/28/2012
editions which may not be A
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