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PL-12-1316Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 175914 Permit Number: PL -7 -12 -1316 Scheduled Inspection Date: September 10, 2012 Inspector: Hernandez, Rafael Owner: DOSAL, MARGARITA Job Address: 1551 NE 103 Street Miami Shores, FL 33138- Project: <NONE> Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Drainfield Contractor: ALL PRO SEPTIC & SEWER INC / ALL PRO PLUMBING SEP' Phone Number Parcel Number 1132050310210 Phone: (305)635 -3002 Building Department Comments REPLACE EXISTING DRAINFILED Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments HRS IN FILE September 07, 2012 For Inspections please call: (305)762 -4949 Page 9 of 35 09/06/2012 13:46 3056357473 ALLPRO SEPTIC SEWER ,R .ti• STATE OP FLORIDA DEPARTMENT OF EEALTE ONSITE SEWAGE TREATMENT AND DZPOSAT4 SYSTEM CONSTRUCTION INSPECTION AND 1~'YNAL APPROVAL PAGE 01/02 �11a -131CQ PERMIT NO. arialtr DATE PAID: SEE PAID: RECEIPT #: APPLICANT AGENT: . PROPERTY ADDRESS: LOT: BLOCK: 4, ; SUBDIVISION: PROPERTY ID #: CRECKED EXc] ITEMS ARE NGT IN COMPLIANCE WITH STATUTE OR RULE AND Ml" sT .8E CO CTED . TANK INSTALLATION [01] [021 [031 1041 105] [06] [071 [08] (09] TANK SIZE [11. sac? t2].7/ % [ TANK MATERIAL t' __lS [ o TrLET DEVICE- [ MULTI - CHAMBERED [ I / N' I [ OUTLET FILTNA Alum 1,E0END ___i_ia________ [ WATERTIGHT { LEVEL [ DEPTH To LID [ DRAINVIELD INSTALLATION [10] AREA [1]/� E2J y4sIg SOFT [111 DI8TRISUTIO X HEADER 4/ (12] NUMBER OF DRAINLINES (13) I14] [15] 116] [17] 1183 [19] [201 1213 AGGREGATE DEPTH )2 // MAINLINE SEP #TION 34' r DRAINLINE SLOPE DEPTH OF COVER; ELEVATION [AEOVE BM SYSTEM LOCATION ' • • r f DOSING PUMPS " /' ' ''" "' N [ AGGREGATE S27E 3 I ,,��jj Ira AGGREGATE EXCESSIVE ?INES FILL, / EXCAVATION MATERIAL (22] 1"ILL AMOUNT 12 [23] FILL TEXTURE 124] EXCAVATION DEPTH 125] AREA REPLACED ' [26] REPLACEMENT MATERIAL EXPLANATION OP VIOLATIONS / REMARKS: [ ] 1 ] [ 1 1 ] try ] f SETBACKS (27] SURFACE SA"ATER. [28] DITCHES [29] PRIVATE WELLS [30] P¢BTtIC' 147EJ�LS ' 1313 [32] (33] [34] [35] IRRIGATION WELLS POTAELL, WAITER LINES EUILDING FOUNDATION »RQ ERTY LINES OTHER FT FT FT 7i FT PT A.- FT FT FILLED / MOUND SYSTEM • [36] DRAINFIL•i1; COVER' 1371 SHOULDERS [38] SLOPES [39] STABILIZATION /A4 ADDITIONAL iNFOR04154N [40] UNQf,TRUCTED• AAA 1411 STORNLI6 .RR. ` " °I'F (4.21 ALARiirtg [43] MAINTENANCE •A REENJ.ENT [44] BUILDING AREA - [451 LOCATION OONF'RN8 wits SITE PLAN [46] FINAL SITE GRADING [47] CONTRACTCif2 . '.:�.,,(/r4©" [4 81 OTHER ABANDONMENT (49] TANK PUMPED . / 1 [50] TANK CRUSHED &'' FILLED CONSTRUCTION y... SAPPRQVEDj : 1r9 t. . (, 7-~,Nre DC 4 C D DATE: — i FINAL SYSTEM [APPROVE /DISAPPROVED] ' � OEID DATE: ,:11A DH 4016, 08/09 (Obsoletes all premiums editions which may not be used) Incorporated: 64'6 - 6,003, PAC Paga2 cif 3 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 ' I l( INSPECTION'S PHONE NUMBER: (305) 762.4949 Permit No. PL 2� 1 51. BU LDING PERMIT APPLICATION FBC 20 t0 Permit Type: PLUMBING Owner's Name (Fee Simple Titleholder) Owner's Address ASS i '-% £• 16 3 City µ c-111-"5-S1,644- State P2__ Master Permit No. rt)t-7A-*" Phone # Tenant/Lessee Name A-% t 14- Email 00 l4 Zip 33IS$ Job Address (where the work is being done) 1S-5 1 Phone # City Miami Shores Villa e County Miami -Dade FOLIO / PARCEL # 1 t 3 O. oS— 0 31 - 0 a v -(57, Is Building Historically Designated YES NO Zip 1-3O Contractor's Company Name " - p✓ °;o -1° "c'' ' Phone , -2 1 Contractor's Address 4 OD A?o, Al P ? 4-0-k City kL State FL . Zip 21 i..4 a Qualifier Name IRA-044 ¶14 Phone # 2 1 p-o c - -M' l 3 State Certificate or Registration No. S f-{-0q4 133"a Certificate of Competency No. Contact Phone! 1 9--04:4-44..- 9 3 E -mail 4-It P tlQ1 & S 1 &t.A.K. i-q L Architect /Engineer's Name (if applicable) 1 A---- Phone # Flood Zone 63s.3da a° Value of Work For this Permit $ 1 1 1 00°' Square / Linear Footage Of Work: Type of Work: ❑Addition ❑Alteration ❑New a Repair/Replace ❑ Demolition Describe Work: T34X1,. et.4-1- /1 11Z44- 0 C- (7 �- P-t L *0 Iva-cg �J A- to 6 8 ******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees*********:*:* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Submittal Fee $ Permit Fee $ 300 CCF $ CO /CC $ Notary $ Training /Education Fee $ Technology Fee $ Scanning $ Radon $ DPBR $ Bond $ Double Fee $ Violation date: e2° Structural Review. $ Total Fee Now Due $ )..�( 1 See Reverse side Bonding.Company's Name (if applicable) Bonding Company's Address City B 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 The foregoing ins day of who i rsonally known t• me or who has produced who is rsonally knoe or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Print: 0f4 t 3Ntr r or Agent ment was acknowledged before me this Signature Contractor The foregoing instrument was acknowledged before me this 201.2, by RCLA ON-R,P day of , 20 L7, by L4 4. J My Commission Expires: gs• JEFFREY DOWSETT tf ,. MY COMMISSION # DD 947106 _' - . EXPIRES: April 11, 2014 ?,�"..`a Bonded Thru Notary Public Underwriters i Sign: Print: 3 My Commission Ex JEFFREY DOWSETT MY COMMISSION # DD 947106 EXPIRES: April 11, 2014 Bonded Thru Notary Public Underwriters * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ******************************************* * * ** * ** * * * * * ** ******* ** * * ** **** APPROVED BY Mans Examiner Revised 07 /I0 /07)(Revised 06/10/2009) Engineer Zoning Clerk checked STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: Margarita Dosal PERMIT #: 13-SC-1419066 APPLICATION #: API076885 DATE PAID: FEE PAID:, RECEIPT #: D0CUI4ENT #: PR879684 PROPERTY ADDRESS: 1551 NE 103 St Miami, FL 33138 LOT: 1819 BLOCK: 6 SUBDIVISION: PROPERTY ID #: 11- 3205-031 -0210 [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 [ 1,350 ] GALLONS / GPD Septic existing ] GALLONS / GPD ] GALLONS GREASE INTERCEPTOR. CAPACITY 375 ] GALLONS DOSING TANK CAPACITY D [ 428 ] SQUARE FEET R [ ] SQUARE FEET A TYPE SYSTEM: [x] STANDARD I CONFIGURATION: [ ] TRENCH N F LOCATION OF CITh : FFE: 6.90' NGVD CAPACITY CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ SYSTEM SYSTEM [ ] FILLED [ ] MOUND [x] BED [ ] ] I ELEVATION OF PROPOSED SYSTEM SITE E BOTTOM OF DRAINFIELD TO BE L O T E R FILL REQUIRED: [ 0.00 ] INCHES [ 12.00 ] [I INCHES I FT ] [ ABOVE 4 BELOW b BENCHMARK /REFERENCE POINT [ 34.00 ] [) INCHES I FT ] [ ABOVE /) BELOW b BENCHMARK /REFERENCE POINT EXCAVATION REQUIRED: [ 22.00] INCHES - Install 428 sq ft drainfield (minimum). - Elevation of bottom of drainfield to be no less than 7.40' NGVD. - Existing 1350 g septic tank, and 375 g dosing tank, to remain. - Potable water lines to use sch /40 pipes or be sleeved within 10' of - The system is sized for 2 bedrooms with a maximum occupancy of a total estimated sewage flow of 200 g /d. - Not for additions The contractor (or designee) is required to perform a soil boring adjacent to the drainfield excavation at the time of final inspection. Prior to Anal Approval, the OOH system. inspector shall witness the soil boring and compare the f 4 persons, results to the original site evaluation submitted. A reinspection fee will be assessed if the contractor is not at the jobsite at the arranged time. SPECIFICATIONS BY: Barry G Te . . APPROVED BY: DATE ISSUED: i 09/2 • • TITLE' Master Septic Tank Contractor : Engineer Specialist II Dade DH 4016, 08/09 (Obz etas all previous editions which may not be used) : 003, FAC Incorporated' 64. v 1.1.4 AP1076885 EXPIRATION DATE: 10/07/2012 3E874115 CHD • Page l of 3 STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM .CONSTRUG1.1ON PART 1I - SITEPLAN /5 st /0 ,/) VIVI, 7-,d -.mss MARS fz Scale: Each block re. resents 10 feet and 1 inch = 40 t. Aim.. .. t s• 111111 MEM III IN HEIM 11111 r�■� _ ® ■il111•.'il■ iiiiii miam I ■ ■■ II 1111111111111111111111111111 ■ ■lO•liiiffiilii!®i■ ■■IMP ®1■■■ ■■ I�onlasomminimmtsaiiiirimaiirom POI raI■ ■!1■■ ■►I.2 =2.■®® ■111■11111 1 111 l■ ®11!!!,ELIE ■IISI!r ■ ■■■U Imo■ J1I1111 'i3 ■1_1$ I Ir1�■� ®�■► ! ■ � IhIl is ■■1Millliiii 11!2 ■■�■1u �i ®a `" II15 11� ■■ 1111MI , VI M®■ MEZaa it MOE 11 1111111111111M1 U11511111MIWIFER111111i1111111 111111111VliifCES■■MMNiI Ali inmotsi ■s. %■■■ ■�� - ] liM11 ■M/! ■■ i ■� �( l'""""11-77-71;r7armormagawrorricgimpawrizitadm Notes: _E L iertikpLA- e:" Ora 11 Lc 610 4)� s Site Plan submitted sigttr. Plan Approved By. Not Approved e Date. Cc .t ty Health Department ALL CHANGES MUST BE APPROVED BY THE COUNTY F E LTH D PART tiENT • DH 4015,10/96 (Replaces HRS -H Form 4016 which may be used) (Stock Number 5744- 002 - 4015 -6) • • Page 2 of 4 ACORD — CERTIFICATE OF LIABILITY INSURANCE E DATE(MMIDGNYYY) W MVU THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.©9HISa12 CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDMONAL INSURED, the policy(Ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer fights to the certificate holder in Lieu of such endorsement(s). PRODUCER Keen Battle Mead & Company 7850 Northwest 146 Street Suite 200 Miami Lakes, FL 33016 corm= PHMIE 305.558.1101 FAx 305:822.4722 Ems'' I> fA/C. No): =meat PRODUCER CUSTOMER 10 tk INSURER(S) AFFORDING COVERAGE NAIC INSURED All Pro Plumbing Corp;A11'Pro Septic & Sewers Inc;A11 Pro Plumbing Septic & Sewers, Inc;A11 Pro Investment;A11 Pro Investment Holdings 2700 NW 27 Avenue Miami, FL 33142 INSURERA: Hartford Fire Ins Co d 19682 INSURER 8 : Travelers Indemnity Co of Amer 25666 INSURER C: Bridgefield Employers Ins Co 10701 mum D: 02101/2013 INSURER E: $ 1,000,000 $ 300,000 $ 5,000 INSURER F : COMMERCIAL GENERAL CLAIMS-MADE COVERAGES CERTIFICATE NUMBE MED EXP (Any one person) R. 12 -13 Gl/UMBJWCJAUTO REVJSiON NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAW, THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POL(gES LIMITS SHOWN MAY HAVE 1NSR TYPE OF INSURANCE W MVU BEEN POLICY NUMBER REDUCEyDJDT {MDUIYYYYI PAID CLAOAS. {MM/DDIYYYY) LIMITS A GENERAL UABR ITY LIABa1iY OCCUR 21UENQ072910210112012 02101/2013 sack occ Ra $ 1,000,000 $ 300,000 $ 5,000 �► :■ COMMERCIAL GENERAL CLAIMS-MADE GET RENTED MED EXP (Any one person) PERSONAL a ADV INJURY $ $ 1,000,000 2,000,000 GENERAL AGGREGATE GENT. ri LOC PRODUCTS - COMP/OP AGO $ IS 2,000,000 ref B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS - BA0326R11012SEL 05/20/2012 0512012013 COMBNED SINGLE LIMIT Ma accident ) $ 1,000,000 $ II BODILY INJURY {Per parson) BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ 1 $ A oMSRELLA LMB EXCESS LAB X OCCUR • CLAIMS -A 21HHUQ07292 0210112012 02/0112013 EACH OCCURRENCE $ $ . $ 1,000,000 1,000,000 IIII AGGREGATE DEDUCTIBLE RETENTION $ 10,000 COMPENSATION X WORMERS $ C AND EMPLOYERS' LIASU.rn' OPRCEWMEMBER EXOLuoED? II yyee�� describe NH) under DESCRIPTION.OFOPERATIONS Y/ N N / A 0830 -27445 44/08/2012 04/0612013 i X E l - CUTIVE ■ E.L EACH ACCIDENT $ $ $ - 1,000,000 1,000,000 10000, 000 below El. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT )ESCRIPTION OF OPERATIONS 1 LOCATIONS t VEHICLES (Attach ACORD 101, Addlfonal Remarks Schedule, If more space le required) :ERTIFICATEWr)I _ nPR ________ ----_ -- =AX: 305.756.8972 City of Miami Shores 10050 NE 2 Ave Miami Shores, FL 33137 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ■CORD 25 (2009100) AUTHORIZED REPRESENTATIVE Alex Perez /3MC ®1988 -2009 ACORD CORPORATION. All rights reserved, The ACORD name and logo are registered marks of ACORD