PL-13-666Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 188563 Permit Number: PL -4 -13 -666
Scheduled Inspection Date: June 24, 2013
Inspector: Hernandez, Rafael
Owner: DAVIS, HERBERT
Job Address: 46 NW 105 Street
Miami Shores, FL 33150-
Project: <NONE>
Contractor: SR0061536 MR C'S PLUMBING & SEPTIC INC
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Septic
Phone Number
Parcel Number 1121360131190
Phone: (305)651 -7859
Building Department Comments
INSTALL DRAINFIELD
Infractio Passed Comments
INSPECTOR COMMENTS
False
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
hrs in file
June 21, 2013
For Inspections please call: (305)762 -4949
Page 10 of 37
DIVISION OF
Enntronmen al Health
Florida Dgartment of Beaith
MiaJnieDa ar my Health Department
3STDSlWeIi Division
11805 5014 St. ° M#am1 L 33175
[ ] [
[ [03] OUTLET DEVICE
[04] MULTI- CHAMBERED ( Y /05l
(05] OUTLET FILTER ,f
[06] LEGEND
[07] WATERTIGHT
[08] LEVEL
02] TANK MATERIAL
[ ] [27] SURFACE WATER
[ l [28] DITCHES
[ ] [29] PRIVATE WELLS
PUBLIC WELLS r—
IRRIGATION WELLS _
POTABLE WATER LINES • Q
BUILDING FOUNDATION �-
PROPERTY LINES "- J.
OTHER _;-
I ] [30]
( [31]
[32]
[ -'r [33]
[ -'J/ [34]
[35]
(09] DEPTH TO LID `7
DRAINFIELD INSTALLATION
[10]
[111
[12]
[13]
[14]
[151
[16]
[17]
[18]
[19]
[20]
[21]
AREA [1] [2] 3a aSQFT [
DISTRIBUTION BOX HEADER /4' I
NUMBER OF DRAINLINES [
DRAINLINE SEPARATION .2. y m..� I
DRAINLINE SLOPE
DEPTH OF COVER /4 ''
ELEVATION (ABOVE BM
SYSTEM LOCATION,jy-
DOSING PUMPS
AGGREGATE SIZE .", l_
AGGREGATE EXCESSIVE FINES
AGGREGATE DEPTH .h✓
FILL / EXCAVATION MATERIAL
[221 FILL AMOUNT ®k
[23] FILL TEXTURE
[24] EXCAVATION DEPTH
[25] AREA REPLACED
[26] REPLACEMENT MATERIAL
EXPLANATION OF VIOLATIONS / REMARKS:
]
1
l
l
J
FILLED / MOUND SYSTEM
[36] DRAINFIELP COVER
[371 SHOULDERS
[38] SLOPES
(39] STABILIZATION
FT
FT
FT
FT
FT
FT
FT
FT
FT
ADDITIONAL INFORMATION
[a-4.-- [40] UNOBSTRUCTED AREA
[41] STORMWATER RUNOFF
[ ] [42]
.[ , ] [43]
[ __.3 [44]
[� [451
[ (46]
[ [47]
[ 1 [48]
ALARMS
MAINTENANCE AGREEMENT
BUILDING AREA
LOCATION CONFORMS WITH SITE
FINAL SITE GRADING
CONTRACTOR
OTHER
PLAN
ABANDONMENT ).--,41
[
11 [49] TANK PUMPED / / ,J
I 3 [50] TANK CRUSHED & FILLED / /
]
) /
CHD DATE : / ° g^ 1 3
y_ 9 /3
CONSTRUCTIO
/DISAPPROVED]:
D
`INAL SYSTE<iiPPRO /DISAPPROVED] : 6t2A e1 .� --JC' 0 (
`16, 08/09 (Obsoletes all previous editions which may
rated: 64E- 6.003, FAC
not be used)
CHD DATE:
Page 2 of 3
f�i
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 1,0
BUILDING Permit No. PL) 3
PERMIT APPLICATION
Permit Type: PLUMBING
JOB ADDRESS:
City:
A,W l or sr
Master Permit No.
Miami Shores County: Miami Dade Zip: 533 150
Folio/Parcel #: if - /3 6 0/3 -- // z�''O
Is the Building Historically Designated: Yes
NO Flood Zone:
OWNER: Name (Fee Simple Titleholder): 114C6GM a vi5. Phone #: Tir‘ .1,214 477
Address: LF/ 01 /oT s r
City: /N% 3404.49 State: /e2'' zip: .73/3V-
Tenant/Lessee Name: Phone #:
Email:
CONTRACTOR: Company Name: ft r (3 P1/4 ! r^{ , ,f rfre Phone #: s$ $/ 7 Jy
Address: Migo . A/W A' ,/
City: ('s. ... , State: fG-- Zip: ,3$ id,
Qualifier Name: X44-64 &W ".-id Phone #: 30 eV 7 ins,
State Certification or Registration #: Certificate of Competency #:
Contact Phone #: Email Address:
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ g T 5i) • 60 Square/Linear Footage of Work: -360 `?
Type of Work: DAddress DAlteration New epair/Replace ODemolition
Description of Work: , 4St't/ 064iit fel"
************* ****** *************m****** Fees* *************** ***** ** * ***m**********+x*+x***
Submittal Fee $ i, , Permit Fee $ /� 0 . x CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
Technology Fee $
,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 S e 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 FT.RCTRICAL 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 approved and a reinspection fee will be charged.
Owner or Agent
The foregoing instrument was acknowledged before me this It"
day of , 20113, by ,1t V S
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC.
Sign:
Print:
My Commission E ^P1;. KEMBLE ETTRICK
t MY COMMISSION # DD 891340
_ EXPIRES:
September 14, 2013
ita'ss ded Thru NOT)! Public Underwrite
rs
APPROVED BY
Signature
Contractor
The foregoing instrument was acknowledged before me this a
day of April ,20 a, by
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
3 Plans Examiner
Structural Review
(Revised3 /12/2012)(Revised 07 /10 /07)(Revised 06/10/2009)(Revised 3/15/09)
Sign:
State of Ptodda
FY endes
y Commission EE017813
Ir0s 10123/2014
Zoning
Clerk
MIAMI-D ADE COUAt1q .
HEALTH DEP - --
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Herbert Davis
PERMIT #:13 -SC- 1463972
APPLICATION #: AP1102637 '
DATE PAID:
FEE PAID:
•RECEIPT #:
DOCUMENT #: PR901945
PROPERTY ADDRESS: 46 NW 105 St Miami, FL 33150
LOT: 910
BLOCK: 125 SUBDIVISION:
PROPERTY ID #: 11- 2136- 013 -1190
[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, E.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 tank
] GALLONS / GPD
] GALLONS GREASE INTERCEPTOR CAPACITY
] GALLONS DOSING TANK CAPACITY
CAPACITY
CAPACITY
[MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
]GALLONS @[ ]DOSES PER 24 HRS #Pumps [
D [ 300 ] SQUARE FEET bed configuration drainfiel SYSTEM
R [ ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [s] STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [ ] TRENCH Ex] BED [ ]
N
F LOCATION OF BENCHMARK: FFE 13.1' NGVD
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE
L
D FILL REQUIRED:
0
T
H
E
R
] INCHES
[ 25.20 ] II INCHES Y FT ] [ ABOVE 4 BELOW b BENCHMARK /REFERENCE POINT
1 53.20 ] 11 INCHES I FT 1 [ ABOVE 4 BELOW b BENCHMARK /REFERENCE POINT
EXCAVATION REQUIRED: [ 40.00] INCHES
1.- Existing 900 gala septic tank, certified by Mr. C's Plumbing & Septic on 3/28/2013 to remain.
2.- Install 300 sf of drainfield in bed configuration.
3.- Install 12" of slightly limited soil at the bottom of the drainfield.
4.- Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed or drain trench.
5. -Invert elevation of drainfield to be no less than 9.17' NGVD.
6. -Bottom of drainfield elevation to be no less than 8.67' NGVD.
System sized for 3 bedrooms with max occupancy of 6 persons (2 per bedroom), for a total est. sewage flow of 300GPD.
SPECIFICATIONS
APPROVED BY:
DATE ISSUED:
DH 4016, 08/09
Incorporated:
BY:
Kemble Ettrick
Erlande Omisca
04/02/2013
(Obsoletes
64E- 6.003,
all previous
FAC
1.1.4
TITLE:
TITLE: Engineering Specialist II
Dade CHD
EXPIRATION DATE:
h
editions whic tg668r* lY, Vie) is required to perform
soil boring adjacent to the drainfield excavation at the
"P1Rgtime c final inspection. Prieerto 4x01 Approval, the DOH
ctor shall witness the soil boring and compare the
results to the original site evaluation submitted. A
reinspection fee will be asses:er, It the contractor is not
at the jobsite at the arraw iiitid
07/01/2013
Page 1 of 3
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATION
APPLICANT: Herbert Davjs
APPLICATION # AP1102837
PERMIT # 13-SC- 1463972
DOCUMENT # SE894478
CONTRACTOR / AGENT: / MrC 'S
LOT: 9 10
SUBDIVISION:
BLOCK: 125
ID# : 11- 2136 -013 -1190
TO BE COMPLETED BY ENGINEER, HEALTH DEPARTMENT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEERS MUST
PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS.
PROPERTY SIZE CONFORMS TO SITE PLAN: [X]YES [ ]NO
TOTAL ESTIMATED SEWAGE FLOW: 300 GALLONS PER DAY
AUTHORIZED SEWAGE FLOW: 525.00 GALLONS PER DAY
UNOBSTRUCTED AREA AVAILABLE: 450.00 SQFT
BENCHMARK/REFERENCE POINT LOCATION:
ELEVATION OF PROPOSED SYSTEM SITE
FFE 13.1' NGVD
25.20 [
NET USABLE AREA AVAILABLE• 0.21 ACRES
RESIDENCES- TABLE1
1500 GPD /ACRE OR
UNOBSTRUCTED AREA REQUIRED:
/
OTHER -TABLE 2 ]
SQFT
2500 GPD /ACRE
450.00
INCHES
/ FT ] /ABOVE /
BELOW
] BENCHMARK /REFERENCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES
SURFACE WATER: N/A FT DITCHES /SWALES: N/A FT NORMALLY WET: [ ]YES [ ]NO
WELLS: PUBLIC: N/A FT LIMITED USE: N/A FT PRIVATE: N/A FT NON- POTABLE: 30 FT
BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: 5 FT POTABLE WATER LINES: 40 FT
SITE SUBJECT TO FREQUENT FLOODING?
10 YEAR FLOOD ELEVATION FOR SITE:
SOIL PROFILE INFORMATION SITE 1
[ ]YES [ X ]NO
FT [ MSL /
USDA SOIL SERIES:
Munsell ft/Color
Urban land
Texture
Depth
10YR 3/1
Sand
0 To 6
10YR 5/4
Sand
6 To 20
10YR 5/4
Oolitic Limestone
20 To 72
OBSERVED WATER TABLE:
NGVD
10 YEAR FLOODING? [ ]YES [X]NO]
] SITE ELEVATION: 11.00 FT [ MSL /
SOIL PROFILE INFORMATION SITE 2
NGVD
USDA SOIL SERIES:
Munsell #/Color
Urban land
Texture
L
Depth
10YR 3/1
Sand
0 To 6
10YR 5/4
Sand
6 To 20
10YR 5/4
Oolitic Limestone
20 To 72
INCHES [ ABOVE / BELOW ] EXISTING GRADE TYPE:
ESTIMATED WET SEASON WATER TABLE ELEVATION:
HIGH WATER TABLE VEGETATION: [ ]YES
90 INCHES [ ABOVE /
BELOW
/ PERCHED /
APPARENT
] EXISTING
[X]NO MOTTLING: [ ]YES [X]NO DEPTH:
SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING:
DRAINFIELD CONFIGURATION: [ ] TRENCH
REMARKS /ADDITIONAL CRITERIA
SITE EVALUATED BY:
GRADE
INCHES
Replacement 4 -FS /0.60 DEPTH OF EXCAVATION: 40 INCHES
[ X ] BED
] OTHER (SPECIFY)
Ettrick, Kemble (Title: ) (Mr. Max Septic Semi)
DH 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated: 64E- 6.001, FAC
DATE: 03/28/2013
Page 3 of 4
AP1102837 E1D1483972 v 1.0.2
NOTICE OF RIGHTS
A party whose substantial interest is affected by this order may petition for an
administrative hearing pursuant to sections 120.569 and 120.57, Florida Statutes. Such
proceedings are govemed by Rule 28 -106, Florida Administrative Code. A petition for
administrative hearing must be in writing and must be received by the Agency Clerk for the
Department, within twenty -one (21) days from the receipt of this order. The address of the
Agency Clerk is 4052 Bald Cypress Way, BIN # A02, Tallahassee, Florida 32399 -1703. The
Agency Clerk's facsimile number is 850 -410 -1448.
Mediation is not available as an altemative remedy.
Your failure to submit a petition for hearing within 21 days from receipt of this order
will constitute a waiver of your right to an administrative hearing, and this order shall become
a 'final order'.
Should this order become a final order, a party who is adversely affected by it is
entitled to judicial review pursuant to Section 120.68, Florida Statutes. Review proceedings
are governed by the Florida Rules of Appellate Procedure. Such proceedings may be
commenced by filing one copy of a Notice of Appeal with the Agency Clerk of the
Department of Health and a second copy, accompanied by the filing fees required by law,
with the Court of Appeal in the appropriate District Court. The notice must be filed within 30
days of rendition of the final order.