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PL-13-459p Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 186928 Permit Number: PL- 3- 13-459 Scheduled Inspection Date: March 28, 2013 Inspector: Hernandez, Rafael Owner: MENDOZA, ERNESTO Job Address: 149 NW 106 Street Miami Shores, FL 33138- Project: <NONE> Contractor: SR0061536 MR C'S PLUMBING & SEPTIC INC Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Septic Phone Number Parcel Number 1121360080280 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 March 28, 2013 For Inspections please call: (305)762 -4949 Page 3 of 12 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 ID BUILDING Permit No. L- 1 -9S1 PERMIT APPLICATION Master Permit No. Permit Type: PLUMBING JOB ADDRESS: 1 % t\l/3 lb t, S� City: Miami Shores County: Miami Dade Zip: 3 3 ] S Folio/Parcel #: 11'a.VIC °— (6 DIT.) Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): Gfi 1 Z Phone #: &' S-4C S— Address: ft1 f 1C it City: /4144-t, ; State: e.._ Zip: 3l 5 O Tenant/Lessee Name: Phone#: . Email: CONTRACTOR: Company Name: i t (S /616 115 T Phone# ; 0-‘37 77.T Address: % i4 Jot DOW a l`'g`r City: /4-.. P. P State: fL zip: 33 /6Gl Qualifier Name: K . P e--6fuc. Phone #: 3D,5-6517tJ �I State Certification or Registration #: -52 O / 6-3‘ Certificate of Competency #: Contact Phone#: Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ a ///U . W Square/Linear Footage of Work: 3� Type of Work: ❑Address OAlteration ONew OTepair/Replace ODemolition Description of Work: f ,/ztt.c //ee ******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Submittal Fee $ t Permit Fee $ / CCF $ CO /CC $ Scanning Fee $ 1� Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ t ° 4G�" Bonding Company's Name (if applicable) Bonding Company's Address, City State Zip Mortgage Lender's Name (if Mortgage Lender's Address City applicable) State Zip Application is hereby made t obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the iss ance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdicti n. I understand that a separate permit must be secured for FT F.CTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNA S, BOTLRRS, 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 co struction 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the , f Tst inspection whic occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection wjll not be approv d and a reinspection fee will be charged. r ` tii Signature , (r E. U r-ti0/7& Signature Li: 'owner or Agent Contractor The foregoing instrument V,cas acknowledged before me this The foregoing instrument was acknowledged before me this ? day of , 20 b fg 7.0 AN ! ill-A , day of M 4'R Cl4 , 20 /3_, by Lae 1. l 3 who is personally known to a or who has produced is personally known to m)ar who has produced ("-- As ide tification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: Sign: "" KEMBLE t ITK Print: t , '''.. AN COEMMISSl0N 8 00 891340 ° EXPIRES: September 14, 2013 My Commission Eoff :0 Bonded Thru Notary Public Underwriters APPROVED BY NOTARY PUBLIC: Sign: Print: My Co r _ Notary Public Skate of Florida Sheryl A Mendes My Commission EE0175t3 or rces 1012312014 7*** Plans Examiner Zoning Structural Review Clerk (Revised3 /12/2012)(Revised 07 /10 /01)(Revised 06 /10 /2009)(Revised 3/15/09) REPAIR MIAMI-DADE COUNTY HEALTH DEPARMENT STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: Emesto Mendoza PERMIT #:13 -$C- 1458595 APPLICATION #: API 099294 DATE PAID: FEE PAID: RECEIPT #:. DOCUMENT # : PR899024 PROPERTY ADDRESS: 149 NW 106 St Miami, FL 33150 LOT: 12 BLOCK: 205 SUBDIVISION: PROPERTY ID #: 11- 2136- 008 -0280 [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 1 900 ] GALLONS / GPD septic tank CAPACITY A [ ] GALLONS / GPD CAPACITY N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ] D R A I N F I E L D 0 T H E R [ 300 ] SQUARE FEET bed configuration SYSTEM [ ] SQUARE FEET SYSTEM TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND CONFIGURATION: [ ] TRENCH [g] BED [ ] LOCATION OF BENCHMARK: FFE 12.5' NGVD ELEVATION OF PROPOSED SYSTEM SITE BOTTOM OF DRAINFIELD TO BE FILL REQUIRED: ] INCHES [ 22.80 ] [I INCHES I FT ] [ ABOVE 4 BELOW b BENCHMARK /REFERENCE POINT [ 56.80 ] [) INCHES r FT ] [ ABOVE A BELOW b BENCHMARK /REFERENCE POINT EXCAVATION REQUIRED: [ 46.00] INCHES 1.- Existing 900 gal. septic tank, certified by Mr. C's Plumbing & Septic on 2/28/2013 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. 5. -Invert elevation of drainfield to be no less than 8.27' NGVD. 6. -Bottom of drainfield elevation to be no less than 7.77' NGVD. (Comments Continued on Page 2.) SPECIFICATIONS BY: Kemble Ettrick APPROVED BY: ���� o,'a TITLE: TITLE: Dade cfm DATE ISSUED: 03/05/2013 EXPIRATION1, DATE : 06/03/2013 DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E- 6.003, FAC ��� 1 of 3 The contractor (or designee) is!'rers_iirecl to pert 1.1.4 AP1099294 5001 boring adjaWhillAte dradi'field exnvalicn at The brie of final inspection: Prior to Final Approval, the DOH inspector small witness the soil h©,'irtig and compare the results t0 the original site evaluat On scbrnittc '. A reinspection tee will he rsessed if the contractor is not at the jabsite at the arranged Uil DOCUMENT #: PR899024 The system is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total estimated sewage flow of 300 GPD. STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATION APPLICANT: Emesto Mendoza CONTRACTOR / AGENT: MrC "s LOT: 12 SUBDIVISION: APPLICATION # API099294 PERMIT # 13-SC- 1458595 DOCUMENT # SE891783 BLOCK: 205 ID# : 11- 2136- 008 -0280 TO BE COMPLETED BY ENGINEER, HEALTH DEPARTMENT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEERS MUM 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: NET USABLE AREA AVAILABLE: 0.21 ACRES RESIDENCES- TABLE1 1500 GPD /ACRE OR 450.00 SQFT UNOBSTRUCTED AREA REQUIRED: BENCHMARK /REFERENCE POINT LOCATION: ELEVATION OF PROPOSED SYSTEM SITE FFE 12.5' NGVD 22.80 OTHER -TABLE 2 ] SQFT 2500 GPD /ACRE 450.00 INCHES / FT 3 [ 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 [ ]N0 WELLS: PUBLIC: N/A FT LIMITED USE: N/A FT PRIVATE: N/A FT NON- POTABLE: N/A FT BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: 15 FT POTABLE WATER LINES: 20 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 # /Color Urban land Texture Depth 10YR 3/1 Sand 0 To 6 10YR 5/4 Sand 6 To 24 10YR 5/4 Oolitic Umestone 24 To 72 OBSERVED WATER TABLE: NGVD 10 YEAR FLOODING? [ ]YES [X]NO] ] SITE ELEVATION: 10.60 ET [ 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 24 10YR 5/4 Oolitic Umestone 24 To 72 INCHES [ABOVE / BELOW ] EXISTING GRADE TYPE: ESTIMATED WET SEASON WATER TABLE ELEVATION: [ PERCHED / APPARENT 85 INCHES [ABOVE / BELOW ] EXISTING GRADE HIGH WATER TABLE VEGETATION: [ ]YES [X]N0 MOTTLING: [ ]YES [X]NO DEPTH: INCHES ] SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: Replacement 4-F6/0.60 DEPTH OF EXCAVATION: 46 INCHES DRAINFIELD CONFIGURATION: [ ] TRENCH [X] BED [ ] OTHER (SPECIFY) REMARKS /ADDITIONAL CRITERIA SITE EVALUATED BY: DATE: 02/28/2013 Ettrick, Kemble (ntle: ) (Mr. Max Septic Servi) DH 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated: 64E- 6.001, PAC Page 3 of 4 A P1099294 EID1458595 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 govemed 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.