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PL-11-1962Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 165797 Permit Number: PL -10 -11 -1962 Scheduled Inspector: do Date: Septem er 28, 2012 Owner: GRAHAM, BARBARA Job Address: 9132 NE 3 Avenue Miami Shores, FL Project <NONE> Contractor: A AMERICAN SEPTIC & PLUMBING Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Septic Phone Number (305)751 -8765 Parcel Number 1132060133360 Phone: (305)866 -5600 Building Department Comments 900 GALLONS SEPTIC TANK 225 DRAINFIELD IN TRENCH CONFIGURATION Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments HRS IN FILE GRASS AND SIDEWALK TO = ADDRESS WITH PERMIT# DS12 -1784 September 28, 2012 For Inspections please call: (305)762 -4949 Page 2 of 18 ) ) TANK INSTALLATION [01] TANK SIZE [1] ` . t [2] [02] TANK MATERIALQ L'- -[03] OUTLET DEVICE -a. [04] MULTI - CHAMBERED (/ N ] , [05] OUTLET FILTE �% -� [06] LEGEND ' +t`.? ^ tf ; ,43 C 9 [07] WATERTIGHT [08] LEVEL [09] DEPTH TO LID DRAINFIELD INSTALLATION [10] AREA [1]! O [2] SOFT [11] DISTRIBUTION BOX HEADER [12] NUMBER OF DRAINLINES [13] [14] [15] [16] [17]. [18] [19] [20] [21] DRAINLINE SEPARATION': DRAINLINE SLOPE DEPTH OF COVER ' ELEVATION [ABOVE BM SYSTEM LOCATION DOSING PUMPS r` ^` AGGREGATE SIZE 41- AGGREGATE EXCESSIVE FINES, AGGREGATE DEPTH T°t9. FILL / EXCAVATION MATERIAL [22] FILL AMOUNT ix ,i [23] ', FILL TEXTURE [24] EXCAVATION DEPTH [25] AREAREPLACED [26] REPLA E, T MATERIAL EXPLANATION OF VIOLATIONS / R)►ARKS: oz. cif SETBACKS [ ] [27] SURFACE WATER FT [ ] [28] DITCHES FT [ ] [29] PRIVATE WELLS FT [ ] [30] PUBLIC WELLS FT [ 1 [31] IRRIGATION WELLS FT [ ] [32] POTABLE WATER LINES ! FT [ ] [33] BUILDING FOUNDATION r / FT PROPERTY LINES / ; FT OTHER FT [34] 1 [35] FILLED / MOUND SYSTEM [36] DRAINFIELD COVER [37] SHOULDERS [38] SLOPES [39] STABILIZATION 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 GRADING r [47] CONTRACTOR+ [48] OTHER ABANDONMENT [49] TANK PUMPED [50] TANK CRUSHED & FILLED CONSTRUC 'r +► ' "' • ED /DISAL'PRO FINAL SYST: ti APPROVE`> /DISAPPROVED]: DH 4016 (Page 2), 10/97 (Previous Editions May Be Used) Stock Number: 5744- 002 - 4016 -4 CHD DATE! ` CHD DATE' PT 1: Applicant PT 2: Installer /Contractor PT 3: Building Department PT 4: Health Department Page 2 of 3 Recycled G Pay, OCT. 24. 2011 8:53AM ERMDO3r j--.- (pc( 05 STATE OP" 'LORIDA DEPARTMENT OF REALTI3 ONSYTE SEWAGE TREATMENT AND D =SPOSAL SYSTEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR; OSTDS Repair APPLICANT : Barbara Graham NO, 456 PERMIT #; 13-SC- 1374506 APPLICATION * AP 1050228 DATE PAID: FEE PAID: • 8ECEIYT #:. DST #: PR857238 _ PROPERTY ADDRESS: 9132 NE 3 Ave Miami, FL 33138 LOT: 1 BLOCK; 25 suecro'ISION: Miami Shores Sec 1 Amd LSCl'ioN, TOWNSHIP, RANGE , PARCEL NUMBER] [OR TAX ID Ni3MB A) PROPERTY ID #: 11- 3208 -013 -3360 SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION 381.0065, F'.S., AND CHAPTER 64E -6, 'F".A.C. DDPARTMeNT APPROVAL OF SYSTEM DOES NOT GUAR TEE SATISFACTORY PERFORMANCE FOR ANY' SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL PACTS, WHIC1r SERVED As A EA.SIS F'OR ISSUANCE of T'RIS PERMIT, REQU3R2 Tam APPLICANT TO MODIFY THE HERMIT APPLICATION. SUCU ,MODIFICATIONS WAY RESULT IN TBXS PERMIT BEING MADE NULL AND VOID. ISSUANCE OF TATS PERMIT DOES NOT EY:EMPT THE APPLICANT FROM COMPLIANCE WITH OTBER FEDERAL STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY. SYSTEM DESIGN AND SPEC /F'ICATIMM T [ 800 ] GALLONS / i;PD : Septic CAPACITY • A I 0 2 GALLONS / GPP CAPACITY N 1 0 ] GALLONS GREASE INTERCEPTOR CAPACITY (QOM CAPACITYY SINGLE TANN:1250 GALLONS) N L ] GALLONS DOSING TANK CAPACITY 1 ]GALLONS 9[' 'IDOSES PER 24 RAS #Pumps [ ] D I 225 3 %QUARE FAT sxsx�a R [ 0 ] SQOARB FEET SYSTEM A TYPE SYSTEM [x3 STANDARD [ I FILLED [] MOUND [ ] I CONFIGURATION: [x] TRENCH L 7 SED I y.. N F LOCATION or BENCHMARK: F.F.E.; 11.7' NGVD f ELEVATION OP PROPOSED SYSTEM SITE [ 20.40 3 LI u c $ / FT 11 ABOVE S S.00r SENC /RECCE POINT E BOTTOM OF Mawr nip- TO in 1 49.40 ] El =cams], FT 1 I ABOVE 4 sELOWlIBENC ZC /aNPMNCE P0ita L D FILL REQUIRED: L 0.00 ] INCHES EXCAVATION REQUIRED: I 29.002 INCHE3 1— Install 900 gal. category-3 septic tank equipped with an approved filter. 2 -The Iicensed'contractor installing the system O is responsible for installing the minimum category of tank in accordance with sec. 64E- 8.O13(3)M. 3- Install 225 sf of T drainfield in trench configuration. 4- Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed H absorption trench. 5 -Invert elevation of drainfeld to be no less than 8.18' NGVD. 6. Bottom of dr'ainfleld elevation to be kis ;-. ., no less than 7.68' NGVD. 7. This permit includes the Abandonment of existing tip; p THIS PERMIT IS NOT FOR ADDITION(s). .. ". R iiii,414 6 4 4A 1 (4 SPECIFICATI APPROVED H DATE YSS De 4016, 0B /09 �T CYAN' 4 editi6n3 phial: may Incorporated: ��P l�gS n Ar/'� ra*, �e �i! ?a sa: 4- ' &�reV - red Anommo ��thee s? o o�j /o era d ds/4 �/Y 'gAp �� tea, 114q /f49 fi 424, rye .4 the not toe used) Dade CAD ExRATION DATE: .01/19/2012 ss854i32 Page 1 of 3 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 2Qc Permit Type: PLUMBING OWNER: Name (Fee Simple Titleholder): j44fbb& C L'� Phone #: /! cG '�� 4 �� Address: 9/32 4E 5 City: 1 Gt/&Ai %,.SJ710trk n State: Zip: (J i3$ Tenant/Lessee Name: Phone #: Email: Permit No. Master Permit No. JOB ADDRESS: ads City: Miami Shores Folio/Parcel #: Is the Building Historically Designated: Yes County: Miami Dade Zip: NO Flood Zone: CONTRACTOR: Company Name: l`4 1) VVt9/f C f1I .-c _ Phone#: Address: / S 5- 6 ®,J ca-}(�°� Bud_ • v1• L 9 �'C) City: / (Ld.� State: L Zip: 3 3 /B/ Qualifier Name: Phone#: State Certification or Registration #: Certificate of Competency #: Contact Phone #: Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: °Address °Alteratti on g New °Repair/Replace °Demolition Z'UI-' Description of Work: : �,/{��. N 1 ( PO 1 '° /16, +x********** :. x** ***+xu:****.r**x:*********** Fees**** ***** ***x: ****x• **** *******x:*****.x******** Submittal Fee $ Permit Fee $200 -0 3 CCF $ CO /CC $ Scanning Fee $ -E.D —r Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 0 CDS 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 CONDmONERS, 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 Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this 27 The foregoing instrument was acknowledged before me this day of OPT, 20 12, by 13 J , day of , 20 _, by who is personally known to me or who has produced fl who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: V 0111111111101/41 . : . • % Sign: Sign: =.. -- : - Print: z.: ow ., :...,- 44' %. 'z' Fc, . �� My Commission ommission Ex ires: M Commission Expires: " ° 4 r `'L NOTARY PUBLIC: APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) l 6(t UILDING PERMIT APPLICATION Master Permit No. FBC 2004 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 VED 8tt27011 BY: Permit No. Q) lor6 Permit Type: Plumbing Owner's Name (Fee Simple Titleholder) 34tr to (4r A q'1' ah & M Phone # f t 11 -41 9 4 61.0 Owner's Address 4132 WE 3 ftre- citywamti Shores State Zip 33 in Tenant/Lessee Name Phone # E -MAIL: Job Address (where the work is being done) Q132- tt 3 AV UL City Miami Shores Village County Miami -Dade Zip 33(3? FOLIO / PARCEL # 3Z0 (O' 0 3 — 3 3 (O 6 Is Building Historically Designated YES NO Contractor's Company Name tA'IYe,'1 �� + P `GY 31)- (auto Z Contractor's Address 1 iscc Ciacztyne Lu' J 'a-410 City 4 • m5 tLrv' t state " � PL. Zip 331 Qualifier Name d, TD--Ah %/1 V1fH U ( p-a Phone # (p 2-30 scetq State Certificate or ReAlistration No. Se P b Certificate of Competency No. 5$- 0-0 0 0 T41" E- MAIL:i'vta v K- (4) atti, e-r'ic..attp L mto vng Inc, l om . Architect/Engineer's Name (if applicable) t 1 'm Phone # pJ Value of Work For this Permit $ "'Y`" ' Square / Linear Footage Of Work: Type of Work: []Addition []Alteration Describe Work: ❑New \A Repair/Replace ❑ Demolition I ra.i r f 1il Ref alr + ref [ate ***************************************F le******************************************* Submittal Fee $ Permit Fee $ 3c 0 CCF $ CO /CC Notary $ Training/Education Fee $ Technology Fee $ Scanning $ Radon $ DPBR $ Zoning $ Bond $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ (A _ See Reverse side —> Bonding Company's Name (if applicable) Ileaufmg -Company's Address City - State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City 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 A191-4,&2-4.&) Owner or Agent The foregoing instrument was acknowledged before me this -__ day of DC-- ,20 Ll ,by Jazai Z. who is personally known to me or who has produced -F`,,. As identification and who did take an oath. NOTARY PUBLIC: Sign: 7 �n 1'rint:� azz i NOTARY PUBLIC-STATE OF FLORIDA C C I TAia f e A ;II :, mow -.. sal..,.,.. .. vin (jl —j�LZ My Commission Expires: APPLICATION APPROVED BY: (Revised 02/08/06) Contractor The foregoing instrument was acknowledged before me this day of be-01— , 20 tl , by 4-0.7.241114n CflQ. wn to me or who has produced -'t as identification and who did take an oath. who is NOTARY PUBLIf4TARy pum J STATE OF FLORIDA fho _� .1n s Sign: �"® 'y Ex �r V E'� ,fitf±lla`. Print -J t 2 BfkiLBll WIC BONING Ca, ING '1 L Yl My Commission Expires: Plans Examiner Engineer Zoning Registered Septic Tank Contractor WILLIAM M WOODARD 12555 BISCAYNE BLVD. #970 NORTH MIAMI FL 33181- A AMERICAN SEPTIC & PLUMBING, INC. Business Authorization: SA0000947 SR0001342. Registration Expires on September 30, 2012 FIRST-CL ASs U.S. POSTAGE PAID fl: fl- THIS IS NOT A BILL — DO NOT PAY 423171-8 RENEWAL BUSINESS NAME 1 LOCATION REC�r 441 883�i A AMERICAN SEPTIC <& PLUMBING INC CC# SEP000947 17027 W DIXIE HWY 112' 33160 NORTH MIAMI BEACH OWNER A AMERICAN SEPTIC PLUMBI IG INC See. T of Business es 196A SPECIALTY PLUMBING CONTRACTOR Blear; TAX RECEIPT:IT WIDER TO IROIATE ANY zONING UMW OF THE COUNTY OR ones. io DOES n.T HOLDER FROM ANY OTHER MINT REQUIRED BY LAW. HOT A ON -+ DO NOT FORWARD A AMERICAN SEPTIC & PLUMBING INC WILLIAM MARK WOODARD PRES 12555 BISCAYNE BLVD 970 PMMERTMWOMM NORTH MIAMI FL 33181 mammosommwrim 08/30/2011 60020000337 000045.00 SEE MI