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PL-13-73
Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 193397 Permit Number: PL- 1 -13 -73 Scheduled Inspection Date: June 12, 2013 Inspector: Hernandez, Rafael Owner: ORTH, SCOTT ALLAN & MARCY Job Address: 9707 NE 5 Avenue Road Miami Shores, FL Project: <NONE> Contractor: STATEWIDE SEPTIC CONNECTIONS Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Septic Phone Number Parcel Number 1132060180030 Phone: (954)963 -0082 Building Department Comments REPLACE BROKEN SEPTIC TANK AND INSTALL NEW 1050 GALLON TANK 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 CREATED AS REINSPECTION FOR INSP - 184145. need hrs HRS IN FILE June 11, 2013 For Inspections please call: (305)762 -4949 Page 32 of 38 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 193397 Permit Number: PL- 1 -13 -73 Scheduled Inspection Date: June 13, 2013 Inspector: Hernandez, Rafael Owner: ORTH, SCOTT ALLAN & MARCY Job Address: 9707 NE 5 Avenue Road Miami Shores, FL Project: <NONE> Contractor: STATEWIDE SEPTIC CONNECTIONS Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Septic Phone Number Parcel Number 1132060180030 Phone: (954)963 -0082 Building Department Comments REPLACE BROKEN SEPTIC TANK AND INSTALL NEW 1050 GALLON TANK 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 CREATED AS REINSPECTION FOR INSP- 184145. need hrs HRS IN FILE June 12, 2013 For Inspections please call: (305)762 -4949 Page 22 of 36 TANK INSTALLATION [ i>i [01] TANK SIZE [1] [ [02] TANK MATERIAL [ J [03] [ rY [04] [ .% [05] 0 [2) r OUTLET DEVICE -y" MULTI- CHAMBERED OUTLET FILTER [ A [061 LEGEND / S% /3 [ / [07] WATERTIGHT [ 4j [081 LEVEL [ 1 [091 DEPTH TO LID. /1... it_ 1 1 1 ] 1 1 1 DRAINFIELD INSTALLATIQN: `_.. [10] AREA [1] "" [2] SQFT (11] DISTRIBUTION BOX _ HEADER [12] NUMBER OF DRAINLINES [13] DRAINLINE SEPARATION [14] DRAINLINE SLOPE [15] DEPTH OF COVER [16] ELEVATION [ABOVE /BELOW] BM [ [17] SYSTEM LOCATION [ [18] DOSING PUMPS [ J [19] AGGREGATE SIZE �//�� [ ] (20] AGGREGATE EIC1;SSI'VF/FN'EIS [ [21] AGGREGATE DEPTH A/ FILL / EXCAVATION MATERIAL [ ✓Y [ 1 [22] FILL AMOUNT [ ] [ ] [23] FILL TEXTURE [ ] [24] EXCAVATION DEPTH [ ] (25] AREA REPLACED [ 1 [26] REPLACEMENT MATERIAL EXPLANATION OF VIOLATIONS / REMARKS: [ ] [ 1 ] [ ] SETBACKS [27] SURFACE WATER FT [28] DITCHES FT [29] PRIVATE WELLS FT [30] PUBLIC WELLS FT [31] IRRIGATION WELLS FT [32] POTABLE WATER DINES '7,j FT [331 BUILDING FOUNDATION 5 FT [34] PROPERTY LINES '7 FT [351 OTHER FT FILLED / MOUND SYSTEM [36] DRAINFIELD. COVER [37] SHOULDERS [38] SLOPES [39] STABILIZATION ADDITIONAL INFORMATION [40] UNQBSTRUCTED AREA [41] STORMWATER RUNOFF [42] ALARMS [43] MAINTENANCE AGREEMENT [44] BUILDING AREA [45] LOCATION CONFORMS WITH SITE PLAN [46] FINAL SITE GRAD [47] CONTRACTOR [48] OTHER (� ABANDONMENT , { g [49] TANK PUMPED ! / -23//3 (nQ�] [50] TANK CRUSHED & FILLED 7- //3 CcP CONSTRUCTIOPROV /DISAPPROVED] 4,74-P-1/ 'INAL SYST [APPRO /DISAPPROVED] '16, 08/09 (Obsoletes all previous editions which may not be rated: 64E- 6.003, FAC used) MD DATE: I 3')3 CHD DATE/ -3 - Page 2 of 3 BUILDING Miami Shores Village Building Department IOW N.E2nd Avenue, Miami Nimes, Florida 11138 Tel: (305) 795.2204 Fa= (305) 756.8972 likWECTION'S PHONE NUMBER: (395) 762.4949' JAN 1,t1 B Y: ........... FBC 211 Permit No. PERMITAPPLICATION- •-• • ••• -, • Permit Type: PLUMBING Jos Amara*. 9107 N E qY: fortoParcems ***am { .'• 5 Ave Rol • ; • •;,;.; ; OWNER: Name (Fee Simple Tidebokter): Sq,) Address: 17 t:Vi' rCf1,.'! ?),0s--6- CONTRACTOR: ColnPanY Num $1-61+- 0G633 Aare= (9059 S23 City: M k rctre‘Ct r state: FL QUalliri 14881e: Te;:es:,a. 40 L ,F-rio,-, State Certification or Registration' #: S. 11 1 c;p: 2. ' Certificate of COMpetencY # CoMact Phone* Email Address.' DESIGNER : Architectifingineer: Value of Work for this Permit: Type of Warta CiAddress Deseritilion of Work: T&r re/7 q ork t 2 3 go 23' SquarelLinear Footage of Work: to So OAkiXat011- I:Mew s cfp' o+i Menvoinion F4 f,e, Trk7:Kteel k 0 So °Mon c eL9 , , ■ 1 , , Subedital Fee $ Peen* Fee $ (57) CCF $ COICC $ Seenarag Fen $ Radon Fee $ , , 110,FR $ Road $ Nanny $ TridninfReintion Fee $ Teeltwiew Fee $ Double Fee $ SOnstieval Review $ TOTALFERNOWDUR (a (-.• Boudhog Company's Name (if applicable) Bonding Company's Address City Mortgap Lender's Name (if antlicable), t , ' Mortgage Lender's Address aty - - - ZIp Application is hearhy made to obtain *on* *.l.do dm work and installations as inailitikh tairti* A P‘ octonnenced prime to the issuance of a permit and that au VOA will be performed to it *be standouts of all laws regalia* coustrudion in this jurisdiction. 1 unthorstand that a separate permit must be secured for ELECTRICAL WORK, PLUMING, SIGNS, WELLS, POOLS, FUNACES, BOK.EitS, HEATERS, TANKS and AIR CONDITIONERS, EKte, °WM'S AnteMAVTI: I eerily that alt the frangoing itdormaion is accurate and that an work will be done in compliance with alt appflicable laws Insulating consuuction and zoning. t "WARNING TO °OWNER: YOUR FAILURE TO RIECORIf A 'NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING 'IVICE rou D4E110kVEMENTS TO YOUR PROPERTY. IF YOU TO xOBTAIN ETNANCING, CONSULT WITH YOUR LENDER OR AN ATTOItNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a builifing permit withan estimated value exceeding $2500, the applicant promfre in ore faith that © of the 710111Ce of arinkmaticement and coristractket nen knv brochure will be detiverett to the person whose property is subject to attachment Also, a certifted copy of the tecorded notice of commencement ants be posteit' Erthe joib eite for the ftrst inspection which occurs seven (7) days after the build* g permit is Lava ht the absence of such posted notice, the inspection Win Wet be appoved wed fee will be charge& The foregoing Monument was acknowledged befbre me this day of k361.N , tINCk Ce:-/ , day who is pasonany known to ne or who has Produced ? who _ As idemificatint mut who did take an oath. NOTARY PUBLIC: Signature 11111 • w Sign Print My Con-Mission Expires: ■47:1 11AL aclutowhodged se? or who has pmduced as identification awl who ertil take an oath. NOTAR PUBLIC: e-0-1411; TERESA zaw MY COMMISSION # EE131936 EXPIRES November 08, 2016 FloildeNotaryServte.com APPROVE!) BY Sign: Prim: My CI -H1711t. 111 111‘ a "1."Nr7. WPAt'41'111ro afyir fru 4111'crr:, aide • M Cm .3' A opV - COMMiS4faie Eiloollnitr' Bonded Through National Notary Assn. - • Plinitianitter Zoning • ••'; 'ltriiieturatiteview- attit•'• (Revised3/1212012Xitevaand 07 , AVIN*93/044,14014r,Se9) STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: Scott & Marcy Orth PERMIT #:13 -SC- 1448663 APPLICATION #:API093359 DATE PAID: FEE PAID: RECEIPT #: Doct»ENT #: PR894105 PROPERTY ADDRESS: 9707 NE 5 Ave Rd Miami, FL 33138 LOT: C BLOCK: 98 SUBDIVISION: Miami Shores Sec 4 PROPERTY ID #: 11- 3206 -018 -0030 [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 [ 1,050 ] GALLONS / GPD Septic CAPACITY A [ 0 ] GALLONS / GPD CAPACITY N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ] D [ 225 ] SQUARE FEET existing SYSTEM R [ 0 ] SQUARE FEET SYSTEM A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ] I CONFIGURATION: [ ] TRENCH [x] BED [ ] N F LOCATION OF BENCHMARK: FFE: 11.4'ngvd I ELEVATION OF PROPOSED SYSTEM SITE E BOTTOM OF DRAINFIELD TO BE L D FILL REQUIRED: 0 T H E R SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: [ 0.00 ] INCHES [ 24.00 ] [) INCHES if FT ] [ ABOVE /) BELOW b BENCHMARK /REFERENCE POINT [ 60.00 111 INCHES I FT ] [ ABOVE /) BELOW 11 BENCHMARK /REFERENCE POINT EXCAVATION REQUIRED: [ 0.00 ] INCHES - Install 1050 g septic tank. - 4 comers of existing drainfield to be exposed for inspection. - The system is sized for 4 bedrooms with a maximum occupancy of 8 persons, for a total estimated sewage flow of 400 g /d. - Not for additions Teresa J'ln TITLE: Master Septic Tank Contractor TLE: Engineer Specialist II DH 4016, 08/09 (0• etes all previous editions which may not be used) Incorporated: 64 6.003, FAC v 1.1.4 AP1093359 Dade CHD EXPIRATION DATE: - 04/10/2013 8E887179 Page 1 of 3 ATE; FLORIDA emu" DEPARTMENT OF HEALTH APPLICATION FOR ONS!TE SEWAGE. DISPOSAL SYSTEM'CONSTRUGTION PERMIT Permit Application Number -- PART`II - SITE PLAN ---- Scale: Each block represents 5 feet and 1 inch = 50 feet "# : : "^ t } } : :"•1 # # x x F # • E i ii } i ; i ¢ v i� � � i — ! J { > C .. ` f # # } } Y r # # # , yj { Y1! ¢ { } i { } I • ,1 T = } € { 9 ; j p Ip [ y t }" — t i —Ti- r It: i -„ate! i .,,.yj.�( E f- ...f'.i (_"`{ 5 E x f'f £ 1 2 i£ i t- • i � •: i 3 t 5¢ 3 E 1 F 1 E I I 3£ P '' • } •yl , } i i 3 t - }i • i3 i • I �� 'lf.;:al�_. ' 4.'� ' ,tyrRp ' i' i i F v9 r y I i i• ( l f F . 'Y ., # 2 5.. } F } ! ,� j i'- -� - #_w \ \S- ii...E: ¢}. D r t 4 � ,di'_' > �!/l7 ' '`�1 F �xpt►�� ! $ l >t' Q Nil % t ¢ L ¢ ( i} = t •^�-- i % i a } # } } J 3E L L x `� i } E } } .. i if o }(( � �„`� ;,.1 € } i—� ,. }' i'`"..,w €— ..•...,1 ; j ,i y}' ' {(£- } 1 / ill- . �. 1 1 i �>+ � i? /A[fJ �'.I�t { 'k V •`• i i P_`. �t..j�3 • i ; �_.. {�t7�, i ''t -' 3 S t i• F j o,:' . t f r I 2 ' ( } 3 : i i E a r t¢,,,,f, t g l "'i f i :. # , ,I �'.. . • • i i i 1 t y y ii 3 331£ i y1? { e'!'i� £��£..,3ifj# i 3 f .,�._� F 3 i4i(ii € E�'¢ • £ i x ¢ :. } } } l ll� 3 3. f f" J JJ _ { I f ( _ `� 1 1._ i kF '� i £- £ -`E " ". } 7 } '��i - qn{i� t J} i µ - .¢,.A._.1... • i ! •' i j.; $ ! _„ . . } 7 > t t 3 J J i i — } It : 1 —I } I '. I a ?i,` S S ^' g g_.i i I ' ; F £ 4 4� ..# 1 '- . z,., _ _•.i. j - # ; £ • .. -s--}. 1 _ ¢ b' I I . .,.t.,_..• } .: } �', f ftiijl µ ., 't � .Y ' ' . i i • .f...Hi i i , ,rt 1. E j 1 L • -.. .-d : •+ — F i �, 4 .L . Site Plan submitted by: rt Plan Approved County Health Departmen'.; ALL CHANGES MUST BE APPROVED' BY THE COUNTY' HEALTH DEPARTMENT 014 4015, 10(06 (Replaces 14115 -14 Form 4015 which may beused) {Stock Number: 5744- 002 - 4015 -6J