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PL-12-2289Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 182422 Permit Number: PL -12 -12 -2289 Scheduled Inspection Date: June 13, 2013 Inspector: i4e,mcindez cae \ Owner: CARVER, CHRISTOPHER AND (IneocDI V Job Address: I1165 NE 91 Terrace Miami Shores, FL 33138- Project: <NONE> Contractor: STATEWIDE SEPTIC CONNECTIONS Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Septic Phone Number Parcel Number 1132050010180 Phone: (954)963 -0082 Building Department Comments REPLACE 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 June 12, 2013 For Inspections please call: (305)762 -4949 Page 5 of 36 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 Permit Type: PLUMBING JOB ADDRESS: I, ( 65 NE 9\ l FBC 20 Permit No. P--* Master Permit No. City: Miami Shores County: Miami Dade Zip: 3 3 13 Folio/Parcel #: 2°5- 8 O Is the Building Historically Designated: Yes NO ✓ Flood Zone: OWNER: Name (Fee Simple Titleholder): On el f ®. f s YY1 1 y Ph Address: C& OA PINL> City: State: Zip: Tenant/Lessee Name: Phone #: Email: CONTRACTOR: Company Name: L 1 Qi ' ,' s ► Phone #: 303- 66 I- 66 3-3 Address: (00 (bi S 25 City: f-A,l`r0■v -"lt IC State: . 2 Zip: 3 0 3 Qualifier Name: 7-RJ -e , , SO 6 1 P trial Phone #: State Certification or Registration #: 5 M 0 Oil (.Z6 2 Certificate of Competency #: Contact Phone #: Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ - © Square/Linear Footage of Work: 2-2. Type of Work: DAddress DAlteration DNew Repair/Replace Description of Work: Peep 1 10tC1?, O ch 0-j Q la DDemolition **** ********** ***** ********a :*a: **+xa::x**** Fees**** ******u:*****, x** * ***:x****** * * ********+x*** Submittal Fee $ ' n Permit Fee $ //6-41 CCF $ CO /CC $ ri Scanning Fee $ V . 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 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 inspe tion which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection wil not be proved and a reinspection fee will be charged. Signature Owner or Agent The foregoing instrument was acknowledged before me_ this 4- day of D1°C , 2 , by 01 r l St� roi Co tver who is personally known to me or who has produced RA- r(Nf li As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: i My Commission Exp' :�.: .,� A J SOLOMON .�� MY COMMISSION # EE131935 aoj1nye EXPIRES November 08, 2015 ryservice.com ************************** ************* APPROVED BY r °' 2' &\-01-cur_ Contractor The foregoing instrument was acknowledged before me this l day of %1 _(L.� , 20 02rby �� ��-r 2' -C!4*" StSt—e.r" p who is personally known to me or who has produced �'�' ,J as identification and who did take an oath. NOTARY PUBLIC: Plans Examiner 1 Sign: , ea.l�unf!!!►!! Prin t: eg My Commission Expires: =`Q� ��0 . o � �izjttt►►lS T A���\oZoning Structural Review Clerk (Revised3? _ 20121(1&pvised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: Christopher & Kimberly Carver PROPERTY ADDRESS: 1165 NE 91 Ter Miami, FL 33138 LOT: 20, 21 PERMIT #: 13-SC-1442672 APPLICATION #:AP1090141 DATE PAID: FEE PAID: RECEIPT #: DOCUMENT #: PR891086 BLOCK: 1 SUBDIVISION: Watersedge PROPERTY ID #: 11- 3205- 001 -0180 [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 [ D R A I N F I E L D 0 H E 900 ] GALLONS / GPD 0 ] GALLONS / GPD 0 ] GALLONS GREASE INTERCEPTOR CAPACITY ] GALLONS DOSING TANK CAPACITY [ Existing septic tank to remain CAPACITY CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ [ 225 ] SQUARE FEET Trench configuration drain SYSTEM [ 0 ] SQUARE FEET SYSTEM TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ] CONFIGURATION: [x] TRENCH [ ] BED [ ] LOCATION OF BENCHMARK: F.F.E., 7.20' NGVD ELEVATION OF PROPOSED SYSTEM SITE BOTTOM OF DRAINFIELD TO BE FILL REQUIRED: [ 16.80 ] [I INCHES / FT ] [ ABOVE A BELOW 1] BENCHMARK /REFERENCE POINT [ 43.80 ] 11 INCHES 1 FT 1 [ ABOVE 4 BELOW 1] BENCHMARK /REFERENCE POINT [ 0.00] INCHES EXCAVATION REQUIRED: [ 27.00 ] INCHES *Invert elevation of drainfield to be no less than 4.05 ft. NGVD. *Bottom of drainfield elevation to be no less than 3.55 ft. NGVD. -The system is sized for 3 of bedrooms with a maximum occupancy of 6 of persons (2 per bedroom), for a total estimated sewage flow of 400 gpd. SPECIFICATIONS APPROVED BY: DATE ISSUED: DH 4016, 08/09 Incorporated: BY: Carlos TITLE: TITLE: Carp I•aza fi-imgotrOq4r or designee) is required to perform a so °Tb,,;ing autacent to tine (ObsoEiiste4 fiRillinf',�@Yc1r? � % `i� i � not be used) ° `'ior WFirial Approval, the D01-1 64E- 6illOWE)orMII witness the soil boring and tBgiq,/he results to the 'kite evaluation subm e . A reinspection tee will be assessed if the contractor is not at the jobsite al Vic arranged time. Dade cap EXPIRATION DATE: 03/04/2013 5E884401 Page 1 of 3 FLORIDA DEPARTM NT OF HEALTH APPLICATION- FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION '• Permit Al)plicatic,ri Nu . . 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Notes: - i 10011 S re,..,1- 1)GS NE Q11 Tex: - .• , 0\ cfr 04-ev4low. ■,*p.i,-. 'f, o_ , Site Plan submitted .i. 11 i cc d)Nti Signature Plan Approkted V . NOt Aporoved id Da e Itt t Li By County Health l)epartmen A CHANGES MUST BE APPROVED By THE COUNTY HEALTH DEPARTMENT DH 4015•iiITZ9(Fte9faces HRS-11 Form 4015 Which - be =zed) Page 2 of (Stocict,i " : 744-00-4015-6) - DLVIsian OF Environmental Health Florida Depot of Health Miami-Dade County Health Department OSTDs/Welrl Division 11805 SW 26 St. • Miatp,is,FL 33175 Inspoetr Addicts Comments:_ QSTDS #41 Signati>Je. CHECKED L1 i tr.d 1 1 1 1 1 1 3 3 1 1 I 1 1 1 1 3 1 TANK INSTALLATION [01] TANK SIZE [1] [21 (02] TANK MATERIAL; ("7 ®�,.. (03] OUTLET DEVICE (041 MULTI- CHAMBERED [05] OUTLET FILTER (06] LEGEND ....�t (07] WATERTIGHT. [08] LEVEL (09] DEPTH TO LID Nl ef /S'r DRAINFIELD INSTALLATION AREA (1105')(J5 (21 ..2.2 S QFT [ l DISTRIBUTION BOX HEADER____ [ ] NUMBER OF DRAINLINES DRAINLINE SEPARATION 2„ (p [ 1 DRAINLINE SLOPE / [10] [11] [121 [13] [14] [15] I16] [17] [18] [19] [20] [21] DEPTH OF COVER,/ t' ELEVATION CABO SYSTEM LOCATION DOSING PUMPS AGGREGATE SIZE AGGREGATE EXCESS' V FINES AGGREGATE DEPTH r4 /' FILL / EXCAVATION MATERIAL [22] FILL AMOUNT /2 n [23] FILL TEXTURE [24] EXCAVATION DEPTH [25] AREA REPLACED (26] REPLACEMENT MATERIAL, EXPLANATION OF VIOLATIONS / REMARKS: C 1 [ ] SETBACKS [27] St7RFACE WATER [28] DITCHES [29] PRIVATE WELLS [30] POBLIC WELLS [31]. IRRIGATION WELLS [32] POTABLE WATER LINES [33] BUILDING FOUNDATION [34] PROPERTY LINES [35] OTHER .CTEP . FT FT FT FT FT 3 2 FT Je--- FT S-° FT FT FILLED / MOUND SYSTEM [36] DRAINFIELP 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 QONFORMS WITH [46] FINAL SITE G N (47] CONTRACTOR (48] OTHER SITS PLAN s . er7k ABANDONMENT j p [49] TANK PUMPED (Bk., [50] TANK CRUSHED & FILLED /a //6 / / CONSTRUCTION 1 APPROVED / ISAPPROVEDI: ‘&22Z.. FINAL SYSTEM CHD /DISAPPROVED) : i'+'z•1 C 1 DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 644- 6.003, FAC DATE:1,2^ 12 12 CUD DATE:12. Page 2 of 3