PL-12-2224Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 183811 Permit Number: PL -11 -12 -2224
Scheduled Inspection Date: January 09, 2013
Inspector: Hernandez, Rafael
Owner: GARCIA, RICARDO
Job Address: 436 NE 93 Street
Miami Shores, FL
Project: <NONE>
Contractor: SMITH SEPTIC TANKS OF HOMESTEAD, INC.
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Drainfield
Phone Number (305)756 -5301
Parcel Number 1132060140210
Phone: 305 - 245 -7220
Building Department Comments
REPLACE DRAINFIELD
Infractlo 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
January 08, 2013
For Inspections please call: (305)762 -4949
Page 31 of 40
APPLICANT:
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DIPOSAL SYSTEM
CONSTRUCTION INSPECTION AND FINAL APPROVAL
Ci
AGENT: LL.,
PERMIT NO.
DATE PAID:
FEE PAID:
RECEIPT #:
S 7/
PROPERTY ADDRESS: •
LOT: e BLOCK:,5 0 SUBDIVISION: Z_j_- t! / d___PROPERTY ID #:
CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED.
TANK
[01]
[02]
[03]
[04]
[05]
[06]
[07]
(08]
INSTALLATION
TANK SIZE [1] e cD (2].
TANK MATERIAL, /7' ,!nbEAZ_ .
OUTLET DEVICE
MULTI - CHAMBERED (/ N 1
OUTLET FILTER
LEGEND %
WATERTIGHT
LEVEL
[09] DEPTH TO LIp
4./X(3 PVC)
DRAINFIELD INSTALLATION e®
[10] AREA [1] [21=2 !0 SQFT
[11] DISTRIBUTION BOX _ HEADER
[12] NUMBER OF DRAINLINES 3/
(13] DRAINLINE SEPARATIONS
[14] DRAINLINE SLOPE
[15]
[16]
[17]
[18]
[19]
[20]
[21]
FILL
[22]
[23]
[24]
[25]
[26]
DEPTH OF COVER /2 °j
ELEVATION [ABOVE LOW BM
SYSTEM LOCATION
DOSING PUMPS A
AGGREGATE SIZE Al://,04.09
AGGREGATE EXCESSTft FINES
AGGREGATE DEPTH "" /-
/ EXCAVATION MATERIAL
FILL AMOUNT -
FILL TEXTURE
EXCAVATION DEPTH
AREA REPLACED
REPLACEMENT MATERIAL
EXPLANATION OF VIOLATIONS / REMARKS:
(
[ 1
[ ]
(
1
1
1
1
SETBACKS •
[27] SURFACE WATER
[28] DITCHES
(29] PRIVATE WELLS
[30] PUBLIC WELLS
[31] IRRIGATION WELLS
(321 POTABLE WATER LINES
[33] BUILDING FOUNDATION
(34] PROPERTY LINES
[35] OTHER
FILLED / MOUND SYSTEM
J [36] DRAINFIELD COVER
1 (37) SHOULDERS
] (38] SLOPES
] [39] STABILIZATION
FT
FT
FT
FT
FT
FT
FT
FT
FT
ADDITIONAL INFORMATION
(-1" [40] UNOBSTRUCTED AREA
r-4- [41] STORMWATER RUNOFF
[ 7] [42]
[ / ] [43]
[ l _ [44]
{ (451
[ a [46]
t ._-J [471
[ 1 (48]
1
ALARMS
MAINTENANCE AGREEMENT
BUILDING'AREA
LOCATION CONFORMS WITH SITE PLAN
FINAL SITE GRADING ? /
CONTRACTOR 4/./ .,,.t�'7��c- c�G
OTHER
ABANDONMENT J yQ
] [49] TANK PUMPED / / /
] [50] TANK CRUSHED & FILLED / /
CONSTRUCTION {APPROVED ISAPPROVED] s( at - -A -
FINAL SYSTEM
APPROVE
/DISAPPROVED] : GEC w4,+ _..Q- I J�ir -�.
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E- 6.003, FAC
CHD DATE: //- 2 S -I
CED DATE: 41--2S -/
Page 2 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
NOV 2 j2012
FBC 20
BUILDING Permit No. FL 1 '7.,-222:1
PERMIT APPLICATION Master Permit No.
Permit Type: PLUMBING
JOB ADDRESS: 4'13 t ,71-
City: Miami Shores County: in Miami Dade
Folio/Parcel#: / / o 'g a 0 4,
Is the Beating Historically Designated: Yes NO
Zip: 33/3
Flood Zone:
OWNER: Name (Fee Simple Titleholder): n t (° 0 v at I' C i \ek Phone*: -315.- 9 a ) / 9 9'
Address: ' G 91-3 ¶
City: J44 4, 4 State: Zip:
Tenant/Lessee Name: Phone#:
Finail•
CONTRACTOR: Company Name: 5/// %all ..pn c -j ,t i O FiirtAt.50-4P, one#: � A Y � °' 7 720
Address: / 5/ 0 5- 5 w O 5 -FE l�
City: IA c9v t ST�I State:
Qualifier Name: GPI §� �1_L �p� 11-1-1
-1-,j
State Certification or Registration #:
Email Address:
FL
Zip: 3d 3
Phone#: SO 5- a to -6/ 416— S
5 D ! O Certificate of Competency S P O7 %
A-A) 4G S �' Sivt 177-1 ?,#077c /�iuKS�Cs�
DESIGNER: Architect/Engineer: Phone#:
Contact Phone#: 7O aLf -- %%2 O
Value of Work for this Permit: $ 2 ®- Square/Linear Footage
Type of Work: DAddress
Description of Work:
OAlteration O■ew
Work: a,0 0
r =' epair/Replacp UDemolition
* * * * ** ** ** **** * * *** *** * * * *** *** **** * * *F ************* ****** * * *** * ***** * * * * * * * *** ****
Submittal Fee $ b, l) „� n . ermit Fee $ /45-0 CCF $ CO/CC $
a,.. .
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
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 properly 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��' /���
Owner or Agent
The forego' g instrument was r7edged before me this /544
day of / ' 20 , by
who is personally known to me or who has produced Ft Lk.
As identification and who did take an oath.
Contractor
The foregoing instrument was ackno ed before me this /51'6A
day of 1/ , 20 /a , by 12 T' >
who is prrsknsn to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC: -15 3 -C3 NOTARY PUBLIC:
Sign: :L ..�►!r' ?�P - an'�►- t_JI■�1
Print: 4.ii'1 \v iii w. 1/AL ite
My Comnnss �. # LE 6242
emodulaish Nosy ma
***************** v*********************************************************** * * * * * * * * * * * * * * * * * * * * * *** * * * * * **
APPROVED BY
Z& °-lam- Plans Examiner
Structural Review
(Revised3 /1212012)(Revised 07 /10 /070Revised 06/10/2009XRevised 3/15/09)
Zoning
Clerk
PERMIT #: 13-SC-1438536
APPLICATION 4:API087771
STATE OF FLORIDA
DEPARTMENT OF HEALTH DATE PAID:
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID:
CONSTRUCTION PERMIT
RECEIPT #:
DOCUMENT #: PR889050
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Ricardo Garcia
PROPERTY ADDRESS: 436 NE 93 St Miami, FL 33138
LOT: 8
BLOCK: 50 SUBDIVISION: Miami Shores Sec 2
PROPERTY ID #: 11-3206-014-0210
[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 [ 900 ] GALLONS / GPD Existing septic tank to remain 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 [ 200 ] SQUARE FEET bed configuration drainfile SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [ ] TRENCH [x] BED [ ]
N
F LOCATION OF BENCHMARK: F.F.E., 10.51' NGVD
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE
L
D FILL REQUIRED: [ 0.00 ] INCHES
O
T
H
E
R
[ 13.50 ] [I INCHES I FT ] [ ABOVE /) BELOW II BENCHMARK /REFERENCE POINT
[ 43.50 ] [i INCHES I/ FT ] [ ABOVE 4 BELOW b BENCHMARK /REFERENCE POINT
EXCAVATION REQUIRED: [ 42.00] INCHES
*Potable water line within 5 ft. of drainfield shall not be located at an elevation lower than the drainfield absorption
surface.
*Invert elevation of drainfield to be no less than 7.40 ft. NGVD.
*Bottom of drainfield elevation to be no Tess than 6.90 ft. NGVD. V24 a`r.,.i
*Install 12" of slightly limited soil under the bottom of the drainfield.
- Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed or drain trench.
-The system is sized for 2 of bedrooms with a maximum occupancy of 4 of pe' s (2 per_ bedroom), fora total estimated
SPECIFICATIONS BY:
APPROVED BY:
Carlos
C Icaza
TITLE:
DATE ISSUED: 11/06/2.'L'
DH 4016, OS /09Tf�b:so1 es all previous editions which may
Incorporated S0d4E' -6y0g3 Bkd19nee) is required perform
elrnr ar` ,u 1?- 6,1 i °J thejdraidfield ex avation 1oa7-/71
Insa, :urn„ s,�i ,; ;- ;Un. Prior to Final Approval, the
r,, is o; t �,..3s the soil boring proval the DOH
nnos the . original site evaluation, sub d compare
.,,, :pe ttion ir'.e Sul be assessed if miffed. r is the
! �e c t re arranged time, the contractor is rqn_
not be used)
Dade CHD
EXPIRATION DATE: 02/04/2013
5E882547
Page 1 of 3
STATE QE FLORIDA
DEPARTMENT OF HEALTH a
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PEFI T
i Permit Application Number " \
- -- - - - - -- - PART II ITEPLAN
Scale: Each block represents 10 feet and 1 inch = 40 feet.
r
'BARE MOPERTINEN'FEATURES ONAOJACENT
PR�[,'SA�ORRAACROSSSSTTHE STREcTTHATMAYBI
otes:
Si nafu
Site Plan submitted by: �Q „ .,�� ...,: r,� , � ,�fi.DELL SM ! �y�� "`�°°�
Title
Plan Approved 9Not Approved Date 1. I 7 //.
By County Health Department-
ALL CHANGES MUST,BE APPROVED SY THE COUNTY HEALTH DEPARTMENT
DH 4015, 10/96 (Replaces HRS -H Form 4 )16 which may be itsed)
(Stock Number. 5744- 002 - 40156)