PL-12-24144Xa
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 183326
Scheduled Inspection Date: January 10, 2013
Inspector: Hernandez, Rafael
Owner: QUINTON, ALBERT
Job Address: 457 NE 95 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: A AARON SUPER ROOTER
Permit Number: PL -12 -12 -2414
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Drainfield
Phone Number
Parcel Number 1132060140630
Phone: 305 - 944-8886
Building Department Comments
�.. «....... ne
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
HRS IN FILE
•ne
For Inspections please call: (305)762 -4949
DIVISION
Environmental Health
'loricta Department of Ilea
1 v Ixi -Dade ef.ounty Health
OSTDS/Well Division
1I HOC %W 76 tit.. Mimi, Fl. 33175
Inspector
Address .,
Commez l
OSTDS {�
BUILDING
Miami Shores Village
Building Department
IiX)50 N.E.2nd Avenue, Miami Shares, Florida 33138
Tel: (305) 7952204 Fa= (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
At DEC 262012 �'
BY; oseesm0000mams�vomoe
,.. ..7.1ua -aa14-
PERMIT APPLICATION M Perna No
Permit Type: PLU ING
JCR ADDRESS:
1+ 6 N6 6 Str -e
City: Miami Slroxes County:
Polio/P=4#: 11, zo 6- o I t+-- O6 3
is the Build* flasterkmay Designatetk Yes
33(38
OWNER: Name (Fee Simile Titer): N b
(CP €)
Address:
City State P`
Tenant/Lessee Name: Phoire#:
Email:
CONTRACTOR: Company Naive:
Address:
City:
Qualifier Name:
/r, _.
Go Z2 sw 35 \.r
state
v
dokIn T)
s. Ctq-16
: 339Z3._
Phone#:
State Certification or Registration # tti ficate of Competency*: .._ ,
Cmsiact Phan#: Email Address:
DESIGNER: Architect/Engineer:
6131 Value of Wok for this : $ 2.1-to 0 Square/Linear Footage of Wei r6 (X)
Type of Wei ClAddress EIAlieratiaa �y
U� of Warta ` i pY r`A `e C1
UNew
XRepairfitesace
CIDemolition
****** ***tea** *tea * ***
Submittal Fee $ Permit Fee $ 15-0 CCF $ CO/CC $
Fee $ Radon Fee $ D"HPR$ Bead $ s
Notary $ Training/Education Fee $ Technology Fee
Double Fee $ Structural Review $
TOTAL FEE NOW
$6/02z"
Bowling Cry's Name (11 1c)
Bonding Company's Address
CIty
Mortgage Lender's Name (if applicable)
Mortgage Id's Address
City, ZIP
Application is hey made lei a permit to do the work and lustalbtions as indicated. I certify that no has
i=maenad pries to the issuance of a permit end that all work will be performed to meet the standards of all laws rig
tAntsnectke that a separate permit must be Sect for ELECIRICAL WORK, PLUMBING, SIONS,
WELLS, MKS, FURNACES, BOILERS., HEATERS, TANKS and AIR CONDITKINERS, El'E,.....
"S A Y1T: 1 certify that = a the foregoing infornsation is acomate and that af work w_ be done its cue with c !
applicable laws regulating onnstructi'on
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE
OVEMENTS TO YOUR PROPERTY. IF YOU ' > ° , OBT
FINANCING, CONSULT WITH YOUR LENDER OR AN A
RECORDING YOUR OiJ NOTICE OF COMMENCEMENT."
Notice to Applicant: :�pAs a conditi4h to the issuance of a building permit with an estimated value exoee4ing $ice, the ?z F' • must
promise in good fin* * that a copy of the notice of commencement and � hen is bra will be Jelly' Cled the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of enient mist be pasted at the job site
for the first inspection occurs seven (7) days after the budding permit is issued • absence c f such prod nodce, the
inspection will not be • , ,: A sew fee will be charged.
Agile/ 1
Signatire li Contractor
The ing ,, & acknowledged before rte this 2-o ( Ti3e foregoing IIISIMMOU was acimoavksiged before rise
day of QeC , P . 12\16 eAft i e , day of Dec , 20 12-, by J cv1 T
who is personally
�p known 10 me car who ;...s._ who is /iy 1 to tae or who has proddu�ced V take
�y�� i Y c �.C- AS.0-_ P441'.(-4 i.R', ivi,'3. ' L, ` ;,,:,.2,.,,, ae y3+i:'. ±.; did
NOTARY C: NOTARY PVBUC:
My C.ommission
c
APPROVED BY
;I'S MY COMMISSION # Eel 31935
8 4 EXPIRES November 08, 2015
oov 39&0153 Pt •• dahtotaryService
RU
SPE
Print'
My
/�- 2c —/ Z-- Plans
'MY COMMISSION # EE131935
gXPIRES November 08, 2015
7) 39&0155 F eaNc a .ccrwice.com
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
PERMIT # :13 -SC- 1442478
APPLICATION # : AP 1090041
DATE PAID:
FEE PAID:
CONSTRUCTION PERMIT ;]'.4; RECEIPT # •
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Albert Quinton
q
DOCUMENT #: PR890882
PROPERTY ADDRESS: 457 NE 95 St Miami, FL 33138
LOT: 19 22
BLOCK: 53 SUBDIVISION:
PROPERTY ID #: 11- 3206 -014 -0630
[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 [
1,050 ] GALLONS / GPD
0 ] GALLONS / GPD
0 ] GALLONS GREASE INTERCEPTOR CAPACITY
] GALLONS DOSING TANK CAPACITY
Existing septic tank to remain CAPACITY
CAPACITY
D [ 300 ] SQUARE FEET
R [ 0 ] SQUARE FEET
A TYPE SYSTEM: [x] STANDARD
I CONFIGURATION: [ ] TRENCH
(MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
]GALLONS @[ ]DOSES PER 24 HRS #Pumps ( ]
Trench configuration drain SYSTEM
SYSTEM
[ ] FILLED [ ] MOUND
[x] BED [ ]
N
F LOCATION OF BENCHMARK: F.F.E., 10.80' NGVD
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE
L
D FILL REQUIRED:
T
H
[ 0.00 ] INCHES
[ 20.40 1 [i INCHES I/ FT 3 [ ABOVE A BELOW b BENCHMARK /REFERENCE
[ 50.40 ] (I INCHES r FT 3 [ ABOVE A BELOW b BENCHMARK /REFERENCE
EXCAVATION REQUIRED: [ 30.00] INCHES
POINT
POINT
- « ;• rainfieid.
es . o ft. NGVD.
*Bottom of drainfield elevation to be no Tess than 6.60 ft. NGVD.
-The system is sized for XX of bedrooms with a maximum occupancy of XX of persons (2 per bedroom), for a total
estimated sewage flow of XX gpd.
E -The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance
with sec. 64E- 6.013(3)(f). F.A.C.
R
SPECIFICATIONS
APPROVED BY:
DATE ISSUED:
DH 4016, 08/09
Incorporated:
BY:
Carlos M aza
TIT
Carlos aza
•.
TITLE:
ee) is required to perform a
(Obsol��r a�1}44uet"�le!d exc vati n at the t be used)
64E -6. d of Nj spec ion. rior o R �p t t0$t°
in dot all witness the soil bormg and compare the
results to the °o ?iginWi site evaluation sub t@89 '
reinspectlon fee will be assessed if the contractor is no
at the jobsite at ;tie arranged time.
Dade CHD
EXPIRATION DATE:
5E884220
02/28/2013
Page 1 of 3
•
WATE C31. 'FLORIDA.
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
• -
:4 • s W
Permit Application Number
PART II SITE PLAN- •
ach block represents 5 feet and 1 inch= 50 feet.
217'17 ; ;72'
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Notes:
Site Plan submitted
Plan Appr ved
By
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Signature
Not Approved
-nue
Date it 34)//
County Health Departmen
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
04 4015. 10/96 (110placos HRS-H Form 4015 which may be used)
(Stock Number: 5744-002-4015.6)
Pam.. 2 of :