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PL-12-1566Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 177509 Permit Number: PL -8 -12 -1566 Scheduled Inspection Date: September 28, 2012 Inspector: Hernandez, Rafael Owner: DELUCIA, RONALD Job Address: 913 NE 98 Street Miami Shores, FL 33138- Project: <NONE> Contractor: MR C'S PLUMBING SEPTIC INC Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Drainfield Phone Number Parcel Number 1132060143420 Phone: (305)651 -7859 Building Department Comments INSTALL 3000 SQ FT DRAINFIELD Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments HRS IN FILE September 28, 2012 For Inspections please call: (305)762 -4949 Page 8 of 18 BUII,��IN�G j�. PERMIT APPLICATION FBC 20 Miami Shores Village Building Department AUG 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BY INSPECTION'S PHONE NUMBER: (305) 762.4949 �� Permit No. P1 1 —156(1 Master Permit No. Permit Type: PLUMBING (� OWNER: Name (Fee Simple Titleholder): i� pp DW�t� be to Phone#: %66 337 tfS1S Address: 113 NG krsst City: ititteril Skkag.65 State: '`S L.. Zip: 3"g 138' Tenant/Lessee Name: Phone#: Email: JOB ADDRESS: 113 NE 6t. City: Miami Shores County: Miami Dade Zip: 33P d' Folio/Parcel #: 1/ — 3abL 6 /4 3 *7 Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: 1lI- C S F J) f °�/- •'Z. Phone#: 745-45-1 7dS, Address: q13 /iJ Pk S'I- ✓ !!// City: MiA.,i- State: Pl.- Zip: 3`b�j Qualifier Name: Kam. ettn Phone#: State Certification or Registration #: Certificate of Competency #: Contact Phone#: Email Address: DESIGNER: Architect/Engineer. Phone#: Value of Work for this Permit: $ 2 , a' Square/Linear Footage of Work: Type of Work: ❑Address ©Alteration ONew LaRepair/Replace Description of Work: ,101.41.k, 1 Zav, dtii it&f.ce to 3 **** *a * *** * *** * * *******aim * *** * **** ** * **F ******** *a *** * * * ** *: x********** * *** *,z*,x ****** Submittal Fee $ Permit Fee $ 3 ®° CCP $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 1 (0 a . J 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature "/ -144 '/ Owner or Agent The fore ing instrumentrwas ac owledged before. me this day of 20 (s` ; by who is personal y known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Exp' nut! oil ri MY COMMISSION # DD 891340 EXPIRES: September 14, 2013 .47,;!: 1$ Bonded Thru Notary Public Underwriters Signature Contractor The foregoing instrument was acknowledged before me this day of 114' J ,taus(, 20 jam, by who is personally known tome or who has produced as identification and who did take an oath. NOTARY PUBLIC: ****************************************** ** **** * * * * * * * * * * * * * * * ** * ** * * * ** APPROVED BY (Revised 07 /10 /07)(Revised 06/10/2009)(Revised 3/15/09) Plans Examiner Structural Review Clerk STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: Ronald Delucia PERMIT #: 113-SC-1424888 APPLICATION # : AP 1080038 DATE PAID: FEE PAID: RECEIPT #: DOCUMENT #: PR882407 PROPERTY ADDRESS: 913 NE 98 St Miami, FL 33138 LOT: 13-15 BLOCK: 80 SUBDIVISION: Miami Shores PROPERTY ID #: 11- 3206- 014 -3420 [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 CAPACITY A [ ] 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 R A I N F I E L D O T H E R SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: [ 300 ] SQUARE FEET Bed Configuration SYSTEM [ ] SQUARE FEET SYSTEM TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ] CONFIGURATION: [ ] TRENCH [X] BED [ ] LOCATION OF BENCHMARK: FFE: 11.6' NGVD ELEVATION OF PROPOSED SYSTEM SITE [ 24.00 ] [) INCHES r FT ] a[ 4AB�(�,Ve, 6. BOTTOM OF DRAINFIELD TO BE [ 52.00 ] 11 INCHES gj(\l' e,tilt b (16S\ a� \N\‘Q� a� S \��ssesA �\�s. FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQU tai �(i,Mu 4j \� 1.- Existing 900 gal. septic tank, certified by "Mr C's Plumbing & Septic on 897' .�s4246.0Prel 2.- Install 300 sf of drainfield in bed configuration. 0046° 3.- Install 12 of slightly limited soil at the bottom of the drainfield. at 4.- Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed ab , „ti 5.-Invert elevation of drainfield to be no less than 7.77' NGVD. 7. -Bottom of drainfield elevation to be no less than 7.27' NGVD. * *******THIS PERMIT IS NOT FOR ADDITION(s) * ******** Qe d t‘/: qp t\ � pe 0\coV ao 0 Pa ; Q: P ENC E POINT Kok FERENCE POINT G Ettric Astrid V Edwards 08/10/2012 TITLE: TITLE: Engineer Specialist II Dade CHD EXPIRATION DATE: 11/08/2012 DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E- 6.003, FAC v 1.1.4 A81080038 0E876534 Page 1 of 3 NOTICE OF RIGHTS A party whose substantial interest is affected by this order may petition for an administrative hearing pursuant to sections 120.569 and 120.57, Florida Statutes. Such proceedings are governed by Rule 28 -106, Florida Administrative Code. A petition for administrative hearing must be in writing and must be received by the Agency Clerk for the Department, within twenty -one (21) days from the receipt of this order. The address of the Agency Clerk is 4052 Bald Cypress Way, BIN # A02, Tallahassee, Florida 32399 -1703. The Agency Clerk's facsimile number is 850 - 410 -1448. Mediation is not available as an alternative remedy. Your failure to submit a petition for hearing within 21 days from receipt of this order will constitute a waiver of your right to an administrative hearing, and this order shall become a 'final order'. Should this order become a final order, a party who is adversely affected by it is entitled to judicial review pursuant to Section 120.68, Florida Statutes. Review proceedings are governed by the Florida Rules of Appellate Procedure. Such proceedings may be commenced by filing one copy of a Notice of Appeal with the Agency Clerk of the Department of Health and a second copy, accompanied by the filing fees required by law, with the Court of Appeal in the appropriate District Court. The notice must be filed within 30 days of rendition of the final order. STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATION APPLICANT: Ronald Delucia APPLICATION # API080038 PERMIT # 13-SC- 1424688 DOCUMENT # SE876534 CONTRACTOR / AGENT: Mr C LOT: 13-15 SUBDIVISION: Miami Shores BLOCK: 80 ID# : 11- 3206 - 014 -3420 TO BE COMPLETED BY ENGINEER, HEALTH DEPARTMENT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEERS MUST PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS. PROPERTY SIZE CONFORMS TO SITE PLAN: [X]YES [ ]NO TOTAL ESTIMATED SEWAGE FLOW: 500 GALLONS PER DAY AUTHORIZED SEWAGE FLOW: 875.00 GALLONS PER DAY UNOBSTRUCTED AREA AVAILABLE: 450.00 SQFT BENCHMARK /REFERENCE POINT LOCATION: ELEVATION OF PROPOSED SYSTEM SITE FFE: 11.6' NGVD 24.00 NET USABLE AREA AVAILABLE: 0.35 ACRES RESIDENCES- TABLE1 1500 GPD /ACRE OR / OTHER -TABLE 2 ] 2500 GPD /ACRE UNOBSTRUCTED AREA REQUIRED: 450.00 SQFT INCHES / FT ] [ ABOVE / BELOW ] BENCHMARK /REFERENCE POINT THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES SURFACE WATER: NA FT DITCHES /SWALES: NA FT NORMALLY WET: [ ]YES [X]NO WELLS: PUBLIC: NA FT LIMITED USE: NA FT PRIVATE: NA FT NON- POTABLE: NA FT BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: 10 FT POTABLE WATER LINES: 40 FT SITE SUBJECT TO FREQUENT FLOODING? 10 YEAR FLOOD ELEVATION FOR SITE: SOIL PROFILE INFORMATION SITE 1 [ ]YES [X]N0 FT [ MSL / USDA SOIL SERIES: Urban land Munsell # /Color Texture Depth 10YR 3/1 Sand 0 To 6 10YR 5/4 Sand 6 To 24 10YR 5/4 Oolitic Limestone 24 To 72 24 To 72 OBSERVED WATER TABLE: 73.20 INCHES [ ABOVE / ESTIMATED WET SEASON WATER TABLE ELEVATION: BELOW 73 HIGH WATER TABLE VEGETATION: [ ]YES [X]NO NGVD 10 YEAR FLOODING? [ ]YES [X]NCI ] SITE ELEVATION: 9.60 FT [ MSL / SOIL PROFILE INFORMATION SITE 2 NGVD USDA SOIL SERIES: Munsell #!Color Urban land Texture l Depth 10YR 3/1 Sand 0 To 6 10YR 5/4 Sand 6 To 24 10YR 5/4 Oolitic Limestone 24 To 72 ] EXISTING GRADE TYPE: INCHES [ABOVE / MOTTLING: [ ]YES [X]NO BELOW [ PERCHED / EXISTING GRADE DEPTH: INCHES APPARENT SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: Replacement4 -S, CS, LCS/0 DEPTH OF EXCAVATION: 40 INCHES DRAINFIELD CONFIGURATION: [ ] TRENCH REMAARKS /ADDITIONAL CRITERIA [x] BED [ ] OTHER (SPECIFY) SITE EVALUATED BY: Ettrick, Kemble (Title: ) (MR MAX) DE 4015, 08/09 (Obsoletea previous editions which may not be used) Incorporated: 64E- 6.001, FAC AP1080038 E1D1424688 DATE: 08/07/2012 Page 3 of 4 v 1.0.2