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PL-13-1153 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-192090 Permit Number: PL-5-13-1153 Scheduled Inspection Date: November 13, 2013 Permit Type: Plumbing - Residential Inspector: Diaz, Osvaldo Inspection Type: Final Owner: LIAO, CHIA CHING Work Classification: Drainfield Job Address:180 NW 111 Street Miami Shores, FL 33138- Phone Number Parcel Number 1121360030470 Project: <NONE> Contractor: A AARON SUPER ROOTER Phone: 305-944-8886 Building Department Comments REPLACE DRAINFIELD Infractio Passed Comments INSPECTOR COMMENTS False spector ments Passed HRS IN FILE SOP Failed E Correction ❑ Needed Re-inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. November 12,2013 For Inspections please call: (305)762-4949 Page 7 of 38 �A Ow Fiend -O"a t 331 t h au 77 °--� It �L. 5 43 1, m STATE OF FLORIDA PERMIT O. c',DEPARTMENT OF HEALTH DATE PAIDs ONSITE SEWAGE TREATMENT AND DIPOSAL SYSTEM FEE PAID: V.%���. CONSTRUCTION INSPECTION AND FINAL APPROVAL RECEIPT #: I e APPLICANT: `-(°, e° � AGENT: PROPERTY ADDRESS: / C LOT: , S BLOCK: �Z SUBDIVISIONs �,,��� PROPERTY ID #: CHECKED [XI ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RU7,E AND MUST BE,CORRECTE>). TANK INSTALLATION SETBACKS I ' 1 [011 TANK SIZE [1]'700 [21 [ 1 [271 SURFACE WATER FT [ 1 1021 TANK MATERIAL _ [ 1 [28] DITCHES FT [ ] [031 OUTLET DEVICE >— [ ] [29] PRIVATE WELLS FT [ I [041 MULTI-CHAMBERED [ Y 1 1301 PTJBT41C WELLS FT [ 7 1051 OUTLET FILTER -Oq [ 1 [31] IRRIGATION WELLS FT [ 1 [06] LEGEND i►1 [ ] [321 POTABLES WATER LINES /0 FT I 1 [071 WATERTIGHT , [ ] [331 BUILDING FOUNDATION T C l [081 LEVEL ��. [ ] [341 PROPERTY LINES FT L 1 [091 DEPTH TO LII? [ ] [35] OTHER FT DRAINFIELD INSTALLATION FILLED / MO'Q= SYSTEM [ l [101 AREA [1] �" /s I2] Z� sQFT / [ I 1361 DRAINFIELD COVER [ 1 I11] DISTRIBUTION BOX HEADER✓ [ ] [373 SHOULDERS 1 l I121 NUMBER OF DRAINLINES _ 's' 1 [381 SLOPES "'t+ 11 [131 DRAINLINE SEPARATION 2 (� C 1 1391 STABILIZATION I l [141 DRAINLINE SLOPE C 1 [151 DEPTH OF COVEP)g y ADDITIONAL INFORMATION L I {16] ELEVATION [ABU • , ELOti BM 1 1407 UNpBSTRUCTED AREA C I [171 SYSTEM LOCATION [ 1 [41] STORMWATER RUNOFF I 1 [18] DOSING PUMPS [ 1 [421 ALARMS I 1 [191 AGGREGATE SIZE Qy` j..C� .[ ] [431 MAINTENANCE AGREEMENT I 1 [20] AGGREGATE EXCESSIVE FINES { 1 [441 BUILDING AREA { 7 [21] AGGREGATE DEPTH *A/ l!� [ 1 [451 LOCATION CONFORMS WITH SITE PLAN I 1 1461 FINAL SITE GRADING FILL / EXCAVATION MATERIAL [ 1 1471 CONTRACTOR _4�5L L 1 [221 FILL AMOUNT f�z N [ I [481 OTHER I I [231 FILL TEXTURE [ 1 [241 EXCAVATION DEPTH. ABANDONMENT I 1 [251 AREA REPLACED [ 1 [491 TANK PUMPED { 1 1261 REPLACEMENT MATERIAL [ l [50.] TANK CRUSHED & FILLED EXPLANATION OF VIOLATIONS / REMARKS: L 7 I ] CONSTRUCTIO [APPRp DISAPPROVED] s _ Q..P/`�- i CHD DATES 'INAL SYSTEM /DISAPPROVED] CA11_ DATE:,1- `16, 08/09 (Obsoletes all previous editions which may not be used) rated: 64E-6.003, PAC Page 2 of 3 06/0612013 01:02PM 9549678433 PAGE 01/01 3�2t� CERTIFICATE OF L1ABIUTY INSURANC PAOMW t Atbabu ,hm Ttla c,D1rtWCA'f t015�INpAS A I i irmor wpgwAT" ml!!Erna p k ONLY AND COBS Nb UMM UPON THE COMICAlE Mk"W,FL$= W.D,rd G MI'IHO!►1E 0Oft WT M Ex'I 0 CR Phom X44 PDX e Q 4*M MSUMMAFFEROM OqRAc31_ 1VASC X Iht�RAtrD A A super Retry.Ina ACCIDENT INSURANCE co , 8W 350OURT TEi:FINQI.oGY IA151df�4P[CE Wramar.FL 33023- ¢ E054f W-Of Ra OWJIRAOU n uar�wtv� mv�aueo r weup n�tt�a Por w'�r riou r MIYI�i�l1E;M'J'.TEii�1QR OqN ef`AWh'��x7RAc!'�OTI•p�Tt OfJ CCfi�ENr'M11t'F12'"�C)1iYF}l�f3TFU$LFRT�FICATL IAAY�155L16�CR btAYPtRfAIW.T!�I+fs1111�3ROED itY 7lI;!pQ �bi�Nt Lk Y"f�A1;.�Tom.���17F S�Ft . m MI IL SHOWNWMAY W;MnpmgypAD gnM tw+et�rlr�wwq� �oearOYrvrn�t �•�+► rxaa+ur�tnou �� GEWMUABLn IAcm0� 1.000.000 �-4wwV' 1A01JIY AGUMIS24 481a8C10t2 OfI 1Y0i3 M t4O,oQ0 A OEAMBMACI� taCgidt &IID pfP pay ma pareml b 000 vti�OFW.aAD'UIk,IJRIr 1.400. GEMPALAGGREDAT4 2000.000 4�1�'4ALi01l T!Ll�f1E'AM SPp� PR*bUCT @•t70MPA0PA03 ING OPROMar.fj Lt* �+'�oeurLrAt+rrtr ©an�psIMOLELIT AWAM 0 0 0 tIAED�tO9 r Q KMYNJM cA�araeQ.n,r Au'rO�ll-�'.EAAt33�11'. C� AWA4qb AM OLY: ��ru�xu►uae�.mr � � PACtII�E D oeat�r� e�.or�a�r mr tvlrc :3�t OAM&Mx OWMM3 LLON&M.pauctuw 9.000.80Q 8T►ISt! �At�IIOLOlR CANCOAM 7N IOaeo NE 2AVIE VWLWT-WrFM4WTCMOSOSMLL-uepOe OMORTOOO t AMUrY FL 35138 +UT"QFUW Registered Septic' Tank Contractor JOHN .F 6022 SW 35TH COURT MtRAMAR PL 73023- A-APRON SUPER ROOTER, INC. Business Authorization: SA0920648 S-RO92:111-2 Registration Expires on September 30 , 2013 I11 i �-WWI ®r z 6 Mi Mllv�-MI . ................... 12/8612812 88:37AM 9549676433 PAGE . 81/81 PAIO mot'-C1.� vS•PAGE ' 349403-d IM IS NOTA.BXL_ PWAhYNogSj WOd PAY RENEW4L -��t3QTe z 3r� ' 344996-•8 i DOIM JS It, DADS CC STA'�`���648 " AR01+1 SbPF.R M*qn4 Inc Owitr rr 00 MOT FORWARD I ' rum� J► NWW Wet Snar€r ire 922Sv3se Es • fl9�B3QW4�80I f VIA ool WAX flOtlfl$S'SIDE *` x Miami Shores Village g E'i Building Department g p MAY 2 4 2913 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel: (305)795.2204 Fax:(305)756.8972 BY. 6 INSPECTION'S PHONE NUMBER:(305)762.4949; FBC 20 BUILDING Permit No. 1 ° I IS S PERMIT APPLICATION Master Permit No. Permit Type: PLUMBING JOB ADDRESS: l EO NW to Street City: Miami Shores County: Miami Dade Zip: «� Foho/Parcel#: /I— 2,F 00 3 ° ®4f7 0 Is the Building Historically Designated:Yes NO Y Flood Zone: OWNER:Name(Fee Simple Titleholder): �h i& C s n eA 1.E Q 0 Phone#: ��� �$7 �� wo Address: r"e) City: State: Zip: Tenant/Lessee Name: Phone#: Email: C°S CONTRACTOR:Company Name: ra n r' k,,o Phone#: 6,s 6 Address: 6022— &z) _ s Ct City: Pra b'o'la r —State: R, Zip: -3—3®2 3 _ Qualifier Name: � 10 6 0 11) d Phone#: State Certification or Registration#: Certificate of Competency#: Contact Phone#: Email Address: DESIGNER:Architect/Engineer. Phone#: Value of Work for this Permit:$ 0 Square/I.Anear Footage of Work: �)Q o Type of Work: DAddress OAlteration ONew ARepair/Replace ODemolition Description of Work: R n 6 f)y�� Qnfi`t I Submittal Fee$ Permit Fee$ �se/Sa-z` CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$ Ilene* 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 commenc nt must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the a sence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. <7 I I/ Signature - Signature Owner r A nt Contractor The foregoing instrument was acknowledged before me this 2® The foregoing instrument was acknowledged before me this 21c' day of 20 r_l by QW Z Ct day of 0- 20�,by l�� tv- who is personally known to me or who has produced �`� ° who is personally known to me or who has produced `` CU st As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: MON Si OMON Print: -c✓veE" So t' :*- MY COMMISSION#EE131935 *: MY COMMISSION#EE131935 My Commission Expires: - ;o.w EXPIRES November 08.2015 y fission Exp' s` � EXPIRES November 08,2015 r"'•, FbridallotarySarvice.com ervice.00m 407)398-0153 407)398.01 FlOrttleNOtaryS { 9e�9c�4r�e:Y��Y9roY9e4:sk�Ysk9:9itkdczY�Y9e9e9esYaY�Y9e�k�Y9edi�kvY9eaY�tr9e3:dr3:k���YzY'k�YsFat�F9t3nY3e3e9c4e3:�Y&��Y�k9e9e3:&3r3rksY3c3e4nY9ednYst•4i:F4c9e�Y�Y�Y3e4r3e9esY9cSc��9r�4e4e9e�Y:Ytk &��Y APPROVED BY �5—L� 3 Plans Examiner Zoning Structural Review Clerk (R '' 44 ¢10/07)(Revised 06/10/2009)(Revised 3/15/09) PERMIT #:13-SC-1473502 APPLICATION #:AP1108517 STATE OF FLORIDA DEPARTMENT OF HEALTH DATE PAID: ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID: CONSTRUCTION PERMIT F RECEIPT #: DOCUMENT #:PR907087 CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: Chia Ching Liao PROPERTY ADDRESS: 180 NW 111 St Miami,FL 33168 LOT: 15 BLOCK: 220 SUBDIVISION: Miami Shores Ext [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] PROPERTY ID #: 11-2136-003-0470 [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 I l D [ 300 ] SQUARE FEET Trench conflquration drain SYSTEM R [ 0 ] SQUARE FEET SYSTEM A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ] I CONFIGURATION: [x] TRENCH [ ] BED [ ] N F LOCATION OF BENCHMARK: F.F.E., 12.70'NGVD I ELEVATION OF PROPOSED SYSTEM SITE [ 25.20 ] [ INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 61.20 ] [ INCHES FT ] [ABOVE BELOW BENCHMARK/REFERENCE POINT L D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: [ 36.00 ] INCHES "Invert elevation of drainfield to be no less than 8.10'NGVD. 0 *Bottom of drainfield elevation to be no less than 7.60'NGVD. T 'THIS PERMIT IS NOT FOR"ADDITION(s)". H The system is sized for bedrooms with a maximum occupancy of 8 persons(2 per bedroom),for a total estimated flow of 400 gpd. E Required drainfield area based on rule 64E-6.015(6)(c)2. Install a new drainfield to achieve Drainfield size requirement. R SPECIFICATIONS BY: t05 y TITLE: APPROVED BY: TITLE: Dade CHD DATE ISSUED: EXPIRATION DATE: 08/20/2013 DH 4016, 08/09 (ObsoleTta& f1tCt 3 fi tad n�¢ii$t reta¢H@� SrV' anot be used) Incorporated: 64E-6.0"6g b4jid adjacent io the drainfield excavation at the Page i of 3 time of final4njp o a. Prior to Final Ap y8bjj*DOH 58899261 inspector shall dvitness Ine soil boring and compare the results to the original site evaluation submitted.A reinspection fee will be assessed it the contractor is not at the jobsite at the arranged time. 6_Zw713 PERMIT #: 13-SC-1473502 STATE OF FLORIDA APPLICATION #:AP 1108517 DEPARTMENT OF HEALTH DATE PAID: ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID: .� CONSTRUCTION PERMIT RECEIPT #: DOCUMENT #:PR907087 r CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: Chia Ching Liao PROPERTY ADDRESS: 180 NW 111 St Miami,FL 33168 LOT: 15 BLACK: 220 SUBDIVISION: Miami Shores Ext PROPERTY ID #: 11-2136-003-0470 [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 Existinq 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 [ 300 ] SQUARE FEET Trench conflquration drain SYSTEM R [ 0 ] SQUARE FEET SYSTEM A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ] I CONFIGURATION: [x] TRENCH [ ] BED [ ] N F LOCATION OF BENCHMARK: F.F.E., 12.70'NGVD I ELEVATION OF PROPOSED SYSTEM SITE [ 25.20 ] [ INCHES FT ] [ABOVE BELOW BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 61.20][ INCHES FT ] [ABOVE BELOW BENCHMARK/REFERENCE POINT L D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: [ 36.001 INCHES "Invert elevation of drainfield to be no less than 8.10'NGVD. 0 "Bottom of drainfield elevation to be no less than 7.60'NGVD. T 'THIS PERMIT IS NOT FOR"ADDITION(s)". H The system is sized for 4 bedrooms with a maximum occupancy of 8 persons(2 per bedroom),for a total estimated flow of 400 gpd. E Required drainfield area based on rule 64E-6.015(6)(c)2. Install a new drainfield to achieve Drainfield size requirement. R SPECIFICATIONS BY: t05 Y TITLE: APPROVED BY: TITLE: Dade CHD DATE ISSUED: EXPIRATION DATE: 08/20/2013 DH 4016, 08/09 (ObsolAiscoailticlpk iiir6,don6*tibtiiregiiigtutmv aaot be used) Incorporated: 64E-6.Lf6j c1&d adjacent to the drainfield excavation at the Page 1 of 3 time of final4liglgqcrl.;1nor to Final ApMya�4W OOH sse99261 inspector shati vitness the sail boring and compare the resuiis to the original site evaluation submitted.A reinspection fee rnli be assessed if the contractor is not at the jobzite at the arranged time. -ATE Ot:- F -OF110A T OF HEALTH DEPAr TNIFN ISPOSAL SYS FFM COM, I` AP'PLICATIONFOR ONSITE SEWAGE s Pem,itt Apolic:i:n; PAR 1- 11 - Sl I'E 'LAN- e L`ach block rowesents 5 foot at-ld I inch = 50 tout. 7- AT -4, lo 127- owl) L VT 180 t4-,4 r-1 C k27))f NJ by Ll iN o t App rove d THE COUNTY Fi ALT 1 11' `ALL CHANGES MUST BE APPROVED BY T1 tE c .":1:1_`i •�sKn�s�•^:�.ru�:�a+aa?a:� -�+'rr,..,=�s���.zit�?�g a �f,�aa"a,�ro�^wua�a�{:.:ri�°��.;,�.A�t��'a`<"w,�'•;;�---,a^.�� „f,..,.,,s.,r-....�c���"w a.;,�rv-,w�c^w••cr ..c(,c.,y^e:,��u'S �.. -G d " ATE OF FLORIDA DEPARTMENT OF_HEALTH APPLICATION'FOR'ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Numb al PART it SITE PLAN _ _ ------ =` A— ":- Sca;e: Each block represents 5 feet and t inch 50 feet 7� 7 77 i Y L ' -4 i f , w'' 516✓ k ; i $ O q T s � + t' t ?y s e—� tE i t {"'f"j 5 9_. --a '1+.T t -.. ...t_. ....1•ttt---'��'-f- i "4 9 S e j.,.° % �t .�., .,.::€—S 1i--�;•^- •�yr- ::_iv. ` :rte ...._,ell e"#'3 v + q S� — k { f i i + r p am 0 c r- ' 3 y a- 1 t � D ?tin 1 1 y f - :`� 'd"s --f �: f � .d.°. �.�...� ..t.:_ -r $ e t �'•,�-�,-^'r'. yr ) ..• Y i•--« b ....»r—'r'r•>..�'._I.u.^'•^_6 �,—; L... ..yt3 'q 2 Y 7 t �� -' > i -r-q+-v. .�»..i-• •.•r .-�. Fp _.r.._: i..+ ;w�. .y '�--•b r,_ .. .rro w., �,e S § } � i'"�iR4 4 €` ...! E7 a.._"44- :. "ik k y *t- -.fir s• r�''� < -s 7 c a ';r - t �. el UZI K, u Site Plan submitted by. ,e Signature, Plait. ppro .e ' . Not Aparove.ci Date .. ! y- County Health Departmen LL CHANGES MUST BE APPROVED RY TH'E COUNTY HEALTH DEPARTMENT r�.,�� DH 40'5.101./"9 (Replaces HR&H Pon 4015 which may be used). PQICdk IurTbW:5744-C,02.4015.6} Dann of