PL-13-2213,
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 205935 Permit Number: PL -10 -13 -2213
Scheduled Inspection Date: February 20, 2014 Permit Type: Plumbing - Residential
Inspector: Diaz, Osvaldo
Inspection Type: Final
Owner: SHARON R GENTILE, GARY GENTILE Work Classification: Septic
Job Address: 1200 NE 103 Street
Miami Shores, FL
Project: <NONE>
Contractor: STATEWIDE SEPTIC CONNECTIONS
1:1w
�n•11a 11:111( �
PUMP ABANDON REPLACE BROKEN TANK ONLY
INSTALL NEW 1050 GALLON TANK
Phone Number 305 - 754 -6024
Parcel Number 1132060340290
INSPECTOR COMMENTS False
Phone: (954)963 -0082
Inspector Comments
Passed
F 0 CREATED AS REINSPECTION FOR INSP- 200166. NO PERMIT NO
ANSWER AT RESIDENCE
Failed
Correction ❑ �-�
Needed
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
February 19, 2014 For Inspections please call: (305)762 -4949 Page 14 of 31
< 5 '
ATE Oi- FLORIDA
r - DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SENIAGE DISPOSAL SYSTEM CONSTRUCTION PERiIMIT
1� �'• Permit Application Number _ -._ --
-
Plan Approve - Not Approved -
Title
Date--4- > £ fir! �..
COUnty Health Departmen
?(LL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
OH 40'5, 10/56 (Rc)Ia ws HRS-N orrr l;5 h may be jj )
(Stock uut) r- 5744.042-4015.61
a -
OCi' 012013
STATE OF FLORIDA _
DEPARTMENT OF HEALTH BY-_(
ONSITE SEWAGE TREATMENT SPOSAL JS M
CONSTRUCTION PERMIT fi T
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: (Sharon Rose Gentile Liv Trust)
PROPERTY ADDRESS: 1200 NE 103 St Miami, FL 33138
LOT: 7
PROPERTY ID #
BLOCK: 186 SUBDIVISION: Miami Shores Sec. 8
11- 3206 - 034 -0290
PERMIT #:13 -SC- 1491537
APPLICATION #: AP1118337
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR915466
[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 [ 1,050
] GALLONS / GPD
New Septic Tank 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 bed confiquration drainfiel 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., 12.00' NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 24.00][ INCHES FT ] [ ABOVE BELOW BENCHMARK /REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [,x4.'00][ INCHES FT ][ABOVE BELOW BENCHMARK /REFERENCE POINT
L LL7fi-
D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: [ ] INCHES
Tank replacement only. (an approved outlet filter shall be installed.),,
0 Inspector to verify the existing septic tank is properly abandoned before final approval.
T Contractor shall uncover the 4 corners of existing drainfield to make it available to the inspector to verify the existing 300
H sq.ft. of drainfield and original conditions under which the system was approved.
The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance with
E sec. 64E- 6.013(3)(f). F.A.C.
R "THIS PERMIT IS NOT FOR " ADDITION(s) ". (Comments Continued on Page 2.)
SPECIFICATIONS BY: Teresa S 1 mon TITLE:
Master Septic Tank Contractor
APPROVED BY: TITLE: Dade CHD
Ca los Icaz ThQ contractor (or d�
DATE ISSUED: 08/2 �'XP�i`RP;TfbN` 'bAT�E rriorrn .- 11/26/2013
d '19 adjacew
08/09 (Obsoletes all ri Un8
DH 4016
previous editions which may not be `�s�tl� t.G ;, i, , ,.. ,,�
Incorporated: 64E-6.003, FAC Page 1 of 3
v 7..7..4 AM18337 a ui1 Of 1 �8�i���99J�If IiGi1 ii1 �l (itfF ;p, d{
remspc,r;1Ion fe° fir
at thr
DOCUMENT #: PR915466
The system is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total estimated flow of
400 gpd.
The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance with s.
64E- 6.013(3)(f), FAC.
�- DIVISION OF
Environmental Health
O Florida Department of Health ,!
® Miami -Dade County Health Department �Io�
Q� OSTDS /Well Division
11805 SW 26 St. - Miami, FL 33175
Inspector Date 0 Address b �� �D �l OSTDS #I
Comments:
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
FBC 20
BUILDING Permit No.
PERMIT APPLICATION
Permit Type: PLUMBING
JOBADDRESS: � 2_v® Ns 1®3 °9+rte
pCi 012013
Master Permit No. j
/
City: Miami Shores County: Miami Dade Zip: 3 .313
Folio/Parcel #: _j(= c;e _ y.34- - 029
Is the Building Historically Designated: Yes NO PZ Flood Zone:
OWNER: Name (Fee Simple
E2-Q® Ajf= 1o2a
Ccr)+,Ie
t City: to Zip:
Tenant/I.essee Name: Phone #:
Email:
9.03e
CONTRACTOR: Company Name: 3:t d -4e i a9i d Z G GI ty S (-I( Phone #: � �
�
Address: &b32 .O 2- 3 a+
City: to 1Y q r,\G r State: iz Zip: -3 340 2� S
Qualifier Name: rPx"-Sc SO (`o Phone #:
State Certification or Registration #: &' Ma 9 i I Certificate of Competency #:
Contact Phone #: Email Address:
DESIGNER: Architect/Engineer Phone #:
Value of Work for this Permit: $ Z 2 00 6v Square/Linear Footage of Work:
Type of Work: ❑Address OAlteration ONew ORepair/Replace ODemolition
Description of Work: A-bc2 s) Jon (C c--e_
bi-0 0 _ k .fit e,, 11
N C1,-0 ( 090 Ge- 1( ,o., 4 t-`\ 1C
4f
Submittal Fee
Scanning Fee $
Notary
Permit Fee $ % CCF $ CO /CC $
Radon Fee $ DBPR $ Bond $_
Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ ° 'J
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
zip
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 Signature R C Q �
caner or Aaent Contractor
The foregoing instrument was acknowledged before me this
oigi
day of "+"p, ` , 20`�, by �Zfrhror 2ok &.%+^le
The foregoing instrument was acknowledged before me this(/
day of , 20 L&, by le-,P s,—, �� /� amaon
who is personally known tome or who has produced P i v t ip who is personally known tome or who has produced
6 F-.,A As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC:
My Commission Expires:
NOTARY PUBLIC:
APPROVED BY /<Yf 4,J Plans Examiner Zoning
Structural Review Clerk
(Revised3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)