PL-13-2099Number: I NSP- 206008
Inspection Worksheet
Miami Shores Village
10060 N.E. 2nd Avenue Miami'Shores, FL.
Phone. (306)M-2204 Fax. (30$)75"97
,Scheduled lripe0lort DaW. .January 201-20-14
hispmtor: T%c,'Ossvaldo
owner: ULLY, STUART
Job Address: 0,W NE 0:Avenue
Miami Shy; FL
Project <NONE>
Permit Number; PL-9-1 -3-2090
Permit Type: Pl b ng - Residential
l tapftdon Tom: Final
Work Classificatton;,'DrainflW11A.
Phone Number
Parcel Number 11=M091?28
Contractor: STATEWIVE SEPTIC CONNECTIONS Phone. (964 )9$34002
no gEpamnent commen"
ALL 375 ,GALLON DOSING TANK to as"ct Cookkoft
re CTbR CWME{�lTS F4196
ALL 4CIO :SQ Fr BED DRAIN FIELD IM
s ) Inspector
Passed CREATED AS REIN$PEC` ION FOR (NSP -2 Sh6. JD IS DOWN
NO PERMIT ON SITE AND HRS APPROVAL SLIP REQUIRED'
Failed
Correction
Needed
t.
Re- Inspection
Fee
No CM91 IfIsOCUano to 909&ed U1110
re-Inspe is pal
January 27, 2014 For Inspedtidns please trait. (305)762490 Page 21 of 29
DIVISION Of
Environmental Hes r.
Ida Department of Health
uie 'aunty Health Department
OSTDS /Well Division
8001 SW 26 St. ° Nisnd, FL 33175
Date
nSpector Y
.,Address
OSTDS #
Signature
11
IM
1
N
Q
DIVISION OF
..• Enviranmental Health,
1F1!��'ida Department i
eaith Deparhtll�eni
M(ami -Dade County
OSTDS /Weil Division N%o
l ISas sw 26 st. • wand, FL 33175
Date
Inspector
OSTI75 #
Address
signature
91
Miami Shores Village
Building Department SSP 17 2013
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
BUILDING
PERMIT APPLICATION
Permit Type: PLUMBING
JOB ADDRESS: 11 8 0 c) 4e l'3 /i y t
FBC20(Z�
Permit No.
Master Permit No. l 13 - 2 ®9
City: Miami Shores County: ? Miami Dade Zip: -331-36
Folio/Parcel #: It 32-0 5- ®c, 9- o 2 8 0
Is the Building Historically Designated: Yes NO tf' Flood Zone:
OWNER: Name (Fee Simple Titleholder): S t U „,+ ,- J'tr-w-+ 6' 1 V Phone#:
Address: 99-7 Cep N e- 1,3 P ye
City: PA4
S10
State: F-c- Zip: 33 (38
TenandLessee Name: Phone#:
Email:
CONTRACTOR: Company Name: I C S C Phone#:
Address: s-w Z3 St
City: i Y-aw'o”- State: f_1 L Zip: 30 2- `1
Qualifier Name:, kee a &G "_Von Phone#:
State Certification or Registration #:'s M 0 oy Z-6 Certificate of Competency #:
Contact Phone#: Email Address:
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $ 100 Q Square/Linear Footage of Work: k 0 0
Type of Work: ❑Address ❑Alteration ❑New Wepair/Replace ❑Demolition
Description of Work: iV% yteu t 3 -1 S 4-'1 ®I-" C
k l,� to i 4 Se, .�t Pyrd b d ak ,'O fi-e (d
Submittal Fee $ ®• LAZ Permit Fee $ ''43C'(' CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ C ® Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $2275-AE
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
Application is hereby madq td, 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 rein ct'on fee will be charged.
Signature Signature -�:J
Owner or A Contractor
The foregoing instrument was acknowledged before me this r
day of , 20 � �, by gtv Ae+ bill—,
who is personally known tome or who has produced �j V'
Ll '&f As identification and who did take an oath.
NOTARY PUBLIC:
Sign: I
Print: C e,.& f4
The foregoin instrument was acknowledged before me this
day of , 20, by r
who is personally known to me or who has produced t" °-•� 1
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
�•�.
moo• o� °�. .!-44 AU ._
Print:
� v °• TERESA J SOLOMON
My Commission Expires: = =.' My Commission ExAg.�
*; *c MY COMMISSION # EE131935.
�ao7��ts3 EXPIRENowembar06, 2015 �i / / /� ' ��t� \\�� °�
APPROVED BY �i a / Plans Examiner Z61iing
Structural Review Clerk
(Revised3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)
J
LOT: 1718 BLOCK: 2 SUBDIVISION:
PROPERTY ID #: 11- 3205 -009 -0280
[SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
[OR TAX ID NUMBER]
SYSTEM MUD_= 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 Septic CAPACITY
A [ 0 ] GALLONS / GPD CAPACITY
N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ 375 ] GALLONS DOSING TANK CAPACITY [77.00 ]GALLONS @I 6 ]DOSES PER 24 HRS #Pumps [ 1 ]
D [ 400 ] SQUARE FEET
R [ 0 ] SQUARE FEET
A TYPE SYSTEM: [X]
I CONFIGURATION: [ ]
N
Bed configuration drainfiel SYSTEM
SYSTEM
STANDARD [ ] FILLED I I MOUND
TRENCH [s] BED I ]
F LOCATION OF BENCHMARK: FFE 6.8' NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 18.00][ INCHES FT ][ABOVE BELOW BENCHMARK /REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 39.60][ INCHES FT ][ABOVE BELOW BENCHMARK /REFERENCE POINT
L
D E
O
T
H
E
R
ILL REQUIRED: L U.UU J IMUkI u WWAVA .LuM rNWuiA%m1J; L L "I.OU J -Munzz
"*Performing Lift Dosing.
Pumps must be certified as suitable for distributing sewage effluent.
1.- Existing 1050 gal. septic tank, certified by "Statewide Septic Connections Inc. on'09/11/13" to remain.
2.- Install 400 sf of drainfield in bed configuration.
3.- Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed or drain trench.
(Comments Continued on Page 2.)
SPECIFICATIONS BY: Betsy Lange TITLE: Engineering Specialist II
APPROVED�BY: �� �y���y TITLE: �Ir�/p -]� ' Dado CHD
DATE ISSUED: 09/13/2013 EXPIRATION DATE: 12/12/2013
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E- 6.003, FAC
v 1.2.9 AP1119877
Page 1 of 3
+@ M*actor (or designee) is required to perform a
soil boring adjacent to the drainfield excavation at the
time of final inspection. Prior to Final Approval, the DOH
inspector shall witness the soil boring and compare the
results tug the original site evaluation submitted. A
reinspe tion fee will be assessed if the contractor is not
at the jobsite at the arranged time
'#W . `% ,
DOCUMENT #: PR916767
nvert elevation of drainfield to be no less than 4.0' NGVD.
3ottom of drainfield elevation to be no less than 3.5' NGVD.
a system is sized for 4 bedrooms with a maximum occupancy of 8 persons (2 per bedroom), for a total estimated flow of
1 gpd.