PL-13-2469Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 207842
Scheduled Inspection Date: March 12, 2014
Inspector: Diaz, Osvaldo
Owner: DARYA MEDVEDYEVA, SHANNON
Dfluuo' 1
Job Address: 78 NW 95 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor:
MIAMI DADE ENVIROMENTAL
tiuliming uepanment comments
Permit Number: PL -10 -13 -2469
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Septic
Phone Number (786)597 -3705
Parcel Number 1131010340080
Phone: 786 -251 -4099
INSTALLING A NEW 900 SEPTIC TANK AND 200 SQ FT Infractio Passed Comments
OF DRAINFIELD I INSPECTOR COMMENTS False
spector Comments
Passed CREATED AS REINSPECTION FOR INSP- 202698. provide hrs approval
HRS IN FILE
Failed -SOD
Correction v '- C A,t IC U >�
Needed ❑
Re- Inspection ❑ 3
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
March 11, 2014 For Inspections please call: (305)762 -4949 Page 21 of 34
I1��1�3
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,
BUILDING
PERMIT APPLICATION
Permit Type: PLUMBING
0CT 31 M3
FBC 20
Permit No.
Master Permit No._ R/
JOB ADDRESS: 13 - ,) di
City! _ Miami Shores County: Miami Dade Zip: RE 7
Folio/Parcel#: Y -`eft) I _ -;�(4 -nn zn
Is the Building Historically Designated: Yes
Zone:
OWNER: Name (Fee Simple Titleholder): O� fi !U w1i Po tat `1 Phone#:
Address:? 8 (16 S-r
City: 1w u { S-gop"Ps State. Zip: si A 1:5
Tenant/Lessee Name:
CONTRACTOR: Company Name: JtL4 IA i ®A fl e E 7 d a 1 AO i f UT/Z 1 Phone#: &. 2 M -
City: State: Zip: J
Qualifier Name -Z&-2 % L/ 9, 9
State Certification or Registration #: S R. C'M G Certificate of Competency #• SM ffl2yg t I
Coact Phone#: `Ze-& •%S<• � 0 i 9 Email Address:.YlA 1t SOU 1 Aot? Ike dn( 1 (A S' , P
DESIGNER: Architect/Engineer.
Value of Work for this Permit: $ A _S 0 d Square/Linear Footage of Work: Jon
Type of Work: OAddress OAlteration UNew WRepair/Replace ODemolition
Description of Work: IJ p, td 00 o c ' L tl (l AJ fN 7 e)() 0(2 r /-
Submittal Fee $ Q Permit Fee $ ��J�' -® CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
Technology Fee $
TOTAL FEE NOW DUE $ C�
V
Bonding Company's Name (if applicable) f p
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
zip
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
EMPROVEMENTS 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 o Krs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approv and a reinspection fee will be charged.
A
Signature Signature
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this 1 The f oing instrument was acknowledged before me this
day ofo bek201, by $a 1rt<® ay ®ale+_Ll day of a� 20� byJnS�
who is personally known to me or who has produced ice- who is personally known to me or who hat producedZ3 4
As identification and who did take an oath. !;O-T.3 202 eas identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:
Print Print:
My Commission Expir JOSE R. BOLAN08 My Commission Expires:
'ia' Nousy Public, Slate of Flom
commis W #
My CMb m Wo Od. 00, 2014
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APPROVED BY Plans Examiner
zoning
Structural Review Clerk
{ReAS00 /12012)(Rewised 07 /10 /07XRevised 06 /1=009)(Revised 3/15/09)
STATE OF FLORIDA OCT 31 2013
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DI ,n2YS
CONSTRUCTION PERMIT
fitrAl
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Shannon Powell
PROPERTY ADDRESS: 78 NW 95 St Miami, FL 33150
LOT: 12 BLOCK: 167 SUBDIVISION:
T # :13 -SC- 1502618
' #ATIoN #:AP1124609
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR920749
PROPERTY ID #: 11- 3101 -0340080 [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 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 @I ]DOSES PER 24 HRS #Pumps
D [ 200 ] SQUARE FEET bed configuration drainfiel SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [X] STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [ ] TRENCH (x] BED I ]
N
F LOCATION OF BENCHMARK: F.F.E., 12.40' NGVD
I ELEVATION OF PROPOSED SYSTEM SITE 1 25.20][ INCHES FT ][ABOVE BELOW BENCHMARK /REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 43.201[ INCHES k FT ][ABOVE BELOW BENCHMARK /REFERENCE POINT
L
D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: [ ] INCHES
Inspector to verify the existing septic tank is properly abandoned before final approval.
O *Invert elevation of drainfield to be no less than 9.30' NGVD.
T *Bottom of drainfield elevation to be no less than 8.80' NGVD.
H 'THIS PERMIT IS NOT FOR " ADDITION(s) ".
The system is sized for 2 bedrooms with a maximum occupancy of 4 persons (2 per bedroom), for a total estimated flow
E of 300 gpd.
R Required drainfield area based on rule 64E- 6.015(6)(c)2. /
BY: Jose
TITLE: Registered Septic Tank Contractor
APPROVED BY: — TITLE:
Car M I a
DATE ISSUED: 10 /3d o The contractor t,Or designee) is required to perform EXPIRATION DATE:
DH 4016, 08/09 (Obsoletes all previc&W W1"Ja*We0tddhe 4x4nfiedikeltavdWvMthe
Incorporated: 64E - 6.003, FAC time of final inspection. Prior to Final Approval, the DOH
V 1.1.4 Inspector shall witnA§j t I boring and compaftthe.565
results to the original site evaluation submitted. A
reinspection fee will be assessed If the contractor is not
1hp ?nhsite at the arranged time.
Dade CHD
01/28/2014
Page 1 of 3
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STATE OF FLORIDA ` 2Li(09
CEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRICTION INSPECTION AND FINAL APPROVAL
APPLICANT: 9 J''l x dt t-L o n
AGENT:
PROPERTY ADDRESS:
LOT; BLOCK:
PERMIT No
DATE PAID:
FEE PAID:
RECEIPT [):
SUBDIVISION: �-
_ PROPERTY ID 0 4 1 1 0 1 ®.3 4! ®®AQ f
13HECKED 1X) ITEMS ARE
NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED. ,
:xzozaz —zzz4 z zs=ze=
zaz= zzs:z`aaaaaaz z==as a z z a =zc�z
TANK INSTALLATION
I J
1011
TANK St2E [1) - '" 2 J
SETBACKS
I 1 (021
TANK MATERIAL �"- (,e I
1 1271
SURFACE WATER FT
( 1 1Q31
C 1 (04)
OUTLET DEVICE (
MULTI - CHAMBE (
1 1281
1 (291
DITCHES FT
PRIVATE WELLS
( J 1051
_
OUTLET FILTER S t c 4'e t F 4 (
1 [301
IT
PUBLIC WELLS
( 1 (06)
LEGEND l c� 1 D C 3 (
1 [311
IRRIGATION WELLS FT
[ 1 (071
WATERTIGHT (
1 [321
POTABLE INATER LINES __ 2 0 FT
I 1 1061
LEVEL I
J 1331
BUILDING (FOUNDATION 7' FT
C 1 [091
DEPTH TO LID / I
2 1Y (
] (341
1 136)
PROPERTY LINES — FT
OTHER
A- A f
DRAINFIELD INSTALLA N
FT
I 1 (101
AREA [11.141 (2) SOFT, /
FILLED
!AROUND SYSTEM
( 1 fill
DISTRIBUTION BOX _.__, H te (
J [361
DRAINFIELD COVER
C 1 [12)
NUMBER OF DRAINLINES (
J (37)
SHOULDERS
( ) 1131
DRAINLINE SEPARATION (
1 (381
SLOPES
( 1 114)
DRAINUNE SLOPE A-z' L,7� (pJ I
1 (39)
STABILIZATION
[ 1 (161
I 1 1161
DEPTH OF COVER
ELEVATION (ABOV&BELAVVI BM-A-3" 6) 1
ADDITIONAL INFORMATION
[ l 117)
(
SYSTEM LOCATION r/
1 1401
UNOBSTRUCTED AREA
[ 1 [18)
I
DOSING PUMPS
J [411
STORMWATER RUNOFF
[ 1 (191
( 1 1201
-- _----------- (
AGGREGATE SIZE [
AGGREGATE
) (421
j [43)
ALARMS
MAINTENANCE AGREEMENT
( 1 1211
EXCESSIVE FINES (
AGGREGATE
1 [441
BUILDING AREA
DEPTH (
1 1451
LOCATION CONFORMS WITH SITE PLAN
FILL / EXCAVATION MATERIAL (
1 1461
FINAL SITE GRA
I
I 1 1221
FILL AMOUNT (
1 1471
CONTRACTOR
I 1 1231
FILL TEXTURE (
1 1481
OTHER A=---es Vr�`s - �Evt•�
I 1 1241
EXCAVATION DEPTH ®u
ABANDONMENT
I 1 1251
( ) (26)
AREA REPLACED I
REPLACEMENT MATERIAL
1 [491
TANK PUMPED /
[
) 1601
TANK CRUSHED & FILLED—/—/_
EXPLANATION OF VIOLATIONS / REMARKS:
CONSTRUCTION IAP WED /DISAPPROVED):
FINAL SYSTEM IAP� ED/DISAPPROVED): _
DH 4016 (Pe9e 2), t0 /97 (Previous Edilions May Be Used)
Stack Number. 5744. 002. 4018.4
PT 1: Appiloanl
PT 2: la�lakerlCOnlratciot
PT 3: Building Depw"ant
PT 4: Mean DepaAmenl
&V" G ."M
11
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