PL-13-2695Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shdtes, FL
Phone: (306 )795 -2244 Fax: (345 }756-8972
Inspection Number: INSP-203766 Permit Number: PL -11-13 -2665
Scheduled Inspection Date. "06, 2014 Permit Type: Plumbing - Residential
Inspector: Diu, Osvaldo
Inspection Type, Final
Owner LEONE, DEBORAH Work Classification: Dreinfield
Job Address: 5 NW 105 Sfteet
Miami Shores, FL Phone Number
Project <NONEy Parcel Number 4121360050320
Contractor MR C'5 PLUMBING s SEPTI[0 ![NC Phone: (306)654 -7$59
Comments
NEW DRAIN FIELD
False
May 00, 2014 For Inspectlone please call: (305)M.4$49
page .2 Of $7
4nspectcw Comments
Passed
HRS IN FILE
PLEASE GIVE HER TIME TO OPEN THE DOOR.
Failed
�d OIL
Correction
Needed
Fie- Inspection
❑
Fee.
No Additional Inspedians can be Scheduled until
re- inspection fee is paid.
May 00, 2014 For Inspectlone please call: (305)M.4$49
page .2 Of $7
Vi jEnVl DIVISION OF
0*0 ronmentai Health
®O Florida Department of Health
Miami -Dade County Health Department
OSTDS/Well Division P,
In , speCtor 11805 SW 26 St. - M1,,,j, FL
33175
4 r Date
Address coo
Comments_
Miami Shores Village
Building Department . Nov 2,6 gas
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 tAmzz�
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING
PERMIT APPLICATION
Permit Type: PLUMBING
FBC 20
Permit No.
Master Permit NoP_ U3_—_26 ® S
JOB ADDRESS: f
City: Miami Shores County: At Miami Dade Zip:
Folio/Parcel #:
Is the Building Historically Designated: Yes
NO ._ Flood Zone:
OWNER: Name (Fee Simple Titleholder): PULEorkA 4'0� Phone #: 133/ ud
S AA-) fv S
City: State:
Tenant/Lessee Name: Phone #:
Email:
CONTRACTOR: Company Name: A �% � d-f�� Z Phone #: J�9—dS7 714�0
Address: 0%�� f% r2�
City: Ar.. , State: Zip: c35/, l
Qualifier Name: )_' 1�Cre Phone #: Y6S79 6l AO
State Certification or Registration #: 4K' D& 1 536 Certificate of Competency #:
Contact Phone #• Email Address:
DESIGNER: Archite6VFrngineer. Phone#: o
Value of Work for this S are/Linear Footage of Work:
Type of Work: ❑Address ❑Altneration PNew UKepair/Replace
Description of Work:
L� 00
Submittal Fee $ J U Permit Fee $ ���'� CCF $ CO /CC $
Scanning Fee $
Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
DBPR $ Bond
Technology Fee $
TOTAL FEE NOW DUE $
ODemolition
Bonding Compgpy'p -Name (ifapplicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
Zip
Zip
r
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 —9 Signature Qp
Owner or Agent
The foregoing instrument was acknowledged before me this D 0
day of Ael_{ 120 If, by &2kPikk ko ,
who is personally known to me or who-has produced t/'
NOTARY
Sign:
Print:
Contractor
The foregoing instrument was acknowledged before me this y
day of i� � , 20 ff, by - -a ,
who is personally known to me or who has produced
i ME= a an oath.
- Sheryl A Mender i�t�C A MendeS� . _..�.
My C=MnW bn EE017513 NOT EE017513
bpkn 10123/2014
4.... Emowm 101l3120f4
Sign:
Print:
My Commission Expires: My Commission Expires:
APPROVED BY Plans Examiner
Structural Review
(Revised3 /12/2012 )(Revised 07/10/07 )(Revised 06 /10 /2009)(Revised 3/15/09)
Zoning
Clerk
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Deborah Leone
PROPERTY ADDRESS: 5 NW 105 St Miami, FL 33150
LOT: 16 BLOCK: 203 SUBDIVISION:
PROPERTY ID #: 11-2136-005-0320
PERMIT #: 13-,SC4 506324
APPLICATION #: AP1126747
DATE PAID:
FEE PAM:
RECEIPT #:
Docuum #: PR922734
[SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
[OR TAX ID NUMBER]
SYSTEM MUST B9 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 PZMUT, REQUIRE THE APPLICANT TO MDIE'Y THE
PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADB 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 [
750 ]
GALLS ! GPD Septic
CAPACITY
A [
0 ]
GALLS J GPD
CAPACITY
N [
0 ]
GALLONS GREASE INTERCEPTOR CAPACITY
[leaMIM4 CAPACITY SINGLE TANK:1250 GALLS]
K I
I
GALLONS DOSING TANK CAPACITY [
IGAL+LONS El[ IDOSES PER 24 HRS #Pumps I
D I 200 ] SQUARE FEET Bed configuration drainirel SYSTEM
R I 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [al STANDARD [ I FILL= [ ] Pa13ND [ ]
I CONFIGURATION: [ I TRENCH [x) BED [ ]
N
F LOCATION OF BENCHMARK: FFE 12.5' NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 22.801 INCHES FT I ABOVE I,pW BENCHMARK /REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE 1 72.80] q INCHES FT I[ ABOVE i H=CMWdC/REF0U=Z POINT
L
D ii
0
T
H
E
R
ILL REQUIRED: [ 0.001 INCHES EXCAVATION REQUIRED: [ 62.00 J rrsN
1.- Existing 750 gal. septic tank, t erNed by "Mr. C's Plumbing and Septic" on 11/11/2013 to remain.
2.- Install 200 sf of drainfield in bed configuration.
3. Install 12" of slightly limited soil at the bottom of the drainfield.
4.- Perimeter of excavation area shall be at least 2 it wider and longer than the proposed absorption bed or drain trench.
(Comments Continued on Page 2.)
SPECIFICATIONS BY: Mr C" s Plumbing TITLE:
APPROVED BY: TITLE: Engineering Specialist II Dade CHD
Betsy Lange
DATE ISSUED: 11/2112013 EXPIRATxoN DATE: 0211912014
DH 4016, 08/09 tObsoletes all previous editions which may not be used/
Incorporated: 64E- 6.003, FAC Page 1 of 3
v 1,1.4 AP1126747 The contragW19VOesillnee) is rewired to perform a soil
boring adjacent to the drainfield excavation at the time of final
inspection. Prior to Final Approval, the FDOH inspector shall
witness the soil boring and compare the results to the original
site evaluation submitted. A reinspection fee will be assessed
if the contractor is not at the jobsite at the arranged time.
APPLICANT:
STATE OF FLORIDA APPLICATION # AP1126747
DEPART OF HEALTH PERMIT # I"C- 1506324
ONSITE SEWAGE TRZATb1ENT AND DISPOSAL SYSTEM DOCUMENT # SE913319
SITE EVALUATION AND SYSTEM SPECIFICATION
ncshnraah Lane
CONTRACTOR / AGENT: MrC "sPknWng
LOT: JA BLOCK: 223
BENCHMARK/REFERENCE POINT LOCATION: FFE 12.5' NGVD
ELEVATION OF PROPOSED SYSTEM SITE 22.80 (1 a umm / FT ] t ABOVE WWREFERENCE POINT
THE MINIMUM SETBACK WHICH CAN BE b9►INTAnw FROM THE PROPOSED SYSTEM TO THE FOLL0TIIdG FEATURES
SURFACE WATER: FT DITCHES /SWALES: FT N0RbS•LLY WET: I ]YES I ]NO
WELLS: PUBLIC: FT LIMITED USE:' FT PRIVATE: FT NON - POTABLE: FT
BUILDING FOUNDATIOiS: 5 FT PROPERTY LINES: 5 FT POTABLE WATER LINES: 40 AFT
SITE SUWXCT TO FREQUENT FLOODING?
10 YEAR FLOOD ELEVATION FOR SITE:
.,,,..c+rr� so�tmv�vs�mT/lAT atTT@ 9
I ]YES IX]NO 10 YEAR FLOODING? I ]YES IX]NO]
FT [ MSL /i__.t] SITE ELEVATION: 10.60 FT t 14SL /Fwml
sOIL PROFILE INFORMATION SITE 2
USDA SOIL SERIES: Urban lend
MunseU #/Color Texture
Depth
10YR 311 Sarni
0 To 6
10YR 54 Send
6 To 26
10YR 514 000c Lhnestor►e
26 To 72
10YR 54
Oowc l.imsaltorle
USDA SOIL BERM: Urban land
MunsonXCotor Texture __
_,;_Depth
10YR 3/1
Sand
0 To 6
10YR 514
Sand
6 To 26
10YR 54
Oowc l.imsaltorle
26 To 72
OBSERVED WATER TABLE: INCHES I ABOVE /] EXISTING GRADE pT-Y— PE:: -� I PERCHED / APPARENT ]
ESTIMATED WET SEASON WATER TABLE ELEVATION: 1-855 nicHBS [ ABOVE / 1 BELL 1] EXISTING GRADE
HIGH WATER TABLE VEGETATION: [ ]YES [X ]NO MOTTLING: I ]YES IXINO DES: INCHES
SOIL TERTURE /LOADING RATE FOR SYSTEM SIZING: Replacement 4- FS10.60 DEPTH OF EXCAVATION: 62 INCHES
DRAINFIELD CONFIGURATION: [ I TRENCH IX I BED I l OTHER (SPECIFY)
REMARKS/ADDITIONAL CRITERIA
SITE EVALUATED BY: DAB 11/18/2013
Gtr C"s pWMbft [rdle: ] (Ur C"s Pkrmi3hV)
DS 4015, 08/09 (Obsoletes previous editions vbiah may not be used) Incorporated: 64E- 5.001, PAC Page 3 Of 4
AP1126747 E1015M24 v142