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PL-14-693n Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 210426 Scheduled Inspection Date: April 23, 2014 Inspector: Diaz, Osvaldo Owner: GREEN, MATTHEW & AMANDA Job Address: 930 NE 95 Street Miami Shores, FL Project: <NONE> Permit Number: PL -4 -14 -693 Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132050070070 Contractor: SOUTHERN SEPTIC CONTRACTORS INC Phone: (305)598 -8266 l3wicaling Department comments SEPTIC TANK AND DRAINFIELD INSPECTOR COMMENTS False Inspector Comments Passed HRS IN FILE Failed �� �� S r o ��� `�t ►��. Correction - Needed Re- Inspection 44° 2-3 -! Fee pow No Additional Inspections can be scheduled until re- inspection fee is paid. April 22, 2014 For Inspections please call: (305)762 -4949 Page 18 of 37 /9/ /`/-693 DIV IVOR t of W W W -W IW EnAronwenb Hed* & Florida Health Miami -Dade County P OSTDS^Vell Division OP 11805 SW UP Sbva • Miami, FL 33175 speetor Ms" %te— Date 14 11 c> 14 Address 3 0— OSTDS # L1131.71 Comments: Signature L C- ` - . t,` Comments: Signature t®l'ttltlA� HeS��1 . Florida Health Miami -Dade County OSTDS/Well Di'v'ision �0 11805 SW 26°i Sheet Ibtismi. FL 33175 Inspwor 1"� e- Date �wT• Address--'130 � � � OSTDS # �$ � Comments: Signature i _ • STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: Amanda Greene PROPERTY ADDRESS: 930 NE 95 St Miami, FL 33138 LOT: 4 BLOCK: na SUBDIVISION: PROPERTY ID #: 11- 3205 -007 -0070 PERMIT #:13 -SC- 1529874 APPLICATION #: AP1141333 DATE PAID: FEE PAID: RECEIPT #: DOCUMENT #T R934919 [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 1,050 l GALLONS / GPD septic tank CAPACITY A [ 0 l GALLONS / GPD CAPACITY N [ 0 1 GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K [ 1 GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ D [ 300 1 SQUARE FEET Bed confiquration drainfiel SYSTEM R [ 0 1 SQUARE FEET SYSTEM A TYPE SYSTEM: [X] STANDARD [ ] FILLED [ ] MOUND [ ] I CONFIGURATION: [ ] TRENCH [X1 BED [ ] N F LOCATION OF BENCHMARK: FFE 13.07' NGVD I ELEVATION OF PROPOSED SYSTEM SITE [ 28.401[ INCHES FT ][ABOVE BELOW BENCHMARK /REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 70.441[ INCHES FT ][ABOVE BELOW BENCHMARK /REFERENCE POINT L D E O T H E R ILL MWuJLKF..D: L U.UU J INCHM5 ZAL;AVATIVN MWVIAMU— L y{.UU J La'-,nr.0 1.- Install a 1050 gal min. septic tank with an approved filter. 2. -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. 3.-Install 300 sf of drainfield in bed configuration. 4.- Install 12" of slightly limited soil at the bottom of the drainfield. 5.- 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: Roberto_ Rodriguez TITLE: APPROVED BY: ,� ,� TITLE: Engineering Specialist II Dade CHD Betsy Lange- Olmino DATE ISSUED: 04/01/2014 EXPIRATION DATE: 06/30/2014 DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E- 6.003, PAC age rm 3 v 1.1.4 aPiiaisss The contr�,�(�r designee) is require�to pe orm 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 bcrlrg and compare the results to the original site evaluation submitted. A reinspection fee will be assessed if the contractor is r42 a% the jobsite at the arranged time. Docmdm #: PR934919 := Invert elevation of drainfield to be no less than 7.7' NGVD. . -Bottom of drainfield elevation to be no less than 7.2' NGVD. . -This permit includes the abandonment of the existing septic tank. 'he system is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total estimated flow of 00 gpd. 'HIS PERMIT IS NOT FOR ANY ADDITIONS. NOTICE OF RIGHTS A party whose substantial interest is affected by this order may petition for an administrative hearing pursuant to sections 120.569 and 120.57, Florida Statutes. Such proceedings are governed by Rule 28 -106, Florida Administrative Code. A petition for administrative hearing must be in writing and must be received by the Agency Clerk for the Department, within twenty-one (21) days from the receipt of this order. The address of the Agency Clerk is 4052 Bald Cypress Way, BIN # A02, Tallahassee, Florida 32399 -1703. The Agency Clerk's facsimile number is 850 -410 -1448. Mediation is not available as an alternative remedy. Your failure to submit a petition for hearing within 21 days from receipt of this order will constitute a waiver of your right to an administrative hearing, and this order shall become a 'final order. Should this order become a final order, a party who is adversely affected by it is entitled to judicial review pursuant to Section 120.68, Florida Statutes. Review proceedings are governed by the Florida Rules of Appellate Procedure. Such proceedings may be commenced by filing one copy of a Notice of Appeal with the Agency Clerk of the Department of Health and a second copy, accompanied by the filing fees required by law, with the Court of Appeal in the appropriate District Court. The notice must be filed within 30 days of rendition of the final order. STATE OF FLORIDA APPLICATION # API 141333 DEPARTMENT OF HEALTH PERMIT # 13-SC- 1529874 ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM DOCUMENT # SE924420 SITE EVALUATION AND SYSTEM SPECIFICATION APPLICANT: Amanda Greene CONTRACTOR / AGENT: Southern Septic LOT: 4 BLOCK: na SUBDIVISION: ID #:11- 3205 -007 -0070 TO BE COMPLETED BY ENGINEER, BEAT TH DEPARTMENT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEERS MUST PROVIDE REGISTRATION NOMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS. PROPERTY SIZE CONFORMS TO SITE PLAN: [X ]YES [ ]NO NET USABLE AREA AVAILABLE: 0.29 ACRES TOTAL ESTIMATED SEWAGE FLOW: 400 GALLONS PER DAY [ I RESIDENCES - TABLET / OTHER -TABLE 2 ] AUTHORIZED SEWAGE FLOW: 724.98 GALLONS PER DAY [ 1500 GPD /ACRE OR 1 2500 GPD /ACRE ] UNOBSTRUCTED AREA AVAILABLE: 600.00 SQFT UNOBSTRUCTED AREA REQUIRED: 600.00 SQFT BENCHMARK /REFERENCE POINT LOCATION: ELEVATION OF PROPOSED SYSTEM SITE THE MINIMUM SETBACK WHICH CAN BE MAI SURFACE WATER: FT WELLS: PUBLIC: FT LIMI BUILDING FOUNDATIONS: 5 FT SITE SUBJECT TO FREQUENT FLOODING? 10 YEAR FLOOD ELEVATION FOR SITE: SOIL PROFILE INFORMATION SITE 1 FFE 13.07' NGVD 28.40 [FINCHES]/ FT ] [ ABOVE % [BELOW ] BENCBMAItR /REFERENCE POINT NTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES DITCHES /SWALES: FT NORMALLY WET: [ ]YES I ]NO TED USE: FT PRIVATE: FT NON- POTABLE: FT PROPERTY LINES: 5 FT POTABLE WATER LINES: 50 FT [ ]YES [X]NO 10 YEAR FLOODING? [ ]YES IXINo] FT [ MSL /NGVD ] SITE ELEVATION: 10.70 FT [ MSL / NGVD SOIL PROFILE INFORMATION SITE 2 USDA SOIL SERIES: Urban land Munsell #/Color Texture Depth 10YR 4/1 Loamy Sand 0 To 35 10YR 813 Oolitic Limestone 35 To 72 USDA SOIL SERIES: Urban land Munsell #/Color Texture Depth 1 OYR 4/1 Loamy Sand 0 To 38 10YR 8/3 Oolitic Limestone 38 To 72 OBSERVED WATER TABLE: INCHES [ ABOVE / BELOW ] EXISTING GRADE TYPE: [ PERCHED / APPARENT ] ESTIMATED WET SEASON WATER TABLE ELEVATION: 81 INCHES [ ABOVE / BELOW ] EXISTING GRADE HIGH WATER TABLE VEGETATION: [ ]YES [X]NO MOTTLING: [ ]YES [X]NO DEPTH: INCHES SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: Replacement 4-FS/0.60 DEPTH OF EXCAVATION: 54 INCHES DRAINFIELD CONFIGURATION: [ ] TRENCH [XI BED [ ] OTHER (SPECIFY) REMARKS/ADDITIONAL CRITERIA SITE EVALUATED BY: DATE: 03/02/2014 Rodriguez, Roberto (Title: ) (Southern Septic Contractors, Inc.) DH 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated: 64E- 6.001, PAC Page 3 of 4 AP1141333 EID1529874 v 1.0.2 Miami Shores Village P , C F � �F Tl � Building Department APR 0 7 014 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 B►LLTIILDING- _ _ . - Permit•No. PERMIT APPLICATION Master Permit No.��� Permit Type: PLUMBING JOB ADDRESS: C150, City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: I I r O r 0 O -7 Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): A in A ^ d k 6 r g&'N Phone#: Address: N C City: 1" 1 i ryh.C< State: Zip: Tenantarssee Nam: Phone#. CONTRACTOR Company Name: Ott T,'►E Address: 1 tA Z 1 S W City. tom.. -State: JJ Zip: Qualifier Name lc raV►'e Phone#• 3 O S�4 Y X 26 L. State Certification or Registration #: Z Ceiae of Competency ° 2 /t/ SdQ {rg �:�Go� Contact Phone#: Email Address: � P�'A � 01''1 'C'+^'�u= • �')+�'1 DESIGNER ArcW:ect/Engineer. iJ Phone #: Value of Work for this Permit: $ 2- o °o • o Squarelllnear Footage of Work: Type of Work: ❑Address ❑Alteration ❑New Ntepair/Replace ❑Demolition Description of Work• �����a�e�ee�a�emmeeee�m�eeeeee�e��ae�aeeeeep�x��e�e�eeeaae�seee�eeeees���r���a��ee�eeea�eee�e�ea� Submittal Fee $� • Permit Fee $ �U . ^ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ B 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 commend prior to the issuance of a permit and that all work will be performed to meet the standards of all lases 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 wilt 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 iss the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged r ) Sig or Agent The foregoing instrument was acknowledged before me this Z_ The foregoing instrument wassNcknow ged before Inc this, day of 20 j , by o!1d rZA&A 11 f day of i 20 �by Ut'L who is personally known to me or who has product who is personally known to me or who has produced As identification and who did take an oath as identification and who did take an oath. NOTARY PUBLIC: Sign: Print:'�L6A)1��•��,_Lo - -- My Commission Expir �� `�a JW VALLECILLO NOWY Public -Site al Florida My Comm. ExPes Mar 27, 2016 APPROVED BY (' i� 4-f"' &'l r--1 Plans Examiner Structural Review (Revised3/i2t2012)(Revised 07 /10RIMvised 06/1(YZd09)(Revised 3/15109) NOTARY PUBLIC: Sign: Print: my G)1 0. JAS VALLEC -__ ftkry i 4WIM 004 tin Clerk CERTIFICATE OF LIABILITY INSURANCE DIDDIYYYYj 044 /07/1/07 /14 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certfficate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terns and conditions of the policy, policies m ay require an endorsemertt. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorseme s . PRODUCER Jimenez & Co., Inc. 8000 Coral Way 1 Miami, FL 33155 Phone (305) 264 -9900 Fax (305) 264 -5382 NAME: JULIO JIMENEZ PHONE FAX (305) 264 -9900- No l: (305) 264 -5382 MAIL PRODUCER CUSTI INSURER(S) AFFORDING COVERAGE NAIC P INSURED SOUTHERN SEPTIC AND LIFT STATION CORP 1421 SW 153 PATH Miami, FL 33194 305 - 598 -8266 INSURER A: COVINGTON SPECIALTY INSURANCE COMPA 13027 INSURER B: MERCURY INDEMNITY COMPANY OF AMERIC 11201 INSURER C : FLORIDA CITRUS BUSINESS & INDUSTRIES F 31259 INSURER D; MED EXP (An one person) INSURER E: PERSONAL & ADV INJURY INSURER F: ❑ %.vrcrvaaw GEKFIFIGATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVF RPI=N RFnucFn RV vein cr AIMS _LTR TYPE OF INSURANCE B POLICY NUMBER POLICY EFF MM/DD POLICY P MMIDD LIMITS A i i GENERAL LL481LITl' 1 COMMERCIAL GENERAL LIABILITY ❑ ❑ CLAIMS -MADE © OCCUR ❑ VBA267783 11/07/2013 11/07/2014 EACH OCCURRENCE $ 1,000,000.00 DAMAGE TO RENTED- PREMISES Es oc •urren •e $ 100,000.00 MED EXP (An one person) $ 5,000.00 PERSONAL & ADV INJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 2,000,000.00 GENL AGGREGATE LIMIT APPLIES PER: © POLICY ❑ PRO- ❑ LOC PRODUCTS - COMP /OP AGG $ 1,000,000.00 $ i B i AUTOMOBILE LIABILITY ❑ ANYAUTO F-1 ALL OWNED AUTOS © SCHEDULED AUTOS ❑ HIREDAUTOS ❑ NON -OWNED AUTOS ❑ BA090000001042 10810212013 08/02/2014 COMBINED SINGLE LIMIT (Es accident) $ 500,000,00 BODILY INJURY (Per person) $ BODILY INJURY (Per accident $ (PRO�PEERTY DAMAGE $ $ $ j j ❑ UMBRELLA LW8 ❑ OCCUR ❑ EXCESS LIAR ❑ CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ ❑ DEDUCTIBLE RETENTION $ $ $ C I WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY OFFICROER/MEMBER PEXCTUDEDE? ECUT� (Mandatory in NH) H es, describe under DESCRIPTION OF OPERATIONS below N J A 106 -50116 07/17(2013 07/17/2014 WC STATU OTH- Olt E.L. EACH ACCIDENT $ 500,000.00 E.L. DISEASE - EA EMPLOYE $ 500,000.00 E.L. DISEASE - POLICY LIMIT $ 500,000.00 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space Is required) SEPTIC TANK SYSTEMS (INSTALLATION, SERVICE AND REPAIR) - SR 0021421 -- GERTIFICATE HOLDER VILLAGE OF MIAMI SHORES 10050 NE 2 AVE MIAMI SHORES, FL 33138 FAX- 305 - 756 -8972 ACORD 25 (2009109) OF BOVE DESCRIBED POLICIES BE CANCELLED BEFORE THEREOF, NOTICE WILL BE DELIVERED IN E POLICY PROVISIONS. )9 ACORD CORPORATION. All rights reserved. name and logo are registered marks of ACORD