PL-14-1597Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-216503 Permit Number: PL -7-14-1597
Scheduled Inspection Date: August 20, 2014 Permit Type: Plumbing - Residential
Inspector: Diaz, Osvaldo Inspection Type: Final
Owner: LA HOZ, NOEMI Work Classification: Drainfield
Job Address: 1180 NE 100 Street
Miami Shores, FL 33138- Phone Number
Parcel Number 1132050190390
Project: <NONE>
Contractor: MR C'S PLUMBING & SEPTIC INC Phone: (305)651-7859
tsunamg uepartment comments
TANK AND DRAINFIELD
INSPECTOR COMMENTS False
Inspector Comments
Passed F�y HRS ON FILE
Failed
Correction ❑
Needed
Re -Inspection ❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
August 19, 2014 For Inspections please call: (305)762-4949 Page 7 of 26
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Miami Shores Village
.DVXV Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972 .
INSPECTION LINE PHONE NUMBER: (30S) 762-4+949
BUILDING
PERMIT APPLICATION
❑ BUILDING
M/PLUMBING
JOB ADDRESS:
❑ ELECTRIC ❑ ROOFING
2014
FB.0 20 ,L _
Master Permit No.. -PL _ 114 �
Sub Permit No.
❑ REVISION ❑ EXTENSION nRENEWAL
[-]MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
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City: Miami Shores County, Miami Dade Zia:
Q3f1 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: f_Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple T•itieholder):A I OL&k (At*; k lk2A Phone#: 79 WA7
Address: 110 be i4o S*
city: l State: f- zip: 33 ( Sir
Tenant/Lessee Name: Phone#:
Email: q
CONTRACTOR: Company Name: r C 3 1 Phone#:.7dS eV W -f
Address.• 111,72 AV J O- ,1 ^
City: Apl.; State: �G Zip: 33 !6
Qualifier Name: _Kstl� W Phone#:.? -74`
State Certification or Registration _Certificate of Competency#:
DESIGNOL Architect/Engineer. Phone#:
Address City: State: Zip:
Value of Work for this Permit: $ ckn Square/LineaWR:lr/Replace
of Work: , . '� 0
Type of Work: ED Addition F-1 Alteration New ❑ Demolition
r , 2 ,.�.�. ,2TA
Specify color of color thm tile:
Submittal Fee $ Permit Fee $
X(f=� CCF $, MCC $
Scanning Fee $ Radon Fee $ DBPR $ 1 Notary $
Technology Fee $ Training/Education Fee $
Structural Reviews $ _
(RevfsedDZj24l2M4)
Double Fee $
Bond $
TOTAL FEE NOW DUE $-D�
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (If applicable)
Mortgage Lender's Address
City State
Trp
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 ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC.....
OWNER'S AFFIDAVIT: 1 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 on estimated value exceeding $250D, 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 cerdfled copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (21 days after the building permit Is issued. In the absence of such posted notice, the
Inspection will not be approved and o rgMspectUligh fife will be charged.
SignatureAU Signature
OWNER or AGENT
The foregoinIllinstrument was acknowledged before me this The foregoing instrument was acknowledged before me this
. day of �50 Ly . 20 �, by day of �V L—Y . 20 �-N . by
. who is personally known to ✓ who is personally known to
me or who has produced as me or who has produced as
Identification and who did take an oath.
NOTARY PUBLIC:
identification and who did take an oath.
NOTARY PUBLIC:
Sign: Sign:
Prim Print:
Pu N Pl0tid9
Seal:� .isYN0)0(y � Seat:
Sheryl A MendE
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Vii,+t ,., �xAini810123 14 �, Notary "118SW 0 111000
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Dom10/2014
7
APPROVED BY .P� Plans Examiner t'' - Zoning
Structural Review
(R-bed0V24/2s4)
Clerk
REPAM
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STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Brenda Chiabra
PROPERTY ADDRESS: 1180 NE 100 St Miami, FL 33138
LOT: 3 BLOCK: 178 SUBDIVISION:
PROPERTY ID #: 11-3205-019-0390
PERMIT #:13 -SC -1549922
APPLICATION #: AP1153844
DATE PAID:
FEE PAID:
RECEIPT #:
DocmmgT #TR945647
Miami Shores Sec. 8
[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 I GALLONS / GPD new septic tank CAPACITY
A [ 0 1 GALLONS / GPD CAPACITY
N [ 0 I GALLONS GREASE INTERCEPTOR CAPACITY [b9JM§UM CAPACITY SINGLE TANK:1250 GALLONS]
K [ I GALLONS DOSING TANK CAPACITY I ]GALLONS @I ]DOSES PER 24 HRS #Pumps
I I
D [ 300 1 SQUARE FEET bed configuration drainfiel SYSTEM
R [ 0 I SQUARE FEET SYSTEM
A TYPE SYSTEM: [x] STANDARD I I FILLED II MOUND I I
I CONFIGURATION: [ ] TRENCH [xl BED [ ]
N
F LOCATION OF BENCHMARK: Crown of Road 7.8' NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 4.80 I [ INCHE3 FT ] BELOW ] BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE 130.201[ INCHE3 FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: 1 0.001 INCHES EXCAVATION REQUIRED: [ 47.001 INCHES
-i C ®
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1. -Install a 1050 gal min. septic tank with an approved filter.
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2. -The licensed contractor installing the system is responsible for installing the minimum category of tank in a
aQe
T
with s. 64E -6.013(3)(f), FAC.
a0
3.
M
m
300 sf of drainfield in bed configuration.
p
—1
-Install
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4. -Install 12" of slightly limited soil at the bottom of the drainfield.
E
5. -Perimeter' of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed or dra
11renfi.
(Comments Continued on Pa a 2.
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SPECIFICATIONS BY: TITLE:
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APPROVED BY: TITLE:
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DATE ISSUED: 07/21/2014 EXPIRATION DA � rH 10/1920141
DH 4016, 08/09 (Obsoletes all previous editions which noti bQ ed m
Incorporated: 64E-6.003, FAC n n �nr ,;i ^�^1's re uircd Z orf
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V 1.1.4 APi13844 ! � j7j
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J LL 4 2014 J I ;rtr z at th"r ranged time.
BY
DOCUM iT #: PR945647
.-Invert elevation of drainfield to be no less than 5.78' NGVD.
.-Bottom of drainfield elevation to be no less than 5.28' NGVD.
.-This permit includes the abandonment of the existing septic tank.
'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 # AP1153844
DEPARTMENT OF HEALTH PERMIT # 13 -SC -1549922
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM DOCUMENT # SE934065
SITE EVALUATION AND SYSTEM SPECIFICATION
APPLICANT: Brenda Chiabra
CONTRACTOR / AGENT: MrC
LOT: 3 BLOCK: 178
SUBDIVISION: Miami Shores Sec. 8 m#: 11-3205-019-0390
TO BE COMPLETED BY ENGINEER, HEALTH DEPARTMENT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEERS MOST
PROVIDE REGISTRATION NOMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS.
PROPERTY SIZE CONFORMS TO SITE PLAN: [X]YES I ]NO NET USABLE AREA AVAILABLE: 0.25 ACRES
TOTAL ESTIMATED SEWAGE FLOW: 400 GALLONS PER DAY [ RESIDENCES-TABLEI / OTHER -TABLE 2 ]
AUTHORIZED SEWAGE FLOW: 625.00 GALLONS PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE ]
UNOBSTRUCTED AREA AVAILABLE: 600.00 SQFT UNOBSTRUCTED AREA REQUIRED: 450.00 SQFT
BENCHMARK/REFERENCE POINT LOCATION: Crown of Road 7.8' NGVD
ELEVATION OF PROPOSED SYSTEM SITE 4.80 [ INCHES / FT ] [ ABOVE / BELOW ] BENCBMARK/REFERENCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES
SURFACE WATER: FT DITCHES/SWALES: FT NORMALLY NET: [ ]YES [ ]NO
WELLS: PUBLIC: FT LIMITED USE: FT PRIVATE: FT NON -POTABLE: FT
BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: 5 FT POTABLE WATER LINES: 60 FT
SITE SUBJECT TO FREQUENT FLOODING? [ ]YES [X]NO 10 YEAR FLOODING? [ ]YES [X]NO]
10 YEAR FLOOD ELEVATION FOR SITE: FT[ MSL / NGVD ] SITE ELEVATION: 8.20 FT [ MSL /NGVD
SOIL PROFILE INFORMATION SITE 1 SOIL PROFILE INFORMATION SITE 2
USDA SOIL SERIES: Urban land
Munsell #/Color Texture
Depth
10YR 3/1
Sand
0 To 6
10YR 5/4
Sand
6 To 30
10YR 5/4
Oolitic Umestone
30 To 72
OBSERVED WATER TABLE: INCHES [ ABOVE / BELOW ]
USDA SOIL SERIES: Urban land
Munsell #/Color Texture
Depth
10YR 3/1
Sand
0 TO 6
10YR 5/4
Sand
6 To 30
10YR 5/4
Oolitic Umestone
30 To 72
EXISTING GRADE TYPE: [ PERCHED / APPARENT ]
ESTIMATED WET SEASON WATER TABLE ELEVATION: 62 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: 47 INCHES
DRAINFIELD CONFIGURATION: [ ] TRENCH I X I BED [ ] OTHER (SPECIFY)
- REMARKS/ADDITIONAL CRITERIA
SITE EVALUATED BY: DATE: 06/16/2014
Mr C"s, (Title:) (Mr C"s)
DS 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated: 64E-6.001, FAC Page 3 of 4
AP1163844 EID1549922 v 1.0.2