PL-12-1696.0
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972 RC - 12 - LA 9 2
Inspection Number: INSP-178366 Permit Number: PL -9-12-1696
Scheduled Inspection Date: October 11, 2012
Inspector: Hernandez, Rafael
Owner: ,
Job Address: 9767 NE 13 Avenue
Miami Shores, FL
Project: <NONE>
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Septic
Phone Number
Parcel Number 1132050090520
Contractor: A AARON SUPER ROOTER Phone: 305-944-8886
Building Department Comments
INSTALL NEW TANK AND DRAIN FIELD WITH DOSING
TANK AND PUMP, FLOAT AND ALARMS. PUMP AND
ABANDON EXISTING SEPTIC TANK.
Inspector Comments
Passed
- hrs approval
Failed
Correction
Needed ❑
Re -Inspection ❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
October 10, 2012 For Inspections please call: (305)762-4949 Page 77 of 22
Miami Shores Village
Building Department i 9EP I 1 zaq
10050 N.E.2nd Avenue, Miami Shotes, Florida 33138 I
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (30p 762.4949
BUILDINGPermit
No. P L.12 �o
PERMIT APPLICATION
Master Permit No. 9:C=- dZ —`'�a Z
FBC 20
Permitil Types PL
OWNER: Name (Fee Simple Titleholder): NC ► ,
,r � � , "�V��- phone#: -
Address:_
City: State:
6 �'
TenanQUssee Name:
c - ,. _. ,
Email:
JOB ADDRESS:'
City: Miami Shores County: -
Miami Dade 7,ip; U
Folio/P
-
Is the Ba'lldink 01016orleally DWI gnateds Yes NO
T- Flood Looe: �_
CONTRACTOR: Company Name: a
a- )Phone#: 6 - �' 6
Address:
-��J
City: State: "_-
Qualifier Name: k -1>n +,
Phone#:
State Certification ottekistration
Contact Phone#: Email Address:
DESIG1VL�eArchitect/Enkineer
Phone#i
Value of Work for this Permit $ Square/Llnear Footage of Work:
Type of Work: UAddress Alteration ®New
;l tepair/Replace ClDemolition
Description of Work: 1 V..�x�� u' y , y-
" -
_ 0 -
d
Submittal Fee $ Permit Fee $_ CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $. TmWng/Educadon Fee $ Technology Fee $
Double Fee $ Stractural Review $
TOTAL FEE NOW DUE $
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
<a
Mortgage Lender's Address
City 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 ELECTRICA WORK, P).UMB ,SIGNS.
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETCH
OWNER'S AFFIDAVIT: I cer* 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
CONEM[ENCEMENT 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 propeny is subject to attachment. Also, a certified copy of the recorded notice of c ement 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.
i' J
Signature Signature
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this 1_ The foregoing instrument was acknowledged beforeme this—12
2
day of , 20 �l by �i v� J I iti"'� day of 20 by ,
who is personally known tome or who has produced DrIV who ispersonally 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: A
Print:"
My Commission Expires:
APPROVED BY
TERESA J SOLOMON
MY COMMISSION # EE131935
EXPIRES November 08, 2015
(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
Plans Examiner
Structural Review
NOTARY PUBLIC:
Sign:
Print:
My Commission
TENESA J SOL®MON
MY COMMISSION # EE131931
EXPIRES November 08, 2015
zoning
Clerk
STATE OF 'FLORIDA PERMIT NO. C e
} DEPARTMEPNIT OF HEALTH DATE PAID:
ONSITE SEWAGE TREATMENT AND DIPOSAL SYSTEM FEE PAID:
<, CONSTRUCTION INSPECTION AND FINAL APPROVAL RECEIPT #:
APPLIC
AGENT:
PROPERTY ADDRESS: 714
LOT: ,7-_Y BLOCK: `% SUBDIVISION: �p _�
L01k ] ROPERTY ID #:
CHECKED (X]
ITEMS A E'NOP IN COMPLIANCE WITH
STATUTE OR
RULE AND MUST BE CORRECTED.
TANK
INSTALLATION
SETBACKS
[
[01]
TANK SIZE [1]/Ok,0 [2] 3`4' 19
[ 1
[271
SURFACE WATER
FT
[ —3/
[02]
TANK MATERIAG
[ ]
[28]
DITCHES
FT
[ A
[03]
OUTLET DEVICE �
[ ]
[29]
PRIVATE WELLS
FT
[ -.1/
[04]
MULTI-CHAMBEREII [�YJ / N ]
[ ]
[30]
PUBLIC WELLS
FT
[ �J
[05]
OUTLET FILTER Z -7,;,,e,
[ ]
(31]
IRRIGATION WELLS
FT
[
[06]
LEGEND All
[ -1
[32]
POTABLE WATER LINES
FT
[071
WATERTIGHT
[ ✓-Y
[33]
BUILDING FOUNDATION FT
[
[08]
LEVEL
[ °rr'
[34]
PROPERTY LINES S,-
FT
[ --1-
[09]
DEPTH TO LID
[ 1
[35]
OTHER
FT
DRAINFIELD INSTALLATIQN FILLED / MOUND SYSTEM
[10] AREA [1] 7C [21 SQFT [ .X [36] DRAINFIELD COVER
[11] DISTRIBUTION BOX HEADER L,-' [ --r [371 SHOULDERS
[121 NUMBER OF DRAINLINES -Y [-1-' (381 SLOPES
[131 DRAINLINE SEPARATION�b 1010(- (391 STABILIZATION
[14] DRAINLINE SLOPE �\
[151 DEPTH OF COVE Z, ADDITIONAL INFORMATION
[161 ELEVATION BOV /BELOW] BM20, Q ti[ r,3- [401 UNOBSTRUCTED AREA
[171 SYSTEM LOCATION p' [ -,1- [41] STORMWATER RUNOFF
[18] DOSING PUMPS .-✓«', [ �} [42] ALARMS 0
[191 AGGREGATE SIZE � ! C>, [ ] [431 MAINTENANCE AGR EMENT
[20] AGGREGATE EXCESSIVE FINES [I ] [44] BUILDING AREA
[21] AGGREGATE DEPTH,/ j/ [ Y}- [451 LOCATION CONFORMS WITH SITE PLAN
FILL / EXCAVATION MATERIAL [ --r [47] CONTRACTOR G y ING/� 4Z
./�ll ' l�..tRJL.LPa-�--
[22] FILL AMOUNT J,2 /, [ -1- [48] OTHER
[23] FILL TEXTURE
[24] EXCAVATION DEPTH
[25] AREA REPLACED
(261 REPLACEMENT MATERIAL
EXPLANATION OF VIOLATIONS / REMARKS:
[ ]
ABANDONMENT
J& [491 TANK PUMPED
[ 5 01 TANK CRUSHED & FILLEZO/ f
[ l
CONSTRUCTIO PPROVE ISAPPROVED]: �L �� - CHD DATE:2--
P �-
FINAL SYSTE [APPOVE DISAPPROVED] :11"/,./�� �c TCHD DATE: .GAJ
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC Page 2 of 3
444NO<(�
DIVISION OF
Environmental Health
Florida Department of Health
® Miami -Dade County Health Department �a
1 Q�OSTDS/Well Division o
11805 SW 26 St. - Miami, FL 33175
Inspector X1111—W Date � r '2— k
Address 9 Z 7 - G - J3 OSTDS #
Comments:
Signature
09/11/2012 »9:16AM 9549678433
CONST K`TX4W PST 7FOR' CiSt[}S Nsw
APR=Aw r (Angelo Nvpalltano
PROPERTY aW"'JS: 87157 NE 13 Ave hliarr4, P -L 3)138
PAGE 02/02
mavKEfi #- 13-3C4 366526
Attaitiwjcw s; gP1045162
DATE $A=
]MR PAID •
RECEIPT 119
w=mmqT t: PR867707
LOT: 7, 8 BLOCK: 4 Earleton Shvned
PROPXT-Tl ID #: 11f3206 -00M520 JIMCTION, TOWNSHIP, RANGE, PARGS3'. SER]
f OR '± 7W ID Woo=l
SYST:RM MUST ata WMTRDCTRib M ACCOYiD3U, E WTmH SPECIFIC.ATIMS XCO t3=1DARD8 OF SECTION
31.0065, F.S., AM CEMTER 64E-6, E.A.C. DEPARTMENT x1P"PROVAM or 5281"K DOES NOTGUARa=rx
/1�TT83FACToAI PXJkV0V WC$ FMR Atrx aDECZFIC RE 71Z or TINE, ANY C]t3►N= Z9 MATBAXAL FACTS,
MICH SERVW AS A "919 FUR ISHIAN(>3 OP TEAS PERMIT, REQU= THE APPLICANT TO )POSFT =
APPMCATION, SUCH 24MMCA' TOM MA7 RESULT IN THIS 7&7.=W BEING MA= i V74, AWP VOM.
ISSliZN= OF TNI* "UMT D029 MT E7MOT Ti[9S AppLXCANT FOXW CCtUy.+rAMCs WITH OTHER FEARRAL,
STA'Fa>r, OR TACAT+ P1iRMITTING REO TIRED TOR DSYil 1PHENT OF TH3S FROpNRWX.
SYS'.iEM DESIGN AND SPECIFICATIONS
T f 1,050 3 GALLO S / ORD Septic-•CAFACwwr
A t I CALL02as / GR13 N/A CAVACITY
M t ] CALIZNS GREASE MMR=V'1"0R "PAC,2TY fuwr lW CAPACITY SXNMZ TANX! 12150 GALLONSI
K E 300 3 GLOWS DQVn9r3 TAM CARACITY t 02.3A ]RAzW-% @E 0 1"ams MR 20 ERs 31Vurtp11 E 1 7
D [ 524 3 SQvARM FIST bed Crm6guration drainfile 6X5T9X
R { . 3 SWAM MMT NIA SYSTM
A TYFV SYSTEM; t ] 8'13�LTC�►RlD [x] r1UT D t 3mom [ 1 _
I CONFIGURATICX-* { ] 'Z911111t ] fxl BED I I -
N
F LOCATION OF 8E]tCMARX! CL NE 13 ave., 4.3V NGVD
I SLWA.TION 09 PnOPOSED SYSTEM S:TZ E 13.20I � ROM
13 BOTTOM of DFAMi FIHI,p TO BE , f 9.20 1 TNC[i8S E T 1 I SEI ON 3811?i�7C3DffARK/RElo81tENC8 POnU
L
D BST.L RSQI PID: 114.001 niCHES E=AVATION =QU2rjD: E 46,60 ] INCHES
o split spstsm 0 (north) with 374 god of 700 gpd.
#uspector 10 VCdN ttfV=1eting septic faO is prop"abwWan befere final approval -
T InVott alavetion of dralnf]eld to be nu loss then 5.50 fL NGVD_
H `Bottom of dralnfield efvvation to be no lew than 8,00 ft. NGvD.
'Install 42` of slightly limited sari urtder the bottom of the draWmId. ;,
£ -Perimeter cf excavation area shall bo at least 2 ft wilier and longer than the proceed 936sorptlt
R -The licensed con"otor Installing the system Is responsible for installing the minimUtM ca
with sea 6415-$.013(3)(f). FAC.
8Y&CIFxCAT1wS BY; Citr2as 3d TGAEa xxTLXi=
AP33AOVIM AY: WITlds: '(ade CRD
DATE I88V1V:D: 132/23!2012
>)O D OSl23Y1073DH 4016, 08/05 (Obsol/:tea all pxevians editiona which may not be used•yIOOOrporaT�d: 641-0.003, FAC mage 1 of 3v 111.4 APIC451U