PL-14-2765Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-225453 Permit Number: PL -12-14-2765
Scheduled Inspection Date: January 06, 2015 Permit Type: Plumbing - Residential
Inspector: Diaz, Osvaldo
Inspection Type: Final
Owner: Kovac, Giselle Work Classification: Septic
Job Address: 290 NE 98 Street
Miami Shores, FL 33138 -
Project: <NONE>
Phone Number 828 230-5395
Parcel Number 1132060134150
Contractor: MR C'S PLUMBING & SEPTIC INC Phone: (305)651-7859
Building Department Comments
SEPTIC TANK AND DRAIN FIELD INSTALLATION. intractio Passed comments
INSPECTOR COMMENTS False
Inspector Comments
Passed HRS ON FILE
Failed (f j)
Correction
Needed
Re -Inspection ❑
Fee,"---,�
No Additional Inspections can be scheduled until
re -inspection fee is paid.
January 05, 2015 For Inspections please call: (305)762-4949 Page 28 of 45
BUILDING
PERMIT APPLICATION
❑ BUILDING ❑ ELECTRIC
Miami Shores Village
Building Department DEC 2014
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972]
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 20�-
Master Permit No � L:. k �4 t_
Sub Permit No.
❑ ROOFING ❑ REVISION ❑ EXTENSION [:]RENEWAL
y
PLUMBING [] MECHANICAL F-1 PUBLIC WORKS [:]CHANG€ OF ❑ CANCELLATION [:]SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: c�M) ISG /C J 5T_
City: Miami Shores County: Miami Dade Zip: t;
Folio/Parcel#: Is the Building Historically Designated: Yes NO X
Occupancy Type: Load: Construction Type: Flood Zone: BFE: I FFE
OWNER: Name (Fee Simple Titleholder): Lra (moi r Phone#:_i
Address: CP?o Nlc 90 S7—
City: P{AW Sti)2:#-'S State: t�(� Zip: 3 313 ?)
Tenant/Lessee Name: � Phone#:
Email: 13LU v ICC71/AC 6 C �Y A [ �_ , c6Yyi
CONTRACTOR: Company Name:_A 1l5 b(/&br ✓ z Phone#:
Address: 6 ( 4/4) ak'A,-c It
City:
Zip: 33Z � 9
Qualifier Name: ri�.r✓,I�C fiiI77lGlc_ Phone#:
State Certification or Registration #: 5 i? 6 61 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Aririresc � City' State: Zip:
Value of Work for this Permit: $
Type of Work: ❑ Addition
Description of Work:
❑ Alteration
, i,A/
,are/Linear Footage of Work: Soo
❑ New>I<epair/Replace ❑ Demolition
Specify
Submittal
Scanning Fee $
Technology Fee $
Structural ReViews $
(Rev1sed02/24/2024)
Y
Radon Fee $
Training/Education Fee $
DBPR $ Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ - �J
*3onding Company's Name (if applicable)
Bonding Company's Address
City
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City 4 State
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: 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
x �'°7 'RESULT IN YOUR PAYING TWICE, -FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBt-AftlWANCING, CONSULT. ITIVYPUR LENDV 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.
rIW
Signatu e ASignature
GENT CONTRACTOR
The foregoing instrument was acknowledged before me this
day of 120 by
f_ who is personally known to
me or who has produced as
i&ntification and who did take an oath.
Jr
NOTARY PUBLIC: _
Print: -� - KEMBLE ETTRICK
49, State ol Florida
Seal: ' S My Comm. Expires Sep 19, 2017
';9, P.� Commission # FF055732
Bonded Through National Notary Assn.
The foregoing instrument was acknowledged before me this
1� day of ��� r/�S . 20 by
who is personal) known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: i
Seal: g Notary Public - stmt o1 F"a
z' . • 1 My Comm. Expires Oct 23, 2016
Commission # FF 136597
" Bonded Through National NOL" Asm
APPROVED BY /,-�/Z-/; •1)1" Plans Examiner
Structural Review
(Revised02/24/2014)
Zoning
Clerk
ErAtR
i,
aaa
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT- Giselle Kovac
PERMIT #:13 -SC -1574921
APPLICATION #:AP1168496
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR958332
PROPERTY ADDRESS: 290 NE 98 St Miami, FL 33138
LOT: 1, 2 BLOCK: 31 SUBDIVISION: Miami Shores
PROPERTY ID #: 11-3206-013-4150 [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 SPECIFICATIONS ,
T [ 1,200 GALLONS / GPD new septic tank CAPACITY
A ( 0 ] GALLONS / GPD CAPACITY
N [ 0 1 GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY ( ]GALLONS @[ ]DOSES PER 24 HRS #Pumps ( ]
D [ 300 YSQUARE FEET new bed config. drainfield SYSTEM
R [ O ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [ ] TRENCH [x] BED [ ]
N
F LOCATION OF BENCHMARK: FFE 10.9' NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 8.40 ][ INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 58.44][ INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: [,62.00] INCHES
1. -Install a 1200 gal min. septic tank with an approved filter.
0 2. -The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance
T with s. 64E -6.013(3)(f), FAC.
H 3. -Install 300 sf of drainfield in bed configuration.
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 drain trench.
(Comments Continued on Page 2.)
R
SPECIFICATIONS BY: M C\s Plb Sept
APPROVED BY:
DATE ISSUED:
4
TITLE:
TITLE: Engineering Specialist II Dade CHD
EXPIRATION DATE: 03/16/2015
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC Page 1 of 3
v 1.1.4 AP1I6R49e; .>us4552�7
DOCUMENT #: PR958332
6. -Invert elevation of drainfield to be no less than 6.53' NGVD.
T -Bottom of drainfield elevation to be no less than 6.03' NGVD.
8. -This permit includes the abandonment of the existing septic tank.
The system is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total estimated flow of
460 gpd.
THIS PERMIT IS NOT FOR ANY ADDITIONS.
T
STATE OF FLORIDA APPLICATION # AP1168496
DEPARTMENT OF HEALTH PERMIT # 13 -SC -1574921
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM DOCUMENT # SE945620
SITE EVALUATION AND SYSTEM SPECIFICATION
APPLICANT: Giselle Kovac
CONTRACTOR / AGENT: MrC
LOT: 1.2 _ BLOCK: 31
SUBDIVISION: Miami Shores ID#: 11-3206-013-4150
TO BE COMPLETED BY ENGINEER, HEALTH DEPARTMENT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEERS MUST
PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS.
PROPERTY SIZE CONFORMS TO SITE PLAN: [X]YES [ ]NO NET USABLE AREA AVAILABLE: 0.27 ACRES
TOTAL ESTIMATED SEWAGE FLOW: 460 GALLONS PER DAY [ RESIDENCES-TABLEI / OTHER -TABLE 2 ]
AUTHORIZED SEWAGE FLOW: 674.99 GALLONS PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE]
UNOBSTRUCTED AREA AVAILABLE: 450.00 SQFT UNOBSTRUCTED AREA REQUIRED: 450.00 SQFT
BENCHMARK/REFERENCE POINT LOCATION: FFE 10.9' NGVD
ELEVATION OF PROPOSED SYSTEM SITE 8.40 [[INCHES]/ FT ] [ ABOVE / BELOW ] BENCHMARK/REFERENCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES
SURFACE WATER: FT DITCHES/SWALES: FT NORMALLY WET: [ ]YES [ ]NO
WELLS: PUBLIC: _FT LIMITED USE: FT PRIVATE: FT NON -POTABLE: FT
BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: 5 FT POTABLE WATER LINES: 30 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: 10.20 FT [ MSL /NGVD
SOIL PROFILE INFORMATION SITE 1 SOIL PROFILE INFORMATION SITE 2
USDA SOIL SERIES:
Munsell #/Color
Urban land
Texture
Depth
10YR 3/1
Sand
0 To 8
10YR 5/4
Sand
8 To 25
10YR 5/4
Oolitic Limestone
25 To 72
USDA SOIL SERIES:
Munsell #/Color
Urban land
Texture
Depth
10YR 3/1
Sand
0 To 8
10YR 5/4
Sand
8 To 25
10YR 5/4
Oolitic Limestone
25 To 72
OBSERVED WATER TABLE: INCHES [ ABOVE / BELOW ] EXISTING GRADE TYPE: [ PERCHED / APPARENT ]
ESTIMATED WET SEASON WATER TABLE ELEVATION: 86 INCHES [ ABOVE /[[HE] 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: 62 INCHES
DRAINFIELD CONFIGURATION: [ ] TRENCH [XI BED [ ] OTHER (SPECIFY)
REMARKS/ADDIT1UNAL CRITERIA .
SITE EVALUATED BY: DATE:
Mr C's Plb Sept, (Title: ) (Mr C's Plb Septic)
DH 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated: 64E-6.001, FAC
12/08/2014
Page 3 of 4
AP1168496 E101574921 v 1.0.2
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.