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PL-15-4547 a` Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-229285 Permit Number: PL -3-15-454 Scheduled Inspection Date: March 05, 2015 Permit Type: Plumbing - Residential Inspector: Diaz, Osvaldo Inspection Type: Final Owner: LEEMBURG, CYNTHIA Work Classification: Drainfield Job Address: 361 NE 101 Street Miami Shores, FL 33138-2424 Project: <NONE> Contractor: MIAMI DADE ENVIROMENTAL Building Department Comments install drainfield (495 sqft) TO CLOSE PERMIT# PL13-2247 Phone Number Parcel Number 1132060135220 INSPECTOR COMMENTS False Phone: 786-2514099 March 04, 2016 For Inspections please call: (305)762-4949 Page 25 of 38 Inspector Comments Passed ED HRS IN FILE y Failed Correction Needed ❑ Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid March 04, 2016 For Inspections please call: (305)762-4949 Page 25 of 38 BUILDING PERMIT APPLICATION ❑BUILDING PLUMBING JOB ADDRESS: ❑ ELECTRIC Miami Shores Village Building Department 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 10 Master Permit No.* -R-- ❑ ROOFING ❑ REVISION Sub Permit No. ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF CONTRACTOR ❑ EXTENSION ❑ RENEWAL ❑ CANCELLATION ❑ SHOP DRAWINGS Folio/Parcel#: 1 r ,, 2 530-n n Is the Building Historically Designated: Yes .'&_ NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): _%1Q1 %r (_(EF.p/V aoif _Phone#:a�Q (92 Address:_ IL E:1(-, \ eg_) A- City: M \L inn ® `�y e !�' State: Zip: 33 Tenant/Lessee Name: Phone#: Email CONTRACTOR: Company Name: M\CjM e �1�t� i�%i� \ P onee#:&Qa51 �� t Address: }P- _� )I }P 33(. City: fN,-\ \C V -n I State: Zip:caa��_ Qualifier Name: -Y� ��)CL Phone#: �s t `�[ lcj State Certification or Registration #:6" � �C- Certificate of Competency #: DESIGNER: Architect/Engineer: Address: (� City: State: � Zip: t Value of Work for this Permit: $ l �� Square/Unear Footage of Work: —tq Type of Work: ❑ Addition Description of Woi Tletzm (1- ❑ Alteration ❑ New Specify color of color thru the Submittal Fee $ Scanning Fee $ Technology Fee $_ Structural Reviews $ (Revised02/24/2014) 0 Permit Fee $ �' CCF $i ;_ CO/C,. Radon Fee $ DBPR $ Notary $ Training/Education Fee $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ �rlo 2 J 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 Seal. Seal: Zi 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 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. Signatur Signature " OWNER or AGENT CO RACTOR The foregoing instrument was acknowledged before me this The fore inrinstrumen was acknowledged before me this day of ME� � 1 , 20 by _02 day of 120 ► 5 , by L tc" &�is personally known to mg—l-, B&L--A VNo who is personally known to me or who has produced FAc)'(ifJCIPy 0PL.\leg L& me or who has produced —p --t)eJV&— UoRsIge as identification and who did take an oath. NOTARY PUBLIC: identification and who did take an oath. NOTARY PUBLIC: oe Sign: Sign:_ Print: Print: No Public Stets of Florida a Alvarez'N +* n"isero'FC 156_150MY COMM1SM t FF 15M �teE a 09103RD a EXPIRES: October a, 2018 Borded 71n ICY P ft 1lede wk, APPROVED BY Plans Examiner Structural Review (Revised02/24/2014) Zoning Clerk 4> �' • DIVISION OF Environmental Health Q Florida Department of Health Miami -Dade County Health Department IO OSTDS/Well Division 11505 SW 26 St. • Miami, FL 33175 01 Inspector Date ®Cj — S — i 3 Addressed /r1l• L`—'• �i .z]'� OSTDS # +S' Cpmments: r Signature 'o r. REPAIR MLAMl'DADE COU)4TYHEAL STATE OF FLORIDA 11dWPARIWW DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: Cynthia Leemburg PERMIT # :13 -SC -1497255 APPLICATION #: AP1121557 DATE PAID: FEE PAID: RECEIPT #: Docmaw #: PR918257 PROPERTY ADDRESS: 361 NE 101 St Miami, FL 33138 LOT: 19-20 BLOCK: 21 SUBDIVISION: Miami Shores Sec N 1" PROPERTY ID #: 11-3206-013-5220 [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 I 900 1 GALLONS / GPD Septic CAPACITY A [ 0 ] GALLONS / GPD CAPACITY N I 0 l GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS. @I ]DOSES PER 24 HRS #Pumps [ D [ 500 l SQUARE FEET Bed configuration drainfiel SYSTEM R [ 0 I SQUARE FEET SYSTEM A TYPE SYSTEM: [X] STANDARD [ ] FILLED [ ] MOUND [ ] I CONFIGURATION: [ ] TRENCH [g] BED I I N F LOCATION OF BENCHMARK: F.F.E. 10.8' NGVD I ELEVATION OF PROPOSED SYSTEM SITE [ 13.00][ INCHES FT I ABOVE BELOW BENCHMARK/REFERENCE POINT E BOTTOM,OF DRAINFIELD TO BE [ 38.00][ INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT L D E 0 T H E R 11,1, r.NWU11CZLJ: L U.UU J INCHES EXCAVATION REQUIRED: [ 25.00 J INCHES 1. -Existing 900 gal. septic tank, certified by "Miami Dade Environmentals" on 9/20/2013 to remain. 2. -Install 500 sf or all available space of drainfieldin bed configuration. 3. -Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed or drain trench. 4. -Invert elevation of drainfield to be no less than 8.12' NGVD. 5. -Bottom of drainfield elevation to be no less than 7.62' NGVD. System sized for 3 bedrooms with a max occupancy of 6 -persons (2 per bedroom), for a total est flow of 300 gpd. SPECIFICATIONS B etsy Lange TITLE: Engineering Specialist II APPROVED BY: �y TITLE: �j,1q,t(e P&f `�,o64d �•ST ,� Dade CHD DATE ISSUED: 10/01/2013 DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E-6.003, FAC EXPIRATION DATE: 12/30/2013 A'.�1121.957 SE909279 STATE OF FLORIDA APPLICATION # AP1121557 DEPARTMENT OF HEALTH PERMIT # 13 -SC -1497255 ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM DOCUMENT # SE909279 SITE EVALUATION AND SYSTEM SPECIFICATION APPLICANT: Cynthia Leemburg CONTRACTOR / AGENT: Miami Dade Environmental LOT: 19-20 BLOCK: 21 SUBDIVISION: Miami Shores Sec N 1" ID#: 11-3206-013-5220 TO BE COMPLETED BY ENGINEER, HEALTH DEPARTMENT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEERS MUS7 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: 0.22 ACRES. TOTAL ESTIMATED SEWAGE FLOW: 300 GALLONS PER DAY [ RESIDENCES -TABLET / OTHER -TABLE 2 ] AUTHORIZED SEWAGE FLOW: 549.99 GALLONS PER DAY [ 1500 GPD/ACRE OR 1 2500 GPD/ACRE ] UNOBSTRUCTED AREA AVAILABLE: 750.00 SQFT UNOBSTRUCTED AREA REQUIRED: 750.00 SQFT BENCHMARK/REFERENCE POINT LOCATxON: F.F.E. 10.8' NGVD ELEVATION OF PROPOSED SYSTEM SITE 13.00 1 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: 2 FT POTABLE WATER LINES: 2 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: 9.70 FT [ MSL /NGVD SOIL PROFILE INFORMATION SITE 1 SOIL PROFILE INFORMATION SITE 2 USDA SOIL SERIES: Urban land Munsell #/Color Texture Depth 10YR 5/1 Sand 0 To 14 10YR 6/1 Sand 14 To 24 10YR 7/1 Sand 24 To 72 USDA SOIL SERIES: Urban land Munsell #/Color Texture Depth 10YR 5/1 Sand 0 To 14 10YR 6/1 Sand 14 To 24 10YR 7/1 Sand 24 To 72 OBSERVED WATER TABLE: INCHES [ ABOVE / BELOW ] EXISTING GRADE TYPE: [ PERCHED / APPARENT ] ESTIMATED WET SEASON WATER TABLE ELEVATION: 68 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: Sand/0.60 DEPTH OF EXCAVATION: 25 INCHES DRAINFIELD CONFIGURATION: [ ] TRENCH [X] BED [ ] OTHER (SPECIFY) - iCEbG1 RKS/AUL 1'1'1VNAL C:l Il TERYLA SITE EVALUATED BY: DATE: Bolanos, Jose (Title: Registered Septic Tank Contractor) (Maiml Dade Environmental Servi DH 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated: 64E-6.001, FAC 09/26/2013 Page 3 of 4 AP1121557 EID1497255 v 1.4.2 ■iie ■Q2�! ■�7tii�ii�■�eT se.i ■gee e��e■ �.��=�:�ir■_��iiiiiiii■ ■iii��tlilR-��:!:�liii �--_�-_-._�i�iii ��iii ■��i�! .'�tili�j�iii�■ii!�ieii■®1�!�ee■ ■iii 1►:'/ir�tieiiiiiiillii�ai■ n��r�� ee ■��ee�eee�e��r��■ e�eee�er�■ r�e� ■��e��tee��:r� e�ee�eee�ieIMMERAeeIN ■ii■■■lieiL��litiiiiiei�iiillitiii■ iiie�e■■eiiieiiiiiiii�iiiiiiiiM ■i■■�iitii■sii��ii�iiiiiiii■ ■iit�i�si��i%i�l��iieii��iiiiiii■ iNiitei■ ■oi�''�'!�`"'"',, �r''=''�`ieei■ieiiiiiiiiiiisii ■etri�iiiiee�i■ ; 3iiiiieieeiOiiiii■ ■eOie/■r/ii■■iiiii■/MINION iiiliiii ■i��ir��e�e��iie�ll�iieeiiiii e■■ei�� MONOire■