PL-15-247V.
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-227658 Permit Number: PL -2-15-247
Scheduled Inspection Date: March 10, 2015 Permit Type: Plumbing - Residential
Inspector: Diaz, Osvaldo Inspection Type: Final
Owner: PEDRO DE MELLO, CYNTHIA DA Work Classification: Septic
l`r1CTA
Job Address: 1208 NE 95 Street
Miami Shores, FL
Phone Number
Parcel Number 1132060144100
Project: <NONE>
Contractor: MR C'S PLUMBING & SEPTIC INC Phone: (305)651-7859
Building Department Comments
SEPTIC AND DRAINFILED Infractio Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed
F71, I
HRS ON FILE
Failed q�
Corrections
Needed
Re -Inspection
Fee �'�—�' ��, - t S
No Additional Inspections can be scheduled until
re -inspection fee is paid.
March 09, 2015 For Inspections please call: (305)762-4949 Page 8 of 29
Miami Shores Village
Building Department FEB o4 2015
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
BUILDING Master Permit No.l�'�__ Is
PERMIT APPLICATION
Sub Permit No.
❑BUILDING
❑ ELECTRIC
ROOFING
❑ REVISION 0 EXTENSION
❑RENEWAL
PLUMBING
❑ MECHANICAL
❑PUBLIC WORKS
❑ CHANGE OF ❑ CANCELLATION
❑ SHOP
CONTRACTOR
DRAWINGS
JOB ADDRESS:
Obi
D h)6_
[�
g st
City:
Miami Shores
County:
Miami Dade Zip:
3313?
Folio/Parcel#:
11 3PO6 Qtk 4(00
Is the Building Historically Designated: Yes
NO
Occupancy Type:
Load:
Construction Type:
_Flood Zone: BFE:
FFE:
OWNER: Name (Fee
Simple Titleholder):
WMA,
b i'1AU Phone#: /i 99yM_?
Address:
Idol? Ne- °%S .st
City: A-116�,
Tenant/Lessee Name:
Email:
State: /`G zip: 3 313d'
Phone#:
CONTRACTOR: Company Name: M r r (S l(/ur.bf! Phone#: M l 7M
Address: 10 Joh AA� 21- ' { "
City: mf&.'c State: ��- Zip:
Qualifier Name: ) '"q 61V CL Phone#:
State Certification or Registration #: (]6 ( 5 36 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: ❑ Addition El Alteration ❑ New Repair/Replace ❑ Demolition
Description of Work:
Specify col ,,'0j
Submittal Fee $
Scanning Fee $
Technology Fee $_
Structural Reviews $
(Revised02/24/2014)
""rA
il#�ffihru tile:
Permit
Radon
Training/Education Fee $
CCF $ CO/CC $
DBPR $ Notary $
Double Fee$ t
Bond $ C Xm ' 03
TOTAL FEE NOW DUE $
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
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.
Signatu Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this
day of fC-6"t 'l 20 I S by
REMO LARElt who is personally known to
me or who has produced as
identification and who did take an oath.
The foregoing instrument was acknowledged before me this
day of .20 IC by
M Jorsonallyis peknown to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign: "'/'// �)�, A— )"4
"000l Ile
Print: Print:KtMbLt-E II
�Ry pV i
�P .
Seal: 2�, •`o Notary Public State of Florida Seal: •nuu,,, SHERYL A MENOES
• ; My Comm. Expires Sep 19, 2017 r
Commission # FF 055732 Notary Public • SMj! Oi Florida
°'e OF "gip Bonded Through National Notary Assn. ':My Comm Expires Oct 23 2015
" Commission # FF 136597
************* * * * ** ******************s**** *
Al *************
APPROVED BY i2' /S Plans Examiner Zoning
Structural Review
(Revised02/24/2014)
Clerk
•
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION'PERMIT FOR: OSTDS New
APPLICANT: Pedro Correa de Mello
PROPERTY ADDRESS: 1208 NE 95 St Miami, FL 33138
PERMIT #:13 -SC -1566170
APPLICATION # : AP 1163405
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR956362
LOT: 15-16 BLOCK: 85 SUBDIVISION: Miami Shores Sec 3
[SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
PROPERTY ID #: 11-3206-014-4100 [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 [ 900 ] GALLONS /, GPD
new septic tank
CAPACITY
A ( ] GALLONS / GPD
N/A
CAPACITY
N [ J GALLONS GREASE
INTERCEPTOR CAPACITY
[MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING
TANK CAPACITY [
]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ]
D [ 500 ] SQUARE FEET new bed confiq. drainfield SYSTEM
R [ J SQUARE FEET N/A SYSTEM
A TYPE SYSTEM: [XJ STANDARD [ ] FILLED [] MOUND [ ]
I CONFIGURATION: [ ] TRENCH (x] BED [ l
N
F LOCATION OF BENCHMARK: C/L NE 95 ST: 8.15' NGVD
I ELEVATION OF PROPOSED SYSTEM SITE ( 5.40 ]( INCHES FT ][ ABOVE BELOW]BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 24.60][ INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: [ 72.001 INCHES
1. -Install a 900 gal min. septic tank with an approved filter.
O 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)(0, FAG.
H 3. -Install 500 sf of drainfield in bed configuration.
4. -Install 42" 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.
R (Comments Conlvued on Page 2,)
SPECIFICATIONS BY: 1 Tkresa J Solomon
APPROVED BY:
TITLE: Master Septic Tank Contractor
TITLE: Engineering Specialist II Dade CHD
u ley Martin
DATE ISSUED: 1 14 EXPIRATION DATE: 05/21/2016
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC Page 1 of 3
v 3..t.4 S'E943808
DOCUMENT #: PR956362
6. -Invert elevation of drainfield to be no less than 6.6' NGVD.
7. -Bottom of drainfield elevation to be no less than 6.1' NGVD.
8. -Water line within 10 ft of septic system to be Sch 40 PVC or sleeved in accordance with FAC Ch 64E -6.005(2)(b).
The system is sized for 2 bedrooms with a maximum occupancy of 4 persons (2 per bedroom), for a total estimated flow of
300 gpd.
STATE OF FLORIDA APPLICATION # AP1163405
DEPARTMENT OF HEALTH PERMIT # 13 -SC -1566170
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM DOCUMENT #
SE943808
SITE EVALUATION AND SYSTEM SPECIFICATION
APPLICANT: Pedro Correa de Mello
CONTRACTOR / AGENT; Mrc
LOT: 15-16 1 BLOCK: 85
SUBDIVISION: Miami Shores Sec 3 ID#: 11-3206-014-4100
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: 0.22 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 LOCATION: C/L NE 95 ST: 8.15' NGVD
ELEVATION OF PROPOSED SYSTEM SITE 5,40 [ 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: 3 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: $.60 FT [ MSL / NGVD
SOIL PROFILE INFORMATION SITE 1 SOIL PROFILE INFORMATION SITE 2
USDA SOIL SERIES:
Munsell #/Color
Urban land
Texture
Depth
10YR 5/1
Sand
0 To 14
10YR 5/3
Fractured Rock
14 To 60
10YR 6/3
- Oolitic Limestone
60 To 72
HIGH WATER TABLE VEGETATION:
[ ]YES
[X ]NO MOTTLING: [
USDA SOIL SERIES:
Munsell #/Color
Urban land
Texture
Depth
10YR 5/1
Sand
0 To 16
10YR 5/3
Fractured Rock
16 To 48
10YR 6/3
Oolitic Limestone
48 To 72
HIGH WATER TABLE VEGETATION:
[ ]YES
[X ]NO MOTTLING: [
OBSERVED WATER TABLE:
INCHES [
ABOVE / BELOW ] EXISTING
GRADE
TYPE:
[ PERCHED / AFPARENT ]
ESTIMATED WET SEASON WATER TABLE
ELEVATION:
67 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: 72 INCHES
DRAINFIELD CONFIGURATION: [ ] TRENCH [X1 BED [ ] OTHER (SPECIFY)
REMARKS/ADDITIONAL CRITERIA
SITE EVALUATED BY: DATE:
Solomon, Teresa (Title: Master Septic Tank Contractor) (Statewide Septic Connections Inc.
DH 4015, 08/09 (Obsole*.,es previous editions which may not be used) Incorporated: 64E-6.001, FAC
10/20/2014
Page 3 of 4
AP1163406 EID1566170 v1.0.2
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.