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PL-15-27 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-233492 Permit Number: PL-1-15-27 Scheduled Inspection Date: July 08, 2015 Permit Type: Plumbing - Residential Inspector: Diaz, Osvaldo Inspection Type: Final Owner: HURTADO,JOSE LUIS Work Classification: Drainfield Job Address: 166 NW 110 Street Miami Shores, FL 33168- Phone Number Parcel Number 1121360030140 Project: <NONE> Contractor: A AARON SUPER ROOTER Phone: 305-944-8886 Building Department Comments REPLACING DRAIN FIELD Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-232444. CREATED AS Ee REINSPECTION FOR INSP-226085. HRS APPROVAL IN FILE. repair sidewalk 2nd tim out Failed Correction Needed Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid. July 07,2015 For Inspections please call: (305)762-4949 Page 14 of 52 APPLICATION #:AP1170075 STATE OF FLORIDAPERMIT #:13-SC-1577461 DEPARTMENT OF HEALTH DOCUMENT #:F1984929 ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION INSPECTION AND FINAL APPROVAL DATE PAID:03/23/2015 QW& , FEE PAID:55.00 RECEIPT #:13-PID-2622016 APPLICANT: Jose Hurtado AGENT: A Aaron Super Rooter PROPERTY ADDRESS: 166 NW 110 St Miami, FL 33168 LOT: 14 BLOCK: 219 SUBDIVISION: ID#: 11-2136-003-0140 CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED. TANK INSTALLATION SETBACKS I ] 1011 TANK SIZE [1] 1050.00 [21 [ ) [27] SURFACE WATER FT [ ] [021 TANK MATERIAL Concrete [ 1 [281 DITCHES FT I ] [031 OUTLET DEVICE [ ] [29] PRIVATE WELLS FT I l [04] MULTI-CHAMBERED [ Y / N ] [ ] [30] PUBLIC WELLS FT [ 1 [05] OUTLET FILTER [ ] [31] IRRIGATION WELLS FT [ ] [061 LEGEND 1. 2. [ ] [321 POTABLE WATER 30 FT [ 1 [071 WATERTIGHT [ ] [331 BUILDING FOUNDATIONS 5 FT I 1 [081 LEVEL I ] [09] DEPTH TO LID [ ) I341 PROPERTY LINES 2 FT I ] [351 OTHER FT DRAINFIELD INSTALLATION FILLED / MOUND SYSTEM [ ] (10] AREA [1] 300 [2] SQFT [ ] [361 DRAINFIELD COVER [ ) [11] DISTRIBUTION BOX HEADER X [ ] [37] SHOULDERS ( ] [121 NUMBER OF DRAINLINES 1. 4.00 2. [ ] [38] SLOPES I ) [13] DRAINLINE SEPARATION [ ] [39] STABILIZATION [ ] [141 DRAINLINE SLOPE [ ] [15] DEPTH OF COVER ADDITIONAL INFORMATION [ ] [16] ELEVATION [ ABOVE / BELOW ]BM 67.20 [ ] [401 UNOBSTRUCTED AREA ( ] (171 SYSTEM LOCATION [ J [411 STORMWATER RUNOFF [ 1 [18] DOSING PUMPS [ ] [421 ALARMS [ ] [191 AGGREGATE SIZE [ ] [43] MAINTENANCE AGREEMENT I I (201 AGGREGATE EXCESSIVE FINES [ ] [44] BUILDING AREA [ ] [21] AGGREGATE DEPTH [X ] [45] LOCATION CONFORMS WITH SITE PLAN FILL / EXCAVATION MATERIAL I ] [46] FINAL SITE GRADING [ ] [22] FILL AMOUNT [ ] [471 CONTRACTOR JOHN J TUFFY(A AARON S [ 1 [231 FILL TEXTURE I ] [481 OTHER ADS ARC 24 I 1 (24] EXCAVATION DEPTH ABANDONMENT [ ] [25] AREA REPLACED [ 1 [49] TANK PUMPED I ] [26] REPLACEMENT MATERIAL [ ] [501 TANK CRUSHED & FILLED Comments: Comments are on page 2. CONSTRUCTION [ FAPPROVED / DISAPPROVED l : Dade CHD DATE: 01/15/2015 Engineer Spe ' II Joseph R Nverger(Department of Health in Dade Cou FINAL SYSTEM [ APPROVED / DISAPPROVED ] : Dade CHD DATE: 03/24/2015 ngm r ervisor Astrid Edwards(Department o ea m Dade Co (Explanation of Violations on following page) DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E-6.003, FAC Page 2 of 3 EH Database v 1.0.1 AP1170075 EID1677461 Miami Shores Village Building Department artment JANa72014 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 2010 BUILDING Master Permit No. 04 k!�--c�-I­ PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL F-1 PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP , -- CONTRACTOR DRAWINGS JOB ADDRESS: 1�� Vv r d ST / City: Miami Shores County: Miami Dade Zip: .33 (o Folio/Parcel#: 1 2-13 Q –00'3 Q 1 ±Q Is the Building Historically Designated:Yes NO v Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): J.o sc H-U,r—j-Q Phone#: Address: City: M 1 C`r-"I S"10 rf-S State: Zip: 33 Tenant/Lessee Name: Phone#: Email: (� CONTRACTOR:Company Name: /�� >�� � v�� !�-�J�-�r�_Phone#: �S 9� �"` 'sg e� Address: G02,2, Y,.0 �S G City: 1 tea/ Y���' State: Zip: J,3� 2,3 ` Qualifier Name: c�`3h^ J ' Phone#: Q State Certification or Registration#: y 1 �U �G `f(5 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: .w Value of Work for this Permit:$ �3 90 `' 1 Square/Linear Footage of Work: 3oo Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition Description of Work: P. Ce 0 Y-q 6r� 2 Specify color of color thru tile: Submittal Fee$ X50 Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee--$ Structural Reviews$ Bond$ X)` W TOTAL FEE NOW DUE$ < < 0 (Revised02/24/2014) 6 ' Bonding Company's Name(if applicable) Bonding Company's Address City State Zip r s Mortgage Lender's Name(if applicable) 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 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 brochur will be delivered to the person whose property is su ject to attachment. Also, a certified copy of the recorded notice of commence nt must be posted at the job site for the first inspec on which occurs seven (7) days after the building permit is issued. In the sence of such posted notice, the inspection will not a approved and a reinspection fee will be charged. Signature Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument \was acknowledged before me this 4, day of f)Q N ,20 1.S by T day of (JCA,n 20 by J z)S2 r"f"�C a who is personally known to J T" who is personally known to me or who has produced ark( ` as me or who has produced r-" PYI J l �Ce11-4@s identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: 'O C Sign:. Print: ESP a Print: Seal: S al: TERESA J SOL " TERESA J SOI-OMONv , ,,9•' 31935 _+F MY GOM MISSION#EE131935 MISSION�FE bec 08.2015 "= MY GOM }ger 08.2015 PIRES No m EXPIRES Novem µotan/Service.co OF service.comtb F1oA� t9,P APPROVED BY /' � �� Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) PERMIT #: 13-SC-1 577140 APPLICATION #:AP1169878 STATE OF FLORIDA DEPARTMENT OF HEALTH DATE PAID: ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID: CONSTRUCTION PERMIT RECEIPT #: Was DOCUMENT #: PR959546 CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: Mathew Picard PROPERTY ADDRESS: 401 NE 103 St Miami, FL 33138 LOT: 1314 BLOCK: na SUBDIVISION: PROPERTY ID #: 11-2231-015-0130 [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 [ 750 ] GALLONS / GPD existinq septic tank to remain CAPACITY A [ 0 ] GALLONS / GPD CAPACITY N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ] D [ 225 ] SQUARE FEET new trench confiq. drainfie SYSTEM R [ 0 ] SQUARE FEET SYSTEM A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ] I CONFIGURATION: [x] TRENCH [ ] BED [ ] N F LOCATION OF BENCHMARK: FIFE 12.0'NGVD I ELEVATION OF PROPOSED SYSTEM SITE [ 19.20 ] [ INCHES FT ] [ ABOVE BELOW BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 77.16 ] [ INCHES FT ] [ABOVE BELOW BENCHMARK/REFERENCE POINT L D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: [ 58.00 ] INCHES 1.-Existing 750 gal. septic tank, certified by"A Aaron"on 12/08/2014 to remain. 0 2.-Install 225 sf of drainfield in trench configuration. T 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 6.07' NGVD. H 5.-Bottom of drainfield elevation to be no less than 5.57' NGVD. E The system is sized for 3 bedrooms with a maximum occupancy of 6 persons(2 per bedroom),for a total estimated flow of 400 gpd. THIS PERMIT IS NOT FOR ANY ADDITIONS. R SPECIFICATIONS BY: EA aron S.Roote TITLE: APPROVED BY: TITLE: Engineering Specialist II Dade CHD NJ eis Martin DATE ISSUED: /0 /2015 EXPIRATION DATE: 04/02/2015 DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E-6.003, FAC Page 1 of 3 Tf;TE OF FLORIUA #� DrPA;TNIENT OF HEALTH APPLICATION FOE, ONSITE SEWAGE DISPOSAL SYSTEM CONSTP:JGi"IOI'! p- D 45 t Pert-nit ApDIiC;1I 0(i NjfN ------ 1 11 - SITt. Sca e: Each block represents 5 feet and inch = 50 feet. p •1, t f!; i i _ Y t - - _-. �. -- —._ - Ort...�:- .'"i_. __ E�•r r-...._.••ryc•. ... '�••c--4 _. _ t-, .. _ r "..- •E r Sltc Plan submitted by: ;` • � J �� v 3, � - _. Vi Signature ---- --" — --T, ------ — P(a{ Approved Not Approved _ Date ------------- —"----------- OUrI,`/ r-IeaICh IJ:.,)J3ri..il�, ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTME1,!T pE(40'S.101"F.> r'jt, NRS-iii:6rm•EOt 5 wwe;,n may Ix,i r;wd) f P; <:574Q0(37-4015.6)' a,.G: ll:al)r ,} DATE(MM/DD/YY) ,4cc� rr CERTIFICATE OF LIABILITY INSURANCE 01/06/15 PRODUCER Arbelaez Insurance,Inc. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 9971 Miramar Parkway ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE y HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Miramar,FL 33025 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Phone (954)436-5544 Fax (954)436-7733 INSURERS AFFORDING COVERAGE NAIC# INSURER A: ACCIDENT INSURANCE CO INSURED Aaron super rutter. INSURER B: TECHNOLOGY INSURANCE CO 6022 SW 35 COURT INSURER C: Miramar, FL 33023- INSURER D: (954) 967-9933 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OF MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR IN RD DATE MM/DD/YYYY DATE MM/DD/YYYY GENERAL LIABILITY EACH OCCURRENCE 1.000.000 ❑� COMMERCIAL GENERAL LIABILITY DAMAGE TENTED AGL9001824 09/29/2014 09/29/2015 PREM SES QEa occurrence) 100.000 ❑❑ CLAIMS MADE dj OCCUR MED EXP(Any one person) 5.000 A ❑ ❑ PERSONAL&ADV INJURY 1.000.000 ❑ GENERAL AGGREGATE 2.000.000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG INC ❑ POLICY ❑PROJECT ❑ LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ❑ ANY AUTO (Ea accident) ❑ ALL OWNED AUTOS BODILY INJURY ❑ ❑ SCHEDULED AUTOS (Per person) ❑ HIRED AUTOS BODILY INJURY ❑ NON OWNED AUTOS (Per accident) ❑ PROPERTY DAMAGE (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT ❑ ❑ ANY AUTO OTHER THAN EA ACC ❑ AUTO ONLY: AGG EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE ❑ OCCUR ❑ CLAIMS MADE AGGREGATE El ❑ DEDUCTIBLE ❑ RETENTION $ WORKERS COMPENSATION AND WC STATU- ❑ OTH- EMPLOYERS'LIABILITY Y/N TWC3256861 09/23/2014 09/23/2015 TORY LIMITS ER B ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT 1.000.000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE 1.000.000 If yes,describe under E.L.DISEASE-POLICY LIMIT 1.000.000 SPECIAL PROVISIONS below OTHER -jLDESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISION£ CONTRACTORS LICENSE #SA0920648 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL VILLAGE OF MIAMI SHORES 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO 10060 NE 2 AVE THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY MIAMI SHORES. OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE FL 33138 wg---- ACORD 25(2009/01)CIF ©1988-2009 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD /• - (U !P ,e'. ".fi %s• = A' '•�c ffi� e�lr•€s,.8•e�i`€� . r s¢y3;`aro3 ' s F n" �� i i t ¢¢ j ;�. •. 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SA0920648 Bxpirahon Date A ;'8' tion Ninuber Date Issued y'� `• ,Autlx»za CD .Rick Scoot,tiOvely90t' DajAtI79,t,ISM. _ m�i ' !�5<7,:. s:S...-�=��••ro.•'.4' - - • •-t,•�c.�o:':_'ii;c�:vi7-'�We�-r=a�-,-y E�Zi s➢i�s:i��^'Q:.c.'7�)•. #_�'.c_,h-.r:i•ot�cc.c"�.".r.c_w7et.,,.� :�-"�111;11=flwmlml. •�sM ��.1i1 6 ;T ' ;!iT.�_•,,!.{��..^-�R-•..,C�,` v`.-b.`a.••,�•.ti••.f*i.�.y�''�.'a'1 y..'�f�''�a' .,�A. ��r'a�tv•O�m.•''':rc�•4.c=,:Iir�4�'aor"a�.:w t+7 t.�,Llx-,.:..r'�~C�v�:,��'•S'J-ewo�•.'.i�4 _ �wi:�lfllr� �i1 �• ' • ) rr : JAN-07-2015 03:32 From: To:3057568972 Page:3,14 •! If '.":.• �1'.'... ,,ate, D.ad�e Gni Ak ! - � - ,:�"J�� - • � ,.. 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I mtisfbsG1, 1118 2d ort all comwelal yetH"F&;;;J� ;sc 27E� • hliMfFOAA •FAfil,�l;infor'R?anon;UJSif-lei'{yWmiart�1030erjpy/(a4Od Lcfor� �; mm z I n _4L5;v!41. JstMl sl CA ?"'PAM Tic. IL muMUM Sm .19 wag. oll 9 F% n k.,. �M. i -Z W 0-,�V cu • jp� j IL CD %',`!1. 400 t. i7- ! NMI "x- 7 i. Al _W" W..;�ff Zll om 7. W, Q,'fi!-1 UX LL lmoy------- 'r S _W A-tik A-Q_ ro _3 R o yw. tt,y MOO 4 R. .11a ..... ..... ..... rL cl :.•� DIVISION OF #4> Environmental Health Florida Department of Heath Miami-Dade County Health Department OSTDS/Septic Tank Division 7769 NW 48th St.Suite 175 Q Miami,FL 33166 ^ Inspector�. ` JQ�'Q?.r' Date '31 1 Z 15 Address lei., _119 OSTDS# Comments: C) Signature fir I