The URL can be used to link to this page

PL-16-336 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-252342 Permit Number: PL-2-16-336 Scheduled Inspection Date: February 11, 2016 Permit Type: Plumbing - Residential Inspector: Hernandez, Rafael Inspection Type: Final Owner: RICE, CORRIE Work Classification: Septic Job Address:41 NW 105 Street Miami Shores, FL 33150- Phone Number (305)799-5785 Parcel Number 1121360050290 Project: <NONE> Contractor: EMPIRE ENGINEERING SERIVICES CORP Phone: (786)488-8657 Building Department Comments RENEWAL OF EXPIRED PERMIT PL14-1948 Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed IN FILE Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid February 10,2016 For Inspections please call: (305)762-4949 Page 23 of 38 Permit NO. PL-2- 6-336. Miami Shores Village Pgrmit Type,Plumbing-Residential 10050 N.E.2nd Avenue NW IMP*cla"Noadon:Septic """' Miami Shores,FL 33138-0000 ';: .. `Wus:.APPROVED Phone: (305)795-2204 , ; "ta�amA s Expiration: 08108/2016 �. Issue�33e:7.I1412tf'i� p Project Address Parcel Number Applicant 41 NW 105 Street 1121360050290 Miami Shores, FL 33150- Block: Lot: CORRIE RICE Owner Information Address Phone Cell CORRIE RICE 41 NW 105 ST (305)799-5785 MIAMI SHORES FL 33150 Contractor(s) Phone Cell Phone Valuation: $ 6,500.00 EMPIRE ENGINEERING SERIVICES CI (786)488-8657 _. . . . Total Sq Feet: 00 Type of Work:RENEWAL OF EXPIRED PERMIT PL14-1948 Available Inspections: Type of Piping: Inspection Type: Additional Info: HRS Approval Bond Return: Final Classification:Residential Scanning: 1 Review Plumbing Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $4.20 DBPR Fee Invoice# PL-2-16-58605 $4.50 02/05/2016 Credit Card $50.00 $273.20 DCA Fee $4.50 Education Surcharge $1.40 02/10/2016 Credit Card $273.20 $0.00 Permit Fee $300.00 Scanning Fee $3.00 Technology Fee $5.60 Total: $323.20 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS 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 zoniJhermore,I authorize the above-named contractor to do the work stated. February 10, 2016 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy February 10,2016 1 Miami Shores Village rr ,l Building Department FEB ® 6 2096 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 BY INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 BUILDING Master Permit No. P/ zd PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION �ENEWAL (PLU MBING F-] MECHANICAL [:]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS:_1 N 'i.13'j+"'\ S r e eJ- City: Miami Shores County: Miami Dade Zip:3:7) 5 0 Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: 1.. OWNER:Name(Fee Simple Titleholder): O f/1'e R<<Q Phone#: Address: S�- City: e5 State: F Zip: 3 31\-ID Tenant/Lessee Name: Phone#: Email: SS11 CONTRACTOR:Company Name: 1/t eh e n,1 9 f l), Phone#: Address: 2H2 3 Sw 10-1 yrs 34 4 City: M I -n i State: F Zip: r3 3 Qualifier Name: Jorc�C ��11�..� Phone#: 4/14W-W(°Sq State Certification or Registration#: Certificate of Competency#: DESIGNER:Architect/Engineer: _ _ Phone#:_ Address: City: State: Zip: Value of Work for this Permit:$ ftk fir-. 0®Square/Linear Footage of Work: Type of Work: ❑ Addicction ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Wor(: i c z_n L4,-o Specify color of color thru tile.- Submittal ile:Submittal Fee$ Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ QQu Structural Reviews$ Bond$�LA-1011 fF TOTAL FEE NOW DUE$ 01:13.IIA® (Revised02/24/2014) Bonding Company's Name(if applicable) Bonding Company's Address City State Zip 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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issu n the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. I Signature i2�� Signature OWNER or AGENT CONTRACTOR The foregoing instruent was acknowledged before me this The foregoing instrument was acknowledged before me this day of ,/1 LJ y 20 A , by _day of 20 by n� who is personally known to -G)�YYYY3who is personally known to me or who has produced as me or who has produced f ( as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Si Sign: Print: Print: Seal: Seal: public State of Florida Notary LOFEXPIres :r'ap',�J ',Fe blc State of FloridaDr,d` M Fe►icialiciano MY missionFF082753 ssion FF 082753 *1212018 ,n, or / e`, APPROVED BY —�l� Plans Examiner Zoning f fl Structural Review Clerk (Revised02/24/2014) 001337 I l la9d County f� �a Tf1i I NOTA 01G� dtaflfl� E 6958442 � t' �susuveiss� t bCEaTIK#N � 1�P El�trE�tlNRtl� EP1'Elt4, 016 2423,, t U st b k pla+�eci. t Mage of bushws� Pursuantto,AuritY "d Cftal a 8A C$ "fit 30, W,- OWNER SEC TYPE OF 5S1f5t P YMEN1.fiECE1V D EAAr PIRt NGINEERING SERM5 CORP 996 SPECIALTY Pk?il�1tG?l�rFOA BY rax COLLECT,Ecru $M0971' x;82.50 tO/06/2015 ?, (CHECK=#6-0006 = . Thisl(tcai Busines 'it �letmipt oflb6nfiems pe r tffhe }Bttsines$isx Ths Btts aot s ltCottse p. tfftat certifictstuttt fthehotdat'sfpeiificad tbtFa fA., Holdgtttt#tsf hiplgyvifpanygoveTptnerteal oYiatEt# tnmetttt)t�tatoryt Itt#att;attd�regairamad�tadticta<' tc tde h�� 1411, qp �AV LIE Tha ifECElPT N0.above mtat he� on a!!eptatciai"vii6icies MI -8��f►da SaaBa 27B Fel'tttoteiifidnnadon,vlstt"www.mia ,�mtde E ' AM1s Fl.. 22' E Me' 3� t E PtEi Et tNEERf % 31 > utt�o IN e*� ; CI r ,E 10m, r • RL �'� 6 a 07-03-2014 a< JEFF ATWATER STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION CERTIFICATE OF ELECTION TO BE EXEMPT TROM FLORIDA WORKERS' COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 07/03/2014 EXPIRATION DATE: 07/02/2016 x PERSON: MILLAN JORGE M FEIN: 471001615 BUSINESS NAME AND ADDRESS: EMPIRE ENGINEERING SERVICES CORP 2423 5W 147 AVE #344 MIAMI FL 33185 SCOPES OF BUSINESS OR TRADE: 1- IRRIGATION OR DRAINAGE :SYSTEM IMPORTANT. Pursuant to Chapter 44D 0504, F.S„ an officer-of.a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05{12), F.S., Certificates of election to be exempt... apply only within the scope of the business or trade listed an the notice of election to be exempt. Pursuant to Chapter 440.05(.13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets tha rnaotr—t. ,.f .w: -t..., a... ACS :x CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) �.►°� 06/15/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT NAME; Alejandro Moreno Best Rate-Insurance Exchange Of America PHONE , (866)616-0065 AAC No): (305)403-0801 8600 NW 17th Street ADDRESS; brian@instantquotesdirect.com INSURER(S)AFFORDING COVERAGE NA1C N Miami FL 33126 INSURER A: WESTERN WORLD INSURANCE CO INSURED INSURER B EMPIRE ENGINEERING SERVICES CORP INSURER C: 2423 SW 147 AVE INSURER D: #344 INSURER E: Miami FL 33185 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW 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 OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP LIMBS LTR POLICY NUMBER M D MM D X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 300 000 X❑OCCUR DAMAGES(RENTED CLAIMS-MADE PREMISES Ea occurrence) $ 100 000 MED EXP(Any one person) $ 5 000 A NPP1405422 02/17/2015 02/17/2016 PERSONAL&ADV INJURY $ 300 000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 600 000 X POLICY F_]JECTPRO- �LOC PRODUCTS-COMP/OP AGG $ 300 000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Par accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PERTOTH- AND EMPLOYERS'LIABILITY Y/N STAUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached U more space Is required) Septic Tank Installation SM0971292 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2 Ave AUTHORIZED REPRESENTATIVE Miami Shores,FI 33138 ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD r MASTER SEF►TIC TAIOK PONTRAGTQR .iORGE W MILIAN 2423 SW �47'AvENUE#344 K.33185- EMPIRE ENGINEERING SERVICES, 5M0977= usfn s Autitorizatipn: SA0141867 t J This is to certify that the r f:n med on the front of this card has satisfied the r'".M Menftot'P,art III,Chapter 489,Florida Statutes,fot it ,as. septic tank contractor and Is register t tC j(the It fatt!Mnt of Health to provide contras 6,ervlEes hinder t a,business name listed. Report Unl -Seaek on Miami Shores Village 014 Building Department artment �� _ � 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY- Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20LO BUILDING Master Permit No.z_— - �C) PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION DRENEWAL [�LUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP f� CONTRACTOR DRAWINGS JOB ADDRESS: 11 w 10S S1 . City: Miami Shores County: Miami Dade Zip: 3 3 ( S 0 Folio/Parcel#: I`-21 Y" _0M, ^ ®Zq O Is the Building Historically Designated:Yes NO Occupancy Type: SFIP- Load: Construction Type: Flood Zone: BFE: FFE: WNER:Name(Fee Simple Titleholder): coy1riC.. Tice- Phone#: Address: '1 1� _N w 195 51. City: State: F(- Zip: 33 / so Tenant/Lessee Name: Phone#: �®o mail: \ \C.S l oxc� CONTRACTOR:Company Name: 6wi l ie, C w c i n PPliri n� �%j I C'C's Phone#: Address: Z 1-I Z 3 Si iqq 4v,(? 4144 City: IM I A S Zip: Qualifier Name: �0 C 2 h °. T4' "i Phone#: State Certification or Registration#: SM Q 1i 2'�"2 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: w Value of Work for this Permit:$ quare/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration eCw ❑ Repair/Replace ❑ Demolition Description of Work: �.C Specify color of color oo thru tile: Submittal Fee$ �� lJ-� Permit Fee$ 3 x� CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ SOQ -1 , ry TOTAL FEE NOW DUE$ 2r9 L l� (Revised02/24/2014) 4 Bonding Company's Name(if applicable) Bonding Company's Address City State Zip 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 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 issu In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. b Signature c` Signature OWNER or AGENT ICONTRACTOR The foregoing instrument was acknowledged before me thjs ha,fdreg`abirlg�+�t5trument was acknowledged before me this �j r day of 20 I =' � qday of^ 20 12 . by ZJ GC � who is personally known to H 1`111 g!J' ,who is personally known to me or who has produced 0 S- �5 � as me or who has producedkc337V9L�® �s identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: \\`��IIIIIunI / Sign: Print: ��° rent: Seal: = ''m �— Seal: .�""L Notary Public State of Florida C) r < r° �; Joanna M Feliciano -^ o:' C. o�:� ; o My Commission FF 082753 �!, "•. _ �' �OF A°� Expir@s 01/12/2018 APPROVED BY 1-4 Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) r STATE OF FLORIDA PERMIT #: 13-SC-1551722 DEPARTMENT OF HEALTH APPLICATION #: AP1154921 ONSITE SEWAGE TREATMENT AND DISPOSAL DATE PAID: SYSTEM FEE PAID: CONSTRUCTION PERMIT RECEIPT #: DOCUMENT #: PR947603 CONSTRUCTION PERMIT FOR: OSTDS New APPLICANT: Corrie Rice PROPERTY ADDRESS: 41 NW 105 St Miami, FL 33150 LOT: 13 BLOCK: 203 SUBDIVISION: PROPERTY ID #: 11-2136-005-0290 [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 [ 900 ] GALLONS / GPD Septic RAPACITY A [ ] GALLONS / GPD N/A CAPACITY N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK-1250 GALLONS] K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ] D [ 375 ] SQUARE FEET Trench conflquration SYSTEM R [ ] SQUARE FEET N/A SYSTEM A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ] I CONFIGURATION: [x] TRENCH [ ] BED [ ] N F LOCATION OF BENCHMARK: E CL NW 105 st., 10.71'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 XCAVATIAN�t?E UIRED: [ 72,00 ] INCHES 0 *Invert elevation of drainfield to be no less than 9.16' NGVD. LL *Bottom of drainfield elevation to be no less than 8.66'NGVD. T *Install 42"of slightly limited soil under the bottom of drainfield. H -Perimeter of excavation area shall be at least 2 ft.wider and longer than the proposed absorption bed or drain trench. The system is sized for 3 bedrooms with a maximum occupancy of 6 persons(2 per bedroom),for a total estimated flow E of 300 gpd. R The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance with S.64E-6.013(3)(f), FAC. SPECIFICATIONS BY: Jorge M Millan TIT (,0 e APPROVED BY: TITLE: ,Qaa 0� Dade CHD Carlos M Icaza a t DATE ISSUED: 08/12/2014 �e 44- DATE: 02/12/2016 DH 4016, 08/09 (Obsoletes all previous editions which ma >, s ' Incorporated: 64E-6.003, FAC <C`` Page 1 of 3 v 1.1.4 AP1154921 SE 31 809 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. 1 ;1 ✓'rri fir' xrJ, r 1 r V vi � f {p to . APPLICATION #:AP1154921 o 'y_ STATE OF FLORIDA PERMIT #:13-SC-1551722 DEPARTMENT OF HEALTH DOCUMENT #:F1990746 ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION INSPECTION AND FINAL APPROVAL DATE PAID:03/03/2015 FEE PAID:110.00 RECEIPT #:13-PID-2613595 APPLICANT: Corrie Rice AGENT: Empire Engineering PROPERTY ADDRESS: 41 NW 105 St Miami, FL 33150 LOT: 13 BLOCK: 203 SUBDIVISION: ID#: 11-2136-005-0290 CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED. TANK INSTALLATION SETBACKS [ ] [01] TANK SIZE [1] 900.00 [2] [ ] [27] SURFACE WATER FT [ ] [02] TANK MATERIAL Polyethylene [ ] [28] DITCHES FT [ ] [03] OUTLET DEVICE [ ] [29] PRIVATE WELLS FT [ ] - [04] MULTI—CHAMBERED [ Y / N ] [ ] [30] PUBLIC WELLS FT [ ] [05] OUTLET FILTER Tuf-Tite EF-4 [ ] [31] IRRIGATION WELLS FT [ ] [06] LEGEND 1. 70-109-20DC3 2. [ ] [32] POTABLE WATER 6 FT [ ] [07] WATERTIGHT [ ] [33] BUILDING FOUNDATIONS 7 FT [ ] [08] LEVEL [ ] [34] PROPERTY LINES 7 FT [ ] [09] DEPTH TO LID [ ] [35] OTHER FT DRAINFIELD INSTALLATION FILLED / MOUND SYSTEM [ ] [10] AREA [1] 375 [2] SQFT [ ] [36] DRAINFIELD COVER [ ] [11] DISTRIBUTION BOX HEADER X [ ] [37] SHOULDERS [ ] [12] NUMBER OF DRAINLINES 1. 5.00 2. [ ] [38] SLOPES [ ] [13] DRAINLINE SEPARATION [ ] [39] STABILIZATION [ ] _ [14] DRAINLINE SLOPE [ ] [15] DEPTH OF COVER ADDITIONAL INFORMATION [ ] [16] ELEVATION [ ABOVE / BELOW ]BM 24.36 [ ] [40] UNOBSTRUCTED AREA [ ] [17] SYSTEM LOCATION [ ] [41] STORMWATER RUNOFF [ ] [18] DOSING PUMPS [ ] [42] ALARMS [ ] [19] AGGREGATE SIZE [ ] [43] MAINTENANCE AGREEMENT [ ] [20] AGGREGATE EXCESSIVE FINES [ ] [44] BUILDING AREA [ ] [21] AGGREGATE DEPTH [ ] [45] LOCATION CONFORMS WITH SITE PLAN FILL / EXCAVATION MATERIAL [ ] [46] FINAL SITE GRADING [ ] [22] FILL AMOUNT [ ] [47] CONTRACTOR Jorge Millan(Empire Engine [ ] [23] FILL TEXTURE [ ] [48] OTHER ADS ARC 24 [ ] [24] EXCAVATION DEPTH ABANDONMENT [ ] [25] AREA REPLACED [ ] [49] TANK PUMPED [ ] [26] REPLACEMENT MATERIAL [ ] [50] TANK CRUSHED & FILLED Comments: Comments are on page 2. CONSTRUCTION I APPROVED Dad Vr CHD DATE: 09/15/2014 DISAPPROVED Engineering Specialist II Nicole If Gum C orae 2� FINAL SYSTEM [ APPROVED DISAPPROVED ]; OC�� C DATE: 03/12/2015 Engineering Specialist r an e p of Healthade C (Explanation of Violations on following page) a e DH 4016, 08/09 (Obsoletes all previous editions which may Incorporated: 64E-6.003, FAC Page 2 of 3 EH Database v 1.0.1 Ap1154921 56 22