PL-09-751Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 113272
Permit Number: PL -5 -09 -751
Scheduled Inspection Date: April 11, 2012
Inspector: Hernandez, Rafael
Owner: POLANCO, DEYSI
Job Address: 1183 NE 91 Terrace
Miami Shores, FL 33138-
Project: <NONE>
Contractor: EMPIRE ENGINEERING, LLC.
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Septic
Phone Number
Parcel Number 1132050010200
Phone: (305)822 -3765
Building Department Comments
INSTALLATION OF A NEW SEPTIC SYSTEM
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments oy'
April 10, 2012
For Inspections please call: (305)762 -4949
Page 2 of 25
BUILDING'
PERMIT APPLICATION Master Permit No.
FBC 2001
Permit Type: Plumbing '1
Owner's Name (Fee Simple, Titleholder) hero. e14 - Phone #
Owner's Address 11` 3 P F Ter,
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
Permit No.?\ 09-1Z1
NrgeMEIPM1
it MAY 0 52009 Jil
BY: %--)
City M (4.^^,k State F ■- Zip 3 313
Tenant/Lessee Name Phone #
E -MAIL:
Job Address (where the work is being done) 1113 N C It Ter.
Mww.,
Fl 3313%
City Miami Shores Village County Miami -Dade Zip
FOLIO /PARCEL# 32 ®S -pal- ®ZDO
Is Building Historically Designated YES
NO
Contractor's Company Name ,r$ tw4Pnn LL Phone #
Contractor's Address 1`i 3% 5‘../ 40 SI-- '4*- ZD 2
City M t4" v�.F°e+ State l= l- Zip 3 318
Qualifier Name J t1e M41 \kn Phone# 4$co -An ', 3475-*
State Certificate or Registration No. SM 09,1121 - Certificate of Competency No. 5E? 61 '4 121 1.
E- MAIL: ei,...6,roet.-rove et1Q.k:Aton"A. C
Architect/Engineer's Name (if applicable) Phone #
Value of Work For this Permit $ 4 000J Square / Linear Footage Of Work:
Type of Work: ❑Addition ❑Alteration Mew 0 Repair /Replace ❑ Demolition
Describe Work: 1- sn lb MO Se — e,
********* **** *************** ******** * *** Feesx o4si&********* x******* ***********************
Permit Fee $ �K l' 0
Submittal Fee $
Training /Education Fee $ O•O
Notary $ S
Scanning $ Radon $ DPBR $
Bond $ I4 Code Enforcement $ Double Fee $
Structural Review. $
CCF $ 2 'V CO /CC
Technology Fee $. K'
Zoning $
Total Fee Now Due $
See Reverse side -*
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 ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
OWNER'S AFFIDAVIT: 1 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 roust
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 .mmencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is iss `ed. In the absence of such posted notice, the
inspection will not be approved and a reinspecti . n fee will be charged
Owner Agent
The foregoing instrument was acknowledged before me this 5
day of ,20 ®1 G ,by Eeln`�P� who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
APPLICATION APPROVED B
(Revised 02/08/06)
1RES:Jung21,2011
4
NotaryDiscomo Assoc. Co.
Signature
Contractor
The foregoing instrument was acknowledged before me this
day of May , 2001, by yAC. RAAAO ,
who is personally known to me or whO has produced J�j yV / 5
I ii0O as identification and who did take an oath.
NOTARY PUBLIC: f
I.
P
My
Expires:
*****ua****x Jcu s4, 7st** **sY****ie** **e4************9ea ***aFdc4,ti*,tidc********
Plans Examiner
Engineer
Zoning
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION PERMIT FOR: OSTDS New
APPLICANT:
Anthony Fernandez
PERMIT # :13 -SC- 979330
APPLICATION #: AP919750
DATE PAID:
FEE PAID'
RECEIPT #'
DOCUMENT # : PR771884
PROPERTY ADDRESS: 1183 NE 91 Ter
LOT: 23 & 24
PROPERTY ID #:
Miami, FL 33138
BLOCK: 1 SUBDIVISION:
11 -3205- 001 -0200
[SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
[OR TAX ID NUMBER]
SYSTEM MUST
381.0065, F.S
SATISFACTORY
WHICH SERVED
PERMIT APPLI
ISSUANCE OF
STATE, OR LOCAL
BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION
., AND CHAPTER 64E -6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE
PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS,
AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE
CATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID.
THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL,
PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY.
SYSTEM DESIGN AND SPECIFICATIONS
T[
A [
N [
K [
D
R
A
I
N
F
I
L
D
0
T
R
1,050 ] GALLONS / GPD Septic
] GALLONS / GPD N/A
] GALLONS GREASE INTERCEPTOR CAPACITY
] GALLONS DOSING TANK CAPACITY [
[ 572 ] SQUARE FEET
] SQUARE FEET
TYPE SYSTEM: [ ] STANDARD
CONFIGURATION: [ ] TRENCH
LOCATION OF BENCHMARK:
N/A
[ ] FIT.T.F.D
[x] BED [
CAPACITY
CAPACITY
DeiXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
]GALLONS @[ ]DOSES PER 24 HRS #Pumps [
SYSTEM
SYSTEM
[x] MOUND
4.48' NGVD C/L NE 91 St & E. P/L
ELEVATION OF PROPOSED SYSTEM SITE [ 0.72 ][IINCHESk FT ][ IABOVE k BELOW1BENCBMARK /REFERENCE POINT
BOTTOM OF DRAINFIELD TO BE
FILL REQUIRED:
[ 24.00] INCHEs
6.72 ] [I INCHES i FT ] [I ABOVE It BELOW 1 BENCHMARK /REFERENCE POINT
EXCAVATION REQUIRED: [ 37.00] INCHES
MOUND SYSTEM - must comply with all the requirements of Chapter 64E- 6.009(3).
1.- Install a 1050 gal min. category-3 septic tank with an approved filter.
2. -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.
3.-Install 572 sf of drainfield in bed configuration.
4.- Install 42" of slightly limited soil at the bottom of the drainfield.
5.- Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed.
;006,
= id V Edw rds
far SPECIFICATIONS B
APPROVED BY:
Astrid V Edwards
DATE ISSUED: 04 /27/2009
TITLE: Engineer Specialist II
TITLE: Engineer Specialist II
DH 4016, 10/97 (Previous Editions May Be Used)
v 1.1.4 AP919750
Dade
EXPIRATION DATE: 10/27/2010
8E786229
CHD
Page 1 of 3
DOCUMENT # : PR771884
6.- Invert elevation of drainfield to be no Tess than 5.50' NGVD.
7. -Bottom of drainfield elevation to be no Tess than 5.00' NGVD.
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 Statues. 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 altemative 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
govemed 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.
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATION
APPLICANT: Anthony Fernandez
APPLICATION # AP919750
PERMIT # 13 -SC- 979330
DOCUMENT # SE786229
CONTRACTOR / AGENT: Jorge Milian Jr
LOT : 23 & 24
SUBDIVISION:
BLOCK: 1
ID# : 11- 3205 -001 -0200
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
TOTAL ESTIMATED SEWAGE FLOW: 400 GALLONS PER DAY
AUTHORIZED SEWAGE FLOW: 650.02 GALLONS PER DAY
UNOBSTRUCTED AREA AVAILABLE: 1145.00 SQFT
BENCHMARK /REFERENCE POINT LOCATION:
ELEVATION OF PROPOSED SYSTEM SITE
NET USABLE AREA AVAILABLE: an ACRES
RESIDENCES- TABLE1
1500 GPD /ACRE OR
UNOBSTRUCTED AREA REQUIRED:
4.48' NGVD C/L NE 91 St & E. P/L
/ OTHER -TABLE 2 ]
2500 GPD /ACRE
1143.00
SQFT
0.72 [ INCHES / FT ] [I ABOVE
/ BELOW] BENCHMARK /REFERENCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES
SURFACE WATER: N/A FT DITCHES /STILES : N/A FT NORMALLY WET: [ X ] YES [ MO
WELLS: PUBLIC: N/A FT LIMITED USE: N/A FT PRIVATE: N/A FT NON- POTABLE: N/A FT
BUILDING FOUNDATIONS: 31.7 FT PROPERTY LINES: 7.2 FT POTABLE WATER LINES: 53.2 FT
SITE SUBJECT TO FREQUENT FLOODING?
10 YEAR FLOOD ELEVATION FOR SITE:
SOIL PROFILE INFORMA
[ ]YES [X ]NO
FT [ MSL /
USDA SOIL SERIES: Urban land
Munsell #/Color Texture
Depth
10YR 3/3
Loamy Sand
0 To 11
10YR 6/1
Fine Sand
11 To 38
10YR 6/1
Fine Sand
38 To 72
36 To 72
OBSERVED WATER TABLE: 18.50 INCHES [ ABOVE /
ESTIMATED WET SEASON WATER TABLE ELEVATION:
BELOW
18
HIGH WATER TABLE VEGETATION: [ ]YES [X]NO
]
NGVD
10 YEAR FLOODING? [ ]YES [X]NC1
] SITE ELEVATION: 4.54 FT [ MSL /
SOIL PROFILE INFORMATION SITE 2
NGVD
USDA SOIL SERIES:
Munsell #/Color
Urban land
Texture
Depth
10YR 3/3
Loamy Sand
0 To 9
10YR 6/1
Fine Sand
9 To 36
10YR 6/1
Fine Sand
36 To 72
EXISTING GRADE TYPE:
INCHES [ ABOVE /
MOTTLING: [ ]YES [X]NO
BELOW
[ PERCHED /
EXISTING GRADE
DEPTH: INCHES
APPARENT
]
SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: Replacement 4-S, CS, LCS /O. DEPTH OF EXCAVATION: 37 INCHES
DRAINFIELD CONFIGURATION: [ ] TRENCH [X ] BED [ ] OTHER (SPECIFY)
- REMARKS /ADDITIONAL CRITERIA
SITE EVALUATED BY:
Milian, Jorge (TIUe: -Legacy)
DH 4015, 09/2006 (Previous Editions May Be Used)
DATE: 04/16/2009
Page 3 of 4
AP919750 EIL979330 v 1.0.2