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PL-12-1169r Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 175162 Permit Number: PL -6 -12 -1169 Scheduled Inspection Date: March 18, 2013 Inspector: Hernandez, Rafael Owner: WAGAR, KIRK W B Job Address: 145 NE 94 Street Miami Shores, FL 33138- Project: <NONE> Contractor: JASON'S SEPTIC INC Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Septic Phone Number Parcel Number 1132060132920 Phone: 305 - 252 -1080 Building Department Comments NEW TANK AND DRAINFIELD Passed x/ Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments HRS IN FILE March 15, 2013 For Inspections please call: (305)762 -4949 Page 2of54 1(A- 1161_ STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DIPOSAL, SXSTEM CONSTRUCTION INSPECTIQN AND FINAL APPROVAL PERMIT NO. at/04164 c DATE PAID: FEE PAID: RECEIPT #: APPLICANT: AGENT: . PROPERTY ADDRESS: LOT: 2O.7 BLOCK: .21/ SUBDIVISION: PROPERTY ID # :. CHECKED [X] ITEMS A E NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED. 1 1 1 1 1 1 1 1 TANK INSTALLATION • [01] TANK SIZE [11 - R.57C)(2] -cal C.) [02] TANK MATERIAL [ ] [03] [04] [05] [06] [07] [08] 109] OUTLET DEVICE �"-� -- MULTI-CRAMMED KEW N ] OUTLET FILTER LEGEND 27C)- Y 3 ! 3 ,0(..� C S'S C 3 [ ] [ 1 WATERTIGHT LEVEL DEPTH TO LID DRAINFIELD.INSTALLATIQN [10] AREA [1]/_,S4_221 b SOFT [11] DISTRIBUTION BO _ HEADER [12] NUMBER OF DR;AINLINES [13] DRAINLINE SE:PARATION,,,Zy., [14] DRAINLINE SLOPE [15] DEPTH OF COVER), 'J [16] ELEVATION CA:SOVE 0 BM [17] SYSTEM LOCATION [18] DOSING PUMPS 2,o 6) /i., (9t/ [19] AGGREGATE S I Z E � � , p 1 1 ] [20] AGGREGATE EKDE FINE a,j..' [211 AGGREGATE DEPTIL4&41 [ `,] FILL /EXCAVATION NATERIAL [-1' [22] FILL AMOUNT t2 of [ 1 [23] FILL TEXTURE [24] EXCAVATION DEPTH [251 AREA REPLACED [26] REPLACEMENT MATERIAI, [ H EXPLANATION OF VIOLATIONS / REMARKS: 1 eok epA #41/ SETBACKS [27] SURFACE WATER [28] DITCHES [29] [30] [31] [32] [33] [34] [35] PRIVATE WELLS PUBLIC WELLS IRRIGATION WELLS POTABLE WATER VINES BUILDING FOUNDATION PROPERTY LINES OTHER FT FT FT FT FT S`b FT FT /6 FT FT FILLED / MOpND SYSTEM [36] DRAINFIELD COVER [37] SHOULDERS [38] SLOPES [39] STABILIZATION ADDITIONAL INFORMATION [40] UNOBSTRUCTED AREA [41] STORMWATER RUNOFF [42] ALARMS [431 MAINTENANCE AGREEMENT [44] BUILDING AREA [45] LOCATION CONFORMS WITH SITE LAN •= [46] FINAL SITE G- •ING� [47] CONTRACTOR [48] OTHER ABANDONMENT [499] TANK PUMPED 4, Re/j< [50] TANA CRUSHED & FILLED 4/2..g/Z. CONSTRUCT/0 DISAPPROVED]: FINAL SYSTEM /DISAPPROVED]: L,/ CHD CBD DH 4016, 08/09 (Obsoletes all previous editions which may not be used) incorporated: 64E- 6.003, FAC DATE: C; DATE() Page 2 of 3 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 T_ JUN 2 8 2 rya ) , FBC 20 10 B Iirt NG Permit No. PERMIT APPLICATION Master Permit No.PU Permit Type: PLUMBING JOB ADDRESS: )L' N E 94 34- City: Miami Shores County: Miami Dade Zip: SS l-Tr" FoliolParcel #: 1 L ITOL100 13 A%) Is the Building Historically Designated: Yes NO _ Flood Zone: OWNER: Name (Fee Simple Titleholder): ,6 I1- t. N1 a c wr Phone#: Address: ILAS E 44 54. Ci �-� C4- ( .! �'' � r�� State: - Zip: \..j.% Phone#: Tenant/Lessee Name: Email: CONTRACTOR: Company Name: t JC(StANt S C Phone#: 3 -a' lCa.) Address: 13?)l 1 Q_ City: a 1 State: - Qualifier Name: Son N e S-2 (1(uo State Certification or Registration #: Certificate of Competency #: Contact Phone#: eat Ac Email Address: i s DESIGNER: Architect/Engineer: \ Phon zip: 31 -1t41 Phone#: Value of Work for this Permit: $ I ?O 0 Square/Linear Footage of Work: Type of Work: °Address °Alteration ZINew ORepair/Replace °Demolition Description of Work: -1-trAr1 R nnot of Q Submittal Fee Scanning Fee $ e * * * * * *** * * * * * * * * * * * * * * * * * * * * * *F ************* * * * * * * * * * * * * * * * * * * * * * * * ** * * * * ** Permit Fee $ 0 CCF $ CO /CC $ r Radon Fee $ DBPR $ Bond $ Training/Education Fee $ Technology Fee $ Structural Review $ TOTAL FEE NOW DUE $ (5 .d soo so 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 FT FCTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 proved and a reinspection fee will be charged Sign Owner or Agent eforegoing instrument was acknowledged before me this 2(4 day of who is personally known to Asi NOTARY PUBI IC: Sign: Print: My Commission Expires: Contractor fore ing instrument was acknowledged before me this 262 day of , 20 I who is personally known to me or who has produced as 'dentification and who did take an oath. NOTAR • • NESTOR VAZQUEZ P � � ` ' �;'�: •''i MY COMMISSION # DD823828 EXPIRES Sepiembe ° , 2013 Sign: L:u '; ._ Fl. x .:.o :.f iae.0 m Print: My Commission Expires: * * * * *** * * * * * * * * * * * * * * * * * * * * ** ,i . ************* ***** * * *** ** * *** *** *********a **** * **** ************** ** * * **+ *** APPROVED BY Structural Review (Revised3 /1212012)(Revised 07 /10 /07)(Revised 06/10/2009XRevised 3/15/09) Zoning Clerk MIAMI -DADE COUNTY TAW CO LAGLT RRST. 1st FLOOR MIAMI, FL 33130 2012 LOCALMISINESSTAXRECEIPT 2013 MIAMI DADE 1upjTY _ STATE OF FLORIDA EXP R s SEPT. 30,2013 MUST BE DI YED AT PLACE OF BUSINESS PURSUAA1T' i D CODE CHAP'S 8A . ART. 8 & 10 517556-7 THIS IS NOT A BILL — DO NOT PAY 33176 DADE COUNTY `7 "JASONS SEPTIC INC 11-i 14�'� likeTALTY PLUMBING CONTRACTOR x: • :::....._ L rA.. 60010000185 000075.00 OTHER SIDE :.a RENEWAL CC #R C 1444 540967 -7 FIRST-CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 231 WORKER /S 3 DO N'OT FORWARD JASONS SEPTIC INC JASON NESENMAN PRES 1334/ SW 88 AVE MIAMI FL 33176 J lt lltnJJ :ilt ?1J1,1Jijj1Fiiddli}lujj1111 i;bjJintidi f1 113 Registered Septic Tank Contractor JASON A NESENMAN 13341 SW 88TL1 AVE MIAMI FL JASON'S SEPTIC INC. 33176- Business Authorization: SA0031157 SR0031444 Registration Expires on September 30, 2013 v ■ 865: 6 4 £ 6 £1-181/11 03113/2013 13:24 7862067066 PRODUCER Galloway Insurance 17354 South Dixie Highway Miami, FL 33157 Phone (305)255-1661 GALLOWAY INSURANCE PAGE 01 CERTIFICATE OF LIABILITY INSURANCE DATE `1" D ") THISCERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THB COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIL # INSURER k The Burlington Insurance Company INSURER B: Fax (786)206 -7066 INSURED .Jason's Septic:, Ino. 13341 SW 88th Avenue Miami, Florida 33176 i Vendor # 254564 INSUR R C: INSURER D: INSURER E: COVERAGES THE 1POUCIES 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 OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. ACSCitttt3A I k LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. nNSR APRNL _ POLICY EFFECTIVE PCUCY EXPIRATION LTR map TYPE OF INSURANCE POLICY NUMBER DATE Lam DATE OMIT GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY ❑ ❑ CLAIMS MADE ❑ OCCUR A RI. PD: Ded: $250/CIaInt OEN L AOOREOATE LIMIT APPLIES PER: © POLICY ❑ PROJECT ❑ LOC AUTOMOBILE UAEILI Y ❑ ANY AUTO ❑ ALL OWNED AUTOS ❑ ❑ SCHEDULED AUTOS ❑ HIRED AUTOS ❑ NON OWNED AUTOS 0 GARAGE LIABILITY ❑ ❑ ANY AUTO 183B010854 12/08/2012 12/08/2013 LIMITS EACH OCCURRENCE DAMAGE TO RENTED PREMISES Me occurrence) MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS • COMP/OP AGG $1,000,000 $100,000 $5,000 $1,000,000 $2,000,000 $1,000,000 COMBINED SINGLE LIMIT (Qa aczkient) BODILY INJURY Beet person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) EXCESS / UMBRELLA LIABILITY ❑ OCCUR ❑ CLAIMS MADE n DEDUCTIBLE ❑ RETENTION S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR / PARTNER / EXECUT WEY/N OFFICER / MEMBER EXCLUDED? (Mandatory In NH) nSPECIdescribe OVISIO NS below OTHER AUTO ONLY - EA ACCIDENT OTHER THAN EA ACC AUTO ONLY: AGO EACH OCCURRENCE AGGREGATE ❑ SUM- TORY S ❑ ER ' E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE POLICY LIMIT DESCRIPTION of OPERATIONS c LOCATIONS/ VEHICLES i ExCLUSfQNS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Installation, Service, Repair, Excavation, Maintenance and Cleaning of Septic Tanks... **Please note that any changes to this policy must be Submitted to the Insurance Company for approval*... CERTIFICATE HOLDER Miami Shores Village 10050 NE 2nd Avenue Miami Shores, Florida 33138 Attn: Building Dept 1Fax # 305- 756 -8972 AcORD 26 (2009101) OF CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES B EXPIRATION DATE THEREOP, THE IS'CuINO INSURER 30 DAYS MITTEN NOTICE 10 THE CERTIFICA THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE OF ANY KIND UPON THE INSURER, ITS AGENTS OR AUTHORIZED REPRESENTATIVE Jose H Romero, Licensed Agent-A225234 CANCELLED BEFORE THE L ENDEAVOR TO MAIL R NAMED TO ON OR LIABILITY TIVES. ®1988 -2009 ACORD CORPO TION. All rights reserved. The ACORD name and logo are registered marks of ACORD ST• ATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: OSTDS New APPLICANT: Kirk Wagar PROPERTY ADDRESS: 145 NE 94 St Miami, FL 33138 LOT: 20 21 PERMIT #: 13-SC-1397612 APPLICATION #: API064665 DATE PAID: FEE PAID: RECEIPT #: DOCUMENT #: PR871980 BLOCK: 21 SUBDIVISION: PROPERTY ID #: 11- 3206 -013 -2920 [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 [ 1,200 ] GALLONS / GPD Septic CAPACITY A [ ] GALLONS / GPD N/A CAPACITY N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K [ 375 ] GALLONS DOSING TANK CAPACITY [ 83.00 ]GALLONS @[ 6 ]DOSES PER 24 HRS #Pumps [ 1 ] D [ 625 ] SQUARE FEET Trench configuration drain SYSTEM R [ ] SQUARE FEET N/A SYSTEM A TYPE SYSTEM: [x] STANDARD 1 ] FILLED [ ] MOUND [ ] I CONFIGURATION: [x] TRENCH [ 1 BED [ ] N F LOCATION OF BENCHMARK: CL NE 94 st., 9.98' NGVD I E L D 0 T H E R SPECIFICATIONS BY: Carlos M Icaza APPROVED BY: ELEVATION OF PROPOSED SYSTEM SITE BOTTOM OF DRAINFIELD TO BE FILL REQUIRED: [ 0.00 ] INCHES [ 3.72 31 INCHES r FT ] [ABOVE 4 BELOW b BENCHMARK /REFERENCE POINT [ 33.72 ] [I INCHES Y FT ] [ ABOVE 4 BELOW b BENCHMARK /REFERENCE POINT EXCAVATION REQUIRED: [ 30.00] INCHES Performing Lift Dosing. Pumps must be certified as suitable for distributing sewage effluent. Inspector to verify the existing septic tank is properly abandon before final approval. *Invert elevation of drainfield to be no less than 7.67 ft. NGVD. *Bottom of drainfield elevation to be no less than 7.17 ft. NGVD. -The licensed contractor installing the system is responsible for installing the minimum category of tank i with sec. 64E- 6.013(3)(f). F.A.C. Carlos M Icaza DATE ISSUED: 04/04/2012 TITLE: TITLE: EXPIRATION DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E- 6.003, FAC 8E867 v 1.1.4 AP1064665 10/04/2013 CHD Page 1 of 3 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 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.