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PL-13-268Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 185580 Permit Number: PL -2 -13 -268 Scheduled Inspection Date: March 13, 2013 Inspector: Hernandez, Rafael Owner: JANVIER, EDNER Job Address: 67 NW 109 Street Miami Shores, FL 33168 -4314 Project: <NONE> Contractor: STATEWIDE SEPTIC CONNECTIONS Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1121360030270 Phone: (954)963 -0082 Building Department Comments PUMP ABANDON AND REPLACE BROKER SEPTIC AND INSTALL NEW SYSTEM Infractio Passed Comments INSPECTOR COMMENTS False Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments HRS IN FILE March 12, 2013 For Inspections please call: (305)762 -4949 Page 14 of 43 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION INSPECTION AND FINAL APPROVAL APPLICANT: EdnerJanvier AGENT: Statewide Septic PROPERTY ADDRESS: 67 NW 109 St Miami, FL 33168 LOT: 27 SUBDIVISION: APPLICATION # : API 096427 PERMIT # :13 -SC- 1453860 DOCUMENT #:F1901255 DATE PAID: 02/04/2013 FEE PAID :200.00 RECEIPT # :13 -PI D- 2089100 BLOCK: 219 ID# : 11- 2136 -003 -0270 CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED. TANK INSTALLATION [01] [02] [03] [04] [05] [06] [07] [08] [09] TANK SIZE [1] TANK MATERIAL OUTLET DEVICE MULTI- CHAMBERED OUTLET FILTER 900.00 [2] Polyethylene I Y V Polylok N LEGEND 1. 01- 011 -04 2. WATERTIGHT LEVEL DEPTH TO LID DRAINFIELD INSTALLATION [10] AREA [1] 225 [11] DISTRIBUTION BOX [12] NUMBER OF DRAINLINES [13] DRAINLINE SEPARATION [14] DRAINLINE SLOPE [15] DEPTH OF COVER [16] ELEVATION [ ABOVE [17] SYSTEM LOCATION [18] DOSING PUMPS [19] AGGREGATE SIZE [20] AGGREGATE EXCESSIVE [21] AGGREGATE DEPTH [2] FILL [22] [23] [24] [25] [26] Comments: SQFT HEADER X 1. 5.00 2. BELOW ] BM 45.60 FINES / EXCAVATION MATERIAL FILL AMOUNT FILL TEXTURE EXCAVATION DEPTH AREA REPLACED REPLACEMENT MATERIAL SETBACKS [27] SURFACE WATER [28] DITCHES [29] PRIVATE WELLS [30] PUBLIC WELLS [31] IRRIGATION WELLS [32] POTABLE WATER [33] BUILDING FOUNDATIONS [34] PROPERTY LINES [35] OTHER FIr,r,F D / MOUND SYSTEM [36] [37] [38] [39] 25 10 6 15 DRAINFIELD COVER SHOULDERS SLOPES STABILIZATION ADDITIONAL INFORMATION FT FT FT FT FT FT FT FT FT [40] UNOBSTRUCTED AREA [41] STORMWATER RUNOFF [42] ALARMS [43] MAINTENANCE AGREEMENT [44] BUILDING AREA [45] LOCATION CONFORMS WITH SITE PLAN [46] FINAL SITE GRADING [47] CONTRACTOR Teresa J Solomon (Statewide [48] OTHER ADS ARC 24 ABANDONMENT [49] TANK PUMPED 02/15/2013 [50] TANK CRUSHED & FILLED 02/15/2013 CONSTRUCTION I FINAL SYSTEM [ APPROVED APPROVED DISAPPROVED ]: / DISAPPROVED 1: (Explanation of Violations on following page) DH 4016, 08/09 (Obsoletes all previous Incorporated: 64E- 6.003, FAC EH Database v 1.0.1 Dade CHD DATE: 02/15/2013 Ronald E Cave (Dade County Environmental Health) Dade Ronald E Cave (Dade County Environmental Health) editions which may not be used) A P1086427 EID1453860 CHD DATE : 02/15/2013 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 7` FTC 0 ,, By:s ,e&A, @p1`D FBC 20 1t> B I ING Permit No. 12f C' 2- PERMIT APPLICATION Master Permit No. Permit Type: Electrical JOB ADDRESS: Gi N1,k) p oq Stree City: Miami Shores County: Miami Dade Zip: 168 Folio/Parcel #: 0 21 36- 3_ ©2 -70 NO Flood Zone: OWNER: Name (Fee Simple Titleholder): JQr g E.daP Phone #: Address: C SO rrw) City: State: Zip: Is the Building Historically Designated: Yes Tenant/Lessee Name: Phone #: Email: CONTRACTOR: Company Name: Stake ,gyp crptil C Cr14YIK Phone#: 30S-- (o4,( -�Ob Address: (0o?,z S, Z3 Strf 9e-rr City: ravel Or r- State: FL Zip:. )a®23 Qualifier Name: T�e5 q �o� ®� Phone #: State Certification or Registration #: 5 �O dJ i4 t 62 Certificate of Competency #: Contact Phone#: Email Address: DESIGNER: Architect/Engineer: Phone #: (-000 Value of Work for this Permit: $ Square/Linear Footage of Work: 7S Type of Work: ❑Address UAlteration ❑New epair/Replace ❑Demolition Description of Work: INre-\e' A- ba.Otor 4 kr ce Orr, . Scetc tart (eiSta Oo 6G ( "rtc d- NeW Z2‘ t err,& Drca1., '6.zl4 ******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Submittal Fee $ Permit Fee $ RO C3 CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 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 Al'FllAVIT: 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 wh'ch occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be a' ro 1d and a reinspection fee will be charged. Owner or Agent The forego': g ins u ment.as ackno ledged bef e me this day of CaA t Eby y o is a sonally kn wn4o me or who has produced V l %' ®Yidentification and who did take an oath. NOTAR ' UBLIC: Sign: Print: My Commission Expires Signature The fo; ! of i g instrument was s1 acknowl day of t Al .I �:.I , 2OJ , by who i onally own to m; or who has produced fication and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commis axes: Bonded through National Notary Assn. **** * * ** *** * * ** *** *** *** **************************************************** * **** ** ****** ** * ***** **** ** **** ti APPROVED BY g t- 13 Plans Examiner Zoning Structural Review Clerk (Revised 3 /12 /2012)(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: Edner Janvier PROPERTY ADDRESS: 67 NW 109 St Miami, FL 33168 LOT: 27 PERMIT #:13 -SC- 1453860 APPLICATION #: API096427 DATE PAID: FEE PAID: RECEIPT #: DOCUMENT a : PR89654 BLOCK: 219 PROPERTY .ID . #-: 11-2136-003-0270 SUBDIVISION: [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] [OR TAX ID NUMBER] SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS 381.0065, F.S., AND CHAPTER 64E -6, F.A.C. SATISFACTORY PERFORMANCE FOR ANY SPECIFIC WHICH SERVED AS A BASIS FOR ISSUANCE OF DEPARTMENT APPROVAL OF PERIOD OF TIME. ANY THIS PERMIT, REQUIRE AND STANDARDS OF SECTION SYSTEM DOES NOT GUARANTEE CHANGE IN MATERIAL FACTS, THE APPLICANT TO MODIFY THE MADE NULL AND VOID. WITH OTHER FEDERAL, PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY. SYSTEM DESIGN AND SPECIFICATIONS T A [ N [ K [ D t R [ A TYPE SYSTEM: I CONFIGURATION: 900 3 GALLONS / GPD 0 ] GALLONS / GPD 0 1 GALLONS GREASE INTERCEPTOR CAPACITY 1 GALLONS DOSING TANK CAPACITY New Septic Tank 225 ] SQUARE FEET 0 ] SQUARE FEET [x] STANDARD (x] TRENCH CAPACITY CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] ]GALLONS @[ ]DOSES PER 24 HRS #Pumps Trench configuration SYSTEM SYSTEM [ ] FILLED (] MOUND [ I BED [ ] N F LOCATION OF BENCHMARK: F.F.E (top of next higher floor) 12.90' NGVD [ 25.20 ] [I INCHES c FT ] [ ABOVE / BELOW BENCHMARK /REFERENCE POINT [ 63.20 I (1 INCHES f FT ] [ ABOVE 4 BELOW b BENCHMARK /REFERENCE POINT I ELEVATION OF PROPOSED SYSTEM SITE E BOTTOM OF DRAINFIELD TO BE L D FILL REQUIRED: 0 H E R SPECIFICATIONS BY: APPROVED BY: [ 0.001 INCHES EXCAVATION REQUIRED: 1 38.00] INCHES Inspector to verify the existing septic tank is properly abandon before final approval. *Invert elevation of drainfield to be no less than 8.13 ft. NGVD. *Bottom of drainfield elevation to be no less than 7.63 ft. NGVD. system is sized for 3 of bedrooms with a maximum occupancy of 6 of persons (2 per bedroom), for total estimated sewage flow of 300 gpd. -The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance with sec. 64E- 6.013(3)(f). F.A.C. DATE ISSUED: DH 4016, 08/09 Incorporated: Carlos Mr, ca ea !i1J � Carlos M_. °aka 02/06/2013 , ertUrm a EXPIRATION DATE: 05/07/2013 ��e contra ci; (3 — ,∎, r''e) required to P at the of be used) (obsosoii i � 'oi:use aY l t ' 64E -6 11Q�t fil�+nss�ect ;c,:, rarior to Final APp inspector shatimitm:A. me soil boring and compare the results to the ori,llft:3i site evaluation subrdiffiank427 reinspection ted `ii hea sse1 t d i the contractor is no at the iob'site'4.'. TITLE: TITLE: Dade SE889416 CHD Page 1 of 3 1 STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR CONSTRUCTION PERMIT Permit Application Nun1 PART II - SITEPLAN scale: Each block re • resents 10 feet and 1 inch = 40 feet. _ • 1 _ 14„,111 _ --1 RI - ilk "1�■ m � " ��i ■ ■�����11111 el n iiuu L nom i i I I i ix -.�.0 i willwremi m P11., � miniairm i i i L. L L -- � 1, -- w vikaliall110210:121,41:4111PMEII , , ( Notes: 0 cY C 3 Site Plan submitted by! Plan Appr By Not Approved 13 up ti-Vrc' Date C) 13 0 '5 County Health Department L CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT DH 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated: 64E- 6.001, FAC (Stock Number: 5744 - 002 - 4015 -6) Page 2 of 4