HomeMy WebLinkAboutSewageSTATE OF FLORIDA
r DEPARTMENT OF HEALTH
ONSITE SEWAGE' TitEATMENT AND DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
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• PRO #: Zi02�' IG3 ' Q d 5/ O� Q ~'7 [Section/Township/Parcel No. or Tax ID Number]
TO BE COMPLETED BY ENGINEER, HEALTH DEPARTMENT EMBLOYEE,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- [ ] YES [ ] NO NET USABLE AREA AVAILABLE: • �3 ACRES
TOTAL ESTIMATED SEWAGE FLOW: 174" GALLONS PER DAY 3- 1/0THER-TABLE2]
AUTHORIZED SEWAGE FLAW: 0 GALLONS PER DAY [1500 GPD/ACRE O GPD/
UNOBSTRUCTED AREA. AVAILABLE: SQFT UNOBSTRUCTED AREA. REQUIRED: `SQFT
SENCHf0.RK/REFERENCE POINT LOCATION: 51, �M 4-po-i I�401,rU a. 2- 7
ELEVATION OF PROPOSED SYSTEM SITE IS 1--l-_ IN /ET [ABOV� W] BENCHmm/REFERENCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING. FEATURES
SURFACE WATER: y� y,� IT DITCHES/SWALES: FT NORMF.►I,LY WET? LV YES [ j NO
WELLS: PUBLIC: FT LIMITED USE: FT PRIVATE:_____,__FT NON -POTABLE: FT
BUILDING FOUNDATIONS: 5 FT PROPERTY LIKES: 6- S FT POTABLE WATER LINES:. rFT
SITE -SUBJECT TO FREQUENT FLOODING: [ ] Igs [)a, NO 10 YEAR FLOODING? [ ] YES Co NO
10 YEAR FLOOD ELEVATION FOR SITE: U� -- FT NSL/NGVD SITE ELLVATION: ,r�6 F°l' MSL/fqGVD
SOIL PROFILE INFORMFiTION SITE 1
MUNSELL #/COLOR TEXTURE
DEPTH
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0 TO IT
�',
/LTO;Zo
�(D
e ( —ems
OTo X
p K 1t Gam_
To 0
d L Cf
5W TO 7
TO
TO
TO
TO
USDA SOIL SERIES: c� L"4 t'r
e,A• `V_X b
TEXTURE
TO
TO
TO
TO
TO
USDA SOIL SERIES:
OBSERVED WATER TABLE: INCHES [ABOVE / EXISTING GRADE. TYPE • PERCHED / ]
ESTIMATED WET SEASON WATER TABLE ELEVATION: INCHES A80VE / BXISTI�P�DE
HIGH WATER TABLE VEGETATION: [ ] YES [ENO MOTTLING: ["S [ ] NO DEPTH: ?c- INCHES
SOLI. TEXTURE/LOADING RATE FOR SYSTEM SIZING: S - e-6 DEPTH OF EXCAVATION: 5r v INCHES
DRAINFIELD CONFIGURATION: [)j,_TRENCR [ ] BED' [ ] OTHEt (SPECIFY)
RE0&ARKS/ADDz9!T0 AL CRITERIA: 5' NS % hr, eft m ^e, (P , '..,
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f�� LL o- � •l%O , +
SITE EVALUATED SY: !� C � ��V `J c7ru'al ( _�'�$ �•i: / 1 ( --
DH 4015, 00/09 (Obsoletes previous editions which may not be used) Inoorporated: .001.F 3 of 4,
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