HomeMy WebLinkAboutSEWAGE�k By
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT
SITE EVALUATION AND SYS
APPLICANT:_
LOT:
PROPERTY ID #:
4411
BLOCK: SUBDIVIS
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,'FILE COPS',,
DISPOSAL SYSTEM
SPECIFICATIONS
AGENT:
[Section/Township/Parcel No. or Tax ID Number]
TO BE COMPLETED BY ENGINEER, HEALTH DEPARTEMENT EMPLOYEE,OR OTHER QUALIFIED PERSON. ENGINNEERS
MUST PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL..COMPLETE ALL ITEMS.
PROPERTY SIZE CONFORMS TO SITE PLAN:
TOTAL ESTIMATED SEWAGE FLOW:
AUTHORIZED SEWAGE FLOW:
UNOBSTRUCTED AREA AVAILABLE:
BENCHMARK/REFERENCE POINT LOCATION:.Z
ELEVATION OF PROPOSED SYSTEM SITE IS
S [ ] NO NET USABLE AREA AVAILABLE: 2-Z ACRES
GALLONS PER DAY [RESIDENCES -TABLE 1/OTHER-TABLE2]
GALLONS PER DAY (1500 GPD/ACRE OR 2500 GPD/ACRE]
SQFT UNOBSTRUCTED AREA REQUIRED: SQFT
e Qr,/, /&,,;,o €c . 2,F VG ,
FT] [ABOVE OW �/REFERENCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES
SURFACE WATER:•'? r FT DITCHES/SWALES:�FT NORMALLY WET? [ ] YES [ ] NO
WELLS: PUBLIC: 7-amO FT MITED USE: Flo d FT PRIVATE: -7 5-- FT NON -POTABLE: <-O FT
BUILDING FOUNDATIONS: FT PROPERTY LINES: S FT POTABLE WATER LINES: I'Co FT
SITE SUBJECT
TO FREQUENT FLOODING: [
] YES [ ] NO
10 YEAR FLOODING? [
] YES [ ] NO
10 YEAR FLOOD
ELEVATION FOR SITE:
I FT MSL/NGVD
I
I
I
SITE ELEVATION:
FT MSL/NGVD
SOIL PROFILE INFORMATION SITE 1
MUNSELL #/COLOR TEXTURE DEP7
TO
TO
TO
TO
TO
TO
TO
TO
TO
USDA SOIL SERIES:
SOIL PROFILE INFORMATION SITE 2
MUNSELL #/COLOR
USDA SOIL SERIES:
TEXTURE DEPTH
TV
TO
1'V
TO
TO
TO
TO
TO
TO
I
OBSERVED WATER TABLE: INCHES [ABOVE / BELOW] EXISTING GRADE. TYPE:[PERCHED / APPARENT]
ESTIMATED WET SEASON WATER TABLE ELEVATION: INCHES [ABOVE / BELOW] EXISTING GRADE
HIGH WATER TABLE VEGETATION: [ ] YES [:] NO MOTTLING: [ ] YES [ ] NO DEPTH: INCHES
SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: DEPTH OF EXCAVATION: INCHES
DRAINFIELD CONFIGURATION: [ ] TRENCH I [ ] BED [ ] OTHER (SPECIFY)
REMARKS/ADDITIONAL CRITERIA:
SITE EVALUATED BY: DATE: CeA
DH 4015, 08/09 (Obsoletes previous editions whisk may not be used) Incorporated: 64E-6.001, FAC Page 3 of 4
I