HomeMy WebLinkAboutD O H SEWAGE TREATMENT - DISPOSAL SITE EVAL AND SYSTEM SPECIFICATIONS 7-27-18STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
PERMIT #.
IE CONSTRUCTION GROUP AGENT: BSE CONSTRUCTION GROUP
LOT: BLOCK: SUBDIVISION:
PROPERTY ID # : 2421-234-0005-000-3 [ Tax ID Number � : 13y ]
��' Ode County
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.
PROPERTYI SIZE CONFORMS TO SITE PLAN: [✓] YES [ ] NO NET USABLE AREA AVAILABLE: 0.548 ACRES
TOTAL ESITIMATED SEWAGE FLOW: GALLONS PER DAY [ RESIDENCES -TABLE 1/OTHER-TABLE 2 ]
AUTHORIZED SEWAGE FLOW: GALLONS PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE ]
UNOBSTRUCTED AREA AVAILABLE: SQFT UNOBSTRUCTED AREA REQUIRED: SQFT
BENCHMARK/REFERENCE POINT LOCATION: (SITE BENCHMARK ONE) SEE SURVEY
ELEVATION OF PROPOSED SYSTEM SITE IS1.0 [Fr ] [BELOW ] BENCHMARK/REFERENCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES
SURFACE WATER:75 FT
DITCHES/SWALES:15 FT
NORMALLY WET? [ YES ]
] NO
WELLS: PUBLIC:200 FT
LIMITED USE:100 FT PRIVATE:75
FT NON-POTABLE:50
FT
BUILDING FOUNDATIONS:5
FT PROPERTY LINES:10 FT
POTABLE WATER LINES:10
FT
SITE SUBJECT TO FREQUENT
FLOODING: [ ] YES [ ] NO 10 YEAR FLOODING? [ ] YES [
] NO
10 YEAR FLOOD ELEVATION
FOR SITE: FT MSL/NGVD SITE
ELEVATION:. FT MSL/NGVD
SOIL PROFILE INFORMATION SITE 1
MUNSELL!#/COLOR TEXTURE DEPTH
TO
TO
TO
TO
TO
TO
TO
TO
TO
USDA SOIL SERIES:
SOIL PROFILE INFORMATION SITE 2
MUNSELL #/COLOR TEXTURE DEPTH
TO
TO
TO
TO
TO
TO
TO
TO
TO
USDA SOIL SERIES:
OBSERVEDIWATER TABLE: INCHES [ABOVE/BELOW r] 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
RF14ARKS /
E/LOADING RATE FOR SYSTEM SIZING: DEPTH OF EXCAVATION:
CONFIGURATION: [ ] TRENCH [ ] BED [ ] OTHER (SPECIFY)
ITIONAL CRITERIA:
SITE EVALUATED BY:
DATE: 07/27/2018
INCHES
DH 4015, 12/11 (Obsoletes previous editions which may not be used) Incorporated: 64E-6.001, FAC Page 3 of 4