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HomeMy WebLinkAboutD O H SEWAGE DISPOSAL SITE EVAL - SYSTEM SPECIFICATIONS - 1-21-98APPLICANT: LOT: PROPERTY ID #: STATE"OF FLORIDA DEPARTMENT OF HEALTH ONSITE 'SEWAGE DISPOSAL -SYSTEM - SITE EVALUATION AND SYSTEM SPECIFICATIONS 0 8 4 R J -f V (vTill A jI 0 L.. LV AGENT: PERMIT # 413 Y2 8 Sc�N st<<,��ey�Fo L 0 Lo 6CO BLOCK: / SUBDIVISION: TAY 6 n8 nk fV, [Section/Township/Range/Parcel No. or Tax ID Number] TO BE COMPLETED BY ENGINEER, HEALTH UNIT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEER'S MUST PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE'OF SUBMITTAL. COMPLETE ALL ITEMS. __===-____________________-____________=__ PROPERTY SIZjE CONFORMS TO SITE PLAN: [ ] YES [ J NO NET USABLE AREA AVAILABLE: ACRES 11 TOTAL ESTIMATED 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/RE,FERENCE POINT LOCATION: J!/}M _rlJ P40 '"]'�.0 1-7 � /1".zaVC �`. yt S d 1y& 6It4d4; ELEVATION OF�PROPOSED SYSTEM SITE IS 'I CHE"/FT] [ABOVELO�1 C REFERENCE POINT THE MINIMUM SURFACE WAT WELLS:,PUBL BUILDING FO' SITE SUBJEC' 10 YEAR FLO SOIL PROF oETBACK WHICH'CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES: t: FT DITCHES/SWALES: FT NORMALLY WET? [ ] YES [ ] NO FT LIMITED USE: FT PRIVATE: FT NON -POTABLE: FT IDATIONS: FT PROPERTY LINES: FT POTABLE WATER LINES: FT yoas slrZ L J<lt TO FREQUENT FLOODING: [ ] YES [.] NO 10 YEAR FLOODING? [ ] YES [ ] NO 1 ELEVATION FOR SITE: FT MSL/NGVD SITE ELEVATION: FT MSL/NGVD INFORMATION SITE' 1 Munsell. #/6olor Texture Depth )a vie /' a O to /D �— <-3 rs /o to. !e fF-S /&C _to 2 q �� � • � Fti� .� Y to 2�r -z 4S 2 to 2- I Spa®rc 36 to y2 4 Z ! +? to 72, to to USDA SOIL SERIES: SOIL PROFILE INFORMATION SITE 2 Munsell #/Color Texture Depth it) rs d to /© O -to, /f to Zy i Y f s L t026 -2F5 2Sr to36 2-I�_to yz G _2L y to to to USDA SOIL SERIES: ER TABLE:, $� INCHES [ABOVE / ELO EXISTING GRADE. TYPE -.-[PERCHED %) APPARENT] ESTIMATEDWETSEASON :WATER TABLE ELEVATION- '�� INCHES [ ABOVE / ELO STING GRADE. HIGH ..WATER TABLE VEGETATION: [ ] YES 1%4 NO MOTTLING: [ ']'YES [+ 0 D TH: INCHES SOIL TEXTURE LOADING RATE FOR SYSTEM SIZING: I®.r9 6 DEPTH OF EXCAVATION: %D INCHES DRAINFIELD CONFIGURATION: j ] TRENCH [ BED [ J OTHER (SPECIFY) REMARKS/ADDITIONAL CRITERIA: SITE EVALUATED BY: ... ,r'!� '• DATE:.. Page 3 of 3 DH 4015, 10196 (Replaces HRS-H Form 401'5 [Page 3],which may be used) (Stock Number: 5744-003-4015-1) - INSTRUCTIONS: PERMIT NUMBER: APPLICANT;, AGENT: LOT, BLOCK, SUBDIVISION PROPERTY ID NUMBER: PROPERTY SIZE: Permit tracking number by County Health Department. i i Property owner's full name. Property owner's legally authorized representative. Lot, block, and subdivision for lot. 27 character number for property (property appraiser ID number or section/township/range/parcel number). Check if property at site conforms to submitted site plan. Record net usable area available - lot1drea exclusive of all paved areas and prepared road beds within public rights -of -way or easements and exclusive of streams, lakes, normally wet drainage ditches, marshes, or other such bodies of water. ' Ili SEWAGE FLOW: Record the estimated sewage flow for the establishment from Table 1 (residence) or Table 2 (noh residential), Chapter 1 OD-6, FAC. Record the authorized sewage flow for the lot based on net usable area aril water supply (1500 gallons per day per acre for private water supplies and 2500 gpd per acre for public waterlisupplies). If authorized sewage flow does not equal or exceed the estimated sewage flow, the application must be denied. UNOBSTRUCTED AREA: Record the square feet of unobstructed area available and the amount required. Unobstructed area must be at least 2 times as large as the drainfield absorption area and at least 75 percent of the unobstructed, area must meet minimum setbacks in Chapter lOD-6, FAC. The unobstructed area must be contiguous .to the drainfield. BENCHMARK INFORMATION: Record the location of the benchmark. If using a surveyor's benchmark record the actual elevation. Record the elevation of the proposed system site in relation (above or below) to the benchmark. MINIMUM SETBACKS: Record minimum setbacks which can be meet to all listed features. Actual measurements must I "NA" for nonapplicable features. Features on site plan or within 75 feet of the applicant lot must , recorded or be measured. The location of any public drinking well within 200 feet of the applicant's lot must also be veril ed. w FLOOD INFORMATION: Record information on lot's subject to flooding. For lots subject to flooding record 10 year floe J g J g Y elevation for site and actual site elevation. SOIL PROFILE INFORMATION: Two soil profiles within the proposed absorption area to a minimum depth of 6 feet or refusal are identification will use USDA Soil Classification methodology (Munsell colors and USDA soil teIxtures). required. Soil Refusals must be clearly documented. Provide USDA soil series if available, record "UNK" if the series cl nnot be determined. WATER TABLE: Record the depth of the observed water table at the time of the evaluation. Mark "perched" or "apparent" as appropriate. Record the estimated wet season water table elevation based on site evaluation, USDA soil maps, and historical information. Indicate if there is high water table vegetation present. Indicate if mottling is present and depth. SOIL TEXTURE: Record soil texture or loading rate for system sizing. DEPTH OF EXCAVATION: If applicable record depth of excavation required. Record "NA" if not applicable. DRAINFIELD CONFIGURATION: Check drainfield configuration required. If other, specify type. ADDITIONAL CRITERIA: Record any additional remarks pertinent to site or installation. Ex. dosing required. SITE EVALUATED BY: Signature of evaluator, title, and date of evaluation. Professional engineers must seal all documents submitted. ELEVATION WORKSHEET ELEVATION OF BENCHMARK / REFERENCE POINT IS: BENCHMARK SITE 1 SITE 2 [ + ] SHOT H.I. H.I. H.I. [ - ] SHOT [-]SHOT SITE 3 H.I. [ - ] SHOT