HomeMy WebLinkAboutD O H SEWAGE DISPOSAL SITE EVAL - SYSTEM SPECIFICATIONS - 1-7-98APPLICANT:
I Its
LOT:
6
PROPERTY ID #:
STATE OF FLORIDA PERMIT
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES SCIaNNED
ONSITE SEWAGE DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS BY
St Lucie County
)OERT & CYNTHIA JOLLY AGENT:PORT ST. LUCIE PROPERTIES/AYLOR, INC.
BLOCK': SUBDIVISION:
8 Jay Gardens
[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.
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PROPERTY SIZE CONFORMS TO SITE PLAN: [X] YES [ ] NO NET USABLE AREA AVAILABLE: 15,875SQ.FT.ACRES
TOTAL ESTIMATED SEWAGE FLOW: 300 GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2]
AUTHORIZED SEWAGE FLOW: 540 GALLONS PER DAY [1500 GPD/ACRE OR 2500 GPD/ACRE]
UNOBSTRUCTED:,AREA AVAILABLE: 1400 SQFT UNOBSTRUCTED AREA REQUIRED: 924 SQFT
BENCHMARK/REFERENCE POINT LOCATION: Nail in 6" - =10 0' assumed
ELEVATION OFi1PROPOSED SYSTEM SITE IS 3 -- INCH /FT] [ABOVE. LO /REFERENCE POINT
THE MINIMUM SET ACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES:
SURFACE WATER: FT DITCHES/SWALES: 1.5 FT NORMALLY WET? [ ] YES [X] NO
WELLS: PUBLIC: 20 FT LIMITED USE: 100 FT PRIVATE: 75 FT NON -POTABLE: 50 FT
BUILDING FOUNDATIONS: �7 _ FT PRO ERTY LINES: 11 T POTABLE WATER LINES: N A FT
SIVE SUBJECT41TO FREQUENT FLOODING: [ ] YES [X] NO 10 YEAR FLOODING? [ ] YES [X] NO
10 YEAR FLOOD ELEVATION FOR SITE: FT MSL/NGVD SITE ELEVATION: 9.8 FT MSL/NGVD
SOIL PROFILE11INFORMATION SITE 1 SOIL PROFILE INFORMATION SITE 2
Munsell #/Color Texture
Depth
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I
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j
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Q
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-
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4i
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USDA SOIL SERIES:
Munsell #/Color Texture Depth
to
to
to
to
to
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to
-
to
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USDA SOIL SERIES:
OBSERVED WATER TABLE: NO H2O INCHES [ABOVE / BELOW] EXISTING GRADE. TYPE •-.[PERCH / APPARENT]
ESTIMATED WET SEASON WATER TABLE ELEVATION: INCHES [ ABOVE / BELOW] EXISTING GRADE.
HIGH WATER TABLE VEGETATION: [ ] YES [X] NO MOTTLING: [ ] YES [X] NO DEPTH: INCHES
SOIL TEXTURE%LOADING RATE'.FOR-SYSTEM SIZING: DEPTH OF EXCAVATION: INCHES
DRAINFIELD CONFIGURATION,::'`[`=;J TRENCH [ ] BED [ ] OTHER (SPECIFY)
REMARKS/ADDITIONAL
SITE EVALUATED BY: '•.v ,��A -. ,' E GEOi2(T=''M. AYLOR, JR.-REGISTERED LAND SURVEYOR DATE: 1-7-98
'ar�aa �0.eR
HRS-H Form 4015, Mar 92 (Obsoletes '0P4V'us editions which may not be used) Page 3 of 3
(Stock Humber: 5''744-003-4015-1)
INSTRUCTIONS:
p6wt4z" :`A Permit tracking number assigned by CPHU.
TWA -.1 .3
Property owner's full name.
AGENT: Property owner's legally authorized representative.
LOT, BLOCK, SUBDIVISION: Lot, block, and subdivision for lot.
PROPERTY ID#: 27 character number for property. (property appraiser ID # or section/township/range/parcel
PROPERTY SIZE: Check if property size at site conforms to submitted site plan. Record net usable area available - to"'rea
exclusive Of
all paved areas and prepared road beds within public rights -of -way or casements and exclusive of steams,
lakes,
normally wet drainage ditches, marshes, or other such bodies of water.
SEWAGE FLOW: Record the estimated sewage flow for the establishment from Table I (residences) or Table 2 (non-residential),
Chapter
I OD-6, FAC. Record the authorized sewage flow for the lot based on net usable area and water supply
ply (1500 gallons
per day per acre for private water supplies and 2500 gpd per acre for public water supplies). If autI16rized
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 I
ust be at least 2
times as large as the drainfield absorption area and at least 75 percent of the unobstructed area must I
eet minimum
setbacks in Chapter 1013-6, FAC. The unobstructed area must be contiguous to the drainfield.
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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 be recorded
for non applicable features. Features on site plan or within 75 feet of the applicant lot must be measured.
or "NA"
The location
of any public drinking well within 200 feet of the applicant's lot must also be verified.
FLOOD INFORMATION: Record information on lot's subject to flooding. For lots subject to flooding record 10 year flood elevation
for site and
actual site elevation.
SOIL PROFILE INFORMATION
WATER TABLE:
DEPTH OF EXCAVATION:
DRAINFIELD CONFIGURATION:
ADDITIONAL CRITERIA:
SITE EVALUATED BY
ELEVATION WORKSHEET
Two soil profiles within the proposed absorption area to a minimum depth of 6 feet or refusal are r64,uired. Soil
identification will use USDA Soil Classification methodology (Munsell colors and USDA soil textures). a). Refusals must
be clearly documented, Provide USDA soil series if available, record "UNK" if the series cannot b I� determined.
Record the depth of the observed water table at the time of the evaluation. Mark "perched" or. .-pp
I
l appropriate. Record the estimated wet season water table elevation based on site evaluation, USDA
historical information. Indicate if there is high water table vegetation present. Indicate if mottling � I
Record soil texture or loading rate for system sizing.
If applicable record depth of excavation required. Record "NA' if not applicable.
Check drainfield configuration required. If other, specify type.
Record any additional remarks pertinent to site or installation. Ex. dosing required.
Signature of evaluator, title, and date of evaluation. Professional engineers must seal all
ELEVATION OF BENCHMARK / REFERENCE POINT IS:
BENCHMARK SITE I SITE 2 SITE 3
1+1 SHOT: H.I. HJ, H.I.
H.I. [-] SHOT 1-1 0 SHOT [-1 SHOT
rear as .it nis, and
present
r sent and depth.
submitted.