HomeMy WebLinkAboutD O H SEWAGE TREATMENT - SITE EVAL - SYSTEM SPECS 5-4-20STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
PERMIT #
021 •J2.
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PROPERTY ID #1: [Section/Tow7nship/Rsnge/Parcel• o. 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 SIZEi CONFORMS TO SITE PL}AN:�!•� . YES -[ ] NONETUSABLEAREA AVAILABLE: 2- ' ACRES
TOTAL ESTIMATED SEWAGE FLOW: (.�LJ GALLONS PER DAY [RE DENCES- ABLE 1 / OTHER-TA
AUTHORIZED SEWAGE FLOW: �T�-�- GALLONS PEP. DAY (iR"2 � CRE] .
UNOBSTRUCTED AREA AVAILABLE: ��Etd SQFT UNOBSTRUCTED AREA REQUIRED: °` � SQFT
BENCHMARK/REFERENCE POINT LOCATION:
ELEVATION OF PROPOSED SYSTEM SITE IS�
/FT] [ABOVt//BELOW]..BENCHMARK/REFERENCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE P %POSED SYSTEM TO THE•,FOLLOWING-_FEATURES'":
SURFACE WATER: FT DITCHES/SWALES: l /A FT NORMALLY WET.? [" ] : YES " [%'Ej NO
WELLS: PUBLIC;: FT ���•L•��IMITED USE: �FT ,PRIV TE: _ FT . NON -POTABLE:-` Kjf�,-� FT
BUILDING FOUNDATIONS: 2V FT PROPERTY LINES: �� FT POTABLE WATER'LINES': O FT
SITE SUBJECT TO FREQUENT FLOODING: [ ] YES
10 YEAR FLOOD ELEVATION FOR SITE:
SOIL PROFILE INFORMATION SITE 1'
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IUSDA SOIL SERIES:
[?<J NO 10 YEAR FLOODYNG7 [ ] YES. t ] NO
FT MSL/NGVD-,' SITE ELEVATION: FT MSL/NGVD
SOIL PROFILE INFORMATION SITE 2
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USDA SOIL SERIES
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OBSERVED WATER TABLE: INCHES [ABOVE / BELOW EXISTING GRADE. TYP iF2�-BED 14 ]
ESTIMATED WET SEASON WATER TABLE ELEVATION: INCHES ['-XSOVE"'/ ELOWj ] EXISTING GRADE.
HIGH WATER TABLE VEGETATION: [ ] YES N NO MOTTLING: [ ] YES [> NO DEPTH: INCHES
SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING:/(r%~ DEPTH OF EXCAVATION: INCHES
DRAINFIELD CONFIGURATION: [ ] TRENCH [ BED [ ] OTHER (SPECIFY)
REVS/ADDITIONAL CRITERIA:
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SITE EVALUATED BY: / L (. f� It -' DATE: y"74aL
' DH 4015, 10/96 (Replaces HRS-H Form 4015 [Page 31 which may be used) Page 3 of 3
(Stock Number: 5744-003-4015-1)
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