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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. moo wET•-- '° ._ __., .. , AGENT: APPLICANT: GlJ l I 1 1 a d 9�y .J� . i� ! I... �~ ( , (( 6f q t LOT:�i. K: SUBDIVIS.ION:6 &1 V, �� z 7 ; 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. - 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' Texture Denth _ -TIC:to '`i to e� 0 to M.-l—to to-74— to to IUSDA SOIL SERIES: [?<J NO 10 YEAR FLOODYNG7 [ ] YES. t ] NO FT MSL/NGVD-,' SITE ELEVATION: FT MSL/NGVD SOIL PROFILE INFORMATION SITE 2 l USDA SOIL SERIES Death U to 1C _777 to—.7T— to to 7)- 7 Ito `3 to (L $p to to to 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: r r, ; • 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) r