HomeMy WebLinkAboutD O H SEWAGE DISPOSAL SITE EVAL - SYSTEM SPECS - 2-24-97STATE` OF FLORIDA
.E o :DEPARTMENT. OF ,HEF.���1D,, RERABILITATIVE. ;SERVICES
ONSLTE ,SEWAGE DISP.O ^SYSTEM A
SITE .EVALUATION" AND_SYSTEM,SPECIFICATIONS X.
CAD WET „ SCANNOD ..
APPLICANT. AGENT.' BY
ROSERT �, BARBARA'RICE elf eSI:_L , C��,ROPERTIESMAYLOR, INC.---
LOT: BLOCK: SUBDIVISIONS
28 20 Lakewood mark ##3
PROPERTY• IDI; # [Section/Township/Range/Parcel No. or••,Taix 'ID 'Number)
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TO,BE 'C^MPLETED 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:15,520 ACRES
I:
TOTAL ,ESTIMiATED'SEWAGE FLOW. 300 GALLONS PER DAY [RESIDENCES' -TABLE 1 /: OTHER -TABLE 2].
I.AtJTHORIZED 'SEWAGE. FLOW 540 GALLONS',PER DAY ':[1500 GPD/ACRE OR 2500. GPD/ACRE]'
UNOBSTRUCTED,AREA AVAILABLE: 1475 SQFT UNOBSTRUCTED AREA REQUIRED: _SQFT
BENCHMARK/'RI FERENCE' POINT LOCATION: Cf) lomar, St. -painted red "X"melev.=10,00' assumed
ELEVATION .O ,,, PROPOSED SYSTEM "ST.TE �IS %. 3 �, :' . '. , INCHES j;� _ ]' [ABOVEfBE W_. 3EN /REFERENCE POINT
THE MINIMUM �'SETBACK' WHICH :CAN BE .MAINTAINE�FROM°'THE�'PROPOSED SYSTEM TO THE FOLLOWING -'FEATURES: -SURFACE TE WA'R 75, FT DITCH' S/SWAL, S �•.�,? F,T, , NORMALLY WET?, [ ,] YES;; .[X J NO
WELLS:, PUBL'IC'. 20® F LIMITED USE. ,.' 100,' FT PRYVATE"t �,75 . , . FT.;, NON -POTABLE. 50 FT.
BUILDIPIG FOUNDATIONS 7 ; FT F;,.0PE.RTY LINES:A .,'1.1 FT. POTABLE WATER LINES:. N FT
SITE SUBJEC��
• T •TO FREQUENT F.LOODING:. [ ], YES,"','„[X ] NO 10 YEAR. FLOODING7• a [.] YES [X ] NO
10 YEAR PLOOD'ELEVATION:FOR'SITE: FT MSI;/NGVD SITE ELEVATION ,,� 7•9 FT M5L/NGVD
SOIL PROFILE INFORMATION SITE 1 SOIL
PROFILE ,INFORMATION SITE 2
Munsell';#/ olor Texture •Depth Munsell #/Color __ Texture Depth,
to to
/ 4 �_t0 Flo' ` C ! to
r �0 to 5;3 `{ °� ' ``� { to
3 to -99'' to
to Z, ,.�� to
to to
'i to to
to to
USDA' SOIL,SERIES: USDA SOIL SERIES':'
I,
•,,�--�,� : /�" � ,
[ABOVE;/ BELOW EXISTING GRADE. TYPE: [PERCHED /-PARENT]
OBSERVED WA7�ER TABLE: 12 INCHES
ESTIMATED`WET SEASON WATER TABLE ELEVATION. INCHES '[ ASOVE / BELOW ] EXISTING,
HIGH WATER TABLE VEGETATION:'[ ] YES [X'] NO`' MOTTLING:.[.] YES [X"] NO bEPTHi INCHES
SOIL. TEXTUREV�ILOADING RATE FOR SYSTEM. SIZING: s r�� DEPTH OF EXCAVATION:. INCHES
DRAINFIELD abNFIGURATION: [,.] TRENCH [ ] BED' j ],OTHER (SPECIFY)
REMARKS/ADDITIONAL CRITERIAi
-41
SITE. EVALUATED BY :�,
s�QRGs XAY JR.-R€GFSTERED'LA9d0 SURVEYOR DATE: 2624-97 ..
HRS,H Form.4015,;IMar 92 (Obsol�etes„previous.=edi,t.ions.uhi;ch-ma.y,.not be`used). _; Pa,ge 3 ,of. 3
(Stock • Number: 5Ii744-003-4015 ;,1) >gy 4 ,_,�
INSTRUCTIONS:
i.
PERMIT #:
Permit tracking number assigned:by,CPHU.
APPLICANT:
owner's full name.
,).roftily
T
AGENT:*. prdriy'&wner's legally authorized representative.
LOT, BLOCK, SUBDIVISION:
Lot, block, and subdivision for lot.
PROPERTYID#:
27 character number for property. (property appraiser ID # or section/township/range/parcel number)
PROPERTY SIZE:
Check if property size at site conforms to submitted site plan. Record net usable area available - lot aic'
all paved areas and prepared road beds within public rights -of -way or casements and exclusive of strear,
normally wet drainage, ditches, marshes, or other such bodies of water.
SEWAGE FLOW:
Record the estimated sewage flow for the establishment frorn'Table I (residences) or Table 2 (non-resid
'1013-6, FAC. Record the authorized sewage flow for the -lot bised on net usable area and water suppl�,
11
per day per acre for private water supplies and,2300 gpd per acre r for public water supplies). If author:
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 mu I
lairle least 75
is the draikefdabsorptiiiift a' and at
percent of the unobstructed area must Mel times as, aces
setback I s in - Chapter IOD-0i 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. Re
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 rec r
for non applicable features. Features on site plan or within 75 feet of the applicant lot must be measure
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 cleval
a exclusive of
is, lakes,
-ntial), Chapter
(1500 gallons
,ed sewage flow
be at least 2
I nummurn
cord the
led or "NA"
1. The location
actual site elevation.
SOIL PROFILE INFORMATION: Two soil profiles within the proposed absorption area to a minimum depth oft-feeV or refusal are q
-identification will use USDA Soil Classification methodology (M6hsell colors,and- USDA soil ,- textures).'
be clearly documented. Provide USDA soil series4 availabi record "UNK" ifthe series cannot:b.e,det
WATER TABLE: Record the depth of the observed water table ai the'time of the evaluation. Mark "perched" or "appari nt
appropriate. Record the estimated wet season water table elevation based on site evaluation, USDA soil
historical information. Indicate if there is high water table vegetation present. Indicate if mottling is pre
SOIL TEXTURE: Record soil texture or loading rate for system sizing.
C
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 docurrientati:)n
ELEVATION WORKSHEET ELEVATION OF BENCHMARK I REFERENCE POINT IS:
BENCHMARK SITE I SITE 2 SITE 3
.[+].SHOT: H.I.
H.I. SHOT SHOT [+SHOT
on for site and
red.
Soil,.•
Refusals must
ermined.
" as
maps, and
sent and depth.
submitted.