HomeMy WebLinkAboutD O H SEWAGE DISPOSAL SITE EVALUATION - SYSTEM SPECIFICATIONSI
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
APPLICANT: 1' S.M. & TAf4ELA S. ROBINSON
LOT:. 13 I BLOCK: 3
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PROPERTY ID L:
PERMIT #
AGENT: PORT ST. LUCIE PROPERTIES/AYLOR, INC.
SUBDIVISION: AERO ACRES
[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 SIZE CONFORMS TO SITE PLAN: [X] YES [ ] NO NET USABLE AREA AVAILABLE: 96,OOOSQ.FT•ACRES
TOTAL ESTIMATED SEWAGE FLOW: 300 GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2]
AUTHORIZED SEWAGE FLOW: 525 GALLONS PER DAY [1500 GPD/ACRE OR 2500 GPD/ACRE]
UNOBSTRUCTED AREA AVAILABLE: 1500 SQFT UNOBSTRUCTED AREA REQUIRED: 924 SQFT
BENCHMARK/ REFERENCE POINT LOCATION: C/L TRANQUILITY BASE LAND -PAINTED RED " K"-ELEVa10.00 t ASSUMED
ELEVATION OF PROPOSED SYSTEM SITE IS 6 INCHES FT] ROVE BELOW rBENC16MRKkREFERENCE'POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES:
SURFACE WATEFJ: > 75 FT DITCHES/SWALES: } 15 FT NORMALLY WET? [ ] YES [X] NO
WELLS: PUBLIC: `-200 FT LIMITED USE: >100 FT PRIVATE: > 75 FT NON -POTABLE: �5Gl FT
BUILDING FOUNDATIONS: >'7 FT PROPERTY LINES: 11 FT POTABLE WATER LINES: N/A FT
SITE SUBJECT TO FREQUENT FLOODING: [ ] YES [X] NO 10 YEAR FLOODING? [ ] YES [X] NO
10 YEAR FLOOD ELEVATION FOR SITE: FT MSL/NGVD SITE ELEVATION: 10.5 FT MSL/NGVD
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SOIL PROFILEIINFORMATION SITE 1
Munsell #/Collor
Texture Depth
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to
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USDA SOIL SERIES:
SOIL PROFILE INFORMATION SITE 2
Munsell #/Color Texture Depth
-to-
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to
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USDA SOIL SERIES:
OBSERVED WATER TABLE: NO H2O INCHES [ABOVE / BELOW] EXISTING GRADE. TYPE: PERCHED /� PARENT]
ESTIMATED WET1 SEASON WATER TABLE ELEVATION: INCHES [ ABOVE / BELO� $ STING GRADE.
HIGH WATER TABLE VEGETATION: [ ] YES [X] NO MOTTLING: [ ] YES [X] NO DEPTH: INCHES
SOIL TEXTURE/
DRAINFIELD CC
REMARKS/ADDIT
kDING RATE FOR SYSTEM SIZING: DEPTH OF EXCAVATION: INCHES
[GURATION,a"': ,...TRENCH BED [ ] OTHER SPECIFY
' � a. -. � tic+ � ➢: � � %1
SITE EVALUATED BY: GEOfGE M.. AYLOR, JR-REGI
DH 4015, 10/96 (Replaces HRS-H Form 4015 [Page 3] which may be used)
(Stock Number: 5744-003-4015-1)
DATE: 7-13-00
Page 3 of 3
INSTRUCTIONS:
PERNMITNUMBER:
APPJACANT�
AGENT:
i,ar, B1,OCK., SUBDIVISION
PROPERTY ID NUMBER:
PROPERTY SIZE,:
SEWAGE- Fl..OW:
UNOBSTRUCTED AREA:
111',NCHMARK iNFORNIATION:
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Permit tracking number by County Health Department.
Property owner's bill name.
Property owner's legally authorized representative.
Lot, block. and subdivision forlot.
271 character number for property (property appraiser ID number or number). .
Check if propty at site conforms to submitted site plan. Record net usable area available - to I t area exclusive of
all paved areas and prepared road beds within public rights -of -way or casements and exclusive of streams. likes,
normally wet drainage ditches, marshes, or other such bodies of water.
Record the estimated sewage flow for the establislinunit front Table 1 (residence) or fable 2 (non-residential),
Chapter I OD-6, FAC. Record the authorized sewage flow for the lot based on net usable area and water supply
(1500 gallons per day per acre for private water supplies and 2500 gpd per acre for public water supplies). if
authorized sewage Ilow does not equal or exceed the estimated 5ewage flow, the application mqst be denied,
Record the square feet or unobstructed area available and the amount required. Unobstructed area must be at
least 2 firnes as Large as the drainfield absorption area and at least 75 percent of the unobstructd area must meet
mininiurn setbacks in Chapter I OD-6. FAC. The unobstructed area must be contiguous to the j�ainfield.
Record the location of the benchmark, If using a swNcyor's benchmark record the actual elevation. Record the
elevation of the proposed system site in relation (above or below) to the benchmark.
�MINIM[Jkl SETBACKS: Record minimum setbacks which cart be meet to all listed features. Actual mensurenientq must ; be recorded or
"NA" for nonappilcable tcatures. Features on site plan or within 75 feet Of the applicant let n1pst be measured.
The location of any public drinking well within 200 feet of the applicant's lot must also be verified.
FI..00D INFORMA,no'N': Record information on lot's subject to ficmding. For lots subject to flooding record 10 year flood cievatimi for
site anti nctual site elevation,
SOIL, PROFII.F. INFORIMATTOK: Two soil profillics within the proposed absorption area to a rainimum depth of 6 feet or refusal thc required. Soil
identification will use USDA Soil Classification methodology (Munseli colors and USDA soil:textures ' 1. Refusals
must be clearly documented. Provide USDA soil series if available, record "UNK- if the series; cannot be
determined.
WATER TAULE: Record the depth of the observed water table at the time of the evaluation, Mark -'perched" c411 I apparent" as
appropriate. Record the estimated wet season watc.r table elevation based on site evaluation, U;SDA soil inaps,
and historical informalion. Indicate ifthere is hiph water table vegetation present. Indicate ii',motding is present
and depth.
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SO11- TF KI URE: Record soil texture or loading rate for system sizing.
Df-','PTR OF EXCAVATION: 117applicable record depth of excavation roquired. Record "NA" if not applicable.
DRAINFIELD CONFIGURATION: Check drainfield configuration required, If other, specify type.
ADDITIONAI.. CRITERIA: Record any additional remarks pertinent to site or installation. Ex. dosing required.
SITE EVAUJATED BY: Signature ofcvaluator, title, and date of evaluation. Professional engineers must seal ail dectliments submined.
ELEVATION WORKSHEET ELEVATION OF BENCHMARK 1 REFERENCE POINT IS:
BENCHMARK SIT F I S1TE 2 SITE i
SHOT IIJ. 14.1. H.I.
S140T SHOT
SHOT