HomeMy WebLinkAboutD O H SEWAGE TREATMENT DISPOSAL SITE EVALUATION SYSTEM SPECS 9-12-00LOT : I '
PROPERTY
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STATE OF FLORIDA PERMIT # . OC) ..2F�
DEPARTMENT OF HEALTH"
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
SI//TE'E EVALUATION AND SYSTEM
,SP%ECCI�FICATIONS
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BLOCK:�SUBDIVISION:0
[Section/Township/Parcel No.. or Tax ID Number]
TO BE COMPLETED BY ENGINEER, HEALTH DEPARTEMENT EMPLOYEE,OR OTHER QUALIFIED PERSON. ENGINNEERS
MUST PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE+ [ALL ITEMS.
PROPERTY SIZE CONFORMS TO SITE P 4 YES [ ] NO NET USABLE AREA AVAILABLE: A .� ACRES
TOTAL ESTIMATED SEWAGE FLOW: GALLONS PER DAY [RESIDENCE -TABLE 1/OTHER-TABLE21
AUTHORIZED SEWAGE FLOW: GALLONS PER DAY 1500 GPD/ACR OR 2500p�GPD/ACRE]
UNOBSTRUCTED AREA AVAILABLE: // SQFT UNOBSTRUCTED AREA REQUIRED: p� SQF
BENCHMARK/�2EFERENCE POINT LOCATION: CY(,_ 4 DMO C1W9JZ(__;t
ELEVATION OF PROPOSED SYSTEM SITE ISNCHE /FT] [ABOV BELOW] NCHMARR REFERENCE POINT
THE MINIMUM SETBACK ICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES
SURFACE WAITER: FT DITCHES S ES: Y_FT OTLLY WET? [ ] YES NO
WELLS: PUBLIC: FT LIMITED USE: FT PRIVATE: FT NON -POTABLE: FT
BUILDING FOUNDATIO S: FT PROPERTY LINES:�y FT POTABLE WATER LINES: FT
SITE SUBJECT TO FREQUENT FLOODING: [ ] ].NO 10 YEAR FLOODING? kYES
* NO
10,YEAR FLOOD ELEVATION FOR SITE: FT MSL/NGVD SITE ELEVATION ,/,FT MSL/NGVD
SOIL PROFILE INFORMATION SITE 1 SOIL PROFILE INFORMATION SITR 2
COLOR
TO
TO
TO
TO
USDA SOIL SERIES:
MUNSE L #/COLOR TEXTURE
j�k _ram
USDA SOIL SERIES:
TO
TO
TO
OBSERVEp WATER TABLE:Q1 0 - INCHES [ABOVE / ELOW EXISTING.GRADE. TYPE: PERCHED / APPARENT.
ESTIMATED WET SEASON WATER TABLE ELEVATION:1 INCHES [ABOVE / EL
OW EXISTING GRADE
HIGH-WATER�TABLE VEGETATION: [ ] YES [ ] NO MOTTLING: _P4 YES [ ] DEPTH:_3�INCHES
SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING:�:� DEPTH OF EXCAVATION: At,*'. ' INCHES
DRAINFIELD CONFIGURATION:1[ ] TRENCH BED [ ] OTHER (SPECIFY)
REMARKS/ADDITIONAL CRITERIA:
SITE EVALT
DH 4015, 10/
BY:
(Replaces HRS-H
4015 [page 31 which may -lie
_DATE:
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