HomeMy WebLinkAboutD O H SEWAGE DISPOSAL - SITE EVALUATION - SYSTEM SPECIFICATIONSt• �,
APPLICANT:
N2° of
LOT: Al of
S23° of
PROPERTY I
• STATE OF FLORIDA PERMIT
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
SITE EVALUATION AND,SYSTEM SPECIFICATIONS
11ILLIE BRADLEY AGENT: PORT ST. LUCIE PROEPRTIES/AYLOR, IR!C.
9 BLOCK: 28 SUBDIVISION: San Lucie Plaza Subdivision f#1
#: [Section/Township/Range/Parcel No. or Tax ID Number]
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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: 11,775S9.F'T.ACRES
TOTAL ESTIMATED SEWAGE FLOW: 45-110CI&D GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 21
,,AUTHORIZED SEWAGE FLOW: 4 0S GALLONS PER DAY [1500 GPD/ACRE OR 2500 GPD/ACRE]
UNOBSTRUCTED AREA AVAILABLE: 1500 SQFT UNOBSTRUCTED AREA REQUIRED: 1125 SQFT
BENCHMARK/REFERENCE POINT LOCATION: Bail in —power pole-elev.=10.00® assumed
ELEVATION OIF PROPOSED SYSTEM SITE IS 3 INCHES?FT]� OVE$ELOW BFNCHMAI/'REFERENCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINT}YI1D FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES:
SURFACE WATER: 75 FT DITCHE /SWALES: > 15 FT NORMALLY WET? [ ] YES [ ] NO
WELLS: PUBLlIC: 200 FT LIMITED USE: ) 100 FT PRIVATE: > 75 FT NON -POTABLE: > 50 NFT
FT PROPERTY LINES: > 11 FT POTABLE WATER LINES: _ff/A FT
BUILDING FO�NDATIONS: 7
SITE SUBJECT TO FREQUENT FLO_UDING: [.] YES [X].NO 10 YEAR FLOODING? [ ],YES [X] NO
.10 YEAR FLOOD ELEVATION FOR -SITE: FT MSL/NGVD SITE ELEVATION: 10.2 FT MSL/NGVD
SOIL PROFILE INFORMATION SITE 1 SOIL PROFILE INFORMATION SITE 2
IUSDA SOIL S
OBSERVED WAT
ESTIMATED WE
HIGH WAT R T
SOIL TE TURE
DRAINFIELD C
REMARKS/ADDI
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Munsell #/Color Texture Depth
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USDA SOIL SERIES:
TABLE: 62 INCHES [ABOVE BELOW] %ISTING GRADE. TYPE:" PERCHED APB PARENT]
SEASON WATER TABLE ELEVATION: INCHES [ ABOVE BELOW EXISTING �G--R1tD�E..
LE VEGETATION: [ ] YES X] NO MOTTLING: [ ] YES [X]-NO—DEPTH: INCHES
6 ;lD %
OADING.RATE FOR SYSTEM SIZING: Co *h DEPTH OF E%CAVATION:_,M INCHES
FIGURATION: [ ] TRENCH BED [� ] OTHER (SPECIFY)
ONAXOIC411T*M'YA:
�•'.~ .^ •-d�ryry
' SITE EVALUATEDBt:'V
NRS-H Form 4015, Mar -92.1,06s
-: - (Stock Number: 5Z44-003,461
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7.F✓:S;i Rn
5 ;.ormoi GEE o. AYLOR, JR.®REGISTERED LAW
pre%pio/us editions which may not be used)
DATE: 1-5-96
Page 3 of 3
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INSTRUCTIONS:
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PERMIT N: Permit tracking number assigned by CPHU.
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APPLICANT: Property owner's full name.
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AGENT: Property owner's legally authorized representative.
LOT, BLOCK, SUBDIVISION: Lot, block, and subdivision for lot.
PROPERTY ID11: 27 character number for property. (property appraiser ID :# or section/township/range/pareel number)
PROPERTY SIZE: Check if property size at site conforms to submitted site plan. Record net usable area available - lot area exclusive of
all paved areas and prepared road beds within public rights -of -way or easements and exclusive of streams, lakes,
normally wet drainage ditches, marshes, or other such bodies of water. II
SEWAGE FLOW: Record the estimated sewage flow for the establishment from Table I (residences) or Table 2 (non-re,sldential), Chapter
IOD-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 2300 gpd per acre for public water supplies). If authoized sewage flow
does not equal or exceed the estimated sewage flow, the application must be denied. Iil
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UNOBSTRUCTED AREA: Record the square feet of unobstructed area available and the amount required. Unobstructed area must be at least 2
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times as large as the drainfield absorption area and at least 73 percent of the unobstructed area must i eet minimum
setbacks in Chapter IOD-6, 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.i;Record the
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 re"NA"or "NA"
for non applicable features. Features on site plan or within 73 feet of the applicant lot must be measured. The location
of any public drinking well within 200 feet of the applicant's lot must also be verified.
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FLOOD INFORMATION: Record information -on lot's subject to flooding. For lots subject to flooding record 10 year flood elevation for site and
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actual site elevation. I;
SOIL PROFILE INFORMATION: Two soil profiles within the proposed absorption area to a minimum depth of 6 feet or refusal are required. Soil
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identification will use USDA Soil Classification methodology (Munsell colors and USDA soil textures). Refusals must
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be clearly documented. Provide USDA soil series if available, record "UNK" if the series cannot l e determined.
WATER TABLE: Record the depth of the observed water table at the time of the evaluation. Mark "perched" or "apparent" as
appropriate. Record the estimated wet season water table elevation based on site evaluation, USDksoil maps, and
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historical information. Indicate if there is high water table vegetation present. Indicate if mottling ps present and depth.
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SOIL TEXTURE: Record soil texture or loading rate for system sizing.
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. I
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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 documcr tion submitted.
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ELEVATION WORKSHEET ELEVATION OF BENCHMARK / REFERENCE POINT IS: I�I
BENCHMARK SITE 1 SITE 2 SITE 3
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