HomeMy WebLinkAboutD O H SEWAGE DISPOSAL SITE EVAL - SYSTEM SPECS - 12-2-98STATE OF FLORIDA
n DEPARTMENT OF HEALTH
11. ONSITE SEWAGE DISPOSAL SYSTEM
SITEEVALUATION'AND SYSTEM SPECIFICATIONS
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PERMIT
`APPLICANT: AGENT:"
ALLEN & MEBORAH YCDER PORT ST: LUG I E PROPERTIES/AYLOR, INC.
'-LOT: BLOCK:" SUBDIVISION,
7 �, 62_ .,Lakewood Park Unit 6
1
PROPERTY ID.#: [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 REAL EACH PAGE OF'SUBMITTAL.. COMPLETE ALL ITEMS.
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PROPERTY- SIZE CONFORMS TO'SITE PLAN:` [X] YES [' ] NO NET USABLE AREA AVAILABLE:•13.590SO.FT.ACRES
TOTAL ESTIMATED SEWAGE •FLOW: JOIJ, GALLONS,PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2]
AUTHORIZED SEWAGE.FLOW:. 885 GALLONS PER DAY • [1'500GPD/ACRE'OR 2500 GPD/ACRE]
UNOBSTRUCTED'I'AREA AVAILABLE: 1400 SQFT ,UNOBSTRUCTED AREA REQUIRED: 924& SQFT
YBENCHMARR/REFERENCE POINT LOCATION: C/L Deland Ave. -painted red "X"-'elev.-10.001 assumedsf
-ELEVATION OF!;PROPOSED SYSTEM SITE IS 4 INCHES FT] OV ELO BENCHMARK B,ENCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING MOURES:
'SURFACE WATER: 75 FT' DITCHES/SWALES: 75 FT NORMALLY WET? [ .] YES [X] NO
WELLS: 'PUBLIC: 20O F LIMITED USE: 100 FT PRIVATE:75 FT NON -POTABLE 50 FT
BUILDING FOUNDKTIONS: 7 FT' PR ERTY LINES: , 11 FT POTABLE WATER LINES. N/A FT
'SITE SUBJECT:):TO FREQUENT FLOODING: [ ] YES [X ] NO 10 YEAR FLOODING? [ ] S [X] NO
10 .YEAR FL 0.011LEVATION FOR SITE: FT' MSL/NGVD SITE ELEVATION: 10.3 F MSL/NGVD
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SOIL PROjMW )INFORMATION. SITE. 1
Munsell #/Color Texture Depth
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USDA SOIL SERIES:
SOIL PROFILE INFORMATION SITE 2
Munsell #/Color Texture -Depth
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USDA SOIL SERIES:
OBSERVED WATER TABLE: NO H2O INCHES [ABOVE / BELU{d *% STING GRADE.' TYP [PERCHED APPARENT]
ESTIMATED WET SEASON WATER TABLE ELEVATION:. INCHES [ ABOVE / BELOW ING GRADE.
HIGH,WATER TABLE VEGETATION,: '[ ] YES [X] NO MOTTLING: [ ] .YES [X] NO DEPTH: INCHES,.
SOIL TEXTUR
DRAINFIELD
REMARKS/ADD
DADING RATE.FOR SYSTEM SIZ-ING:_
FIGURAT,ION:,, 1,r [" ;'•], TRENCH [ ' ]
DNAL CRYRIA: '
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SITE EVALUATED BY: €GEORGE P(, AYLOR,
DH:4o15, 10196 (Replaces HRS-H Form 4015 [Page 3] which may be used).
(Stock Number: 6744- 03-4015-1)
-REGI
DEPTH OF EXCAVATION:' INCHES
BED [ ] OTHER.,(SPECIFY)
DATE: 12-2-98
Page 3 of 3 ,
INSTRUCTIONS:
PERMIT NUMBER:
Permit tracking number by County Health Department. i
APPLICANT:
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Property owner's full name.
AGENT:
Property owner's legally authorized representative.
LOT, BLOCK, SUBDIVISION:
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Lot, block, and subdivision for lot.
PROPERTY ID NUMBER:
27 character number for property (property appraiser ID number or section/township/range/parcel number).
PROPERTY SIZE:
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Check if property 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 lof streams, lakes,
normally wet drainage ditches, marshes, or other such bodies of water.
SEWAGE FLOW:
Record the estimated sewage flow for the establishment from Table 1 (residence) or Table 2 (non-residential),
Chapter 1 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 flow does not equal or exceed the estimated sewage flow, the application must be denied.
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UNOBSTRUCTED AREA:
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Record the square feet of unobstructed area available and the amount required. Unobstructed dea must be at
least 2 times as large as the drainfield absorption area and at least 75 percent of the unobstructed area must meet
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. Record the
elevation of the proposed system site in relation (above or below) to the benchmark.
MINIMUM SETBACKS:
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Record minimum setbacks which can be meet to all listed features. Actual measurements must be recorded or
"NA" for nonapplicable features. Features on site plan or within 75 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.
FLOOD INFORMATION:
Record information on lot's subject to flooding. For lots subject to flooding record 10 year flood elevation for
site and actual site elevation.
SOIL PROFILE INFORMATION:
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Two soil profiles within the proposed absorption area to a minimum depth of 6 feet or refusal are required. Soil
identification will use USDA Soil Classification methodology (Munsell colors and USDA soil textures). Refusals
must be clearly documented. Provide USDA soil series if available, record "UNK" if the series cannot be
determined.
WATER TABLE:
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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, USDA soil maps,
and historical information. Indicate if there is high water table vegetation present. Indicate if mottling is present
and depth. Ie
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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. r
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DRAINFIELD CONFIGURATION:
Check drainfield configuration required. If other, specify type.
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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 documents submitted.
ELEVATION WORKSHEET
ELEVATION OF BENCHMARK / REFERENCE POINT IS:
BENCHMARK
SITE I SITE 2 SITE 3 l
[ + ] SHOT
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