HomeMy WebLinkAboutD O H SEWAGE DISPOSAL - SITE EVAL AND SYSTEM SPECS - 6-2-98APPLICANT:
LOT: 14
' STATE OF FLORIDA
PERMIT`
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
E ONSITE SEWAGE DISPOSAL SYSTEM
I' SITE EVALUATION AND SYSTEM SPECIFICATIONS
CATHERINE SIMMONS AGENT:PORT ST. LUCIE PROPERTIES/AYLOR, INC.
PROPERTY ID #'
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TO BE COMPLE
PROVIDE REGI
BLOCK: 121 SUBDIVISION: Lakewood Park #110
[Section/Township/Range/Parcel No. or Tax ID Number]
BY ENGINEER, HEALTH UNIT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEER'S MUST
ATION 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: 22,177SQ.FT.ACRES
TOTAL ESTIMATED SEWAGE FLOW: 300 GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2]
AUTHORIZED SEWAGE FLOW: 765 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 Ft. UaltonR East#ood Dr.- ainted red "X°t-etev.=10.001 assumed
ELEVATION OF11PROPOSED SYSTEM SITE IS 21 NCH FT] ABOVE B-bLOxqBENCHMARK REFERENCE POINT
THE MINIMUM SET ACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES:
SURFACE WATER: 75 FT DITCHES/SWALES: , 15 FT �NORMALLY WET? [ ] YES [ )] NO
WELLS: PUBLIC:, g FT LIMITED USE: % 100 FT PT RIVATE: / l75FT NON -POTABLE: ? 50 FT
BUILDING FOUNDATIONS: 7 FT PROPERTY LINES: > 11 FTPOTABLEWATER LINES: N/A FT
SITE SUBJECT: -TO FREQUENT EIUODING: [ ] YES [X] NO 10 YEAR FLOODING? [ ] [X] NO
10 YEAR FLOOD ELEVATION FOR SITE: FT MSL/NGVD SITE ELEVATION: 11.7 FT MSL/NGVD
SOIL PROFILE�;INFORMATION SITE 1 SOIL PROFILE INFORMATION SITE 2
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Munsell`#/'Color Texture
Depth
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USDA SOIL SERIES:
Munsell #/Color Texture Depth
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USDA SOIL SERIES:
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OBSERVED WATER TABLE: NO H2O INCHES [ABOVE / BELOW] EXISTING GRADE. TYPE. �ERCHEDAPPARENT]
ESTIMATED WET SEASON WATER TABLE ELEVATION: INCHES [ ABOVE / BELOW ] EXISTING GRADE.
HIGH WATER TABLE VEGETATION: [ ] YES [ )J NO MOTTLING: [ ] YES [X] NO DEPTH: INCHES
SOIL TEXTURE%LOADING-RATE-FOR SYSTEM SIZING: DEPTH OF EXCAVATION: INCHES
DRAINFIELD CONFIGURATION .[•.. ] TRENCH [ ] BED [ ] OTHER (SPECIFY)
REMARKS /ADDI,TIQWL -Clk T IA:
SITE EVALUATED Bi:.y._ .bjY \� , � GFO t M. AYL':0�R; JRit` REGISTERED LAND SURVEYOR DATE: 6m2-98
• HRS-H Form 4015,'jMar 92 (Obsofietes previous editions which may not be used) Page 3 of 3
(Stock Number: 5744-003-4015-1)
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INSTRUCTIONS:
PERMIT #:
APPLICANT:
AGENT:
LOT, BLOCK, SUBDIVISION:
PROPERTYID#:
PROPERTY SIZE:
SEWAGE FLOW:
UNOBSTRUCTED AREA:
BENCHMARK INFORMATION
MINIMUM SETBACKS:
Permit tracking number assigned by CPHU.
Property owner's full name.
Property owner's legally authorized representative.
Lot, block, and subdivision for lot.
� 1
27 character number for property. (property appraiser ID# or section/township/range/parcel number)
Check if property size at site conforms to submitted site plan. Record net usable area available - lIIIit'larea exclusive of.
all paved areas and prepared road beds within public rights -of -way or easements and exclusive of s6eams, lakes,
normally wet drainage ditches, marshes, or other such bodies of water.
Record the estimated sewage flow for the establishment from Table I (residences) or Table 2 (non-r"6sidential), Chapter
I OD-6, FAC. Record the authorized sewage flow for the lot based on net usable area and water supply (1500 gallons
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per day per acre for private water supplies and 2500 gpd per acre for public water supplies). If Sul] orized sewage now
does not equal or exceed the estimated sewage flow, the application must be denied.
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 75 percent of the unobstructed area must, ect minimum
setbacks in Chapter IOD-6, FAC. The unobstructed area must be contiguous to the drainfield.
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.
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Record minimum setbacks which can be meet to all listed features. Actual measurements must be recorded or 'NA"
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for non applicable 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. i.1
FLOOD INFORMATION. Record information on lot's subject to flooding. For lots subject to flooding record 10 year flood e ovation for site and
actual site elevation..
SOIL PROFILE INFORMATION: 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).
V 1 a). Refusals must
be clearly documented. Provide USDA soil series if available, record "UNK" if the series cannot b 11 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, S IIsoil maps, and
historical information. Indicate if there is high water table vegetation present. Indicate if mottling i Ill nt and depth.
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.
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 documenta ill
ELEVATION WORKSHEET ELEVATION OF BENCHMARK / REFERENCE POINT IS:
BENCHMARK SITE I SITE 2 SITE 3
+ ] SHOT: H.I. H.I. H.I.
H.I. SHOT [-] SHOT H SHOTIII
submitted.