HomeMy WebLinkAboutD O H SEWAGE DISPOSAL - SITE EVAL AND SYSTEM SPECS - 5-11-00PERMIT # D2-4 G%
STATE OF FLORIDA
r-� DEPARTMENT OF HEALTH
a ONSITE SEWAGE DISPOSAL SYSTEM
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OD WE iSITE EVALUATION AND SYSTEM SPECIFICATIONS �C1
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PPLICANT: r AGENT:
,OT:_;,It Iq BLOCK: SUBDIVISION: CO
ROPERTY ID [Section/Township/Range/Parcel•No. or Tax ID N er)
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'O•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.
'ROPERTY SIZE CONFORMS TO SITE PLAN: ] YES' [._] NO. NET USABLE AREA AVAILABLE: "t ACRES
COTAL ESTIMATED SEWAGE FLOW: - GALLONS PER DAY. [RESIDENCES -TABLE 1 .ABLE 2]
AUTHORIZED SEWAGE FLOW: 'GALLONS PER DAY [-� e_.GPV"/'f eRE""OR Z500 GPI /ACR�]
7NOBSTRUCTED AREA AVAILABLE: UNOBSTRUCTED AREA REQUIRED:�3 SQFT.
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BENCHMARK'/REFE'RENCE ;POINT 'LOCATION: /l--c .�. l`t�X.i �_'
ELEVATIONi .OF PiROEOSED' SYSTEM SITE IS ZNI/') BOV /.BEL[AW] NCHM/�REP>LREH"P�T
THE MINIMUM SETB CK.WHICH CAN.BE MAINTAINED.FROM•THE.PROP.OSED.SYSTEM TO THE FOLLOWING FEATURES:
SURFACE WATER:' FT" •DITCHES SWALES: iI FTNORMALLY WET? [.] YES. /[�] NO
WEIJAi, PUBLIC:{ `✓L.. FT LIMITED USE: „ �T PRIVATE: FT NON -POTABLE.' jr1 FT
BUILDING FOUNDATI.ONScf FT. PROPERTY LINES:. _.FT POTABLE WATER ,LINES:• ( .
FT
SITE "SUBJECT TO'FFEQUENT FLOODING: [ ] ' YES} NO 10 YEAR . FLOODING? [- •� YES [ NO
.
.
`16 YEAR FLOOD,ELEVATI'0N.FOR SITE: _ FT.MSL/NGVD SITE ELEVATION: FT MSL/NGVD
SOIL PROFILE I;NFORMFITION"SITE 1 SOIL PROFILE INFORMATION SITE 2
Mu sell Color Texture Depth •
() I� to J
USDA ' SOIL SERIES,:•
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to
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to -
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Munse.11 # Color Texture Depth.
2-. 11 2.,to ? [ l
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USDA SOIL SERIES'•
OB$EItVED WATER TABLE:14b INCHES [°A$A E / ELO ] ExISTING•,GRAPE. ':. TYPE: ERC"H 3D / PARE]
ELO E%ISTING.G E.
ESTIMATED WETI: SEASON .WATER- TABLE ELEVATION:. INCHES. [: `A330V.E ` / ]
HIGH WATER.TABLE. VEGETATI0N [' ]' YES , [� . N,O ' MOTTLING:. [ .] YES [ ] NO DEPTH: INCHES
SOIL TE%TUBE/LOADING RATEFORSYSTEM SIZING: ? •DEPTH',OF E%CAVATION:-INCHES
DRAINFIELD CONFIGURATION: [.: }'TRENCH [] BED! [ ] OTHER (SPECIFY.)
REMARKS/ADDITIONAL \CRITERIA:
,.
SITE EVALUATED BYf 1 DATE:"/
I Page 3 of 3
DH' 4015. 10166 (Replaces HRS-H Form 4015 [Page 31 which`rnay,
t Stnnk Number: 5744-003-40164) - .. ..