HomeMy WebLinkAboutD O H SEWAGE DISPOSAL - SITE EVAL AND SYSTEM SPECS - 9-24-97STATE OF FLORIDA
DEPARTMENT.,,OF'HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
APPLICANT: DREAMA NAPIER
LOT: "_ _ ___ i'i . BLOCK:
PROPERTY ID.
SUBDIVISION:
PERMIT
AGENT.:
PORT ST. LUCIE PROPERTAkOR., {NC
.
x.
8Y
Indian River Estates Unit 5
St 7%Plw
[Section/Township/Range/Parcel No. or Tax ID Dumber]
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: 33.500SQ.FTacRES
•TOTAL ESTIMATED SEWAGE FLOW: 300 GALLONS PER DAY [RESIDENCES -TABLE 1_/]OTHER-TABLE 2]
AUTHORIZED SEWAGE FLOW: 1155 GALLONS PER DAY [1500 GPD/ACRE OR 2500 GPD/ACRE]
UNOBSTRUCTEDI�AREA AVAILABLE: 1500 SQFT UNOBSTRUCTED AREA REQUIRED: 924 SQFT
BENCHMARK/REFERENCE POINT LOCATION: C L White City Rd.•painted red "X"-elev.=10.00° puqed
ELEVATION OF��PROPOSED SYSTEM SITE IS 12 INCHES FT] [ABO ELO .. NCHMARKAEFERENCE POINT
THE MINIMUM SETCK WHICH CAN BE MAINTAINED FROM THE'PROPOSED SYSTEM TO THE FOLLOWING FEATURES:
A
SURFACE WATER: 75 FT DITCHES SWALES: �15 FT NORMALLY WET? [ ] YES [X] NO
WELLS: PUBLIC: 200 FT LIMITED USE:. 100 FT' ' PRIVATE: �7 FT NON -POTABLE: > 50 FT
BUILDING FOUNDATIONS: 7 FT PROPERTY LINES: 11 FT POTABLE WATER LINES: N/A FT
SITE SUBJECTJ�TO FREQUENT FLOODING: [ ] YES [X] NO 10 YEAR FLOODING? [ ] [X] NO
10 YEAR FLOOD ELEVATION FOR SITE: FT MSL/NGVD SITE ELEVATION: 9.0 FT SL/NGVD
SOIL PROFILE��INFORMATION SITE 1
Munsell #/Color Texture Depth
5-� j4=S /2-
-- to 2 Y
A to 32-
3 to 4 0
(J to-
-to -
to
to
USDA SOIL'SERIES:
SOIL PROFILE INFORMATION SITE 2
Munsell #LColor
Texture
Depth
514
!; to /Z
4—/
pF
I
9
/Z to I
-3
F
/tr to as
A.
z�_to
3 -�iI
toLZ G
to
to
1-y_ to
to
USDA 'SOIL SERIES:
OBSERVED WATER TABLE: NO H2O INCHES [ABOVE,/ BELOW] EXISTING GRADE. TYP • ERCHED / APPARENT,]
ESTIMATED WEST SEASON WATER TABLE ELEVATION: lg " INCHES [ ABOVE / B STING GRADE.
HIGH WATER TABLE VEGETATION: [ ] YES [X] NO MOTTLING: { ] YES [X) NO DEPTH: g INCHES
SOIL TEXTURE�LOADTNG RATE FOR SYSTEM SIZING: F r (P � DEPTH OF EXCAVATION: [S Y INCHES
DRAINFIELD C�ONFIGURAT.I�N��,� {[",j TRENCH [ BED [ ] OTHER (SPECIFY)
REMARKS/ ADD ITIONAL,-'CRITER
SITE EVALUATED GE$RGgl M AYLOR, JR.-REGISTERED LAND SURVEYOR DATE: 9-22-97
HRS-H Form 4015,ElNar 92 (Obsoletes& pA#)Aibus editions which may not be used) Page 3 of 3
(Stock Number: 5744-003-4015-1)
INSTRUCTIONS:
PERMIT #: Permit tracking number assigned by CPHU.
APPLICANT: Property owner's full name.
AGENT: Property owner's legally authorized representative.
LOTI,BLOCK� Sf]PO bd' fi'
IVIS'ION: block, and su ivision or lot.
PROPERTY ID#- 27 character number for property. (property appraiser ID # or section/township/range/parcel numb
r)
PROPERTY SIZE: Check if property size at site conforms to submitted site plan. Record net usable area available - lo
niva exclusive of
all paved areas and prepared road beds within public rights -of -way or easements and exclusive of sty
ams, lakes,
normally 'Wet drainage ditches, marshes, or other such -bodies of water.
SEWAGE FLOW': Recorde estimated sewage flow for the establishment from- Table I (residences) or Table 2 (non- 11
10D-6, FAC. Record the authorized sewage flow for the lot based on net usable area and water suAlply
sidential), Chapter
(1500 gallons
per day per acre for private water supplies and 2500 gpd per acre for public water supplies). If authl�
rized sewage flow
does net equal or exceed the estimated sewage flow, the application must be denied.
UNOBSTRUCTED AREA: Record the square feet of unobstructed area available and the amount required. Unobstructed area i
ust be at least 2
times as large as the drainfield absorption area and at least 75 percent of the unobstructed area must
Let minimum
setbacks in Chapter 10D-6, FAC. The unobstructed area must be contiguous to the drainficld*
BENCHMARK INFORMATION: Ri cord ihe location of the benchmark. If using a surveyor's benchmark record the actual elevation.
Record the
elevation of the propliied 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 r
'Corded or "NA"
for non applicable features. Features on site plan or within 75 feet of the applicant lot must be mes
ured. The location
of any public drinking well within 200 feet of the applicant's lot must also be verified.
11
FLOOD INFORMATION. Record information on lot's subject to flooding. For lots subject to flooding record 10 year flood cl�ovation
for site and
actual site elevation.
if
WATER TABLE:
SOIL TEXTURE:
FAID100MM, 40*14#849
gffl�i�
Two soil profiles within the proposed absorption area to a minimum depth of 6 feet or refusal are Me 'aired. Soil
identification will use USDA Soil Classification methodology (Mansell colors and USDA soil texture's)'Refusals must
be clearly documented. Provide USDA soil series if available, record record 'UN' if the series cannot li(�"Idctermined.
Record the depth of the observed water table at the, time of the evaluation. Mark "perched* or "app "rent' as
appropriate. Record the estimated wet season water table elevation based on site evaluation, USDA il maps, and
historical information. Indicate if there is high water table vegetation present. Indicate if mottling iii:present and depth.
Record soil texture or loading rate for system suing.
If applicable record depth of excavation required. Record "NA* if not applicable.
Check drainfield configuration required. If other, specify type.
Record any additional remarks pertinent to site or installation. Ex. dosing required.
Signature of evaluator, title, and date of evaluation. Professional engineers must seal all
ELEVATION OF BENCHMARK / REFERENCE POINT IS:
BENCHMARK SITE I SITE 2 SITE 3
[+J SHOT: H.I. H.I.
H.I. SHOT SHOT SHOT
submitted.