HomeMy WebLinkAboutD O H SEWAGE DISPOSAL - SITE EVAL AND SYSTEM SPECS - 10-16-97, STATt:�'.OF ,,'tl,6RIDA,,'. PERMIT.
DEPARTMENT;0F HEALTH,,AND,REHABILITATIV-E SERVICES,,
SITE, EVALUATION' AND SYSTEM, 'SPECIFICATIONS. RoU
1\1
AGENT: SCANNED'
rl p I Vi I rl Iu F-_Qu
BLOCKI SUBDIVIS
ION
'iT Lucie County
0 -Tax ID,Nunibdr]
own'shiplitaii4e/Parcel, No; "or 7.JSdction/t a
-----------___ --___ -____ -----------------
TO,J3E '('e,.)MPL`TED'BY, ENGINIEEIR,:.� HEALTH. -UNIT EMPLOYEE, OR, OTHER., QUALIF.IEDPERSON ENGINEER'S, MUST
PROVIDE -REGISTRATION NUMBER -AND SIGN,AND SEAL,'EACH.PAGE,OF SUBMITTAL."'. COMPLETE ALL ITEMS,.
------------ ----------
PROPERTT `91
TOTAL ESTIM
", ..
,AUTHORI ZED.'
ELEVATION
THE. MINIM
WELLS. ,PUB
BUILDING F
, SITE .,SUBJE
10 YEARS FL
SOIL PROFI
IUSDA SOIL
- - - - - - - - - -
---------- 77-7 ------ -77=-7 --- 77--j,
.ACRES
ZE CONFORMS TO SITE PLAN: ,]-�'YE' .]:NO",, NET USABLE AREA 'AVAILABLE v A
ATED,,SEWAGE FLOW: 3oo GALLONS �PiR�ZAY „[RESIDENCES -TABLE 1 /% 6TAER-TABLE,2]
DEWAGE-. FLOW:- . GALLONS', PER DAY. 1500 f,GP4/ACRE OR, 2500', GPD/ACkt]
AREA AVAILABLE:, 1'1-/ 4o , SQFT.' ."UNOBSTRUCTED AREA.- . REQUIRED: SQFT
EFERENCE POINT LOCATION:
„` PROPOSED, SYSTEM' SITE. 19 INCHES?/FT ABOWj AELOW;l' REFERENCE POINT
'SETBACK -WHICH CAN BE. M . AINTAINtD'F'RO'N',THE,,PROPOSED..SYSTEM TO THE FOLLOW I ING ;TE AT . URES:
ER: 777 DITCHES' SWALIE�' 7T, '.NORMALLY 'WET? ES' NO
IiC
5.
FM
VAT FT'- NON-POTAB . LE:%7SO 'FT
>,2,00 FT LIMITED, `USE �7fi�,�J- EFT PkI t:
UNDATIONS:,, -7 FT. P7OPERTY,-,LINES,:',, FT POTABLE. WATER LIKES: FT
Tt,TO' F REO _pEkT OI,6b'D"ING: YES10,,YEAR FLOODING?, YES I]AkiO
6D ELEVATION FOR SITE: FT, M SL , /NGVD S I TE-E . LEVATION: FT, MSL/NGVD
CiINFORMATION SITE I -SOIL PROFILE INFORMATION -SITE 2',
:)lor ,Texture-
Depth,
61 rl
Q to
-7 - I- -r-.S
2-1 Spp 1); c
30 `to 36
5,S-FS'
.36 to, 16
7 -5- F_,�
"to � k
Ss 3 FS
-1k 'to 7 z
to,,
to
to
-,'RIES:
Munsell,#/Color Texture
Depth
e., - /
"
to
7-1 Fs
7 a,", I
to', M
2-1 5,00,91(—
33'f
to.?g
5--S J'--S
3'k.. " to V6
to 6 6'
F�
to 727
to
to
to
USDA SOIL -SERIES:
OBSERVED WATER TABLE: KO INCHES [ABOVE 1(1!�OW) EXISTING GRADE. TYPE�.]�ERPHED,/� �PARgNTj
ESTIMATED-WET��SEASON,WATER,XABLE ELEVATION- INCHES' [',ABOVE • /�NRELO.W:::1 EZISTING' GRADE.
d
HIGH' WATER TABLE VEGETATtOk: "YES 11 Vil"NO MotTLINGi 'YES NO DEPTH: INCHES
,SOIL TEkTUREIJ�LOAD ING RATE FOR SYSTEM, SI'ZING : OF EXCAVATION: 'INCHES
DRAINFIELD'CbNFIGURATION: TRENCH BED OTHER SP ECIFY)._
REMARKS/ADDITIONAL CRITERIA:..
SITE EVALUATED BY: DATE:-' -1? 7
I &
PRS=:H Fprm-4015,
IjMq'r 9,2,(ObsoLetes phevi.ous.edftions,which ,may not be' used) Page 3 'of 3
(Stock- Number:. 7.44-'003_4015-1),
i
INSTRUCTIONS:
•PERMIT #:
APPLICANT:
i .�' F
AGENT:
LOT, BLOCK, SUBDIVISION
PROPERTY ID/!:
PROPERTY SIZE:
SEWAGE FLOW:
UNOBSTRUCTED AREA: -
BENCHMARK INFORMATION:
MINIMUM SETBACKS:
FLOOD INFORMATION:
Permit tracking number assigned by CPHU.
Property owner's full name.
Property owner's legally authorized representative.
Lot, block, and subdivision for lot.
27 character number for property. (property appraiser ID k or section/township/range/parcel number)
f
Check if properly 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 str j ins, lakes,
normally wet drainage ditches, marshes, or other, such bodies of water.
Record the estimated sewage flow for the establishment from Table 1 (residences) 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.
Record the square feet of unobstructed area available and the amount required. Unobstructed area 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 101376, 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.
Record minimum setbacks which can be meet to all listed features. Actual measurements must be recorded or "NA"
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�
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: Two soil -profiles within the proposed absorption aie'a to a minimum depth of 6 feet or•refusal are regi
identification will use USDA Soil Classification methodology (Munsell colors and USDA soil texture,
be clearly documented. Provide USDA soil series'if available, record "UNK" if the series cannot be
WATER TABLE: Record the depth of the observed water table at & 'time df the evaluation. Mark "perched" or "appal
appropriate. Record the estimated wet season water table elevation based on site evaluation, USDA s
historical information. Indicate if there is high water table vegetation present. Indicate if mottling isl,
SOIL TEXTURE:
DEPTH OF EXCAVATION
DRAINFIELD CONFIGURATION
ADDITIONAL CRITERIA:
SITE EVALUATED BY:
ELEVATION WORKSHEET
BENCHMARK
[+] SHOT:..
H.I.
Record soil texture or loading rate for system sizing.
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:
SITE 1 SITE 2
H.I. H.Y. _
[-] SHOT [-] SHOT
SITE 3
H.I.
[-] SHOT
:d. Soil
Refusals must
." as
maps, and
sent and depth.
i
I
Lion submitted.
it