HomeMy WebLinkAboutD O H SEWAGE DISPOSAL - SITE EVAL AND SYSTEM SPECS - 10-7-97STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
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PERMIT i{
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APPLICANT: ROGER & SANDRA SHINN AGENT:RU PORT ST. LUCIE PROPERTIES/AYLOR, INC?
LOT: 1 BLOCK: 109 SUBDIVISION: Lakewood Park Unit 9
PROPERTY ID �: [Section/Township/Range/Parcel No. or Tax ID Number]
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TO BE COMPLE�ED 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.
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PROPERTY SIZ F CONFORMS TO SITE PLAN: [XI YES [ ] NO NET USABLE AREA AVAILABLE: 15,950SQ.FT. ACRES
TOTAL ESTIMATED SEWAGE FLOW: 300 GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2]
AUTHORIZED SEWAGE FLOW: 660 GALLONS PER DAY [1500 GPD/ACRE OR 2500 GPD/ACRE]
UNOBSTRUCTED AREA AVAILABLE: 1450 SQFT UNOBSTRUCTED AREA REQUIRED: 924 SQFT
BENCHMARK/REFERENCE POINT LOCATION: C/L Penny La. -painted red "X`B-e1ev.=10.00' assum
ELEVATION OF PROPOSED SYSTEM SITE IS 15 INCHEb/FT] ABOVE AELOW 16JIjENCHMARK/R_FERENCE POINT
THE MINIMUM SET775
K WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES:
SURFACE WATER: FT DITCHES/SWALES: 15 FT NORMALLY WET2 [ ] YES [Xj NO
WELLS: PUBLIC:200 F LIMITED USE: 100 FT P� RIVATE: 75 FT NON -POTABLE: , 50 FT
BUILDING FOUNDATIONS: 7 FT PROPERTY LINES: 11 FT POTABLE WATER LINES: ' NI/A FT
SITE SUBJECT TO FREQUENT FLOODING: [ ] YES [X] NO 10 YEAR FLOODING? [ ] FES,I [X] NO
10 YEAR FLOOD ELEVATION FOR SITE: FT MSL/NGVD SITE ELEVATION: 11.2 SL/NGVD
SOIL PROFILEINFORMATION SITE 1 SOIL PROFILE INFORMATION SITE 2
Munsell #/Color Texture Depth Munsell #/Color Texture Depth
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USDA SOIL SERIES: USDA SOIL SERIES:
OBSERVED WATER TABLE: NO H2O INCHES [ABOVE / BELOW] EXISTING GRADE. TYPE:(�[PERRED / APPARENT].
ESTIMATED WET SEASON WATER TABLE ELEVATION: INCHES [ ABOVE / BELiiW--]�XISTING GRADE.
HIGH WATER TABLE VEGETATION: [ ] YES [X] NO MOTTLING: [ ] YES [)j NO DEPTH: INCHES
SOIL TEXTURES/LOADING RATE FOR SYSTEM SIZING: DEPTH OF EXCAVATION: INCHES
DRAINFIELD CONFIGURATT N.'[, ] TRENCH [ ] BED [ ] OTHER (SPECIFY)
REMARKS/ADDITIONAI1 AdRIT6fA.p '
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SITE EVALUATED °BYr , rGSORGE' M. AYLOR, JR.-REGISTERED LAND SURVEYOR DATE: 10-7-97
HRS-H Form 4015j Mar 92 (ObsoCetes Previous editions which may not be used)
(Stock Number: 5744-003-4015'°'1)`'°°''
Page 3 of 3
INSTRUCTIONS:
PERMIT #:
Permit tracking number assigned by CPHU.
APPLICANT:
Property owner's full name.
AGENT:
Property owner's legally authorized representative.
LOT, BLOCK, SUBDIVISION:
Lot, block, and subdivision for lot.
PROPERTY ID#:
27 character number for property. (property appraiser ID # or section/township/range/pareel numbl")
PROPERTY SIZE:
Check if property size at site conforms to submitted site plan. Record net usable area available - to
area exclusive of
all paved areas and prepared road beds within public rights -of -way or casements and exclusive of
ants, lakes,
normally wet drainage ditches, marshes, or other such bodies of water.
SEWAGE FLOW:
Record the estimated sewage flow for the establishment from Table I (residences) or Table 2 (non-.
sidential), Chapter
I OD-6, FAC. Record the authorized sewage flow for the lot based on not usable area and water su
)Iy (1500
gallons
per day per acre for private water supplies and 2500 gpd per -acre for public water supplies). If suc
loriyxd sewage flow
does not 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
must be at least 2
times as large as the drainfield absorption area and at least 75 percent of the unobstructed area mu
1
m1 eet minimum
setbacks in Chapter 1013-6, FAC. The unobstructed area must be contiguous to the drainfield.
II
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:
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 me&
lured. 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 e
vation for site and
lil
actual site elevation.
SOIL PROFILE-INFORMATIgN
Two soil profiles within the proposed absorption area to a minimum depth of 6 feet or refusal are
'uired. Soil
identification will use USDA Soil Classification methodology (Mansell colors and USDA soil textuilills).
Refusals must
be clearly documented. Provide USDA soil series if available, record "UNK" if the series cannot b
determined.
WATER TABLE:
Record the depth of the observed water table at the time of the evaluation. Mark "perched" or "ap
arent" as
appropriate. Record the estimated wet season water table elevation based on site evaluation, USD
maps, and
historical information. Indicate if there is high water table vegetation present. Indicate if mottling i'
preserve 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 documenIlion
submitted.
ELEVATION WORKSHEET
ELEVATION OF BENCHMARK REFERENCE POINTIS:
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BENCHMARK
SITE I SITE 2 SITE
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