1770 MARITIME OAK DR - DENSITY REPORT Corporate
Ellis&AssociatesNlC. 7064 Davis Creek Road,Jacksonville,FL 32256 P:(904)880-0960 F:(904)880-0970
Branch Location:
Geotechnical • Materials Testing • Environmental • CEI Services Brunswick: 227 Rose Drive,Brunswick,GA 31520 P:(912)279-0085 F:(912)279-0086
Integrated Engineering Services
el lisassoc.com /? 70 4, 13 0r he
Work Order#: •
REPORT OF IN PLACE DENSITY RESIDENTIAL Project#:
Subdivision: Reported to: Report#:
Unit or Parcel: Location By: Gauge#:
Lot#Block: Date Tested:
Contractor:
•
Street Address: t �L. City:
Method: Course:
Material: Specific Requirements:
Pass/ Elev/ Base/LR/
Fail/ Location Depth Asphalt/ Dry Max.Dry % of Max Moist
Retest /Lift Thickness Density Density* Density %
l2
*Source of Proctor (Project#and/or Work Order#)
P- Test Meets Specification Requirements F- Test Fails To Meet Specification Requirements R- Retest
To Be Completed In Field
Employee Name
Standby Approval
Time Superintendent Printed Name
Start/Stop Travel Standby Job
Superintendent Signature
(Office use)
EA-10(rev. 11/14) white copy-office use yellow copy-personal use pink and goldenrod-client use ) f
Page_I _
FORM BOARD ELEVATION CERTIFICATE
uval County / Clay County
Left'.on site o box
I I No . :
Lot/Subdivision: 10 7 .A 74 \rig, RAO 660A,MY
DATE:---
---------.--- ------------- _-------------------- -.---------
Z/14116
PERMIT
NUMBER: 6 -- ; f K - 169
ADDRESS: 1770 MOT-11/J OK 1) K-
REQUIRED SLAB ELEVATION ON CITY
APPROVED SITE PLAN: 1 Z- 66
ACTUAL ELEVATION OF FORM BOARD OR
GRADE STAKE: G,60
SURVEY COMPANY NAME:
Bartram Trail Surveying, Inc.
1501 CR 315, Suite 106
Green Cove Springs, FL 32043
SIGNATURE F SURVEYOR: (Party Chief)
• C