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� � IMwuarvasqvw�� <br /> ONS17E <br /> Field Evatuation Form SFWAGE <br /> TREATMENT `s,,�^.... <br /> PR6GRAM <br /> _ . .', <br /> y.C011'�dCL I[t(OfiflBtlOB .,.._ _. . .,,,_. .�� �. �:. �:..�. _... .. ... ... . ,..,..� . _ .:�. <br /> . .. ... .....,. . . .....; .�. �� �. � .� . �. :. ; .. <br /> Propetty Owner/Cltent Jeff Sodentrom Cllent Phone Number. <br /> Address 2055 Salem Court,Omno,MN 55356 <br /> �� ;4 �i' Weather Conditions <br /> 1. Utllity artd 5�i'ucei�ralMonnatiort . >: <br /> Utilit Locatiau IdentiHed �Gopher State One CaU <br /> Y �MY Prtvate UdUda : <br /> Pro rt Lines ❑�termined and A ved Ctlent <br /> � y �° � UfentsApprova((initfa!) <br /> ❑Determined But Not Approved <br /> ❑Approximate <br /> �Property Linea Surveyad <br /> Locate and Verlfy(see Slie Eva/uoHon rtx�) <br /> p Exi:nng eulldings ❑�mprvvemencs ❑E.sem�,ts ❑secbedcs <br /> 3. St�e Inforr�ation _ , <br /> Percent Slope Slope Direttion <br /> Landscape Posltion ' 4-. Slope Shepe <br /> Vegetstion type(s) ;"�- <br /> Evldence of at,Hll,compacted or diaturbed arcas O Ya �No 0�ocace Anas on Site Evaluadon Mao <br /> Disans the flooding or run-on potenNal of site �: ; - <br /> Identify benchma�lcs and elevallons(Site Evalulatlon M�) <br /> Proposed soil trcatment arca adequately protected ❑Y� �No <br /> 4. Gaeafat Soits Info�aEloh; - . . <br /> . - : <br /> Ortgtnal soils es �No <br /> Type of observation ❑Sotl Probe �oil Bo►inR ❑Soil PiY 'Sol!pit requlned if dettrmining foading rate witfput perc test <br /> Number of wil oburvations <br /> Sotl observations werc oonducted in the prvposed system tocation �� O No <br /> A soil observation was made within the most limTNng arca of the proposed system �'� O No <br /> Soil bortng log foma completed and attxhed •�� ❑No <br /> Peroolation tests perfomrcd,fortra completed and attached �Y� �No <br /> 5, Pha�►e Ir R�w'tt��l►Mormadon . _ _ <br /> . ,: _, <br /> Depth to standing water inches Anticipated construdlon issues <br /> Flood elevatlon feet <br /> Depth to bedrock inches <br /> Depth to periodlcally satunted soil ���� <br /> Maximum depth of system {�� ! � <br /> Elevation at system bottom feet Dlfferences betwren soil survey and Held evaluation <br /> Percolation rate minNnch f�-� � ��`�v:�`�'- •� <br /> � <br /> Loading rate 4Pd/h= <br /> Contour loading rate gp��� <br /> Site evaluation issues/wmments <br /> I hereby certify that I have compkted this worlc in accordance with app ordinancea,rules and laws. <br /> Pernel Chlp Hen�as 20y� / <br /> (�1�) (Signawre (Lieense#) te <br />