Laserfiche WebLink
' IM�r�v.m m N��xwnn <br /> � Field Evaluation Form �E�G� <br /> TREATMENT <br /> PROGRAM �������y <br /> 1.Contaet Inforniatlon , <br /> P�operty Owner/CBent Client Phone Number. <br /> Address 700 6th A+re North,Orono,hW <br /> Date Weather Conditions <br /> _ _ __. <br /> 2. UNliEq and SC►uc�ure ir�formation <br /> Utility Locations identifted ❑Gopher State One CaU ❑Any P�ivate UtiUNes <br /> Property Lines �Determi�ed and App►oved By CUent I Client's Approval(initic/) <br /> ❑Determined But Not Approved <br /> ❑Approximate <br /> ❑Property Lines Surveyed <br /> locate and Verify(ue Stte Eva(untion mc�) <br /> ❑Existlng Buildings ❑Improvements ❑Easements ❑Setbedcs <br /> 3. Site informallon - <br /> Percent Slope Slope Directlon <br /> Landscape Position Slope Shape <br /> Vegetallon type(s) <br /> Evidence of cut,fill,compacted or disturbed areas ❑Y� ❑No ❑Locate Areas on Site Evaluallon Man <br /> Discuss the flooding or runron potentlal of site <br /> Identify benchmarks and elevatto�s(Slte EvalulaHon Map) <br /> Proposed soil trcatment area adequately proteded �Y� ❑No <br /> _ _ <br /> 4. Ge,neral Solls InfornwNon' _ <br /> _ . _. , <br /> OrigSnal soils Y� ❑� <br /> Type of observation ❑Soil Probe �Soil Borina ❑Soil Pit• "Sof!pit required if determintng loadfng rate withoui perc test <br /> Number of soil observations <br /> Soil observations were conducted in the proposed system location P�-7� �� <br /> A soil observation was made w(thin the most limiting area of the proposed system JlJ�cCs ❑No <br /> Soil boring log forms completed and attached �Y� ❑� <br /> Percolation tats perfomxd,forms completed and attached �Y� �� <br /> _ _ <br /> 5. Phrsse:l.RepoRins informallon <br /> Depth to standing water inches Anticipated construction issues <br /> Flood elevation feet <br /> Depth to bedrock inches <br /> Depth to periodically saturated soil inches <br /> Maximum depth of system inches <br /> Elevation at system bottom feet Differe�ca between sotl survey and field evaluation <br /> Percolation rate minHnch <br /> Loading rate gpd/ft2 <br /> Contour loading rate gpolft <br /> Site evaluation tssues/comments <br /> I hereby certify that I have completed this work in accordance wi a ap ble ordinances,niles a�d laws. <br /> PernN Chlp Hentpes 2064 � <br /> (Designer) (Signaturc) (License#) (Date) <br />