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UNIVERSITY OF MINNESOTA OSTP Field Evaluation Form 1.Contact Information v 11.05.31 Property Owner/Client C' Client Phone Number: A dress Date Weather Conditions T ,✓2 A G { , 2. Utility and Structure Information Utility Locations Identified ❑Gopher State One Call# ❑Any Private Utilities Property Lines ADetermined and Approved By Client Client's Approval(initial) Determined But Not Approved ❑Approximate ❑Property Lines Surveyed Locate and Verify(see Site Evaluation map) Existing Buildings Wmprovements ❑Easements Pi(Setbacks 3. Site Information Percent Slope CSlope Direction Landscape Position Slope Shape Vegetation type(s) �S Evidence of cut,fill,compacted or disturbed areas ❑Yes No ❑Locate Areas on Site Evaluation Map Discuss the flooding or run-on potential of site Identify benchmarks and elevations(SWY/e valuation Mop) e Proposed soil treatment area adequately protected s ❑No 4. General Soils Information Original soils Yes ❑No Type of observation ❑Soil Probe Soil Boring ❑soil Pit Number of soil observations 9 Soil observations were conducted in the proposed system location oyes ❑No A soil observation was made within the most limitin area of the proposed system Yes 13 No Soil boring log forms completed and attached Yes ❑No Percolation tests performed,forms completed and attached V4es ❑No 5. Phase I.Reporting Information Depth to standing water inches Anticipated construction issues Flood elevation feet Depth to bedrock inches Depth to periodically saturated soil inches Maximum depth of system inches Elevation at system bottom feet Differences between soil survey and field evaluation Percolation rate ,�� 60 min/inch Loading rate IW-!�ti/ gpd/ft' Contour loading rate -A�A gpd/ft Site evaluation issues/comments I hereby certify that I have completed this work in accordance with all applicable dinances rules and laws. (Designer) e) (License#) / (Date)