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I hereby certify that I <br />have completed this work in accordance withlivable ordinances, rules and Laws.. <br />Pernel Chip Hentges. <br />(Designer) (Signature) <br />Field Evaluation Form <br />2464 <br />(License !1) <br />rl 11,3 <br />(Date) <br />I�UNSITE .mn <br />SEwace <br />TREATMENT <br />PROGRAM 'C -gni <br />1. Contact Information <br />Property Owner/Client Client Phone Number: <br />Address 2650 Fox Street, Orono, MN 55341 <br />Date Weather Weather Conditions tee+.:-.,,�yS' <br />2. Utility and Structure Information - <br />Utility Locations Identified ❑ Gopher State One Call ❑ Any Private utilities <br />Property lines ❑ Determined and Approved By Client al �'' ' ' '�' -'-"'e t Client's Approval (initial) <br />❑ Determined But Not Approved <br />❑ Approximate <br />❑ Property Lines Surveyed <br />Locate and Verify (see Site Evaluatlon map i <br />❑ Existing Buildings (❑ Improvements ❑ Easements ❑Setbacks <br />3. Site Information - <br />_ a� <br />Percent Slope's + Stope Direction Alk <br />Landscape Position ' Slope Shape <br />Vegetation types) - <br />Evidence of cut, fill, compacted or disturbed areas ❑ Yes ❑ No C1 Locate Areas on Site Evaluation Map <br />Discuss the flooding or run-on potential of site <br />Identify benchmarks and elevations (Site Evaiuiation Mtn j <br />Proposed soil treatment area adequately protected U19/ ❑ No <br />R. General Solis Information <br />Original soils 21�fes ❑ No <br />Type of observation ❑ Soi I Probe oit Boring ❑ Soil Pit' 'Soil pit required if determining loading rate without perc test <br />Number of soil observations DI <br />Soil observations were conducted in the proposed system location 0 -Yes Q No <br />A soil observation was made within the most Limiting area of the proposed system L?"fes ❑ No <br />Soil boring Log fortes completed and attached dyes ❑ No <br />Percolation tests performed, forms completed and attached _UYes ❑ No <br />5. Phase I. Reporting Information <br />Depth to standing water <br />. sv 6 <br />inches Anticipated construction Issues <br />5 C:er`T `F•.e'7y�.� :.. <br />feet <br />Flood elevation <br />- <br />Depth to bedrock'. <br />inches - <br />';" ` ... <br />Depth to periodically saturated soil <br />inches <br />Maximum depth of system <br />t� <br />inches' <br />Elevation atsystem bottom <br />feet. Differences between soil survey and field evaluation <br />Percolation rate <br />,,. <br />minlinch <br />Loadine rate <br />epd/ft= <br />_. _ a_ .. .�- <br />