SSTS DESIGN SUMMARY PROPERTY INFORMATION: Property Name: Phone #: Address: MN City: State: Zip: Township: PID #: Section: PERMIT #: Boring # SOIL BORING LOG Web Soil Survey Map Unit: Depth in USDA Soil Munsell Landscape Position: convex concave plane Inches Texture Color Vegetation Type: Y / Y / Depth to Restricting Layer: Inches Y / Soil Loading Rate (gpd/ft2): Y / Soil Verification #: Boring # SOIL BORING LOG Benchmark Elevation: Depth in USDA Soil Munsell Restricting Layer Elevation: Inches Texture Color Bottom of System Elevation: Y / DESIGN CRITERIA Y / New/ Upgrade/ Replacement/Repair Y / Number Bedrooms: ______ Y / Garbage Disposal? YES NO (Alarm & Effluent Screen Percolation Rates or Detailed Soil Structure Recommended) Test Hole # Lift Pump in Basement? YES NO Test Hole # Hot Tub/Whirlpool? YES NO Area in basement that could be used as a bedroom? YES NO Site Protection Primary & Secondary Sites? YES NO Management Plan? YES NO Employ Flow Measurements? YES NO (Required if Pressurized) Tank Size: Material Trench System: Septic gal Rock _____ Inches Pump gal EZ flow: ________ Inches Holding gal Chambered: ______Inches At-Grade System: Land Slope % Land Slope ______% Lineal Feet of Trench Rockbed Dimensions _______ft x_______ft Depth of Soil over Laterals Inches Mound System: Land Slope % Operating Permit: Rockbed Dimensions ft x ft OP # ____________ of Clean Sand below Rockbed inches Type: Holding Tank MSTS □ □ □ Pressurized Bed: Other System: Rockbed Dimensions ft x ft (Fill/Disturbed Soil, etc.) □Type Pressure Distribution System: (Performance w/ Help) □Type Size of Perforated Laterals: 1.25” 1.5” 2.0” No. of Laterals (Performance) □Type SITE EVALUATOR/DESIGNER INFORMATION: License# Company:
SSTS DESIGN SUMMARY PROPERTY INFORMATION: Property Name: Phone #: Address: City: State: MN Zip: Township: PID #: Section: PERMIT #: Boring # SOIL BORING LOG Depth in Inches USDA Soil Texture Munsell Color Y / Y / Y / Y / Boring # SOIL BORING LOG Depth in Inches USDA Soil Texture Munsell Color Y / Y / Y / Y / Percolation Rates or Detailed Soil Structure Test Hole # Test Hole # Web Soil Survey Map Unit: Landscape Position: convex concave plane Vegetation Type: Depth to Restricting Layer: Inches Soil Loading Rate (gpd/ft2): Soil Verification #: Benchmark Elevation: Restricting Layer Elevation: Bottom of System Elevation: DESIGN CRITERIA New/ Upgrade/ Replacement/Repair Number Bedrooms: ______ Garbage Disposal? YES NO (Alarm & Effluent Screen Recommended) Lift Pump in Basement? YES NO Hot Tub/Whirlpool? YES NO Area in basement that could be used as a bedroom? YES NO Site Protection Primary & Secondary Sites? YES NO Management Plan? YES NO Employ Flow Measurements? YES NO (Required if Pressurized) Tank Size: Material Trench System: Septic gal Rock _____ Inches Pump gal EZ flow: ________ Inches Holding gal Chambered: ______Inches At-Grade System: Land Slope % Land Slope ______% Lineal Feet of Trench Rockbed Dimensions _______ft x_______ft Depth of Soil over Laterals Inches Mound System: Land Slope % Operating Permit: Rockbed Dimensions ft x ft OP # ____________ of Clean Sand below Rockbed inches Type: □ Holding Tank □ □ MSTS Pressurized Bed: Other System: Rockbed Dimensions ft x ft □Type (Fill/Disturbed Soil, etc.) Pressure Distribution System: □Type (Performance w/ Help) Size of Perforated Laterals: 1.25” 1.5” 2.0” No. of Laterals □Type (Performance) SITE EVALUATOR/DESIGNER INFORMATION: Company: License#
SSTS%20DESIGN%20SUMMARY.4.9.13.docx