OSSF Soil Evaluation

Date Performed:_____________________ 

Property Location:___________________  Proposed Excavation Depth:__________________ 

Name of Site Evaluation:________________________   Registration Number:__________________ 

Requirements:
At least two soil excavations must be performed on the site, at opposite ends of the proposed disposal area.  
    Locations of soil boring or dug pits must be shown on the site drawing.
For subsurface disposal, soil evaluations must be performed to a depth of at least two feet below the proposed excavation depth.  
     For surface disposal, the surface horizon must be evaluated.
Describe each soil horizon and identify any restrictive features on the form.  Indicate depths where features appear.

Soil Boring Number__________________
Depth (Feet)	Textural   Class	Structure  (if applicable)	Drainage (Mottles/ Water Table)	Restrictive Horizon	Observations
0  |___ 1  |___  2  |___ 3  |___ 4  |___ 5  |___

Soil Boring Number__________________
Depth (Feet)	Textural   Class	Structure  (if applicable)	Drainage (Mottles/ Water Table)	Restrictive Horizon	Observations
0  |___ 1  |___  2  |___ 3  |___ 4  |___ 5  |___

I certify that the findings of this report are based on my field observations and are accurate to the best of my ability. 

_______________________________________                 ___________________
Signature of Site Evaluator                                                         Date

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Date:___________________                                                       Number:________________

Applicant Information: Name__________________________________ Address________________________________  City ________________State_______________  Zip Code______ Phone_________ Fax_______        Property Location:  Lot_______ Block________ Subdivision______ Street/Road Address______________ County __________ Unicorporated Area? Y or N City_________________ Zip Code___________ Additional Information_____________________  _______________________________________ _______________________________________

Site Evaluator Information: Name__________________________________ Company_______________________________ Address________________________________ City ______________________State________ Zip Code____ Phone __________Fax________ Installer Information: Name__________________________________ Company_______________________________ Address________________________________ City __________________ State____________ Zip Code______ Phone ________ Fax________

Schematic of Lot or Tract

Show:
  Compass North, adjacent streets, property lines, property dimensions, location of buildings, 
    easements, swimming pools, water lines, and other structures where known.
  Location of existing or proposed water wells within 150 feet of property.
  Indicate slope or provide contour lines from the structure to the farthest location of the proposed soil 
    absorption or irrigation area.
  Location of soil borings or dug pits (show location with respect to a known reference point).
  Location of natural, constructed, or proposed drainage ways, (streams, ponds, lakes, rivers, high tide
    of salt water bodies) water impoundment areas, cut or fill bank, sharp slopes and breaks.

Lot Size: ___________________acres.

Compass North Site Drawing  Scale: 1 inch=50 feet

Features of Site Area

Presence of 100 year flood zone Presence of upper water shed Presence of adjacent ponds, streams, water impoundments Existing or proposed water well in nearby area Organized sewage service available to lot or tract

Yes________  No________ Yes________  No________ Yes________  No________ Yes________  No________ Yes________  No________

Site Evaluator:
  Name:__________________________Signature:________________________License No>_________