"Owts Site Evaluation Form" - Rhode Island

Owts Site Evaluation Form is a legal document that was released by the Rhode Island Department of Environmental Management - a government authority operating within Rhode Island.

Form Details:

  • Released on November 25, 2018;
  • The latest edition currently provided by the Rhode Island Department of Environmental Management;
  • Ready to use and print;
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  • Fill out the form in our online filing application.

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Download "Owts Site Evaluation Form" - Rhode Island

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STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS
Department of Environmental Management
Office of Water Resources
Onsite Wastewater Treatment Systems Program
Site Evaluation Form
Part A – Soil Profile Description
Application Number ___________________________
Property Owner: _____________________________________________________________________________________________________________
Property Location: ____________________________________________________________________________________________________________
Date of Test Hole: ____________________________________________________________________________________________________________
Soil Evaluator: _____________________________________________________
License Number: _________________________________________
Weather: _________________________________________________________
Shaded: Yes
No
Time: ________________________
Horizon Boundaries
Soil Colors
Re-Dox
TH____
Soil
Depth
Texture
Structure
Consistence
Re-Dox
Horizon
Category
Dist
Topo
Matrix
Ab. S. Contr.
Features
Horizon Boundaries
Soil Colors
Re-Dox
TH____
Soil
Depth
Texture
Structure
Consistence
Re-Dox
Horizon
Category
Dist
Topo
Matrix
Ab. S. Contr.
Features
TH _______ Soil Class ______________ Total Depth ________ Impervious/Limiting Layer Depth ________(og) GW Seepage Depth ________ SHWT ________(og)
TH _______ Soil Class ______________ Total Depth ________ Impervious/Limiting Layer Depth ________(og) GW Seepage Depth ________ SHWT ________(og)
Comments:_______________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________
Revised 11/25/18
STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS
Department of Environmental Management
Office of Water Resources
Onsite Wastewater Treatment Systems Program
Site Evaluation Form
Part A – Soil Profile Description
Application Number ___________________________
Property Owner: _____________________________________________________________________________________________________________
Property Location: ____________________________________________________________________________________________________________
Date of Test Hole: ____________________________________________________________________________________________________________
Soil Evaluator: _____________________________________________________
License Number: _________________________________________
Weather: _________________________________________________________
Shaded: Yes
No
Time: ________________________
Horizon Boundaries
Soil Colors
Re-Dox
TH____
Soil
Depth
Texture
Structure
Consistence
Re-Dox
Horizon
Category
Dist
Topo
Matrix
Ab. S. Contr.
Features
Horizon Boundaries
Soil Colors
Re-Dox
TH____
Soil
Depth
Texture
Structure
Consistence
Re-Dox
Horizon
Category
Dist
Topo
Matrix
Ab. S. Contr.
Features
TH _______ Soil Class ______________ Total Depth ________ Impervious/Limiting Layer Depth ________(og) GW Seepage Depth ________ SHWT ________(og)
TH _______ Soil Class ______________ Total Depth ________ Impervious/Limiting Layer Depth ________(og) GW Seepage Depth ________ SHWT ________(og)
Comments:_______________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________
Revised 11/25/18
Key:
Part B
Approximate location of test holes
Site Evaluation – to be completed by Soil Evaluator or Class II or III Designer
Please use the area below to locate:
Approximate location of bedrock test holes
1.
Test holes and bedrock test holes,
2.
Approximate direction of due north,
Estimated gradient and direction of slope
3.
Offsets from all test holes to fixed points such as street, utility pole, or other permanent, marked object.*
Approximate direction of due north
*OFFSETS MUST BE SHOWN
Bedrock THs
TH
Depth
1. Relief and Slope: _______________________________________________________________________________________________________________________
2. Presence of any watercourse, wetlands or surface water bodies, within 200 feet of test holes? If yes, locate on above sketch.
NO
YES
3. Restrictive Layer or Bedrock within 4’ below original ground within 25 feet of test hole? Provide all test hole locations & depths above.
NO
YES
4. Presence of existing or proposed private drinking water wells within 200 feet of test holes? If yes, locate on above sketch.
NO
YES
5. Public drinking water wells within 500 feet of test holes? If yes, locate on above sketch.
NO
YES
6. Is site within the watershed of a public drinking water reservoir or other critical area defined in Rule 6.42?
NO
YES
7. Has soil been excavated from or fill deposited on site? If yes, locate on above sketch.
NO
YES
8. Site’s potential for flooding or ponding:
NONE
SLIGHT
MODERATE
SEVERE
9. Landscape position: _____________________________________________________________________________________________________________________
10. Vegetation: ___________________________________________________________________________________________________________________________
11. Indicate approximate location of property lines and roadways.
12. Additional comments, site constraints or additional information regarding site: ________________________________________________________________________
___________________________________________________________________________________________________________________________
Certification
The undersigned hereby certifies that all information on this application and accompanying forms, submittals and sketches are true and accurate and that I have been
authorized by the owner(s) to conduct these necessary field investigations and submit this request.
Part A prepared by: _____________________________________________
Part B prepared by: _____________________________________________
Signature
License #
Signature
License #
DO NOT WRITE IN THIS SPACE
Witnessed Soil Evaluation Decision:
Concur
Inconclusive
Disclaim
Unwitnessed Soil Evaluations Decision:
Accept
Inconclusive
Disclaim
Wet Season Determination required
Additional Field Review Required
_______________________________________________________________________________
Explanation:
___________________________________________________________________________________
___________________________________________________________________________________
__________________________________________________
____________________________
Signature Authorized Agent
Date
Revised 11/25/18
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