Download sketch layout of system - the Oklahoma Department of

ENVIRONMENTAL COMPLAINTS AND LOCAL SERVICES DIVISION
REPORT FOR ON-SITE SEWAGE TREATMENT
SOIL PROFILE
PLEASE PRINT
DEQ USE ONLY
Date Rec’d ________________________
Work Order No. ____________________
System No. ________________________
GENERAL INFORMATION
Name and Mailing Address of Owner: _____________________________________________________________________________
Name
Street Address
City
Zip Code
Facility/Residential Development Name: ___________________________________________________________________________
Property Address: ____________________________________________________________________________________, Oklahoma
Street Address
City
Zip Code
County
Legal Description: _____________________________________________________________________________________________
____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
Finding Location: ______________________________________________________________________________________________
(Blocks or miles from given point)
_______________________________________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________________________________
Lot Area: ___________ ft2 OR
___________ acres
Estimated/Actual flow: _______________________ gal/mo.
 Residential with ______ bedrooms
Type of Facility:
Type of Water Supply:  Individual Well
OR
OR
 Small Public described as a __________________________
 Public Water Supply _______________________________________________
Name
SOIL TEST RESULTS
SOIL PROFILE DESCRIPTION
1
HOLE
DEPTH
Pit
12-18”
18-24”
12-18”
18-24”
12-18”
18-24”
12-18”
18-24”
12-18”
18-24”
12-18”
18-24”
Boring
Pit
2
Boring
3
Boring
Pit
Pit
4
Boring
Pit
5
Boring
Pit
6
Boring
Soil Group
DEPTH
Soil Group
24-30”
30-36”
24-30”
30-36”
24-30”
30-36”
24-30”
30-36”
24-30”
30-36”
24-30”
30-36”
DEPTH
Soil Group
36-42”
42-48”
36-42”
42-48”
36-42”
42-48”
36-42”
42-48”
36-42”
42-48”
36-42”
42-48”
ACCEPTABLE TEST HOLE WITH HIGHEST CLAY CONTENT: __________
Other Required Information
Depth to Water Saturated Soil:
Depth to Impervious Soil/Rock:
Depth to Water Saturated Soil:
Depth to Impervious Soil/Rock:
Depth to Water Saturated Soil:
Depth to Impervious Soil/Rock:
Depth to Water Saturated Soil:
Depth to Impervious Soil/Rock:
Depth to Water Saturated Soil:
Depth to Impervious Soil/Rock:
Depth to Water Saturated Soil:
Depth to Impervious Soil/Rock:
MOST PREVALENT SOIL GROUP IN THAT HOLE: __________
 Check if joint soil profile PERFORMED BY: _______________________________________________
DATE: __________________
Print Name
SOIL TESTER/DESIGNER: ______________________________________________________________ __________________________
Signature of Soil Tester/Designer
Certification Number
________________________________________________________________________________________ __________________________
Mailing Address
Phone Number
FOR DEQ USE ONLY
DEQ: ________________________________________ __________ ___________
ES Signature
Revised 9/16/04
Employee ID
Date
 Reviewed: Rejected ________ Accepted ________
Date
Date
DEQ Form #641-581
The recommended type of on-site sewage treatment system for this tract of land is a(n):
Septic tank with a liquid capacity of __________ gallons and ________ feet of subsurface absorption trenches. The trench
bottom shall be no shallower than _____ inches and no deeper than ______ inches.
Septic tank with a liquid capacity of __________ gallons and a lagoon with bottom dimensions of ___________ feet by
___________ feet.
Septic tank with a liquid capacity of ___________ gallons and __________ feet of evapotranspiration trenches.
Aerobic system with a properly sized trash tank and ANSI/NSF Standard 40 approved treatment unit with _________ gallon
capacity pump tank with ___________ square feet of surface application area.
Alternative system as described on the attached form 641-581Sup, “Supplemental Application for an Alternative System.”
SKETCH LAYOUT OF SYSTEM
Show the location of all test holes in relation to two fixed reference points.
REMARKS:
Revised 9/16/04
DEQ Form #641-581