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� Preliminary & Fieid Evaluation Form <br /> �c«t�.S�pIi�RCsuurcr.rum �crs 1?.-1 <br /> Owner Information <br /> Date 9/17/2017 Sec !l�wp;Rng <br /> Parcel ID 2711823310017 LUG(county,city,township) City of Orono <br /> Propem�Ow�ner. Kevin Scherer Owmers address(if�ditTerent) <br /> Propem Address: 2160 6th Ave N <br /> City%State:'7_ip: Orono, MN 55356 <br /> Flow [aformatioa and Waste T e/Stren 6 <br /> Gstimated Design flow 450 Anticipated Waste strength ❑ Hi Strength � DomesUc <br /> Any Nan-Domestic Waste ❑Yes(dass� � No <br /> Comments: <br /> Sewage ejector.'grinder pump ❑Yes 0 No <br /> Water softener 0 Y� �]No <br /> Garbage Uisposal ❑Yes �No <br /> Daycare/In home business ❑Yes � No <br /> Site Information <br /> Existing&proposed lot 0 Y� ❑� Well casing depth 135' <br /> improvements located Ike sit�map) <br /> Easements on lot located 0 Yes ❑ No Drainfield w/in 100'of ❑Y� [�f No <br /> Iu�sitc mapl residential well <br /> Property (ines determined �Y� ❑ � Site wlin 200'of transient ❑Y� � � <br /> lue site map) noncammunity water supply(ITICWSI <br /> Req'd setbacks determined � Y� ❑Na Site w/in an inner wellhead ❑Y� �No <br /> 1�'c site mapl mgrrtt zone(('W'S/N INCWS) <br /> Utilities located& identified �Yes ❑No Buried water supply pipe ❑Y� �� <br /> (gopher stalc one�:all► w/in 50'of system <br /> Accc.�ss for system mafntenance �Y� ❑ No Site locaied in Shoreland ❑Y� �No <br /> (sho�vn on site map) (�v1in I(NNY oflal:e.3(�'oPriver� <br /> Soil treatment area protected �Y� ❑ No Site map prepared with (�J Yes ❑ No <br /> previous items included <br /> Construction related issues <br />