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Preliminary & Field Evaluation Form <br />www.SepticResource.com vers 12.4 <br />Owner Information <br />Date 10/2/2019 Sec / Twp / Rng <br />Parcel ID 2711823310016 LUG (county, city, township) City of Orono <br />Property Owner. Laura Hirschberg Owners address (if different) <br />Property Address: 2080 Salem Ct. <br />City / State / Zip: Orono, MN <br />Flow Information and Waste Tvae / Strength <br />Design flow 600 Anticipated Waste strength ❑ Hi Strenyth ❑ Domestic <br />Any Non -Domestic Waste ❑ Yes (class V) ❑ No <br />Sewage ejector/grinder pump ❑ Yes No <br />Water softener ❑ Yes ❑ No <br />Garbage Disposal ❑ Yes E] No <br />Daycare / In home business ❑ Yes 0 No <br />Construction related issues <br />Site Information <br />Existing & proposed lot <br />❑ <br />Yes <br />❑ No <br />Well casing depth <br />130' <br />improvements located (see site map) <br />Easements on lot located <br />❑ <br />Yes <br />❑ No <br />Drainfield w/in 100' of <br />❑ Yes <br />❑ <br />No <br />(see site map) <br />residential well <br />Property lines determined <br />F±1 <br />Yes <br />❑ No <br />Site w/in 200' of transient <br />❑ Yes <br />FZ] <br />No <br />(see site map) <br />noncommunity water supply (TNCWS) <br />Req'd setbacks determined <br />❑ <br />Yes <br />❑ No <br />Site w/in an inner wellhead <br />❑ Yes <br />❑ <br />No <br />(see site map) <br />mgmt zone (CWS/NTNCWS) <br />Utilities located & identified <br />❑ <br />Yes <br />❑ No <br />Buried water supply pipe <br />❑ Yes <br />No <br />(gopher state one call) <br />Win 50' of system <br />Access for system maintenance <br />R] <br />Yes <br />❑ No <br />Site located in Shoreland <br />❑ Yes <br />0 <br />No <br />(shown on site map) <br />(w/in 1000' of lake, 300' of river) <br />Soil treatment area protected <br />El <br />Yes <br />❑ No <br />Site map prepared with <br />El Yes <br />❑ <br />No <br />previous items included <br />Construction related issues <br />