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Preliminary & Field Evaluation Form <br />www.SepticRmurce.com vers 12.4 <br />Owner Information <br />Date 10/06/2017 See 1 Twp 1 Rng <br />Parcel ID 0311723320014 LUG (county, city, township) City of Orono <br />Property Owner: Anders Myhran Owners address (if different) <br />Property Address: 2280 Fox Street <br />City C State I Zip: Long Lake, MN 55356 <br />[ Flow Information and Waste Twe 1 Strength <br />Estimated Design flow 450 Anticipated Waste strength <br />❑ Hi Strength <br />0 <br />Domestic <br />Any Non -Domestic Waste <br />❑ Yes (class V) <br />❑ <br />No <br />Comments: <br />Easements on lot located <br />Sewage ejector/grinder pump <br />❑ Yes <br />M <br />No <br />Water softener <br />0 Yes <br />O <br />No <br />Garbage Disposal <br />❑ Yes <br />❑ <br />No <br />Daycare I In home business <br />❑ Yes <br />p <br />No <br />Site Information <br />Existing && proposed lot <br />❑ Yes <br />❑ No <br />Well casing depth <br />50'+ <br />improvements located (see: site map) <br />Easements on lot located <br />❑ Yes <br />❑ No <br />Drainfield wlin 100' of <br />❑ Yes <br />❑ No <br />(see site map) <br />residential well. <br />Property lines determined <br />❑ Yes <br />❑ No <br />Site Win 200' of transient <br />❑ Yes <br />I] No <br />(see site map) <br />noncommunity water supply (TNCWS) <br />Req'd setbacks determined <br />❑ Yes <br />❑ No <br />Site wlin an inner wellhead <br />❑ Yes <br />0 No <br />(sce site map) <br />mgmt zone (CWSINTNCWS) <br />Utilities located & identified <br />0 Yes <br />❑ No <br />Buried water supply pipe <br />❑ Yes <br />21 No <br />(gopher state one call) <br />wlin 50' of system <br />Access for system maintenance <br />0 Yes <br />❑ No <br />Site located in Shoreland <br />❑ Yes <br />❑ No <br />(shown on site map) <br />(who 1000' of fake, 304' of river) <br />Soil treatment area protected <br />i] Yes <br />❑ No <br />Site map prepared with <br />9 Yes <br />❑ No <br />previous items included <br />ion related issues <br />