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Preliminary & Field Evaluation Form <br />www.SepticResource.com vers 12.4 <br />Owner Information <br />Date 10/15/2018 Sec / Twp / Rng <br />Parcel ID 3311823340013 LUG (county, city, township) City of Orono <br />Property Owner: Ross Johnson Owners address (if different) <br />Property Address: 155 Wear Ln. <br />City / State / Zip: Orono, Mn <br />Flow Information and Waste Tvue / Streneth I <br />Design flow 750 Anticipated Waste strength <br />❑ Hi Strength <br />0 DomesbC <br />Any Non -Domestic Waste <br />❑ Yes (dass V) <br />❑ No <br />Sewage ejector/grinder pump <br />❑ Yes <br />No <br />Water softener <br />❑ Yes <br />❑ No <br />Garbage Disposal <br />❑ Yes <br />Q No <br />Daycare / In home business <br />❑ Yes <br />0 No <br />Site Information <br />Existing & proposed lot <br />0 Yes <br />❑ No <br />Well casing depth <br />135' <br />improvements located (see site map) <br />Easements on lot located <br />0 Yes <br />❑ No <br />Drainfield w/in 100' of <br />❑ Yes <br />Q No <br />(see site map) <br />residential well <br />Property lines determined <br />Yes <br />❑ No <br />Site w/in 200' of transient <br />❑ Yes <br />❑ No <br />(see site map) <br />noncommunity water supply (TNCWS) <br />Req'd setbacks determined <br />❑' Yes <br />❑ No <br />Site w/in an inner wellhead <br />❑ Yes <br />No <br />(see site map) <br />mgmt zone (CWS/NTNCWS) <br />Utilities located & identified <br />❑� Yes <br />❑ No <br />Buried water supply pipe <br />❑ Yes <br />❑ No <br />(gopher state one call) <br />w/in 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 />(w/in 1000' of lake, 300' of river) <br />Soil treatment area protected <br />Yes <br />❑ No <br />Site map prepared with <br />El Yes <br />❑ No <br />previous items included <br />related issues <br />