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UNIVERSITY <br /> oF :vliN;vEsoTA OSTP Preliminary Evaluation Form <br /> 7.Contact Information v 11.09.22 <br /> Property Owner/Client: Curtis&Liz LeVang Client Phone Numbe�: <br /> Mailing Address 4010 Bayside Road,Orono,MN 55359 Project ID: <br /> Site Address Same <br /> Parcell.D. 06-117-23-11-006 TownshipJi� Range il Section <br /> Date Oct 25th,2011 Township name Legal Desc or Lat/Long <br /> Evaluatlon for system type ❑New Constnxtion �Replacement Parcel dimensions <br /> 2. Flow Informatlon <br /> Qient-Provided In ormation � <br /> Type(s)o(use(al!that npply) 0 Residential ❑Commercial ❑Other Use(Specify) <br /> No.of bedrooms'(ijapplicable) 4 Unfinished space (ftZ) � <br /> No.of residents in home �Adul[s �Children �Teenagers ❑Dayrare <br /> F�cisting flow measurements ❑Yes(If Yes,atwch readings) 0 ry� <br /> 0 Garbaqe Disposal 0 Water Softener' ❑Iron Filter' <br /> Water-using devices(check a(![hat 0 p�shwasher ❑Sump Pump' Other(speci/y� <br /> °��y� ❑Large Bathtub/Jac�i <br /> 0 High EffYciency Fumace' <br /> ❑Laundry/Large Tub on 2nd Floor ❑Hot 7ub' 'Clear water source <br /> Water use concems(check aU[hat 0 Faucet/Toilet e Mul[iple Loads of Laindry/Day ❑Long-Term Presoiptlon Meds <br /> °��y� ❑In-Home Business �No Lint Saeen 0 Use of And-Bac[erial Soap ❑Frequent Entertaining of Out-of-Town Guests <br /> My addi[ional current or future uses on thls parcel(speci fy) <br /> Any non-sewage discharges to system (speciJy) <br /> Sewage ejector or grinder pump in hane ❑Yes ❑� No <br /> I acknowledge the above is complete and accurate (Qient(s)signature and da[e) <br /> Designer-determined Flow Information <br /> A.Estimated Design Flow(gallons per day) 6� <br /> Mticipated'waste strength values: 0 Domestic ❑High Strength ����--�mg/L <br /> CBOD;�mg/L (TSS):�mg/L 0&G:�mg/L <br /> 3. Preliminary Site Information <br /> B(1).Water supply well(s)within 100 ft of absorptlon area �Yes ❑No <br /> Well(s)were located ��rect Obsena[ion ❑Counry Well Index Maps ❑Personal Communication MN Unique Well Id tl: � <br /> Depth of well(s) �-100 ft Well casing depth(s) 50 ft Source <br /> Impervious Layer e No ❑Yes If Yes,Define 8 Source: Required Setback: 50 ft <br /> B(2).Stte within 200 ft of noncommunity transfent supply well ❑1'es �No Source <br /> B(3).Site within a drinkinp water supply management area ❑Yes �No Source <br /> B(4).Lxation of all existing and proposed bufldings and Improvements on lot(see Site Evaluaffon map) <br /> B(5).Buried water suppiy pfpes within 50 ft of proposed system ❑Yes ❑� Mo <br /> C.Locatfon of all easements on lot(see Site Evaluotion map) Source Hen Cty GIS <br /> D.Elevation of ordinary high water level(OWHL)-MN DNR(if adjacent[o parcel) NA <br /> E.Floodplain designatlon and flood elevation NA Source <br /> F.Determine property lines(see Si[e Evaluation map) ❑Survey ❑Plat Map 0 Other Hen Cty GIS <br /> Site loca[ed in a shoreland district/area ❑y� ❑No <br /> G.Distance of setbacks 0 Property Lines ❑OHWL 0 Easements �Water Supply Pipes 0 WeU s <br /> O <br /> �O[her Butldings <br /> H.Soil Survey Infwmatlon(from web soil survey) 0 MaD Map Uni[s on Parcel L35A,L36A,L41 C2 <br /> List landforms Moraines Slope Range 3-12% <br /> Parent materials-check oll that oppty Landscape Positlon(check all fhot apply) <br /> 0 TiU ❑Outv.esh ❑Lcess ❑Bedrocic ❑AUuvium ❑Summit 0 Shoulder 0 Badcslope ❑Footslope ❑Tceslope <br /> ❑CoUwium ❑Laautrine ❑Organic ❑Cut/Fill ❑(kpressim �Stream ❑Terrace <br /> ❑Manmade ❑Plain <br /> Minimum bedrxk depth:�inches Minlmum bedrock dep[h:❑inches ' <br /> Maximum bedrock depth:�inches Maximum bedrock depth:❑inches <br /> Septic Tank Absorption Field-Trench(AW) <br /> Map Unit <br /> Ratings Septic Tank Absorp[ion Field-At-grade(hW) <br /> Septic Tank Absorp[ion Field-Mound(MN)L47 C2-Very Limited,(1.0) L35A&L36A slightly timited <br />