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� � Preliminary & Field Evaluation Form ����N�4 ,_ <br /> �� _��: <br /> , ` wwtiv.Septicl,2esource.cor��# <br /> ��� <br /> Owner Information <br /> Date 3/22/2016 Sec/Twp/Rng <br /> Parcel ID 3111823420012 LUG(county, ciry,township) Hennepin County <br /> Property Owner: I'!;� ����/�, Owners address(if different) <br /> Property Address: 4220 Chippewa Lane <br /> City/State/Zip: Orono, MN 55359 <br /> Flow Information and Waste Type/Strength <br /> Estimated Design flow 750 Anticipated Waste strength ❑ Hi Strength ,0' Domestic <br /> Any Non-Domestic Waste ❑ Yes(class V),0'No <br /> Comments: <br /> Sewage ejector/grinder pump ❑ Yes �o <br /> #Water Softener should be re-routed �[ <br /> so it does not drain into septic system #€'� Water softener �Yes � No <br /> Water softener can be routed to drain into footing tile and <br /> surface outl Garbage Disposal ❑ Yes „�No <br /> Daycare/In home business ❑ Yes [��No <br /> Site Information <br /> Existing&proposed lot ��Yes � No Well casing depth <br /> improvements located (see site map) <br /> Easements on lot located �"Yes � No Drainfield w/in 100'of ❑ Yes � No <br /> (see site map) residential well <br /> Property lines determined .�Yes ❑ No Site w/in 200'of transient ❑ Yes �` No <br /> (see site map) noncommunity water supply(T'NCWS) <br /> Req'd setbacks determined Yes � No Site w/in an inner wellhead ❑ Yes � No <br /> (see site map) mgmt zone(CWS/NTNCWS) <br /> Utilities located&identified ❑ Yes � No Buried water supply pipe ❑ Yes �/j No <br /> (gopher state one call) � w/in 50'of system �~ <br /> Access for system maintenance �Yes � No Site located in Shoreland ❑ Yes � No <br /> (shown on site map) (w/in 1000'of lake,300'of river) <br /> Soil treatment area protected Yes ❑ No Site map prepared with , Yes ❑ No <br /> previous items included <br /> Construction related issues <br />