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UNIYERSITY OSTP Prelimina Evatuation Form <br /> OF MINNESOTA � <br /> � , , -�. <br /> 1.Contact Infortnation v Q5.13.14 <br /> PropeKy Owner/Clfent: �urav and Rema Mekhija Client Phone Number. 3�2'32��Z049� <br /> Maiting Address ���0 French Creek Dr. Project ID: r- �� <br /> Site nddress Sa^� Legal Descnption <br /> ParcellD: Latitude�--� Lor�iwde <br /> Evaluation for system type �+ewcanmuma, +�tepwament March 72,2015 <br /> Date � <br /> 2. Flow Information <br /> Client-Provided Infamation <br /> TYPe(s)of use(Qlt thaf npply) �esider�tiai [�«nmerdai ��+(��N) <br /> No.of bedraoms•(ijapplicabte) 5 Unfinished space (ft=) � <br /> No.of residertts in home �2 Adults �CMldren �Teenagers <br /> Fxistlng flow measurementr d'es(if res,aaach reamnys) �o <br /> [�arbage Dlsposal �va[er SoRener• Oron W[er� <br /> Water-usi�g devices(check oll Uwt L'.VShwesher �ump wmp� Other(speciJy) <br /> aPP�Y1 [�a�ge eamn�b/�aami <br /> Qf9h Bfldurcy Fvnace` <br /> u.nunAy/Larqe Tub on 2nG RoOr �cTub• 'Gl@df WOtBf SOItfC¢ <br /> Water use concerns(check olt that �auceqrdie��eaics Qf,hpe�naas of tair�ory/Day aorg-Term Prespiptbn Metls <br /> Q15e o(M[FBaduWl Soap <br /> aPp�y1 Qn-Mome 9usinrss �10 Urrt Saeen �requent Entertalnlrg of Out-ot-Town Gueus <br /> My additio�al current or future uses on this parcel{specffy j <br /> My non•sewage discharges W system (specijy) <br /> Sewage ejector or grinder pump in home7 d'g � <br /> I acknowledge the above B complete and accurate (Ctient(s)stgrature arM dafe) �L�� <br /> Desipnerdetermined Flow Information <br /> A.Estlmated Design Flow(gellons per day) �� <br /> Mticipated waste strength values: �°"+�Susngm Qtigh Sirenqm gpp;� <br /> mg/L <br /> GBOD:�mg/L C�ul:�mg/L 0&G:�mg/L <br /> 3. Preliminary Site Informatian <br /> B�t�.Water supply well(s)within 100 k of absorptfon area [�es �u <br /> Well(s}were located �irect obsera�on D'�unry Weli IMex Maps �ersorul Comm�nla[lon MN Unique Well Id Ti: 791988 <br /> Depth of wetl(s) 331 ft Well casing depth(s) 317 -�ft Source Mn County Well ind <br /> Impervious Layer �� �g If Yes,Define&Source: Required Setback- C�f� <br /> B(2).Site witl�in 200 ft of noncommte�ity transimt supply well d'a � Source County <br /> B(3).Site withtn a drinktng water supply management area dei �o Source CouMy <br /> B(4).Loutlon o(all extstlng and propoud buildfngs and Improvwnenu on IoE(see Site Evaluotton map) <br /> B(5).Burfed water wpply pipes withfn 50 ft of proposed system �)'es Q�o <br /> C.Location o(all easemeMs on lot(see Site Evaluation rrap) Source County GIS <br /> D.Elevatlon oi ardinary high water kvel(OWHI)-MN DNR(if adjacmt to parcef� �--� <br /> E.floodplain desianation and flood Nevation Sauce �� <br /> F.Determfrw property Ifnes(see Site Eva[uatJon map) [�wwvey �at wap [�,er. County GIS <br /> Site located in a shoretand district/area '�g � <br /> G.Distance oi setbacks �f0a'�'�^g mh�'+� �recersuppry vipes <br /> [�her Buildings �uenen[5 �Yel(s) <br />