Laserfiche WebLink
``," i �`t" OSTP Pretiminary Evaluation Form <br /> � .,.'�;�;;�;�:;�?_a <br /> 1.ConYact Information v 12.08.06 <br /> Property Ownx/GtenL• Steve Anderson/Deoati Homes Client Phone Nwnber.� � <br /> Maiiing Address Project ID: ; — <br /> Site Address 5t7 Femdate Road Narth.Orono.AW 55391 <br /> Parce{ID: 36-118-23-54-0007 la[i[ude�—� Lons[itude�— <br /> Evaluation for system type �r+�.Caravucnm ❑Rryttm�cx Oate ��19,2015 <br /> 2. Flow Information <br /> Ctient-Provided In wmation <br /> Type(s)of use(alt cnor�pty) ��'Oat ��� ❑�'t�fi'> <br /> No.of bedrooms'(iJ a�plirabfe) 4 � Unfinished space (ft'� Accounted for. —� <br /> No.of resiCen[s in hane ❑2 Adutcs �Chitd�en �Teenagers ❑�re <br /> Existing flov+measurements ❑'!Ps i�f Ya.aaaa,rnaan�s? �no <br /> �G8!D�qf�60�1 J WMCr Soft�fi" �Lon sf�` <br /> Water-using devices(check all tlwt '�-�'��^"�r ��P�' �thef(5D�'��Y) <br /> �A�Y) '`�',Urge BdNR-G`;acum ::J�4�ENoercY Fwnace• — <br /> ��a�nery,�ta�ye��b on zna Flow v t�u Tue' •Ciear wa[er source <br /> Wa[er use concerns/check a((thai ❑Faucet.�oiet�eata ,r_+.�r�wk�tnaas or tau��dn:'�r u L�'i-TeJm vrg�yt��eCs �use o+nrm-saae�ia�soap <br /> �DPIY) ❑In-rlome Susu� �No L"eN Saeen �'Frepue�t Enterta�ing d OtA-of-Ta�rn Gues'S <br /> My additiona!current or future uses an thrs parcet(specify 1 No <br /> My non-sewa3e disd�arges io system (specijy) NO <br /> Sewage ejector or 3rinder pump in home? ❑rg n+o <br /> i ackncwtedge the above ts comptete and accurete {Cfient(s)sigrwNre and dotej <br /> Designer-determined Ftnw information <br /> l�Estimated Design Flow(galbns per day) � <br /> Mtitipated waste streng[h values: ����� u y5^s�s'� �=� mg!L <br /> CBOD:�mg/L iT55)��mglL 0&G:�mglL <br /> 3. Preliminary Site Intormarion <br /> 6(t).Water supply welt(sy witMn f 00 ft of absorpfion area L Ya J�+o <br /> Wel1�s)were Ixated ❑���� ��"�'��I"��� �-%����"�^ Mk Unique WeLt 4d�: � <br /> Depth of welt(s) >100 ft Wel!casing depztr�s) 50 ft Saurce� <br /> Impervian Layer L�'r+o Q ra tf Yes.Define 8 Source: � Required Setbadc: �ft <br /> B(2).Site within Z00 ft of nonc�smunity transient wppiy wNi �=Yg �'-'�"� Source� <br /> B(3).Site within a drinki�water wpply management area ��� ❑� �rce� <br /> B(4).Location of ai4 existing and proposed buildings and improvements on lat(see Site EvoluaYran mt�) <br /> B(5).Buried water wpply pipez within 50 ft of proposed system %�res �f�o <br /> G Lxation of all easements on lot(see Site Eve(uoriwi mc�) Sa�rce Surwy <br /> D.Elevation of wdinary high wafer ieve!(OWHL)-MN DNR(if adjacent to parcel) Na <br /> E.Floodplain desigrwtion and flood eleva[fon NA Source � <br /> F.Determine property lines(see Site Eva(ua[ion map) �saver ❑Pwc wav ❑w�er <br /> Site tocated in a shoreland district:area �-=Y� �� <br /> G.Distance of setbacks u�voem�� �ottvr� �warer su-ov�r�aes <br /> �Otrier Bui�r+4s Q' Eas�*K+xs L'�i wdl(s) <br />