HomeMy WebLinkAboutPermit Record aaa s 5;04-1- Ave.. No .
PERMIT RECORD
Permit No. Date Type of Permit
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PERMIT RECORD
Permit No. Date Type of Permit
DATE TIME
CITY OF ORONO CALLED IN
INSPECTION NQTLCE SCHEDULED /a-7-4a.
PERMIT NO. 5 /7 COMPLETED
ADDRESS
ADDRESS o` ga-S (o a
OWNER CONTR.
TELEPHONE NO.
DESCRIPTION a " 0
W• 01 FOOTING 11 MECHANICAL RI 16 WELL TEST PUMP
W 02 FRAMING 11 MECHANICAL FINAL 18 EXCAV/GRADING/FILLING
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03 INSULATION 24/25 WOOD BURNER/FIREPLACE 19 LAKESHOREIWETLANDS
• 04 WALL BD. 12 WATER HOOK-UP 34 TREE REMOVAL
Q OINAL 13 METER SET/TURN ON 17 SITE INSPECTION
• 07 DEMO—SITE 14 SEWER HOOK-UP 06 PROGRESS
07 DEMO—FINAL 27 SEPTIC MAINT. 21 COMPLAINT
44 09 PLUMBING RI 15 SEPTIC INSTALL. 22 FOLLOW-UP
10 PLUMBING FINAL 23 SEPTIC FINAL
Q OWNER/CONTRACTOR TO MEET YOU:_YES_NO
o COMMENTS:
W
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O
CC
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W
W
CC
W
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CC
XWORK SATISFACTORY:PROCEED PROJECT COMPLETE
CC ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
• ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
BEFORE COVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. C PHOTO TAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR ❑CITATION ISSUED
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance.473-7357
Owner/Contror_gn site:
Inspector. v Q.11
White Copy/Inspector's File Canary Copy/Site Notice
CITY OF ORONO Date
ADDRESS Connected to
CODE SEPTIC SYSTEM INVENTORY CARD Municipal Sewer
Address 2'x-2 A V-6,A), Property I.D. G7-/f8 •-23 2 0006., WELL DA
Standard trench ? ��
0 Mound ` �
�
7
System type Other Legal Description 7/3?? 7C mel
d
Permit No. — Date of permit '— Installer • / v �� p
d
No. Bedrooms Garbage / c_ d
Building type 3 i T��—ri or GPD Z �Laun ishwasher Disposal
—7 _ a
SEPTIC TANKS: Material P.2rCAs Co,Jc • ... 4 ° ¢ c
T— ity 1) i. 2)
/ i- a' 0.
Proper outlet and inlet Baffles depth to RO level 5
ti
_ i
Height of tank bottom above water table 'istance to nearest b ilding �g ,* (Q u
DRAINFIELD: Total lengtl►,of lines umber of li es • Trench width "1
\ Y
c
Total treatment area(sq.ft.) t of drai field ab table co
;4
U
Type of filter material Soil type �•
ao
E _
Distance from nearest bldg. 2 ~Tile size Perc rate min/in 2 a a ,c
A)
a > v
Depth of fill over drainfield Depth of rock over tile under tile c a `�'
D a U ip
LOCATION
INSPECTION RECORD PUMPOUT RECORD SKETCH
DATE COMPLIANCE DATE GALLONS
$-I2-82- Ikk.) SuleFAeiNG No TM 2 N,
,, I,
1
�4 reeds pLYripi - 0_
/6 ,__,,, L -7,
t
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4
.,
Include: 1) Well location
2) Distance from house to
"‘V septic tanks,dist.box,
o and drainfield
C- CONFORMING S-SUBSTANDARD N -NONCONFORMING "I 3) North arrow and road
0/4 STATE OF MINNESOTA DEPARTMENT OF HEALTH
ABANDONED WELL RECORD
I. LOCATION OF WELL MINNESOTA UNIQUE WELL NO.
County Name (leave blank if not known)
Hennepin
r
Township Name Township Number Range Number Section No. Fraction 4. WELL DEPTH (completed) Date sealed
N E k y of y
Orono 118 sr 23 wr 27 SW NE SW 3 ft. / / I i? ' Ci 1
A
Numerical Street Address and City of Well Location or Distance from Road 5. RRLLLING METHOD (if known) ►�/� 1 1.99).
Intersection j1K1 Cable tool 40 Reverse 70 Drivel`r'1IODug--
2225 County Road 6 Orono, MN. . 20 Hollow Rod 50 Air 80 Bored 110
Show exact location of well 30 Rotary 60 Jetted 90 Power Auger
(in section grid with "0") Sketch map of well location
N 6. OBSTRUCTIONS
• Well obstructed es No
- Obstructions removed Yes 0 No If obstructions cannot be
�iic'I 0 removed, contact MOH
M + - PI(I- E 1 1 before sealing.
` I T I 7. USE
- X, 4.R CI
Domestic 40 Monitoring 80 Heat Loop
y` ,l�' 20 Irrigation 50 Public 9[] Industry
S 1 / 30 Test Well 60 Municipal HO Commercial
1 +iL--I 70 Air Conditioning 110
2. PROPERTY OWNER'S NAME I Mailing Address if different than 8. CASING(5)
property address indicated above 1114{Black 40Threaded 70
R & R Excavating 4416 Tonkawood Road 20 Galy. 50 Welded
Minnetonka, MN. 55345 30 Plastic 60 Stainless Steel
HARDNESS OF ,� in. to 139 ft.
3. FORMATION LOG COLOR FORMATION FROM TO
if not known, indicate formation log from new well or nearby well. in. to ft.
Drift 0 143' 9. SCREEN
0 Screened well from ft. to ft.
(If known)
0 Open Hole from ft. to_ ft.
10. STATIC'WATER LEVE
(c ft. below 0 above
land sur ce Date Measured I I q
41 I
11. WELLHEAD COMPLETION
10 Pttless Adapter t4J Found Buried
20 Basement offset 50
"iiiirWell Pit
16. REMARKS, ELEVATION, SOURCE OF DATA - CASINGS REMOVED, CASINGS PERFORATED, ETC.
12. GROUTING INFORMATION
Neat Cement 20 Bentonite 30
Grout 3" Well Approx. 143' deep Grout material from I1(,3toQ ft. cu. yds
6 Bags Cement
8 Lbs. Bentonite — —
2 Men, Labor, Ri and Cement Grout Purr 13. NEAREST SOURCES OF CONTAMINreItN
g P feet direction
type
Well disinfected before sealing? 0 Yes
14. PUMP Removed 0 Not Present
Type: 1[)Submersible 30 L.S. Turbine 50 Reciprocating
itli(Jet 40 Centrifugal 60
15. EXISTING WELLS (Please sketch locations of abandoned and •
active wells in remarks Dec on or on back.)
Other unused well(s) on property? 0 Yes No
Abandoned: 0 Permanent 0 Temporary 0 Not aled
17. WATER WELL CONTRACTORS CERTIFICATION
This well was sealed under my jurisdiction and this report
is true to the best of my knowledge and belief.
DON STODOLA WELL DRILLING CO. , INC,
Licensee Business Name U""").27172
icense No.27172
Address 15306 H . 7 Minnetonka, MN. 55391
Sign. ,.._.
ign.. . '_.--,..4"..- / Date 1/18/91
'ar t•.° a Date 1/18/91
OFFICIAL ABANDONED WELL RECORD (May be used for Property Transfer) Name of Driller
IMPORTANT: FILM WITH REND