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Home My WebLink AboutWell info WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MtNNESOTA UNIQUE WELL NO. County Name WELL AND BORING RECORD 6 9 5 6 4 3 $eAneF�n Minnesota Statutes Chapter 1031 Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed Orono 1.17N 23W 17 ,� ,� ,� 167 " 12-30-03 GPS DRILLING METHOD LOCATION: Latitude degrees __ minutes seconds _ ❑CableTool Driven �j Dug Longitude degrees minutes __ seconds " ,,�quger `�Rotary ❑Jetted House Number,Street Name,City,and Zip Code of Well Location or Fire Number �, 1625 Btihns Paint R.d� OI�OAO SS341 DRILLING FLUID WELL HYDROFRACTURED? J Yes I� No Shop exact location of well in section grid with"X". Sketch map of well location. �a�er � property lines, FROM tt TO ft N tS.�,/ (/�-�, roa and bui�dings USE � ;Monitoring ❑Heating/Cooling ' � �� `��t �� omestic �.j Environ Bore Hole �Industry/Commercial :. --' --'-- - ` `- �( /. �,J Noncommunity PWS �_�Irngation ��'�Remedial ��%� "Y"' J Communiry PWS [_�Dewatering �' L: ""''----'--- --`-"'-"�-- ASIN OLE DIAM C G H . W � I I I E Drive Shoe? L��Yes �No - , , � � � � e e " --;-----�-- —�-- ' � 7 Id d ____ T ., ❑Steel [_;Threadgd �]W 'h M�ile � f.�J.+7�,�� PI25tiC lue.' -. � � � � � '' ' ------ ------ ------------ 1 CASING DIAMETER WEIGHT S 1 , , , � ��.to 252 ft. Ibs./ft. $� ��.to '�5 n. F-1 Mile-� 6 167 in.to R. Ibs./ft. �in.to _ft. PROPERTY OWNER'S NAME/COMPANY NAME in.to ft. Ibs./ft. in.to tt. Pillar HO�C8 SCREEN OPEN HOLE Property owner's mailing address if different than weil location address indicated above. Make___ S�C�. FROM ft. TO ft. 125 Lake .Str@@� W TYPe �Ci Diam. _ — SIoUGauze__ �� Lengih� �� :: Wayzata, MN 55391 Set between Ib2 ft.and 167 ft. FITTINGS kpacker STATIC AWATER LEVEL �V ft.�below '�J above land surface Date measured__ 12�3��3 _ PUMPING LEVEL(below land surface) WELL OWNER'S NAME/COMPANY NAME Pillar Ad$�$ _ft.after _ hrs.pumping 1��' g.p.m. WELL HEAD COMPLETION tK Well owner's mailing address if different than property owners address indicated above. �itless adapter manufacturer_ M�ag Model_ `� _ Casing Protection_ �02 in.above grade ^�At-grade(Environmental Wells and Boring ONLY) GROUTING INFORMATION - Well grouted �Yes [--1 No Grout material �i J Neai cement '��,�entonite �]Concrete ['�..High Solids Bentonite . from� 6 to �5_ft. 3 ❑Yds. �bags ' from. . to fL �, I yds. '�_��bags GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO � from_ to ft. '`I yds. I�"I bags MATERIAL NEAREST KNOWN SOURCE OF CONTAMINATION C.18 j pe l lu�r Q 1 g _ feet _ __ direction rype Well disinfected upon completion �Ves �I No Cil.11�I gray is f�� PUMP �, !�_]Not installed Date installed��`�'� � Ci1.8�► bt $8Dd g78�t �y� �d Manufacturer'sname �" '�l'�.�✓�—.-• Model number__ HP_�Volts Sandwery f iae tan 70 153 (�f�� at U Length of drop pipe tt. Capacity _g.p.m. sand � Y'$VB� 1��@a 1�q �C� Type: Submersible i�LS.Turbine [ Reciprocating r'Jet ` _ _ ' K •� � ABANDONED WELLS � � Does properry have any not in use and not sealed well(s) � Yes � o � - VARIANCE Was a variance granted from the MDH for this well? ❑Yes ' �No TNit WELL CONTRACTOR CERTIFICATION � This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. The informa�ion contained in this report is true to the best of my knowledge. Use a second sheet,if needed REMARKS,ELEVATION.SOURCE OF DATA,eta SCEVEIIH Dri.11�A 6 Ennironmental Svc 8b6S4 --- �---- ---- Licensee Business Nam Lic.or Reg.N�. :,� �\` ,, _ _y �� (.( ; , _ � � Authorized Representative Signature Dat + � Randy Johnaon 1��,��f /�:� ; 6 9 5 6 4 3 Name of Driller Date " � LOCAL COPY He-o,zo5-os�ae�.sioz� ? iC iao-oozo ��..-, - _ . . . ,. . ,. _ . ,. WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring H 2 O�H�Z County Name WELL AND BORING SEALING RECORD MinnlesoNa Unique Well No. Minnesota Statutes,Chapter 1031 or W-series No. Hennepin «aa�a b�a�k�„o,��ow�, Township Name Township No. Range No. Section No. Fraction(sm�ig) Date Sealed Date Well or Boring Constructed Orono 117 23 17 NE NE� NE' 8-8-03 GPS Latitude degrees minutes seconds LOCATION: Depth Before Sealing �II ft. Original Depth ft. Longitude degrees minutes seconds pQUIFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location Single Aquifer ❑Multiaquifer 1525 Bohns Point Rd, Orono E UBORING �/tvteasured ❑ estimated QUG 2 9 2003 ` �Water Supply Well ❑Monit.Well Show exact location of well or boring Sketch map of well or boring 22 in section grid with"X" � bcation,showing property ❑ Env.Bore Hole ❑Other ft. f�l/below a ove d surface . N ' ��`,J � j�hnes,ro�ds and buildin s. CASING TYPE(S) �� y Steel ❑Plastic ❑Tile ❑Other � !��r.�,�r ��i�. -�- -;-- -;-- --;— � � WELLHEAD COMPLETION W --- - -;-- --�— � t'��'j{= ..L._ .�. Outside: ❑Well House Inside: ❑Basement Offset ' - -- f- 3��f.�f! ` �� ❑Pitess Adapter/Unit ❑Well Pit --�- -i-- -i - --�-- � S � 4 f -j �i �� Well Pit ❑Buried �' CJ` �r mde ❑Buried PROPERTY OWNER'S NAME/COMPANY NAME CASING(S) Pil lar HODI@ S Diameter Depth Set in oversize hole? Annular space initially grouted? Property owner's mailing address if different than well location address indicated above L � in.from � tp �•f ft. ❑Yes -f�No ❑Yes ❑ No �Unknown 'r\ 125 Lake St W Wayzata, HId 55391 in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown in.ffom to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown WELLOWNER'S NAME/COMPANY NAME SCREEN/OPEN HOLE P11�.8I $o15eS Well owner's mailing address if different than property owner's address indicated above Screen from 44 t0 4� ft. Open Hole from t0 n. OBSTRUCTIONS ❑ Rods/Drop Pipe ❑ Check Valve(s) ❑ Debris ❑ Fill �No Obstruction Type of Obstructions(Describe) GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? ❑Y0S ❑ NO DeSCflb2 FORMATION - tl not known,indicate estimated formation log irom nearby well or boring PUMP Type h_ Ftnc1 �t� Removed ❑ Not Present ❑Other METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: [�No Annular Space Exists ❑ Annular space grouted with tremie pipe ❑ Casing Perforation/Removal .� in.from to ft. ❑ Perforated ❑ Removed in.from to ft. ❑ Perforated ❑ Removed Type of perforator ❑ Other GROUTING MATERIAL(S) (One bag of cement=94 Ibs.,one bag of bentonite=50 Ibs.) " Grouting Material�e e�.�� irom_�_to��ft. yards �_ bags from to ft. yards bags from to ft yards bags ' OTHER WELLSAND BORINGS REMARKS,SOUACE OF DATA,DIFFICULTIES IN SEALING Other unsealed and unused well or boring on property? ❑ Yes No How many? LICENSED OR REGISTERED CONTRACTOR CERTIFICATION This well or boring was sealed in accordance with Minnesota Rules,Chapter 4725.The information contained in this report is true to the best of my knowledge. Stevens Drilling & Enniro�ental Svc 86654 Contractor Business Name. License or Registration No. \ \ - ' �`,� -- =:�.._._ g-��-U 3 Autho�ized Representative Signature Date 2 Q 18 4 2 Richard Stevens ZS - ��' (�3 LOCAL COPY H Name ol Person Sealing Well or Boring ... j� , . . . . . - . . . _ . . . .._ . .. . ... � ,.. WELL OR BORING�OCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring H 2 O V'T Counry Name WELL AND BORING SEALING RECORD M nn'egoNa Unique Well No. Hennepin Minnesota Statutes,Chapter f031 or W-series No. (Leave bl2nk i�no�known) Township Name Township No. Range No. Section No. Fraction(sm�Ig) Date Sealed Date Well or Boring Constructed Orono 117 23 17 N$ N& NE. $-&-03 � GPS Latitude degrees minutes seconds 57 R�CEIVE ` LOCATION: Depth Before Sealing ft. Original Depth Longitude degrees minutes seconds ppUIFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location Single Aquifer ❑Multiaquifer � Q Ur ) ^ ��0� 1625 Bohns Point �� Orono W VBORING tv�easured ❑ estimated � � % [�Water Supply Well ❑Monit.Well Show exact location of well or boring e Sketch map of well or boring C CITY /'�� in section grid with"X" r�t..,_.� i A location,showing property ❑ Env.Bore Hole ❑Other _ 2J ft. below ❑ab��a T i d«�O � � �� lin r ads,and buildings. N �/,�� Lz-1_� CASING TYPE(S) 1.�'-X�� [y[Steel ❑Plastic ❑Tile ❑Other '��i��.�-="� /\ W -�- -�-� -;-- --;— E WELLHEAD COMPLETION '' , � � � � �`��`-"'`� 1 / Outside: ❑Well House Inside: [�Basement Offset : --�- --- - — --�-- ^'�� ❑ Pitess Adapter/Unit ❑Well Pit -�-- -i— -i-- --�-- � �� ; �•;T p� j�l�'i � ❑Well Pit ❑Buried S �1 mib ❑Buried PROP„�(��YlarEF3$O�S OMPANY NAME CASING(S) Yl Il Diameter Depth Set in oversize hole? Annular space initiall;�grouted? Property owner's mailing address if different than well location address indicated above .�/ 3 in.from � to 53 ft. ❑Yes �yNo �Yes ❑No �Unknown 125 Lake St W '` Wayzata, � 55l�1 in.ffom to ft. ❑Yes ❑No ❑Yes ❑No ❑ Unknown in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown WELL OWNER'S NAME/COMPANY NAME SCREEN/OPEN HOLE Pillar Homes Well owners mailing address if diNerent ihan property owner's address indicated above Screen from �3 t0 57 ft. Open Hole fi Of11 t0 ft. OBSTRUCTIONS ❑ Rods/Drop Pipe ❑ Check Valve(s) ❑ Debris ❑ Fill �No Obstruction Type of Obstructions(Describe) GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? ❑YeS ❑ NO Describe FORMATION If not known,indicate estimated formation log irom nearby well or boring PUMP Type jet Removed ❑ Not Present ❑Other i METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: �`No Annular Space Exists ❑ Annular space grouted with tremie pipe ❑ Casing Perforation/Removal /� in.from to ft. ❑ Perforated ❑ Removed in.from to ft. ❑ Perforated ❑ Removed Type of pertorator ❑ Other GROUTING MA7ERIAL(S) (One bag of cement=94 Ibs.,one bag of bentonite=50 Ibs.) Grouting Material Ne�t Cemen t from�to—��ft. yards _�..�._ bags from to ft yards bags from to ft. yards bags OTHER WELLS AND BORINGS REMARKS,SOURCE OF DATA,DIPFICULTIES IN SEALING Other unsealed and unused well or boring on property? ❑ Yes No How many? LICENSED OR REGISTERED CONTRACTOR CERTIFICATION This well or boring was sealed in accordance with Minnesota Rules,Chapter 4725.The information contained in this report is true to the best of my knowledge. Stevens Drtlling 6 Ennironaental Svc 8b654 Contractor Business Naq�e License or Registration No. ,:' S ti ; , '�, ._ -`"--.--...._ � �k..() 3 Authorized Represenfative Signature Date H �O�� Rich�rd Stevens �- �,� - �)� LOCALCOPY Name of Person Sealing Well or Boring