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Home My WebLink Aboutwell and septic MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring �� WELL OR BORING LOCATION Sealing No. �, H County Name WELL.��AND BORING SEALING RECORD Minnesota Unique Well No. Minnesota Statutes,Chapter 103/ °eaW,s e�ies No. � in Township Name Township No. Range No. Section No. Fraction(sm.-+Ig.) Date Sealed Date Well or Boring Constructed or«� Zi� 2� 03 r�° �r s� � v sF r o ,�r,r�� GPS Latitude____ degrees_____ minutes_____ seconds Depth Before Sealing CJ� ft. Original Depth ft. LOCATION: Longitude___ degrees______ minutes._,___ seconds �FER(S) STATIC WATER LEVEL � Numerical Street Address or Fire Number and City of Well or Boring Location ' ingle Aquifer ❑MuRiaquifer �n�.�/� /� �j I� F� St YL�� WE UBORING �INeasured ❑Estimated Date Measure /T/►�J' /�17 1 �Nater-Supply Well ❑Monit.Well � Show exact location of well or boring ketch map o we boring �i Env.Bore Hole ❑Other �v ft. elow above land surface . in section grid with"X." lo o rty � � N lin s,roads,and b 'Idi s. CASING TYPE(S) i � � � � � � � i --'-----�-- ---`-- ---•-- � � teel ❑Plastic ❑Tile ❑Other � � � � _ . --�--- --'--- ---`-- ---�-- ELLHEAD COMPLETION � � � W W ; � � ; ET � � � � �� Outside: ❑Well House ❑At Grade Inside: ❑Basement Offset 'h Mile �qitless AdaptedUnit ❑Buried ❑Well Pit --,--- --r-- ---------=-- 1 ❑Buried S ❑Well Pit ❑Other �i Mile-� ,� []Other � PROPERTY OWNER'S NAMET/COMPANY NAME CASING(S) ��'i Final G � 1 Di�� f Depth�) / Set in over¢e ole? Annular space initially grouted? Property owner's mailing address if diflerent than well location address indicated above ,r-� �{j� _1jp.from �/ to ti.J 4►ft. ❑Yes � r]Yes ❑No ❑Unknown �i� $Ztif� DC JV�d�� I�4�d 55352 in.from to ft. ❑Yes� ❑No ❑Yes ❑No ❑Unknown in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown WELLOWNER'S NAME/COMPANY NAME SCREEN/OPEN HO +++***�� Well owner's mailing address if different than property owner's address indicated above SCreen from�to "�� ft. Open HOIe ffom_ _to ft. �OB,SATRUCTIONS 'IY�Rods/Drop Pipe ❑Check Valve(s) ❑Debris ❑Fili ❑No Obstruction T �r^� Type of Obstructions(Describe) �� !�-- � ��„ +� GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? es ��No Describe FORMATION If not own,indicate estimated formation log from nearby well or boring. PUMP � � � Type S �/ ` ` [�temoved �]Not Prese ._,Other ___,_ MET OD 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. J Perforated ❑Removed Type of Perforator ❑Other GROUTING MATERIAL(S) (One bag of cement=94 Ibs.,one bag of bentonite=50 Ibs.) �/ /� /"� w � � Grouting Material/'-'�!'f `� ��' "'rfToPo �..� to ��R. yards� bags from to ft. yards bags from ro _ ft. yards bags �' OTHER WELLS AND BORINGS REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING Other unsealed and unused well or boring on property? I_'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. , � I�Stadola �Tcli Dciilin�_ _ 1b91 Licensee Business Na e --�'"� /" License or Registration No. � �- /l � 9 -- - - - ------ ---- ie e resentative Signature..._ Certilied Rep.No. Date ------- - �� -��,.�:��Y H 282669 ---- -- �-r,.- -,�.�,r,."-- Name of Person Sealing Well or Boring HE-01434-11 ICa 140-0423 � 2ioaa � . � � / r i/ � � , CI�'Y of UROl�� , � MunicipalOffices Stree4 Address: Mailing Address: �� '�� 2750 Kelley Parkway P.O. Boz 66 �E�Tr1� - Orono, MN 55356 Crystal Bay, MN 55323�0066 To: The Cun�ent Owner of Address � `� �G �� X City Ordinance requires that onsite sewage treatment systems in Orono be inspected on a periodic basis. The onsite sewage treatment system at the above address has been inspected and the following is known about the system. A sketch of the known components of the system is available for most properties at the Orono City Hall. Imminent Public lth Threat Yes No If yes, please contact the Onsite Systems Manager at 952-249-4626 within 10 days of receipt of this notice. The septic systenl must be brought into compliance within 90 days. Failure to do so will result in referral to the City Attorney for legal action. System Identified as Pton-Compliant Yes No If yes, system must be brouaht into compliance by: December 31, 2007 December 31, 2010 ather Septic 'I'ank(s) Pump out Ivieeded '�es � i�o The City recommends the septic tank(s) and/or lift tanl: be serviced and pumpecl o�_lt ev�ry three years. City records indicate the tanl:(s) were last pumped out on �- �,'- U� . The tanl:(s) should be cleaned throuQh the manhole and not tlu-ough the inspection pipes, this aliows for proper cleanin�. Comments: �. Ins e��iuC/��'�-""� "'" '��:� Date of Inspection �'- � � p 1'z1e��c�� (�;2) ?r�-;�6��i � �� (9�2) ?��-��Y� �a��ss.ci.fl�-o5,o.n.r.�s /'—�� ', � �:. ;/� � �%//O O\��'1� �� C ITY of OR4N0 � � ;� '` � ' j.%�` � 'j �,,� � ya ,'U , � ,�ti �l� Municipal Offices .� ` 'r `��G;�'� Street Address �15o�.-a�{q,�"�6o O Mailing Address: `4$,EggO�'. / 2750 Keliey Parkway P.O. Box 66 - ----'�" Orono, MN 55356 Crystal Bay, MN 55323-0066 To Cunent Owner: Address: I�f�� X S7'. City Ordinance 199 requires that each existing on-site sewage treatment system in Orono be inspected every rivo years. The on-site sewage treatment system at the above address has been inspected and appears to fall into the categories checked below. SYSTEM CONFORMITY (1-3): � � "CODE SYSTEM" An ISTS which meets all the location,design and construction staz�dards of the current Orono Municipal Code. 2 "COMPLIANT SYSTEM" An ISTS which does not meet all the location,design and construction standards of the current Orono Municipa]Code but does meet the three foot separation requirement or two foot requirement for systems installed 1996 or earlier,and which is not failing or an unminent threat to public health or safety. 3 "NON-COMPLIANT SYSTEM" A prohibited ISTS;an ISTS located within a designated 100-year flood plain,any ISTS which may or may not meet all the location,design,or construction stanc�rds of die current Orono Municipal Code and which is failing for any reason;and any ISTS with less than three feet of unsaturated soil or sand between the distribution device and the limiting soil characteristics. TANK CONDITION(5-7): � Tank inspection indicates: 5 Pumpout not needed at this time. �Septic tanks must be pumpLd out this year (city code recommends tanks to be pumped out once every 3 years. Tank was last pumped 1-1�j'� �� ). Make sure septic tanks are pumped through manhole and not through white insaection pipes This allows for the aroper cleanin�. Keep water softner and iron filter discharge out of septic system to prolong life of drainfield Ask pumper to test alarm float to verifv alarm is still workinQ in your house. The alarm warns owner that septage is about to backup into basement 7 Inspection risers missing-tanks could not be inspected. Inspection risers(4" dia.pipe)must be installed in each tank. If tanks have not been pumped out within the last three years,they should be pumped out now. DRAINFLELD CONDITION 8-10 : d' � Drainfield is dry,no surfacing evident. 9 Some evidence of surfacing,not critical yet. 10 Drainfield is saturated and visibly discharging untreated effluent to the surface. Contact the City Inspector immediately.Repairs must be completed within 90 days. COlVIMENTS: /`'��'='^� �Oc;�S ��C�_, �u'� Sc �:�L �-z^�kS S r,r �uc��. � -ZZ—�''� ��^� � Date of Inspection Matt Bolterman - Septic System Inspector Note: In the event that this inspection report is used to satisfy the requirements for a mortgage or other transfer of property,be advised that this report does not guarantee or certify that an existing system will continue to function properly, but is merely an opinion of the adequacy of the system under current conditions based on the available information. � o� o :,:, o ��=-� CITY of ORONO � �5��'=��`�� titi hi�;�, o�� ,�, :��h � � ��.';��„� �g�G � Street Address: Mailing Addrass: �Eg�iO 2150 Kelley Parfcway P.O. Box 66 Orono, MN 55356 Crystal Bay, MN 55323-0066 95d-�49-4600 To Current Owner: Address: i �66 d-' � �£�a F�X st. City Ordinance 199 requires fhat each existing on-site sewa�e treatment system in Orono be inspected every two years. The on-site sewage treatment system at the above address has been inspected and appears to fall into the categories checked below. SYSTEI�t CONFORMITY 1-3 : � 1 "CODE SYSTEM"An ISTS which meets all the location,design and construction standards of the cunent Orono Municipal Code. 2 "COMPLIANT SYSTEM" An ISTS which does not meet all the location,design and construction standards of the current Orono Municipal Code but does meet the three foot separation requiremcnt or two foot requirement for systems installed 1996 or cazlicr,and which is not failing or an imminent thrcat to public hea]th or safety. 3 "NON-COMPLIANT SYSTEM" A prohibited ISTS;an iSTS located within a designated 100-ycaz flood plain,any ISTS which may or may not meet all the location,design,or conswction standards of the curren[Orono Municipal Code and which is failing for any reason;and any ISTS with Icss than three feet of unsaturated soil or sand between the distribution device and the limidng soil characteristics. TANK CONDITION(5-.7�: � Tank inspection indicates: 5 Pumpout not needed at this time. 6� Septic tanks must be pumped out this year (ciry code requires tanks to be pumped out once every 3 years. Tank was last pumped S-I�-�L ). hlake sure septic tanks are pumped throuQh manhole and not throu�h white inspection pipes. This allows for the proper cleanin�. 7 Inspection risers missing tanks could not be inspected. Inspection risers(4"dia.pipe)must be installed in each tank. DRAINFIELD CONDITION -1Q : � 8 Dninfield is dry,no surfacin�evident. 9 Some evidence of surfacing,not critical yet. 10 Drainfield is saturated and visibly dischar�in�untreated effluent to the surface. Contact the City Inspector immediately.Repairs must be completed within 90 days. CO��NTS: SYS-�� I��S ok_ �� ,�KS wa��:� � ��enr. �5-6- (��- ��C !��,.-�..-_ Date of Inspection Matt Bolterman- Septic System Inspector In the event that this inspection report is used to satisfy the requirements for a mortgage or other transfer of properry,be advised that this report does not guarantee ify that an existing system will continue W function properly,but is mercly an opinion of the adequacy of the system under current conditions based on the availab(e ation.