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Home My WebLink Aboutwell info +,,, . . a"` .'-"'�7i"'$i�,-. [. MINNESOTA UNIQUE WELL WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. co,,,,�YNa�„e WELL AND B�RING RECORD � ; � n r� Henne pin Minnesota Statutes,Chapter 103/ � � '•` � � Township Name Township No. Range No. Section No. Fraction WELUBORING DEPTH(completed) DATE WORK COMPLETED , 5 Orono 118N 3W 35 S),�V SW S�, 298 feet f� July 12, 2011 GPS DRILLING METHOD LOCATION: Latitude N degrees 44 minutes 5g seconds 45.t�6 , Longitude __ g �� i..:CableTool -'I Driven _''�..Dug "� W de rees _ 93 minutes 33� seconds 04.14 r�Auger �Rotary �-_Jetted House Number,Street Name,City,and Zip Code of Well Location or Fire Number ii � 1190 Lyman Avenue, Wayzata 55391 DRILLING F�UID WELL HYDROFRACTURED? �J Yes �'No � Show exact location of well/boring in section grid with"X:' Sketch map of well/boring location. Be11tOTllte From ft.To tt. Showing property lines, - roads,buildings,and direction. USE :�� No communi pyyg �Monitoring ❑Heating/Cooling � __j___ _;__ ___�_____;_ [] 'ty Environ.Bore Hole ,_�.Industry/Commercial :' -�^•'""""�"-""� ❑Community PWS _ _Irrigation 'L,Remedial --'--- --;--- ---`-- ---�-- `��"', ! ''Elevator �..Dewatering �..� `! -w > w ; ; ; ; E �. � CASWG MATERIAL Drive Shoe? �'Yes ❑No HOLE DIAM. ° --,-- --- ---� .-- T �� Steel �Threaded ;.'Welded �: , , 'f Mlle � � � - � : , , � _ Plastic .---_- - n�. � �-- �-- --• :- `_... ; l � CASING � ��"`^...,,,,,_ Diameter Welght Specifications , S `'�� 4 � to 268 n 10.791bsJft. —_+�� _ �;� ,268 � � i 1 M�ile—� �°: �' � :(,. .. ."_ _ _ —. . — Y - PROPERTY OWNER'S NAME/COMPANY NAME in.to__. . �� ft. _ _._Ibs./ft. _ __._ in.ro__ ft. Brian & Julia Palmer ��.ro— ft. 1es.�h. �� h SCREEN OPEN HOLE � Property owner's mailing address if differen�than well location address indicated above. - - ------ 520 Indian Mound Street, #3B Make_ Maass __ F,om rt. To____ n. � Wayzata, MN 55391 Type �anc�hlocke�,.l o�am. : �� SIoUGauze.__��1111e�S2.I11�11(S1tL0]].e Length �2 ' X 16V�� 1� 1 �� . Set between Z�G ft.and G7V __fl FITTINGS 1�-paCl�er�2 1� r1Ser� ! Phone: (952)475-3220 STATIC WATER LEVEL Measured from��_7ft�, above �_6__ ft.� �Below �Above land surface Date measured�//-L,_1-1 1_ WELL OWNERS NAME/COMPANY NAME PUMPING LEVEL(below land surface) '•�� Sa.111e 23 S ft.after 1 7 hrs.pumping -_-_GO___ __ g.p.m. �t ," WelUboring owner's mailing address if different than properry owner's address indicated above. WELLHEAD COMPLETION 1� C� Ylr1V �� '�� itless/adaptermanufacturer___ Baner Model.__ `�naYYJ s _ �asing Protection _._ __ �2 in.above grade � ]Arigrade(Environmental Well and Boring ONLY) GROUTING7�I,N�F,,,O�RMATION [� ^� p 1 Well gi"Vi'LIaTldYes � �.f�19� G6p 1 5 �/ Grout teria s Neat ceme Bentonit I Concrete ��. er__ � �en�onite � � � 9b � �P� _/ From To __ fL _. . _ _Yds. �Bags GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO From .To_ . ft. _. _.._ j�Yds. �, �Bags MATERIAL From To ft. � Yds. '', J Bags :� Clay BrOWIl M 0 -34 NEARECST KNOWN SOURCE OF COcNTAMINATION r _ J0+ feet J�_. direction `�ept1C �Pe Rocks/Clay Grey M 161 16g Well disinfected upon completion? es ' No PUMP 1 � / Notinstalled Dateinstalled____ iUly 2S� 2�11 '� Sticky Clay Grey M 204 237 - - - — Manutacturer's name �JrU17CifOS n 16550-38 HP 5 �o„S 230/3phase Shale Tan M-H 253 25g ""°de'"�`"be' - _ -- 1 , ,� A 1L Length of drop pipe 1 �4 X 2`f6� _ft. Capacity 1 V _ g.p.m Shale Red Lvi-r1 ZVO Zp4 Type. ubmersible LS.Turbine I Reciprocating �Jet �J ABANDONED WELLS Shale/Sandstone 1 aIl H 296 337 Does property have any not in use and not sealed well(s)? Yes o VARIANCE Was a variance granted from the MDH for this well? �J Yes o TN# WELL CONTRACTOR CERTIFICATION This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. �� The information contained in this repor�is true to the best of my knowledge. Use a second sheet,il needed. REMARKS,ELEVATION,SOURCE OF DATA,eta C-163 E.H. Renner & Sons, Inc. 1431 `' _ __—__ _ — Licensee Business Name Lic.or Reg.No. �� Elevation: 970 ft MSGS Quad: A105 :.,..--,_.� Open hole collapsed. Maass sandblocker screen was 467 10/07/11 111Stalled. Certdied Rep s�n a i a�ure ��erhfied Rep.No. Date LOCAL COPY 7 7�0 6 2 Ed Renner Name of Driller � IC 140-0020 HE01205-12(Rev.12/08) MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring Q��Q WELL OR BORING LOCATION Sealing No. H N eJ County Name WELL AND BORING SEALING RECORD Minnesota Unique Well No. x or W-series No. Henne lri Minnesota Statutes,Chapter 1031 «Qa�e e,a�k;,�o,k�o„�, Township Name Township No. Range No. Section No. Fraction(sm.-�Ig.) Date Sealed Date Well or Boring Constructed s Orono 118N 23 35 S�V SW� June 23, 2011 Unknown �atitude� degrees� minutes�L �econds De th Before Sealin 91 OCATION: Longitude� degrees� minutes P 9— 7� �t. Original Depth__. __ ft. �,seconds AOUIFER(S) STATIC WATER LEVEL Numerical Sireet Address or Fire Number and City ot Well or Boring Location �Single Aquifer U Multiaquifer 1190 Lyman Avenue, Wayzata 55391 ,�{WaerO-Supply Well ❑Monit Well �� easured I Estimated Date Measured Show exact location of well or boring Sketch map of well or boring G/ in section grid with"X." location,showing property L�Env.Bore Hole ❑Other _ _ ___. fc �3�ielow ❑above land surface N lines,roads,and buildings. CASING TYPE(S) � --'--- --J--- --`-----'-- .: _ �teel r]Plastic ❑Tile ❑Other_ _ _______ � --'--- --'--- -"�" "'`-- WELLHEADCOMPLETION �- W ; ; ; ; ET ,. � � _;____r_ �+ • Outside: ❑Well House ��- ❑At Grade Inside: �asement Offset �-� --�--- --_--- .� \� �� :�, ; , , , , 'F Miie � itless A p dUnrt ❑Buried ❑Well Pit � � ��'' �I P' da te , --,-- --;--- '-- ---.- 1 ' - ❑e�nea ' S j]Well Pit ❑Other F—1 Mile� '�,__J O[hBf PROPERTY OWNER'S NAME/COMPANY NAME CASING(S) ' ' Palmer Diametel O Depth p L Set in oversize hole? Annular space initially grouted? _ Property owner's mailing address if different than well location address Indlcated above O V -�� in.trom to___,____ ft [,Yes ❑No ❑Yes ❑No �Unknown �, 52,� 111C11211 MOU11Cl StTeet� ft3B in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown Wayzata, MN 55391 in.from to ft. ,.��Yes ��No I_1 Yes �No ❑Unknown WELL OWNER'S NAME/COMPANY NAME SCREEN/OPEN HOLE Well owner's mailing address if different than property owner's address indicated above Screen from_ "V _to___�� ft. Open Hole from _to _ft. OBSTRUCTIONS ❑Rods/Drop Pipe ❑Check Valve(s) ❑Debris ❑Fill �Vo Obstruction Type of Obstructions(Describe) GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obsiructions removed? ❑Yes ❑No Describe FORMATION PUMP If not known,indicate estimated formation log from nearby well or boring. C1�1�/ 17TOWI7 3 Type. _ J Removed ;,�Jot Present ❑Other Sand/Gravel/Cl y Grey � 7 METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: f�No Annular Space Exists ❑Annular Space Grouted with Tremie Pipe ❑Casing Perforation/Removal in.from to ft. ❑Pertorated ❑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.) Neat Cement 0 91 15 ' GroutingMaterial___ ___ ___ ,_ trom to ft. yards____ .__ bags from to ft. yards bags from to ft. yards_ bags OTHER WELLS AND BORINGS REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING � �J�, o � Other unseaied and unused well or boring on property. Yes �i'�lo How many. _ . Geology From: LJN #778062 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 ta the best of my knowledge. E.H. Renner & Sons, Inc. 1431 � �� D __ _ __ _ _ _ Lice;<�Business Name License or Registration No. `'' ", � �e�� 467 10/7/11 �/�/�+�g --- - - -- -- . Lrt,rV�ding to MN Stat� Re�ulatiQr�s Certi/iedRepre ntativeSignature Certi/iedRep.No. Date —I Kevin Scheiterlein �o��o� H 292795 _ fi —_ .—_. _. _ —.. __ _. ...__- ..._.._ —. _— ____ __ __ . Name ol Person Sealing Well or Boring . ,HE-01434-12 IC#140-0423 s/OSR