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Home My WebLink Aboutwell info MINNESOTA UNIQUE WELL WELUBORING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. County Name WELL AND BORING RECORD Hennepin Minnesota Statutes,Chapter 1031 742738= Township Name Township No. Range No. Section No. Fraction WELUBORING DEPTH(completed) DATE WORK COMPLETED Orono lion23W 33 81,/ 154 tt. July 26, 2006 GPS DRILLING METHOD LOCATION: Latitude_ degrees minutes—_ seconds El Cable Tool Driven ❑Dug Longitude degrees minutes seconds_ ❑Auger I*otary ❑Jetted House Number,Street Name,City,and Zip Code of Well Location,., or Fire Number 11t�s 160 Old j tal � ong Rd X. � La DRILLING FLUID WELL HYDROFRACTURED? ❑Yes No Show exact location of well/boring in section grid with"X." Sketch map of well location. 111Rts From ft.To Showing property lines, N. N roads,buildings, USE Domestic Monitoring ❑Heating/Cooling n on. ❑Noncommunity PWS Environ.Bore Hole ElIndustry/Commercial - --- - ------`-----`-- ❑Community PWS -.Irrigation ❑Remedial ❑Elevator ❑Dewatering ❑ -"�-"- --i--"----"---r-- CASING MATERIAL Drive Shoe? ❑Yes No HOLE DIAM. W E T ElSteel ❑Thread d E)Welded V lastic --- ------ /z Mile CASING :--- -:-- ---: 1 I Diameter Weight Specifications S81 i 1 Mile 4 in.to 159 ft. lbs./ft. in.to y4" ft. in.to ft. lbs./ft. in,to i��ft. PROPERTY OWNER'S NAME/COMPANY NAME in.to ft. lbs./ft. in.to ft. Leann COO SCREEN OPEN HOLE Property owner's mailing ft g adddress if different than well location address indicated above. Make Ja C CrQ From ft.To . 10 Old "tal UyRd N Type Dia.. Long Lake, MN 553% Slot/Gauze Length Set between ft.and ft. FITTINGS packer STAT W\fTER LEVEL 7-26-06 141 ft.kelow ❑Above land surface Date measured - WELUBORING OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) Leann Goe ft.after hrs.pumping 1 g.p.m. " Well boring owner's mailing address if different than property owner's address indicated above. W LL HEAD COMPLETION 4J%Pitless Adapter Manufacturer Model I I Casing Protection 12 in.above grade ❑At-grade(Environmental Well and Boring ONLY) GROUTING INFORMATION Well grouted? '(Yes ❑No Grout materials 11 Neat ceme.pt_[�entonit 16Concrete ElOth�r From (� To ft. ❑Yds. Bags From To ft. ❑Yds. ❑Bags GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO From To_. _ ft. ❑Yds. Bags MATERIAL — clay yellow {? 45 NEAREST KNOWN SOURCE OF CONTAMINATION Over 50' from sewer feet direction ___type Well disinfected upon completion? ' Yes 11 No Band gravel alXCd 45 78 PUMP ❑Not installed Date installed clay gray 70 145 Manufacturer's name IM Sand gray 145 164 Model Number a HP Volts __.. Length of drop pipe ft. Capacity / g.p.m. Type: ubmersible ❑L.S.Turbine ❑Reciprocating -i-1 Jet -i ABANDONED WELLS Does property have any not in use and not sealed well(s)? ❑Yes KNo VARIANCE ,[ Was a variance granted from the MDH for this well? ❑Yes ANo TN# WELL CONTRACTOR CERTIFICATION This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. The information contained in this report is true to the best of my knowledge. Use a second sheet,it needed. REMARKS,ELEVATION,SOURCE OF DATA,etc. SUVOW Drillias 6 Envireumw l Svc 2255 Licen usiness Na' Lic.or Reg.No. h Authorized Representative Signature Date handy Johnson LOCAL COPY � 742738 �Name of Driller HE-01205-09(Rev.9/05) IC 140-0020 WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring I I / "� 162 County Name WELL AND BORING SEALING RECORD Minnleso aoUnique Well No. L� Hennepin Minnesota Statutes,Chapter 1031 or W-series No. (Leave blank K mt i-) Township Name Township No. I Range No. Section No. Fraction(sm->Ig) Date Sealed Date Well or Boring Constructed Orono 118N 23W 33 SE,,, July 28, 2006 GPS Latitude degrees minutes seconds LOCATION: Depth Before Sealing 55 ft. Original Depth ft. Longitude degrees minutes seconds AQUIFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location [D Single Aquifer ❑Multiaquifer 160 Old Crystal Bay Rd N, Long Lake WELUBORING Measured ❑Estimated Water Supply Well E]Monit.Well Show exact location of well or boring Sketch map of well or boring 14 in section grid with"X" location,showing property E] Env.Bore Hole E]Other ft. �]' below ❑above land surface N lines,roads,and buildings. CASING TYPE(S) 0 Steel ❑Plastic ❑Tile ❑Other W --�- - -- -i-- --i-- E WELLHEAD COMPLETION Outside: ❑Well House Inside:ZI.-Basement Offset 14mnb ❑Pitless Adapter/Unit ❑Well Pit 1 ❑Well Pit ❑Buried S frw. 7 ❑Buried PROPERTY OWNER'S NAME/COMPANY NAME CASING(S) Leann Coe Diameter Depth Set in oversize hole? Annular space initially grouted? Property owner's mailing address if different than well location address indicated above 4145 1 n.from t0 ft. Yes [-]No Q Yes ❑No E]Unknown 60 Old Crystal Bay Rd N Long Lake, MN 55356 in.from 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 Leann Coe 145 155 Well owner's mailing address if different than property owner's address indicated above Screen from t0 ft. Open Hole from t0 ft. OBSTRUCTIONS ❑ Rods/Drop Pipe ❑ Check Valve(s) ❑ Debris ❑ Fill -,a;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 from nearby well or boring PUMP Type St1bID 13,,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 lbs.) Grouting Material Cteat coir-i t from 0 to 155 ft yards I? bags from to ft. yards bags from to ft. yards bags OTHER WELLS AND BORINGS REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING Other unsealed and unused well or boring on property? ❑ Yes 0 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 & Environmental Svc 2255 Contractor Business Name License or Registration No. Authorized Representative Signature D e LOCAL COPY �H241627 .Tason Ramthun Name or Person Sealing Well or Boring