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Home My WebLink AboutWell info � . . � WELL��OCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. '. CountyName WELL AND BORING RECORD . � $ � 4 �` 5 ��SnE��1n Minnesota Statutes Chapter 703/ Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed n. c.�rc�ri�� i 1 i 2 i 11 ,�, ,. �. �`_%;J' 6--�-�6 House Number,Street Name,City,and Zip Code of Well�ocation or Fire Number DRILLING METHOD �4��7 ��C)I E.'.�111� DT1.V� �Ci7�t� �1.��.'4��-.1 ❑ Cable Tool ❑ Driven ❑ Dug t � � ❑ Auger LSJ�Rotary O Jetted Show exact location of well in section grid with"X". Sketch map of well location. ❑ C Showing property lines, � roads and buildings. DRILLING FLUID N �,J �C'.]'i�C?T11L_� _i i i �_ � `�l _ ___ ___ _ � USE ❑ Monitoring ❑ Heating/Cooling i i i i y � �Comestic ❑ Community PWS ❑ Industry/Commercial _i_ _�_ _i_ _i_ }� � Irrigation � � � � � ❑ Test Well � Noncommunity PWS ❑ Remedial W ET i i i \,; ❑ Dewatering ❑ -r -�- -r- -r j i i i � - � '/ZM,e ;� �' ] CASING Dnve Shce? ❑ Yes ❑ No HOLE DIAM. _�_ _ i_ „� ❑ Steel ❑ Threaded ❑ Welded -L- -�- � � —r...� i i i i i � OX?lastic ❑ s �--1 Mile-� CASING D.�AMETER WEIGHTc ^� La �ti� +.7�.c.1 ! ��FCt. �E.: PROPERTY OWNER'S NAME in.to ft. Ibs.ttt. in.to ft. �G�1�= �1i'�li.;(iZ; �t t'S£'`,c.tC..1::t:�S in.to ft. Ibs./ft. +� t�,t f—f'`�,i�?`•� �l �[ Property owner's mailing address if different than well location address indicated above. in.to ft. ibs./ft. _in.to_tt. SCREEN OPEN HOLE ��% �n{':Y�'1'3�`rBr1'�7� Make �C?�lll-.��C'?��1 from ft.to R. �ic3�'Zc�Lc�� 1. �_,:�i� C;-- TYPe_ -��y�7 t11 Eu;c% r-...€�P� Diam. SIoUGauze '�.(1!1 t� Length ' Set between �is� ft.and ��.i: fl. FITTINGS: STATIC WATER LEVEL 1 WELL OWNER'S NAME �i� ft. DKbelow ❑ above land surface Date measured -�� PUMPING LEVEL(below land surtace) Well owner's mailing address if different than property owner's address indicated above. ��`N ft. after_ � hrs.pumping g.p.m. WELL HEAD COMPLETION �;pitless adapter manufacturer f!�'fl f.��9j`_E�Y Model ❑ Casing Protection C�12 in.above grade � ❑ At-grade(Environmental Wells and Borings ONLY) � GROUTING INFORMATION Well grouted? �iYes ❑ No HARDNESS OF Grout Material O Neat cement entonite ❑ Concrete ❑ High Solids Bentonite GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO ., from L� � -S�' ft. R= ❑ yds. C�bags ��r`�J �E'��„ti.�M1 .�.j !,i 7(° from -SL7 to�r'r`f�. ��7 Yds. ❑ bags from to ft. ❑ yds. ❑ bags NEARES <NOWN SOURCE OF CONT INATION � �7'� G�.d�-��sJ-'��E� �irE'�' : 1z�.t �;e � feet �/'r��/ direction type Well disinfected upan comp�etion? ❑ Ves ❑ No �-- � L"��" c'��Y1C: `��'3� :.� �?�� `.'�i PUMP ��-„�� ❑ Not installed Date in�lle� Manufacturers name �x j `'� Modelnumber �'��' � % 4 HP � Volts L-l' Length of drop pipe �� ft. Capacity �� g.p.m. Pressure Tank Capaciry ��TI^� �%�� Type: �Submersible ❑ L.S.Turbine ❑ Reciprocating ❑ Jet ❑ ABANDONED WELLS Does property have any not in use and not sealed well(s)? ❑ Yes LI?alo VARIANCE Was a variance granted trom the MDH for this well? ❑ Yes �Jo - WELL CONTRACTOR CERTIFICATION .f Use a second sheet,ilneeded This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. REMARKS,ELEVATION,SOURCE OF DATA,etC. The information contained in this report is true to the best ot my knowledge. �tECE11�E� �.:� ��x::�, �.�:��r� r�rut��r� c�:��., ar�c. <;��;s: Licensee Business Name Lic.or Reg.No. FEB 2 Q 1997 ,. �._ �. �-�-Q� ,�' ;/�� _;�-�� Authorized Representahve Srgnature Date CtTY OF ORO�O 1's•L-�: Leiby t�w�-•;�, � p� �,.5 �, � f, r..-. Name ol Driller Date ry:, � °'� � ' ' � b`' � - ` HE-01205-OS(Rev.1/95) ._ �..._ . ...._._. __ ..,_._. _ �_ ___ _ _ � ______.�_.... __._ _ _� _ —�..--.� _....�_..._ r � �w�� c�t �a�� c��, .�,�. � 617 13th Ave So • Hopkins, Minnesota 55343 • (612) 935 - 3556 06/13/199s Stodola Well Drilling 15306 Hwy 7 Minnetonka MN 55345 938-2111 REPORT OF WATER ANALYSIS Lab#: 29854 Our Laboratory reports these analytical results, determined on a sample taken by CLIENT on 06/03/1996 from the following location: 148T SHORELINE DR WA12AT/4�MN UNIQUE#580425 Colifam Bacteria <1/100 ml Nitrates Nitrogen <1.0 mg/I The results of these tests indicate that this well is producing weter that meets the standards for F.H.A., V.A., or conventional loans. 7hls report is an analysis for coliform and nitrate only and does not' Gude analysis of Lead and other contaminants. (Unless as specified by Gient). at Clinic, Inc. Bill ^°�ly'at 1.6°r'co�' �� w,c«ao�lr�� soib.wu«ch�io.r Lab CaUfiation i 027-033-119 wELL OR 6tORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring H 10 819 5 . ri WELL AND BORING SEALING RECORD Sealing No. Coun Name Minnesota Unique No. F�I121"�'�lIi Minnesota Statutes,Chapter 1031 or W-series No. (Leave blank ii not known) Township Name Township No. Range No. Section No. Fraction(sm.�Ig.) Date Sealed Date Well or Boring Constructed �E�% ��} � � �� % % % Numerical Street Address or Fire Number and City of Well or Boring Location � "� i ��/ ShcYr�li_ne �1L'� �C?I1CJ� �. .�i�� Depth Before Sealing � 7� ft. Original Depth �/ � ft. Show exact location of well or boring Sketch map of well or boring AQ ER(S) STATIC WATER LEVEL in section grid with"X". location, showing property ingle Aquifer ❑ Multiaquiter ; � lines,roads,and buildings. N ;� WELL/BOHING �vleasured ❑ Estimated � � ; � :�� '�NaterSupply Well ❑Monit.Well l . � --;-- — - -�-- - �--�----� ❑ Env.Bore Hole ❑Other �� ft. �ielow ❑ above land surface W -�-- -�-- -i-- --�-- E '4�.j 1. _�.„, CASING TYPE(S) . � � � -•---- � i , � � � �_ `, i , '�-- -�-- --�-- --�-- \ �/ I� IXSteel ❑ Plastic ❑Tile ❑ Other � i i i �mlle � _-... j f s-1 -�-- -i-- --�-- --�-- � � ,.�----'__`" ..j i s..�.... CASING Diameter Depth j Set in oversize hole? Annualar space initially grouted? r �r�—1 mile�'a � �r in.from_� to�� ft. ❑ Yes �No ❑Yes ❑No ❑ Unknown i PROPERTY OWNER'S NAME in.from to ft. ❑Yes ❑No ❑ Yes ❑ No ❑ Unknown RC71�Zt Ydc�d� & �SCX:1 � Property owner's mailing address if different than well location address indicated above. in.from to ft. ❑ Yes ❑No ❑ Yes ❑ No ❑ Unknown ��i I .71N��111� U�„1V� SCREEN/OPEN HOLE / / �� , ,�j�3'�j� Screen from�to_.�.�� ft. Open Hole from to ft. ��J—ES J�J 3 083TRUCTION/DEBRIS/FILL WELL OWNER'S NAME ❑ Obstruction ❑ Debris ❑ Fill �Qlo Obstruction / � Well owner's mailing address if different than property owner's address indicated above. Type of Obstruction/Debris/Fill � Obstruction/Debris/Fill removed? ❑ Yes ❑ No PUMP Type GEOLOGICAL MATERIAL COLOR HARDNESS OF FROM TO � Removed ot Present ❑ Other_ FORMATION - If not known,indicate estimated formation log from nearby well or boring. METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: -- No Annular Space Exits - :'� �L1� __ ❑ Annular space grouted with tremie pipe ❑ Casing Perforation/Removal in.from_ to ft. ❑ Perforated ❑ Removed in.from �o n, ❑ Perforated ❑ Removed , Type of perforator ❑ Other GROUTING MATERIAL(S) �� / Grouting Material 1,�y�yC�f��dL� from � to� ft. yards � bags �%�J from to R. yards bags _ � from ro ft. yards bags from to ft. yards bags REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING UNSEALED WELLS AND BORINGS Other unsealed well or boring on properry? ❑ Yes o LICENSED OR REGISTERED CONTRACTOR CERTIfI ATION This well or boring was sealed in accordance with Minnesota Rules,Chapter 4725. The information conlained in this report is true to the best of my knowledge. DC�Id �'�'C�Ld� �dF..LL URII.t.IIvG C�;., L�iC. 4 7 7 7 2 Contractor Business Name _ License or Registration No. F s�/'l .l_�:� - 1�,��'�� ....� � ' ; f �th e�trve Sigrt�dture-'� �Date . � � � r � Name of Person Sealing Well or Boring ' " � � "' y - � — -�� LOCAL COPY H � i,� g � ,� 5 HE-01434-02 10/95R