The URL can be used to link to this page

Home My WebLink Aboutwell info � Minnesota Well and Boring WELL OR BORiNG LOCATION MINNESOTA DEPARTMENT OF HEALTH SeaGng No. H � ? �o��Y Name WELL AND BORING SEALING RECORD^^��eso�a u��q�e No �P� Mmnesofa Staiutes.Chapter 103/ o�w-se�ies No. S�1S5O2 �Leave b�ank i�no�knownl Township Name Townsh�p No Range No Section No Fraction(sm •Ig.� Date Sealed Approximate Date Well � �4� �� I/a 'I, 14 � or Bonng Consiruc�ed �� L Numencal SUeet Address or Fve Number and Gty of Well or Bonng Locahon 32h5 Ct � U 5535b Deplh Before Seahng Z�� fl Onginal Depih �1}a�� ft. Show exact localwn ol well or bonng Skelch map of well or bonng Sta6c Water Level �Accurate in secUon gnd wdh"X location.showmg propeny hnes. --rcadz.aod,buddings. ❑Approxima�e N r t I � -�- --- -� �- � ,�[ QS i- -i ' I I � -- U'Single Aquder ❑Multiaquifer �tt. x below aboe�e land surtace -�- -�- - - -�- i CASING TVPE � W ` i T (-..._. _ '_ _�_ _r_ _i_ -� ]� i i i �` ❑Steel L7 Plashc ❑Tde ❑Olher �mi4 _i_ O� ; _i_ � �----�"�"'�� Screen from �� lo �� fl. Open Hole irom to ft S ...--. ��'"'�� O,�B[STRUCTION/DEBRIS/FILL � � LTObslruc�ion ❑Debns ❑RII I PROPERTY OWNER'S NAME Dvn �IeI aber ir�er pipe w/�u1�. �p Type ol debns/obsiruc�ion . Mading Address�I ddferent than property address�ndicated above. y, Obs�ruction/Debris/Fill removed� LJ Yes ❑No PUMP LSRemoved ❑Not Present ❑ Other CASING GEOLOGICAL MATERIAL COLOR HARDNESS OF FROM TO . FORMATION Diameter Depih Set m oversize hole? Annular space mrtially grouted? II not known,indica�e eslimated formation log from nearby well or bonng. w in.irom O to �� ft. ❑Yes �No ❑Ves ❑No ❑Unknown �7► �J i 30 �� 1�9 in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown in.(rom to tt. ❑Yes ❑No ❑Yes ❑No ❑Unknown METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: �No Annular Space Exists ❑Annular space grouted with iremie pipe �� ❑Casing PerforationlFemoval in.(rom �o fl. ❑Per�oraled ❑Rer�noved in.irom �o ft. ❑Per�orated ❑Removed Type of perforalor ❑Other GROUTING MATERIAL T1P_8t CP.L�![]t I� Grouting matenal from to � � tt. yards bags from to ft. yards bags � REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING from to t�. yards bags �.,�,� from �o ft. yards � bags UNSEALED WELLS AND BORINGS Other unsealed well or boring on property? ❑Yes t7 No �ICENSED OR REGISTEHED CONTRACTOR CERTIFICATION � This well or boring was sealed in accordance with Minnesota Rules,Chapter 4725.The mformahon contained in Ihis report is � irue to ihe best of my knowledge. � �PN � 2 199�0 I7an Stodola '�TeII $ri1li� Co., Inc. 27�72 Confractor Business me Lrcense or Reg�sbafron No -- --i fr23-95 �?. ufh �zed Representative Signafurt Date Jim Axrtanson t1��,��' •• ��7 Name ol Person Seal�ng Well or Bonng HE-01434-Oi WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. County Name WELL RECORD 5 613 4 2 Minnesota Statutes Chapter 1031 Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed n. � 23 29 44T0002 �. 216 ;_�'_�S Numerical Street Address and Ciry of Well Location or Fire Number DRILLING METHOD c ❑ Cable Tool ❑ Driven ❑ Dug � 3J� ❑ Auger ❑ Rotary ❑ Jetted Show exact location of well in section grid with"X". Sketch map of well location. ❑ Showing property lines, N roads and buildings. DRILLING FLUID ii {..._._.__...,_._..; . :�_ ' I i _y -L- ___F .. . _'r' ti- � � � � ❑ Heating/Cooling _a- _-- i- ,_ � ,USE Domestic ❑ Monitoring ❑ Industry/Commercial W i � � E � �Irrigation ❑ Public _1_ _s_ __ __ T ❑ Test Well ❑ Dewatering O Remedial I � ' ' '/_-mi. f 1 CASING Drive Shoe? ❑ Yes ❑ No HOLE DIAM. --�- �- ; -r- � o`-y'r�L ❑ Steel ❑ Threaded ❑ Welded � �Plastic ❑ �I milr� .__ ` ,� � CASING DIAMETER WEIGHT PROPERTY OWNER'S NAME �I___in.ro�Q�ft. �JDR Z1. Ibs./ft. I 7�� - in.to_ _ft. Ibs./ft. �in.to�� Mailing address if different than property address indicated above. in.to ft. Ibs./fl. in.to ft. SCREEN_��_ OPEN HOLE Make ��1 from ft.to ft. 1 Type Diam. SIoUGauze 1(1 Length �� Set between �ft.and�i_i-tt. FITTINGS: O� G11 STATIC WATER LEVEL S GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO tt.Ll below ❑ above land surface Date measured MATERIAL X � PUMPING LEVEL(below land surface) ft. after hrs.pumping_ n�g.p.m. WELL HEAD COMPLETION L'lc.�v 1.e1,2� $ 2 Z ]'Q Pitless adapter manufacturer �"�1��£�3t�r Model J ❑ Casing Protection �12 in.above grade � GROUTING INFORMATION Well grouted? �Yes ❑ No ' Grout Material ❑ Neat cement �Bentonite from�to�ft. �_ ❑ yds. � bags � T�$1� S t�n �5 from to ft. ❑ yds. ❑ bags �Ju from to 8. ❑ yds. ❑ bags NEAREST KNOWN SOURCE OF CONTAMINATION Sl�t �Y.'Q�112 S 1S5 l7 �S� feet � direction G�ty �ype Well disinfected upon completion? �] Yes ❑ No PUMP ❑ Not installed Date installed 6-IU--95 /$� G'rs� S � �1 anufacturer's name ��+��,it us Model number �Gc++ 1 ets�f'� HP 7//. Volts 7� —�re� 1 1 Length of drop pipe ft. Capaciry g.p.m. '� Y�1�Q�7 � 21 2i pressure Tank Capacity Type: {:l Submersible ❑ L. . ��r Jet ❑ A s ABANDONED WELLS Does property have any not in use and not sealed well(s)? ❑ Yes No WELL CONTRACTOR CERTIFICATION - t 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,i/needed �OTl st(�,Q�,$ �'IQ1,1 ��,Z�11� CQ�� yjjC• G71/2 REMARKS,ELEVATION,SOURCE OF DATA,etc. �icensee Business Name Lic.orReg.No. � : 6-9-95 'v�� -Au ho z Representative Sig�� Date N i 2 1��Ju Ered Leitrv 6-�3-95 JP. Name o Driller Date LOCAL COPY 5 613 4 2 HE-01205-04(Rev.5/92) � � '� WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. County Name WELL RECORD � �$ 5 0 2 �p� Minnesota Statutes Chapter 1031 Township Name Township No. � Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed n. Urc�o 118 ��.; 2� F�r=_-,(�t}t�;t: �. 14}' 9-9-�4 Numerical Street Address and City of Well Location or Fire Number DRILLING METHOD 32£a5 Cou�tt Fi��ti 5 �n I�CE, Mt�. !�35(i ❑ Cable Tool O Driven ❑ 0�9 y g 3� ❑ Auger �Rotary ❑ Jetted Show exact location of well in section grid with"X". Sketch map of well location. ❑ 3 Showing property lines, N roads and buildings. DRILLING FLUID � � _i _i_ E`&�tE'_r' --r"-�- � � i � i � ,USE �Domestic ❑ Monitoring `� Heating/Cooling "-+" --- �- �- ❑ Industry/Commercial W � � � � E ❑ Irrigation ❑ Public ' T ❑ Test Well ❑ Dewatering � Remedial _1_ _1_ __ __ I ❑ _ � � � f-mi. � , CASING Drive Shoe? ❑ Yes ❑ No HOLE DIAM. --�- � � ' 1 � �- - -r- ❑ Steel ❑ Threaded ❑ Welded � LkPlastic ❑ - h �—l milv� � � � wt� 4 CASING DIAMETER WEIGHT � PROPERTY OWNER'S NAME � L f,� () Cs in.to j�.~i ft. SC�I". �i'� Ibs./ft. � ��0 3C' h. �.i I_.�� ,t�a �' in.to ft. IbsJft. ��o t fl. , Mailing address if different than property address indicated above. in.to ft. Ibs./fl. in.to ft. SCREEN��,.�� OPEN HOLE Make a�u �u� from ft.to ft. Type �J � 1�$ � FA��{ Diam. SIoUGauze !` Length '�� Set between �,% ft.and � ft. FITTINGS:�• STATIC WATER LEVEL GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO J°f-�' MATERIAL ft. ¢�below ❑ above land surface Date measured �'g-�� PUMPING LEVEL(below land surface) - t'� �i "':t �-+ `'I�`� ��-�� •� {' � �t�j ft. after �-i hrs.pumping �� g.p.m. 77 WEIL HEAD COMPLETION Clay ��1it75tJ J L+ L�i r J}�Pitless ada ter manufacturer p �'�W[3'tE.'_"T� Model ❑ Casing Protection �12 in.above grade C�Y �"Z `� �•�}' �J� GROUTING INFORMATION Well grouted? �;Yes ❑ No �,�Y (�'�3��I '�(�1 � �� '�lii�� Grout Material ❑ Neat cement �Bentonite from �' to .3�%ft. < ❑ yds. � bags �I from to ft. ❑ yds. ❑ bags 5�� c� S ��t�� 1�3�� from to ft. ❑ yds. ❑ bags NEAREST KNOWN SOURCE OF CONTAMINATION.1 �p f/..L, �� feet ,� v'7;1 j T1 direction �_type Well disinfected upon completion? [�(Yes ❑ No PUMP (�_1 L.�r� � ❑ Not installed Date inst�JJe��„��,� Manufacturer's name SiE.. �w��: Model number �Volts �� '" Length of drop pipe �L�l tt. Capaciry �t g.p.m. Pressure Tank Capacity ��f��1C.�� LG Type:'�5 Submersible ❑ LS.Turbine ❑ Reciprocating ❑ Jet ❑ ABANDONED WELLS Does property have any not in use and not sealed well(s)? ❑ Yes O7$Jo 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. DC�V :,"I�C�DGi�, WEI,L tYtI.Lt,IIVG GU., �I�SC;. 27 7 74 Use a second sheet,il needed REMARKS,ELEVATION,SOURCE OF DAT t Licensee Business f�me -- (.ic.orR g.No. MAR 3 �� , � �9-9� i�r �� . � /•� ✓ Authonzed RepresentaUve �gnature Date r•r�rz z�ei�y y-9-5�� i �� NameolDriller Date i ' LOCAL COPY 5 4 8 5 0 2 HE-01205-04(Rev.5/92) � � . � � 9 �` 2'zvin Cit 7Nater Clinic, Inc. ,� y � 61713th Ave So • H�kins,Minnesota 55343 • (612)935-3556 09/14/1994 Stodola Well Drilling 15306 Hwy 7 Minnetonka MN 55345 938-2111 REPORT OF WA'TEIt ANALYSIS Lab�: 23968 Our Laboratory reports these analytical results, determined on a sampie taken by YOU on 09/09/1994 from the foliowing location: Don Helqager 3Z65 Cty Rd• Orono,Mn i�niqu�ii 54850Z Coliform Bacteria <1/100 ml Nitrates Nitrogen <1.0 mg/I The results of these tests indicate that this well is producing water that meets the standards for F.H.A., V.A., or conventional loans. This report is an analysis for coliform and nitrate only and does not include analysls of Lead and other contaminants. (Unless as specifled by client). r Clinic, Inc. Bill s Brian ir ��r c�nsa�.� w.tw aody.r Re��4 sa'iR w.fer cbesio.la "t Minnesota Well and Boring H 5 9 4 9 � WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Sealing No. CouNy Name WELL AND BORING SEALING RECORD M��neso�a u��qUe No. '�a��j Minnesota Statutes.Chapter 103/ or W-senes No. ILeave blank if not knownl Township Name Township No. Range No. Section No. Fraction(sm. �Ig.) Date Sealed Approximate Date Well ��r�� p �� g �4�_��4 �� or Boring Constructed c7 Numencal Street Address or Fire Number and City of Well or Boring Location �j _ 3265 County Raaa 6 Long Lake, �. ��3�j Depth Before Sealing ��'" fl Original Depth �� fl Show exact location of well or boring Sketch map of well or boring Static Water Level �Accurate in section giid with"X'�. bcation,showing property lines. N y�� -j roads.and buildings. ❑Approximate � � , , `—� �� i . -,- -,- -;- -; U� �Single Aquifer ❑Multiaquifer ��ft. � below above land surtace -'- -�- -i- -'- v iJ��!I CASING TVPE W i i i i E � � � � T _i_ _�_ _r_ _i_ � f i i i � j �Steel ❑Plastic ❑Tile ❑Other �mile -'- -;- -`- -'- � � _' i32 136 S ; Screen from to R. Open Hole from to ft. c N—7 mile—� . ,, i t OBSTRUCTION/DEBRIS/FILL �Obstruction ❑Debris ❑Fill -�- PROPERTY OWNER'S NAME }�U71 �E.'I.C��"tt7E'.Y' f1 �q� Type of debris/obstruction � r�� /r`��r Mailing Address i(different than property address indicated above. ObsVuction/Debris/Fill removed? �Yes ❑No PUMP �Removed ❑No�Present ❑ Other�;..��,_�_. CASING GEOLOGICAL MATERIAL COLOR HARDNESS OF FROM TO FORMATION Diameter Depth Set in oversize hole? Annular space milially grouted? I(not known,indicate estimated formation log from nearby well or bonng. �• in.from �_to �— fl. ❑Yes �No ❑Yes ❑No ❑Unknown , in.from to fl. ❑Yes ❑No ❑Yes ❑No ❑Unknown in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: [�No Annular Space Exists ❑Annular space grouted with iremie pipe ❑Casing Perforation/Removal in.from to ft. ❑PeAorated ❑Removed in.from to ft. ❑Perforated ❑Removed Type of perforator ❑Other GROUTING MATERIAL Grou�ing material T1AA�' t'A7►1PM'1't' from �_to �ft. yards �_bags from to ft. yards bags REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING from to ft. yards bags from to ft. yards bags UNSEALED WELLS AND BORINGS Other unsealed well or boring on property? ❑Yes �No 1995 LICENSED OR REGISTERED CONTRACTOR CERTIFICATION AP R � This well or boring was sealed in accordance with Minnesota Rules,Chapter 4725 The informa�ion contained in this report is true to the best of my knowledge. IXi�� 3.C'cDGi,A t�'EZT. DRIIJ...I1VG L�)., II�:. �71%� �' Conhactor Business Na e .� License or Registration No. i ;�,. - Representative Signature Date LOCFlL COPY H 5 9 4 9 8 T� �`� Name ol Person Sealing Well or Boring H601434-01