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Home My WebLink Aboutwell info MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. � WELL RECORD 5 4 8 4�4 Minnesota Statutes Chapter 1031 Township Name Township No. - Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed Gr.r�no 71� �� :� _ �:`:t,��.. ,. 1tif��° � 11-4-:�<;. Numerical Street Address and City of Well Location or Fire Number DRILLING METHOD (j�=j ��-jyM �� -�� c�c'";(;� ��p,, ❑ CableTool ❑ Driven ❑ Dug � �� {� ❑ Auger Q�Aotary ❑ Jetted � Show exact location of well in section grid with"X". �; Sket h j,nap of well location. ❑ n r" ��'�" howing property lines, N �,.=�� roads and buildings. DRILIING FLUID . i � � � i � :1: �:_t'_ __r__.y_ _i _1_ i � � � � i ,USE ❑ Heating/Cooling __a_ _�_ �_ �_ L`'I Domestic ❑ Monitoring ❑ Industry/Commercial W � � � � E ❑ Irrigalion ❑ Public ' T ❑ Test Well ❑ Dewatering � Remedial _1_ _1� __ 1' I ❑ � � i : � � i f•mi. CASING Drive Shoe? ❑ Yes ❑ No HOLE DIAM. i '—;' �' — —�' I � `_ ❑ Steel ❑ Threaded ❑ Welded 1 J( w:. �' �Plastic ❑ � 1 mil�—� CASING DIAMETER WEIGHT PROPERTY OWNER'S NAME �' in.ro �1-�ft� Ibs./ft. � ��,� `+{�. .�s.t2 �etirrIl in.to fl. Ibs./ft. �j ��Yp �E_�. Mailing address if ditterent than property address indicated above. in.to tt. Ibs./fl. in.to ft. SCREEN OPEN HOLE Make ��1 from ft.ro ft. TYPe �:3�i �.(�S ��.�E'�. Diam. SbVGauze �f` Length '' � Set between '�� ft.and '�� ft. FITTINGS: STATIC WATER LEVEL GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO 3 1 1^"t�'—i��: MATERIAL �, h�� below O above land surface Date measured Cry ..� �r;.: PUMPING LEVEL(below land surface) _ .lt't�' ... ti Jt� tt. after hrs.pumping g.p.m. � WELL HEAD COMPLETION *S- r`.' �4b �L11'..£.'4».�c:�'L-'.i. �itless adapter manufacturer Model ❑ Casing Protection �I 12 in.above grade GROUTING INFORMATION Well grouted? �„'I Yes ❑ No Grout Material ❑ Neat cement �entoni� from �� to_ —� R. f ❑ yds. C3`bags from from to ft. ❑ yds. ❑ bags NEAREST KNOWN SOURCE OF CONTAMINATION -. : � . '_.. "� ::i... ,, i. : � s�-, feet .�f�:r .. � direction - .. x � tyPe Well disinfected upon completion? �Yes ❑ No PUMP ❑ Not installed Date installed �F"�G:.L.�'J'Y Manufacturer's name ��-'� Model number ��S�=�7��' sL�k{��')t� HP�._ Volts 4�� Length of drop pipe ')��i ft. Capacity i}� g.p.m. Pressure Tank Capacity � Type: C�;Submersible ❑ L.S.Tu�bine ❑ Reciprocating � Jet ❑ � ABANDONED WELLS Does property have any not in use and not sealed well(s)? ❑ Yes QtNo � 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. �,.� Jr.��.%�.✓.'� Vll��,�.rs �... Use a second sheet,i�needed ��.a��a �.� T.�VI.. G.! f l L, REMARKS,ELEVATION,SOURCE OF DATA,eta Licensee Business Name Lic.orReg.No. j 1"i--�--9�; �.��"►�' ��!� A P R 4 1995 ��Authorized Representahve Signature Date ts.�°. �'.l�"jc.`!1�� —��.-1''-- Name ol Driller Date LOCAL COPY 5 4 8 4 7 4 HE-01205-04(Rev.5/92) . ` �I'ivin City 7Nater Clinic, Inc. 61713th Ave So • Hopkins,Minnesota 55343 • (612)935-3556 � 11/09/1994 Stodola Well Drilling 15306 Hwy 7 Minnetonka MN 55345 938-21 1 1 REPORT OF WATER ANALYSIS Lab#: 24399 Our Laboratory reports these analytical results, determined on a sample taken by YOU on 1 1/04/1994 f�om the following location: Liz Hawn 625 Spring Hill Road Orono,Mn u�,q�� s�s�7� Coliform Bacteria <1/100 ml Nitrates Nit�ogen <1.0 mg/I The results of t�`hese tests l�dicate that this well is producing water that meets the standards for F.H.A., V.A., or conventionai loans. This report is an analysis for colifo�m and nitrate only and does not include analysis of Lead and ott�er contaminants. (Unless as specified by client). ,` Wa er CIiMc, Inc. .\ Bill V � Brian B i n,��y�o.��.bu�.bry con.dw�e�ioow Wticr/4ylvwu Rwgo�qs Roiber W�la ClamiaM Lab CaniC�ution/017-0�3-119 Minnesota Well and Boring ,a WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Sealing No. H 5 5 0 9 8 �o��ty Name � WELL AND BORING SEALING RECORD Mmnesota u�iq�e No. j�j��, Minnesota Sta�utes.Chapter 103/ or W-series No. i7C",j3►��Zn ILeave blank if nol known) Township Name Township No. Range No. Section No. Fraction(sm. �Ig.) Date Sealed Approximate Date Well �� }�� .S �� 33�-�C�13 �ia ��t,.:� � ��- .. ��t.� or Boring Consiructed Numerical Street Address or Rre Number and City of Well or Boring Location { (� 625 S`��rir� Hili Rcx�c3 Orono, �"Y7• 3�391 Depth Before Sealing � " `�' fl Onginal Oepth � �0 1�. Show exact bcatron of well or boring Sketch map of well or boring Static Water Level ccurate in sechon grid with��X��. location,showing propecly lines. - N ._ �adsi�d t4ai��gs. ❑Approximate I I I I �' �~ �_Vi' I I I I �� Single Aquiter ❑Multiaqu0er ft. � below above land sur(ace i i i i _i_ _�_ _i_ _i_ CASING TYPE W � i � � E a �1 i i i i T �'�` �ya. -r -7- -r- -r i i i i �,.�e teel ❑Plastic ❑Tile ❑Other _i i i i_ � (� � t (} i_ _ i_ _i_ _ S Screen from ��`�"� to � fl. Open Hole from to it. �—i mi�e—►I OBSTRUCTION/DEBRIS/FILL Obsiruction ❑Debris ❑Fill PROPERTY OWNER'S NAME �.. ,._., Lsl�; �;hI1 >�- Type of debris/obs[ruction ''`�``l� r �-'� ;''E-�' �� .� .�'�"�. }"� Mailing Address rf different ihan property address indicated above. + � Obstruction/Debris/Fill removed? Yes ❑No ` PUMP Lp,Removed ❑Not Present ❑ Other ��.4 �y � V 4 � � ` �_ r�,. � `4 t CASING GEOLOGICAL MATERIAL COLOR HARDNESS OF FROM TO FORMATION Diameter Depth Se!in oversize hole7 Annular space initially grouted? If not known,indicate estimated formation log from nearby well or boring. �in.from {" to � f�� k. ❑Yes � ❑Yes ❑No ❑Unknown � in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown M THOD 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. ❑PeAorated ❑Removed in.from to ft. ❑Perforated ❑Removed Type of perforator ❑Other GROUTING MATERIAL g ' �� y .� bags i - Groutin material g��+.�� ``�hom to � ' `-� ft. ards f ti from to ft. yards bags REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING from to fl. yards bags from to ft. yards bags UNSEALED WELLS AND BORINGS Other unsealed well or boring on property? ❑Yes No LICENSED OR REGISTEHED CONTRACTOR CERTIFI�ATION �� '�' � � `� This well or boring was sealed in accordance with Minnesota Rules,Chapter 4725.The information contained in this report is true to ihe best of my knowledge. S E P 2 i 2994 � �� w�. �ussr�c cu., �Nc. �7�7z r Conhactor Business ame License oi Registration No. \.-�- . .,., . {'.',. . .. ,, . .,. .�� . ., . � ..____ i �-�-� . �� ut zed Representative Signatvre Date �ocn��o�v H 5 5 0 9 8 � �e Name ol Person Sealing Well or Boring HE-01434-01