The URL can be used to link to this page

Home My WebLink Aboutwell info WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. �o��Y Name WELL AND B�RING RECORD 6 5 5 9 7 6 Hennepin Minnesota Statutes Chapter 103! Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed Orono l ll 23 17 1�E i,NEi,SE �i. L07 n 8/3/Ol House Numbec Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD ❑ Cable Tool ❑ Driven [] Dug 12 � ❑ Auger � Rotary ❑ Jetted Show exact location of well in section grid with"X". Sketch map of well location. ❑ _______ Showing property lines, roads and buildings. DRILLING FLUID WELL HYDROFRACTURED? ❑YES eG'l NO N '� i i i Water FROM ft.ta tt. __ _i_ _i_ _i_ ��_��,�.�.......+�+.�� USE ❑ Monitoring ❑ Heating/Cooling i i � i --•..» � �'�"L"�"��-�--��^.. Domestic ❑ Communit PWS _i_ _�_ _�._ _i_ ,,,.1e..�...,..�„+��„�„�.ns..�°r � Irrigation Y ❑ Indusiry/Commercial i i i i ❑ Noncommunity PWS ❑ Remedial w i i i e ^ �y ❑ Erniron.Bore Hole ❑ Dewatering ❑ / ]�[r -i- -i- -i- -; I ` �-�-i"""� CASING Drive Shoe? ❑ Yes p No HOLE DIAM. 4zM�ie i i _i _ _i_ ❑ Steel ❑ Threaded f� Welded -i - i- i i 1 p Plastic � �],(le S -�J.; �—,M�a� j ' CASING DIAMETER WEIGHT 7 PROPERTY OWNER'S NAME 4 in.to �.�Q ft. Ibs./tt. �in.tdi5 ft. �� . i.ro ft. __ Ibs./ft. �In.ta1.Q�ft. Property owner's mailing address if different than well location address indicated above. ___._ __—.in.to____ft. Ibslft. _in.to ft. . P•O.BO� b33 SCREEN OPEN HOLE - '�� Make i�___ from_ ft.to ft. ` Delano, :�+1 55328 T„PQ "�' �(', _ Diam. SIoVGauze__�_.__. _ Length_T_� - Set between _�8�_ft.and�3__fl. FITTINGS: STATIC WATE:R LEVEL WELL OWNER'S NAME �� tt. i7 below ❑ above land surface Date measured A1 Hirseh Builders PUMPING LEVEI(below land surface) �C Well owner's mailing address if different than propeAy owner's address indicated above. _ ft. after___ hrs.pumping. YS g.p.m. �. S$A!� WELL HEAD COMPLETION � Pitlessadaptermanufacturer_. MflAf3 __ Model �j�t ____ Casing Pro[ection _______,_____ L7 12 in.above grade fl At-grade(Environmental Wells and Borings ONLY) .�4 GROUTING INFORMATION Well grouted? [}Yes ❑ No HARDNESS OF Grout Ma[erial �� Neat cement Bentoni�e ❑ Concrete ❑ High Solids Bentonite GEOLOGICAL MATERIA�S COLOR MATERIAL FROM TO from��o�ft. � ❑ yds. ❑ bags - - from _ to __ft. ❑ yds. � bags '� Cl$� YelloM � is from . ._to_ fl. ❑ yds. ❑ bags NEAREST KNOWN SOURCE OF CONTAMINATION �`� , . � . ., L'la� T$II ig 23 .--_-�-. feet _direction __._ - ��type Well disinfected upon completion? ��Yes ❑ No CZSy CaY8 23 3� PUMP ❑ Not installed Date installed ��^ �,F—/j� —_�o�—a—� � Gravel � Sand Mixed �7 iQ7 nnanutacturers name ��:�/: :�,� _ Model number_ _______ � HP H _7 _ Volts �nZ . Length of drop pipe �,[_y_ __ ft. Capacity �� g.p.m. t.:.�v �� Type: Submersible ❑ LS.Turbine ❑ Reciprocating C7 Jet ❑ _ ABANDONED WELLS Does property have any not in use and not sealed well(s)? ❑ Ves No VARIANCE Was a variance granted from the MDH for this wd? ❑ Yes �No TN# WELL CONTRACTOR CERTIFICATION Use a second sheet,if needed 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. REMARKS,ELEVATION,SOURCE OF DATA,etc. $tevens DrillinQ_.� Ehq_ S�rvi��a___��,ggt� Licensee Business Name Lic.or Reg.No. } _/ ---=---.._/C� - L.�., ,I � . . �. . ____-=-. __ __ -- ' ALthorize Representative Signature Date • �A --L�-�f/�) ' ame o rr e� • •Dal� �� 655976 � LOCAL COPY ' HE-01205-07(Rev.2/99) MINNESOTA DEPARTMENT OF HFALTH M�nnesota Well and Boring � y) WELL OR BORING LOCATION Sealing No. ��"� �,�9 i �s� County Name WELL AND BORING SEALING RECORD M�nnesota Urnque No. a., ; , z;{.,, Mmnesota Statutes,Chapter 1031 or W-series No. � � �� ILeave blank 1 nol known) Township Name Township No. Range No. Section No. Fraction(sm.-►Ig.) Date Sealed Date Well or Bonng Constructed : `1') s iir.rr��.�� li7'�' :'�4Y 7 �� ?':� i� lI—.��-00 Numerical Street Adtlress o�Fire Number and Ciry of Well or 8oring Localion /� ��'.7t�i C�)2"l1�::P ��.r'�C+='� �:'07'i� Depth Before Seahng Zv� _ft. Original Depth. n� �' Show exact locatwn of w•ell or poring Sketch map of well or bonng �IFER(S) STATIC WATER LEVEL j in section grid with"X`. locauon, showing property ingle Ayuder ❑ Multiaquiter * lines,roads.and buildings. � N WELUBORING �Measured ❑ Esfimated -_ [�Nater Suppiy Well ❑Monit Well 43 � Env.Bore Hole ❑Other ft. �]below ❑above land surface . W --�- -i-- -i-- --i— E CASING TYPE(S) � � � � � � � � , -'r- -i-- -;-- --�1-- -� [[�,Steel ❑ Plasfic ❑Tile ❑ Other__ ' k mile ' ' ' ' � CASING --`- ---- -�-- --i- Diameter Depih Set in oversize hole? qnnualar space initially grouted? S !� �(}/1 � � ��m�� `� in.from� to_L�tSL ft. ❑Yes ��No ❑Yes ❑No /-'i Unknown '—ti PROPERTY OWNER'S NAME in.from to fl. ❑ Yes ❑No ❑ Yes ❑ No ❑ Unknown �yi �.3- .C.. �':�7 s�. Property owner's mailing address if ElHerent than well loca[ion address indicated above. in.hom to R. ❑ Ye5 ❑No ❑ �es ❑No ❑ Unknown L G .�i�i> FJ33 SCREEWOPEN MOLE ��L 1�� : s�..,.,�: i:;' �:iv >j.3�i{ Screen hom to ft. Open Hole from to R. OBSTRUCTIONS WEII OWNER'S NAME ❑ Rods/Drop Pipe ❑Check Valve(s) ❑Debris ❑Fill �No Obstruction th�.i. l:..L�:::iC:.�i _�P:.u:.�� . Well ownefs meiling address if tliflerent ihan property owner's address indicatetl aDove. Type ot Obstruclions(Describe) �:'??"•= ObsVuctions removed? ❑Yes ❑ No Describe PUMP Type GEOLO(i1CAL MATERIAL COLOH MARDNESS OF FROM TO d Removed ❑ Not Present ❑ Other FORMATION H not krawn,indicate estimeted formatbn log from nearby well or bonng. METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOI.E: � �No Annular Space Exists ❑Annular space grouted with tremie pipe � ❑Casing Perioration/Removal in.from to it. ❑ Pertorated ❑ Removed in.from to R. ❑ PeAorated ❑ Removed ' Type of perforator i ❑ Omer GROUTING MATERIAL(S) �": '� C�ard•._:.., , Grouting Matenal� `• � from � ro �� ft. yards b bags from to ft. yards bays from to ft. yards begs from to__ R. yards bags � REMARKS,SOURCE OF DATA,DIFFlCULTIES IN SEALING OTHER WELLS AND BORINGS ur��kns�wd; Other unsealed and unused well or boring on property? ❑Yes ❑No How many? i LICENSED OR REGISTERED CONTRACTOR CERTIFICATION This well or boring was sealed in accordance wiM Minnesota Fules,Chapter 4725. The infortnation conteined in Mis report is true to Ihe best of my knowledge. 17V�'t.f1..}e:J �1 ..15..._ !Z � .��Y �_., :1. ��.`� a�i � iVJ�� -;g __ S^c. �� Contredor Business Name License a Registretion I'io. � •� � _.._.._._ .___ �� /�y{ C _. fl"'�� G!U ' AuMorized Representative Signature Dete kfcti:�rc1 S�s..>f::�:: H � Neme ol Person Sealing Well or Boring WCAL COPY HE-01434-04 8�98 R