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Home My WebLink Aboutwell info WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. County Name WELL AND BORING RECORD 658611 Hennepin Minnesota Statutes Chapter 103/ Township Name Township No. I Range No. Section No. Fraction WELL DEPTH(completed) nDate Work Completed rono 1 117 123 7 SEANK, SE,/. 394 2-14-01 :635 Tnnj[jaVjeW T.n House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD ❑ Cable Tool ❑ Driven ❑ Dug ❑ Auger X Rotary ❑ Jetted Show exact location of well in section grid with"X". Sketch map of well location. ❑ Showing property lines, /1�p roads and buildings. DRILLING FLUID WELL HYDROFRACTURED? ❑YES ❑NO " Bentonite FROM ft.to ft. USE ❑ Monitoring ❑ Heating/Cooling X Domestic ElCommuni PWS -- -a- - - -- ❑ Irrigation ty ❑ Industry/Commercial ❑ Noncommunity PWS ❑ Remedial WE ❑ Environ.Bore Hole El Dewatering ❑ i /Zrnaa CASING Drive Shoe? X Yes ❑ No HOLE DIAM. ,X Steel ❑ Threaded ❑ Welded 1 EJ Plastic ❑ s i ruin X CASING DIAMETER WEIGHT PROPERTY OWNER'S NAME 4 in.to 370 ft. 231 &Oft. $_in.to Hark Hoon in.to ft. lbs./t6 -1/4 to3_70t. Property owner's mailing address if different than well location address indicated above. in.to ft. lbs./f3 V,to a 9.dt. SCREEN OPEN HOLE J 'f Make from 370 .to 394 ft. Type Diam. Slot/Gauze Length Set between ft.and ft. FITTINGS: STATIC WATER LEVEL WELL OWNER'S NAME 145 ft.X below ❑ above land surface Date measured PUMPING LEVEL(below land surface) Well owner's mailing address if different than property owner's address indicated above. 360 ft. after hrs.pumping S 0 g.p.m. WELL HEAD COMPLETION L*itless adapter manufacturer fdhi t4RVA tlal Model ❑ Casing Protection X 12 in.above grade ❑ At-grade(Environmental Wells and Borings ONLY) GROUTING INFORMATION Well grouted? Wes ❑ No HARDNESS OF FROM TO Grout Material ❑ Neat cement El Bentonite El Concrete ZHigh Solids Bentonite GEOLOGICAL MATERIALS COLOR MATERIAL from 33 to 7 ft. 4 ❑ yds.$ bags from to ft. ❑ yds. ❑ bags sandy cM*dy brown Red 054 54 from to ft. ❑ yds. ❑ bags NEAREST KNOWN SOURCE OF CONTAMINATION sandy clay blue med 54 135 60 feet north direction sewer type Well disinfected upon completion? X Yes ❑ No pipe pe silty sand gray oft f i e 135 2 UMP s� ❑ Not installed Date installed 2"19-01 sandy clay gray med 297 368 Manufacturer's name Myers p Model number HP 1 Volts 230 ShaleXrocx yellow hard 368 394 Length of drop pipe 180 ft. Capacity g.p.m. Type:Xl Submersible ❑ L.S.Turbine ❑ Reciprocating ❑ Jet ❑ ABANDONED WELLS Does property have any not in use and not sealed well(s)? ❑ Yes ] No VARIANCE Was a variance granted from the MDH for this well? ❑ Yes X 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. REMARKS,ELEVATION,SOURCE OF DATA,etc. The information contained in this report is true to the best of my knowledge. t!t,L2L/ add47,R71p Licensee Business N L'.or Reg.N4. Authorized Representative Signature Da e Hob Stodola Name of Driller Date LOCAL COPY 658611 HE-01205-07(Rev.2/99) IC#140-0020 MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring ��^j WELL OR BORING LOCATION SealingNO. H County Name WELL AND BORING SEALING RECORD Minnesota rota Unique Well No. --- -� Minnesota Statutes, Chapter 1031 or W-series No. (Leave dank it n W k—) Township Name Township No,. Range No .Section No. Fraction Ism.-o Ig.) Date Sealed Date Well or Boring Constructed Orono 1 117 Numerical Street Address or Fire Number and City of Well or Boring Location 96 Depth Before Seahrj 1),2 ft Original Depth _�G t ft Show exact location of well or boring Sketch map of well or boring AQUIFER(S) STATIC WATER LEVEL in section grid with"X". location, showing property k Single Aquifer ❑ Multiaquder lines,roads,and buildings. N WELL/BORING Measured El Estimated ]Water Supply Well [-]Monit.Well ❑ Env.Bore Hole ❑Other _ It below ❑ above land surface W --�- -i----- ----------iE { CASING TYPE(S) w , J ----------- ---- --�- V ❑Steel 17_Plastic ❑Tile E]Other Yz mile `��LL _j__ 4_ _4_ � CASING(S) Diameter Depth Set in oversize hole'? Annular space initially grouted? 111l S p�y lye r m®e— : in.from�__ to 2V�t._. it k Yes ❑No EkYes ❑No ❑ Unknown PROPERTY OWNER'S NAME in,from to ft. ❑ Yes ❑ No ❑ Yes ❑ No ❑ Unknown Hark Rnnll Property owner's mailing address if different than welt location address indicated abovein.from to ft. ❑ Yes ❑ No ❑ Yes ❑No ❑ Unknown SCREEN/OPEN HOLE Screen from 9,. 4__to2 Q 7 ft. Open Hole from to ft. OBSTRUCTIONS WELL OWNER'S NAME Rods/Drop Pipe ❑ Check Valve(s) ❑ Debris ❑ Fill ❑ No Obstruction Well owner's mailing address If different than property owner's address indicated above Type of Obstructions(Describe) P I; .-a a n d S•t b Obstructions removed?X12 Yes ❑ No Describe PUMP Type GEOLOGICAL MATERIAL COLOR HARDNESS OF FROM TO Removed ❑ Not Present ❑ Other FORMATION It 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: o Annular Space Exists ❑Annular space grouted with tremie pipe ❑Casing Perforation/Removal in.from to ft. ❑ Perforated ❑ Removed infrom to ry, ❑ Perforated ❑ Removed Type of perforator ❑ Other GROUTING MATERIAL(S) '�(One bag of cement==94 Ibs.,ohne bag of bentonite=50 lbs.) Grouting Material PCi Ct I nij- from 292 too_ ft yards bags from to ft yards bags from to h, yards bags _.•___..____.. from to_._ ft, yards bags REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING OTHER WELLS AND BORINGS Other unsealed and unused weH-or boring on property? ❑Yes a No How many? LICENSED OR REGISTERED CONTRACTOR CERTIFICATION This well or boring was sealed iiYaccordance with Minnesota Rules,Chapter 4725. The information contained in this report is true to the best of my knowledge. Contractor Business Name ..7— License or Registration Pio. l Z t2 . (, Qf Authorized RepresentativesSiggnat re Lea yt)¢ Date cy anes LOCAL COPY H 17 7 a 7'7 Name of Person Sealing Well or Boring