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Home My WebLink Aboutwell info MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring H 108172 WELL OR BORING LOCATION Sealing No. County Name Hennepin WELL AND BORING SEALING RECORD Minnesota Unique No. Minnesota Statutes,Chapter 1031 or W-series No. (Leave blank if not known) Township Name Township No. ange No. Section No. Fraction(sm.i Ig.) Date Sealed Date Well or Boring Constructed R 03:uno 117 2 s L5 1 4-49UUS 7 / -•:r Numerical Street Address or Fire Number and City of Well or Boring Location 46 TbnkaWa. 12cod OT0110, Mn.. 5'-1 56 Depth Before Sealing ;;o.(S ft. Original Depth 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 Single Aquifer ❑ Multiaquifer lines,roads,and buildings. N WELUBORING El Measured Estimated , j�l \\ Water Supply WeII ElMonit.Well /r .,------- ❑ Env.Bore Hole ❑Otherf�_ft. [below ❑ above land surface W E CASING TYPE(S) ---- -�-- ----- -- �teel ❑ Plastic ❑Tile ❑ Other mile -- -�-- -- -- -- -- I CASING Diameter Depth � r Set in oversize hole? Annualar space initially grouted? I mile in.from to�5�� ft. ❑ Yes [Xlo ❑Yes ❑No ❑ Unknown PROPERTY OWNER'S NAME in.from to ft. ❑Yes ❑ No ❑ Yes ❑ No ❑ Unknown Ed Ca1we11 Property owner's mailing address if different than well location address indicated above. in.from to ft. ❑ Yes ❑ No ❑ Yes ❑ No ❑ Unknown 471--1946 SCREEN/OPEN HOLE r i Screen from -7(,—, to—_ ft. Open Hole from to ft. O B S T R U CTI O N/DEBRIS/F I L L WELL OWNER'S NAME ❑ Obstruction [] Debris ❑ Fill Xo 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 El 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 1• ❑ Annular space grouted with tremie pipe ❑ Casing Perforation/Removal in.from to ft. ❑ Perforated ❑ Removed in.from to ft. ❑ Perforated ❑ Removed Type of perforator ❑ Other GROUTING MATERIAL(S) Grouting Material /^/i1/K A-ft�m �_ to , ft. yards _ bags from to ft. yards bags from to 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 property? ❑ Yes o LICENSED OR REGISTERED CONTRACTOR CERTIFICA ION This well or boring was sealed in accordance with Minnesota Rules,Chapter 4725. The information contained in this report is true to the best of my knowledge. Contractor Business Name License or Registration No. ?0K�0-dF&Presentfitiite signature Date Name of Person seal n�g Well or Boring LOCAL COPY H 1- 08172 . HE-01434-02 10/95R WELL LOC*TION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. CounyrNam(; WELL AND BORING RECORD Aj -, 3 Fiet�nepi.n Minnesota Statutes Chapter 1031 � 1 Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed n Orono, 11-1 _-i l)`f �s—ty;i+ii � 16�` �--16-96 House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD 146 'T'Csr'Ikaula Roau Grc)rKA, Fin. 553 56 ❑ Cable Tool ❑ Driven ❑ Dug ❑ Auger ❑,Rotary 71 Jetted Show exact location of well in section grid with"X". Sketch map of well location. ❑ _____ Showing property lines, roads and buildings. DRILLING FLUID mper.,{. N Bto a t e USE El Monitoring ❑ Heating/Cooling i F*Domestic ❑ Community PWS ❑ Industry/Commercial EI Irrigation 71 Noncommunity PWS -1 Remedial we .'i ❑ Test Well i T •�. ❑ Dewatering ❑ i i �` I ---•• CASING Drive Shoe? O Yes [-Dflo HOLE DIAM. 2Miie ❑ Steel ❑ Threaded ❑ Welded d:Plastic ❑ s '\ �1 Mile CASING DIAMETER WEIGHT PROPERTY OWNER'S NAME 4 in.to1�{ ft. 1.0 lbs./ft. i 3i' Ri & A':ry Caldwell in.to ft. lbs./ft. 6 1;�,�, 18rj'I. Property owner's mailing address if different than well location address indicated above. in.to ft. lbs./ft. in.to ft. SCREEN OPEN HOLE Make � 3 'f from ft.to ft. Type • ..ain `ss steel Diam. -a Slot/Gauze 10/10 Length 9 1 _ tl Set between I Bill ft.and leg . FITTINGS: L X .SilN STATIC WATER LEVEL WELL OWNER'S NAME ___=__` ft.X below ❑ above land surface Date measured B--16-96 PUMPING LEVEL(below land surface) Well owner's mailingaddress if different than properly owner's address indicated above. ft. after hrs.pumping '�� '"� m. P P YP P 9 9 P WELL HEAD COMPLETION �.t[7� E Pitless adapter manufacturer nn1`-AeW&_te1 Model ❑ Casing Protection ❑N2 in.above grade ❑ At-grade(Environmental Wells and Borings ONLY) GROUTING INFORMATION Well grouted? 6 Yes ❑ No HARDNESS OF Grout Material ❑ Neat cement ❑Oentoni ❑ Concrete Q FPO Solids Bentonite GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO t i � from to ft. ❑ yds. bags from to ft. ❑ yds. ❑ bags clay yell(-&, S l 118, from to ft. ❑ yds. ❑ bags VEAREST KNOWN SOURCE OF CONTAMINATION j 1W. 'SC-U-i Grey M 118 17 ;- feet direction `-r' type Well disinfected upon completion? 9 Yes ❑ No _ Silty Clay Grey S 1-it) 17 tO PUMP El Not installed Date installed �' ��'�� sarxi 111 LXe0 M 17 8 1 18 Manufacturer's name Wyla M}I ers rAILT Model number HP Volts Length of drop pipe well ft. Capacity g.p.m ell . Pressure Tank Capacity mate 6+ 9 Type: Ci�Submersible ❑ L.S.Turbine ❑ Reciprocating ❑Jet ❑ ABANDONED WELLS y, Does property have any not in use and not sealed well(s)? El Yes Li I VARIANCE Was a variance granted from the MDH for this well? ❑ Yes ❑"No 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. UuN S:.'L OLN IKU DRILLING ING k-`). , INIC. 271 i L Licensee Busin Name Lic.or Reg.No. _f 6--16-96 Authorized Representative Signature Date Chuck A-Axle 8_16-96 Name of Driller Date '_OCAL-COPY 158647 3 HE-01205-05(Rev.1/95) 3.i. City W.I.,, Clinic, J.C. 617 13th Ave So 9 Hopkins, Minnesota 55343 a (612) 935 - 3556 08/29/1996 Stodola Well Drilling 15306 Hwy 7 Minnetonka MN 55345 938-2111 REPORT OF WATER ANALYSIS Lab#: 30712 Our Laboratory reports these analytical results, determined on a sample taken by CLIENT on 08/19/1996 from the following location: Ed Caldwell 746 Tonkawa Rd Orono,Mn Unique Well#586473 Coliform Bacteria <1/100 ml Nitrates Nitrogen <1.0 mg/l 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 analysis of Lead and other contaminants. (Unless as specified by client). �*Ater Clinic, Inc. e kcal gyratory Consultor E g— Water Analysis Reagents Boiler Water Chemicals Lab Certification N 027-033-119