HomeMy WebLinkAboutwell info WVL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO.
County Name He3�ne Irl WELL AND BORING RECORD � 6 Q
Minnesota Statutes Chapter 103/
Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed
n
I
V. v. u
House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD
El Cable Tool p Driven C1 Dug
I t: �'f Il}C<i�v Road Orono, M�t. ❑ Auger f�-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
N ;
USE El Monitoring [IHeating/Cooling
C Domestic ❑ CommunityPWS
❑ Industry/Commercial
-�- - - - - -�- ❑ Irrigation 71 Noncommunity PWS ❑ Remedial
W E T ,..�- ❑ Test Well
11 Dewatering ❑
-r -7- -r- -r
CASING Drive Shoe? ❑ Yes ❑ No HOLE DAM.
:: ❑ Steel ❑ Threaded ❑ Welded
I;k,Plastic ❑
s
1 Mile
CASING DIAMETER WEIG T
PROPERTY OWNER'S NAME " 117 1 'ci 7 7/8 3 f §
Ke1 �1Waters & Tia C1Cl r _i into ft. lbs./ft. qi P
in.to ft. lbs./ft. - in.'to Z—1 1
Property owner's mailing address if different than well location address indicated above. in.to ft. lbs./ft. in.to ft.
SCREEN OPEN HOLE
10340 VikingDr]_i E' Make C3 t33SC`11 from to A.
.SSE. 1 3 0 Type ,t:ainle-`ss bt ep I Diam.
t5 '[�C Slot/Gauze
Eden Prairie, MN. �.,� x Length_
Set between ft.and ft. FITTINGS: = X 3 t° tl xi.`
STATIC WATjR LEVEL
WELL OWNER'S NAME b G ft. E*,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. 1 1 ft. after hrs.pumping 3 t, 1 T g.p.m.
WELL HEAD COMPLETION
41 Pitless adapter manufacturer Wh 1 t'_wa{`.ca TModel
❑ Casing Protection 12 in.above grade
❑ At-grade(Environmental Wells and Borings ONLY)
GROUTING INFORMATION
Well grouted? ❑aYes ❑ No
HARDNESS OF Grout Material ❑ Neat cement ❑ Bentonite ❑ Concrete Ct.,HI h Solids Bentonite
MATERIAL FROM TO
GEOLOGICAL MATERIALS COLOR g
from o to 3 Ift. ❑ yds.t9 bags
from to ft. ❑ yds. ❑ bags
1./ ) Brown _; S' t from to ft. ❑ yds. ❑ bags
NEARESTXNOWN SOURCE OF CONTAMINATION ^ F
t9--, , feet i direction type
[X Yes�•Z } � �f .a�) Well disinfected upon completion? IYes ElNo /! L
W,-!ter Sand Grey S 1 9 J 1 12;L�; 1 PUMP
❑ Not installed Date installed 1 _`J-3 /
Manufacturer's name =
Model number l.; t HP '2 Volts 1
Length of drop pipe 64 } ft. Capacity 1 8 —
9-p.m-Pressure Tank Capacity $')r, C: r
Type: F'-Submersible ❑ L.S.Turbine O Reciprocating ❑ Jet ❑
ABANDONED WELLS
Does property have any not in use and not sealed well(s)? ❑ Yes X No
VARIANCE
Was a variance granted from the MDH for this well? ❑ Yes f�No
WELL CONTRACTOR CERTIFICATION
Use a second sheet,it 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.
DON STODOLA WELL DRILLING CO. , INC.
Licensee Busmes ame -Lic.or Reg.No. --7172
Aut orized Representative Signature pate.
CIhuc.,k Moore i �L _ -1fi
5 8 8 4 6 Name of Driller Date
HE-01205-05(Rev.1/95)
1
Jwin City Water Clinic, Jnc.
617 13th Ave So • Hopkins, Minnesota 55343 • (612) 935 - 3556
12/07/1996
Stodola Well Drilling
15306 Hwy 7
Minnetonka MN 55345
938-2111
REPORT OF WATER ANALYSIS
Lab#: 31655
Our Laboratory reports these analytical results, determined on a sample taken
by CLIENT on 12/03/1996 from the following location:
Keith Waters
1030 Tonkawa Rd
Orono,Mn
Unique Well#586460
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).
at Clinic, Inc.
Bill A ale
A-bicd may Co-uW%FAW—
W&W Andy.: $odor Wam C6emimb
i.b caWmfion 0 02�453-119
WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring o. H 108150
County Name
WELL AND BORING SEALING RECORD MinnSeallesotta Unique No.
Minnesota Statutes,Chapter 1031 or W-series No.
TLnrriapin (Leave blank if not known)
Township Name Township No. Range No. Section No. Fraction(sm.-�-Ig.) Date Sealed Date Well or Boring Constructed
Orono 117
Numerical Street Addressor Fire Number and City of Well or Boring Location /
+� /
7 0'30 •r� Rd, Orono
Depth Before Sealing / ft. Original Depth -12e- 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 propertyIngle Aquifer ❑ Multiaquifer
lines,roads,and bultMngs-';
WELL/BORINGvteasured ❑ Estimated
\\ � _yj• � Water Supply Well ❑Mont.Well �
❑ Env.Bore Hole ❑Other ft. >ielow ❑ above land surface
f
W -� -� ; -� E I CASING TYPE(S)
-�- -i-- --i-- --�- (Steel ❑ Plastic ❑Tile ❑ Other
mile 7
CASING
_ Diameter Depth / Set in oversize hole? Annualar space initially grouted?
"'in. rj
1 mile s r{.�1 from� to J_j_r:� ft. ❑ Yes �J0 ❑ Yes ❑No ❑ Unknown
PROPERTY OWNER'S NAME in.from _ to ft. ❑ Yes r❑_No ❑ Yes ❑ No ❑ Unknown
Keith T
Ratwrs Associates,
Property owner's mailing address if different than well location address indicated above. in.from to ft. ❑ Yes ❑ No ❑ Yes ❑ No ❑ Unknown
10340 Vii ry Dr,,' Ste 110
SCREEN/OPEN HOLE
itY '
ffim Prairie, 55M4 Screen from_1/ 6 o_�� ft. Open Hole from to ft.
OBSTRUCTION/DEBRIS/FILL
WELL OWNER'S NAME Obstruction ❑ Debris ❑ Fill ❑ No Obstruction
Well owner's mailing address if different than property owner's address indicated above. Type of Obstruction/Debris/Fill
Obstruction/Debris/Fill removed? Xes ❑ No
PUMP y��'r/y
Type �� // //—
GEOLOGICAL MATERIAL COLOR HARDNESS OF FRORemoved El Not Present El Other
FORMATION M TO
METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE:
If not known,indicate estimated formation log from nearby well or boring.
tf �
No Annular Space Exits
�. r ❑ 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 ya,/6-�r^ -_ 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 CERTIF CA 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.
ContracTo ins a la Well • +License or Registrati 72
y�
A on �entatN Signature Date
Name of Person Sealing Well or Boring
LOCAL COPY H 108150
HE-01434-02 10/95R
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STATE OF'MINNESOTA DFPARTMENTOI HEALTH
I. LOCATION 01 WE LL
MINNESOTA
WELL NO.
camr Na- WATER WELL RECORD for wre.sample
Hance; n SNeI5M1A.(II (IX 403782 1
Twnship Name
Township Number Han{c Numher Serlion No I I...lion 3. PROPERTY OWNERS NAME
Orow 117n 23w or Gj=1T
Dnlance and Daeclipo from Road Inlrrsee lions or Street Address and Cil,.(Well Location Add a 1030 ioWtava
Lan Lake. MW 5356
------Show exa.l location of well in section grid with"%." Sketch map of well Iocalion. 4. WELL DEPTH(completed) Date of Completion
N Addition Name 13°' Imo ' 65
.-ti - ft.
I❑Cable totd 40 Re— 70 06— 100Dag
W - - �- - E
+
1,11-1,Number
TTz❑Hnnnw rod s❑Air a❑Bnree 110
3 Rnwry 60Jelted 9❑Power Auger,
! Lot Numher 6. USE
__ _--
S
__
ILOOnmesua 40Puhlic Supply 70 Industry
�l nrii. 70Irrigation 50Municipal 80C'ommcrcial
3. FORMATION LOG COLOR HA R DN FSS OF FROM TO
FORMATION 30Test Well 613Air C'nnditioning 9❑
7.CASING HEIGHT: Above/Below HOLE DIAM
top oil ID 2 101410141-1,l4❑Threaded
'�Y��` � �r y4 306a1y. 5❑Welded Surface ft.
ye� clay 2 14 3EXPlastic 613 Drive Shoe? Yea_ No 132
yy` 4 in.toYft ft. Weight �_Ibs./ft. —in.to—ft.
I-my r sand 14 4 in.to ft. Weight tbs./n. —in.loft.
In.to rt. Weight lbs./ft. n.t.—ft.
blues clay 4l 65 _ 8.SCREEN ropen hole
Make J4—N1saRf1111 from
fl.to
boulder Gite—pk b 65 7 Type at. heel Dia. 4• ft.
f
Slnl/Gauze 15 Length
� 28 FITTINGS:
67 Set between ft.and 132 U.
blueclay—redbblack9x��� t f�f
ft.and ft.
9.STATIC WAT'R LEVEL
u` oII� gravel-blueg fl.❑below ❑above Dale Measured 1-10
land surface
100 132 10.PUMPING LEVEL(below land surface)
rt.aper ors.vamping g.p.m.
ft.after hrs.pumping Spot-
11.WELL HEAD COMPLETION
=Pairs.,adapter,manufacturer model
z❑Basemen)offset 3❑At least 12"above grade
12.WELL GROUTED? �gNp
❑Yes MN.
— 1❑Neat C'ero n ]❑Bentonite 30
Grout material from to ft.Cu.Yds.
13.NEAREST SOURCES OF POSSIBLE CONTAMINATION
'a direction type
Well disinfected upon com plellon? YC No❑
�� � •�, 14. PUMP
Lj Dale installed .„ ❑Not installed
Manufactu V.Name nf fltrkat
a
Model Number HY � Volts�_
Length of drop pipe CJ,7 ft.capacity 12 g.p.m.
1 Material of drop Alpe
zaly
Type: *1S.1mu—ihle 30 L.S.Turbine 50 Reciprocating
201et 4❑C'entrifugal 60
Use a second sheet,if needed 16.WATER WELL CONTRACTOR'S CERTIFICATION
15.REMARKS,ELEVATION,SOURCE OF DATA,etc.
This well was drilled under my jurisdiction and This report is true to
the best of my knowledge and belief.
Sie53'"n Well ro. 27194
Licensee B-mm Name License No.
6240 fty 12 v% Maple Plain, M1
Address
Signed Date I,..1 ri...9
Authorized Representative
Richard Stevens Date
Name of Driller
LOCAL COPY 1403782 7/7630M
78 30M
HE-01205-01 2/82 10M -