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Home My WebLink Aboutwell info STATE OF MINNESOTA DEPARTMENT OF HEALTH ABANDONED WELL RECORD t. LOCATION OF WE II MINNESOTA UNIQUE WELL N0. (leave blank If not known) c°r"`r Name Hennepin ianfhl► Name Township Number Range Number Section No. Fractten /. MELL DEPTH (completed) Oate sealed N E � � 01 ti or Ft. Orono 117N or 23W 7 SW NW SE 194 2/20/91 Numerical Street Address and City of Well location or Distance from Road S. DRILLING METHOD (if known) Intersection Ip Cable tool 4E]Reverse 7p Driven 100 Dug 1360 Vine Place Mound, PIN 55364 2E]Hollow Rod U Air 80 Bored lip Show enact button or rail 3p Rotary 60 Jetted 9p Power Auger (IN section grid with 'II') Sketch map of well location 6. OBSTRUCTIONS N Well obstructed Q Yes E] No L - Obstructions rerored 0 Yes 0 No If obstructions cannot be i ! removed. contact MOH W ' ( - E before sealfng. T 1. USE Xw . . Is at. 1R]Domestic 4C]Monitoring BE]Neat Loop 2[] Irrigation SE]Public 9p Industry 30 Test Well 60 Municipal IC(:]Commercial ►-I R La 7[]Air Conditioning lip 1. PROPERTY OWNER'S NATE Milling Address 1f different than B. CASING(S) property address indicated above 10 Black a0 Threaded 20 Earl Norwood 20 Ga Iv. SQ Welded Jp Plastic 6[]Stainless Steel HARDNESS OF 3 In. to ft. 1. FORMATION LOG COLOR FORMATION FROM TO If not known, Indicate formation log from new well or nearby well. In. to ft. Topsoil Black 0 1 9. SCREEN K]Screened well from_ ft. to_ ft. (lr known) Clay Yell 1 30 p open Hole from_ ft. to_ ft. Clay Blue 1 30 42 10. STATIC WATER LEVEL 50 ft. a below p above Clay/Gravel Blue/ rcwn 42 152 land surface Data Measured 2/20/91 Clay/Gravel Redd' h Brown 152 194 Il. WELLHEAD COMPLETION I[] Pltless Adapter 40 Found Surfed 2E] Basement offset 30 Well Pit 16. REMARKS. ELEVATION, SOURCE OF DATA - CASINGS REMOVED, CASINGS PERFORATED, ETC. 12. GROUTING INFORMATION in"eat Cement 20 Santonite U Formation log taken from new well drilled Grout material 6 bagsfrom 0 tol94ft. cu. ydj35 2/18/91 unique welly 478352 13. NEAREST SOURCES OF CONTAMINATION feet direction type Well disinfected before sealing? [] Yes r 11. PUMP ®Removed 0 Not Present Type: ID Submersible 30 L.S. Turbine SD Reciprocating 20 Jet` Ap Centrifugal 60 16. EXISTING WELLS (Please sketch locations of abandoned and active wells 1n remarks seetlon or an back.) Other unused well on property1 0 Yes [� Mo n D Abandoned: p Permanent 0 Temporary 0 Not sealed t1►` 11. WATER WELL CONTRACTORS CERTIFICATION This well was sealed under my Jurisdiction and this report Is true to the best of my knowledge and belief. StevensWell +D�trilling 27194 62VTI-111g"hwa' "1G West License N0. Address Maple PAin,, Mel 55359 Signed Date 2/20/91 Randy Jo son Date 2/20/91 FFICIAI ASAIIOONtN WILL RECORD (May be used for Property Transfer) Name of Driller LAlFMrAaTt IIT1 WrI7 DMW STATE OF MINNESOTA DEPARTMENT OF HEALTH 1.LOCATION OF WELLI MINNESOTA UNIQUE WELL NO. V County Name WATER WELL RECORD llemepip Minnesota Statutes 156A.01.08 for Water Sample 478352 Township Name Township Number Range Number Section No. Fraction 4.WELL DEPTH(completed) Dale of Completion t3lror�cl 1175 23W W 7 SK 1!�T SE / 2X5 rt. :Z/32/91 Numerical Street Address and City of Well Location or Distance from Road Intersection. 5. DRILLING METH015 1360 Vine Place Mound, M 55364 ❑CableTool ❑Reverse ❑Driven ❑Dug Show exact location of well in section grid with'X- ��Li Sketch map of well location. ❑Hollow kod ❑Air ❑Bored ❑ N 1 t t Addition Name SkRotary ❑Jetted ❑Power Auger ��DIj�LLING FLUID }MaT�it._' _ W i Block Number E 7.USE t 2 Domestic ❑Monitoring ❑Heat Pump 1 1 t Lot Number ❑Irrigation O Public ❑Industry t ❑Test Well ❑Municipal ❑Commercial —�— — —�- I ❑Air Conditioning ❑ 1 mile's 1 8.CASING HOLE DIAM. 2.PROPERTY OWNER'S NAME Mailing Address if different than property address ❑Black ❑Threaded HEIGHT:Above/Below indicated above. Surface ft. Earl MmwoOB ❑Galy. ❑Welded Drive Shoe? Yes—Nom QVIastic ❑ 4 in.to n ft. Weight 1_9lbs./ft. n. UGLL(t. 3. FORMATION LOG COLOR HARDNESS OF FORMATION FROM TO in.to ft. Weight lbs./(t. in. to---Jt. in.to ft. Weight- lbs./(t. in. to—Jt. Topsoil Black, Q 1 9.SCREEN Or'open hole T from ft.to. It, clay ,-w ��y Make J� � ,{ Clay Yellow 1 30 Type C Vl. t Diam. +3 111. { l Slot/Gauze 16 slot Length 5 r..:a�.lft- �/� � 21� F}TTING�� Clay uCw -3Q �2 21 Set between�.l\L ft.and�.i.�ft. j'� B1Lzc 10. STATIC (ASTER LEVEL lay AgraVel y) in 42 152v ft.X below ❑above Date Measured? 7 ,��., land surface ',1,^, FCCti,ld.l.l:iii 11.PUMPING LEVEL(below land surface) '^ Clay/gravel rav l s fl.after hrs.pumping j,y0+ g.p.m. lite Y ft.after hrs.pumping g.p.m. Gravel brawn 12.HEAD WELL COMPLETION L�.�., XPitless adapter manufacturer_i7IA Model '❑Basement,offset ❑At least 12"above ground ❑Plastic casing protection 13.WELL GROUTED? 2]Yes ❑No .�Neat Cement ❑Bentonite ❑ ��y Grout material from 0 to M ft.cu.yds.— 14. NEAREST SOURCES OF POSSIBLE CONTAMINATION feet direction type Well disinfected upon completion? *Yes ❑No 15. PUMP Date installed ❑Not installed Manufacturer's name Model numberHPHP-1/2-Volts 7*40 ppryry Length of drop pipe G1�/ ft. Capacity g.p.m. Material of droppipe P Type:$Submersible ❑L.S.Turbine ❑Reciprocating ❑Jet ❑Centrifugal ❑ 16. ABANDONED WELLS '-tP Unused well on property? IiYes ❑No .; Use a second sheet,i/needed Sealed Permanent ❑ Temporary ❑ Not sealed 17.REMARKS,ELEVATION,SOURCE OF DATA,etc. 'S 18.WATER WELL CONTRACTOR CERTIFICATION This well was drilled under my jurisdiction and this report is true to the best of my knowledge and belief. GtlMimi WPl1Drillim ()p_ 27L94 icensee Business Name License Na. Address 6240 1 Q plain_ M 1, 59 Signed 1 � / I. _ Date713 891 Authorized WppreVntatlue Mike]R.Iir xii DaleF tt1", Name o(Drtlfer LOCAL COPY T4783521 5/7430M 7/76 30M 7/7830M HE-01205-03(Rev.9/88) 2182 IoM