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Home My WebLink Aboutwell info _�ATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. nly1: - - Fni j7i;1 WELL RECORD 526431 � Minnesota Statutes Chapter 1031 Township Name 7wnship No. Range No. Section No. Fractipnt WELL DEPTH(completed) R Date Work Completed Numerical 'treet Address and City of Well Location or Fire Number DRILLING METHOD A�-. ❑ Cable Tool ❑ Driven ❑ Du <`v C'. a LertC+�`xi Ilk co i";3_Cin � A� ❑ t ❑ Auger ❑ Rotary Jetted Show exact location of well in section grid with"X". Sketch map of well location. ❑ Showing property lines, N roads and buildings. DRILLING FLUID .;3.:.:. I c ' c � c c t USE C3"Domestic ❑ Monitoring ❑ Heating/Cooling ❑ Industry/Commercial yy ; I E ❑ Irrigation ❑ Public ❑ Test Well ❑ Dewatering Remedial I ; T Ci- 0 f-mi. X CASING Drive Shoe? RI Yes [-1NoHOLE DIAM. --t- c �- — —r- +Steel 1:1 Threaded ❑ Welded �— •� ❑ Plastic ❑ /Mil, K i� � jet? liJA CASING DIAMETER Trish WEIGH PROPERTY OWNER'S NAME " "Z- IL, yy n,�, i1 Mrt -y in.to ft. lbs./ff. in.to_,. in,to ft. lbs./ft. J7(in.to Mailing address if different than property address indicated above. in.to ft. lbs./ft. in.to ft. SCREEN OPEN HOLE Make r" x^ Steel from ft.to ft. Type r Diam. Slot/Gauze 2C,0 Length Set between j`"ff.and ft. FITTINGS: STATICATER LEVEL GEOLOGICAL MATERIALS COLOR HARDNESS OF MATERIAL FROM TO �' ft. CFbelow El above land surface Date measured PUMPING LEVEL(below land surface) ul a ! t � t ft. after hrs.pumping 9— p.m-WELL HEAD COMPLETION c;t •+ ❑-itless adapter manufacturer FYl 4.k. cr � Model ❑ Casing Protection [1:12 in.above grade Lit, : f•�t .;j+ GROUTING INFORMATION Well grouted? ❑ Yes �b No // Grout Material 71 Neat cement ❑ Bentonite a�,TIC i r;%41 t I { I from to ft. ❑ yds. ❑ bags from to ft. ❑ yds. ❑ bags from to ft. ❑ yds. ❑ bags NEAREST KNOWN SOURCE OF CONTAMINATION feet direction type Well disinfected upon completion? EKYes ❑ No PUMP WA ❑ Not installed Date installed [�� Manufacturer's name H(MkIl & — Sta-Rlte , Model number HP 1�4 _Volts Length of drop pipe 146 ft. Capacity Pressure Tank Capacity 1 EC.UNEKS Type: Qp,Submersible ❑ L.S.Turbine ❑ Reciprocating ❑ Jet ❑ ABANDONED WELLS ti> Does property have any not in use and not sealed well(s)? t?Yes ❑ No WELL CONTRACTOR CERTIFICATION 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. lx,A\. AVAXj1A Wk',, 11*11,I,1Uj. .iNC. G!i'i r: Use a second sheet,it needed REMARKS,ELEVATION,SOURCE OF DATA,etc. Licensee Business Name Lic.or Reg.No. Authorized Representative Signature Date I-'.i:.. i`iC.l`e•;:ti ii-;i 5-2'6-93 Name of Driller Date LOCAL COPY 15264311 HE-01205-04(Rev.5/92) TWIN CITY WATER CLINIC, INC. 617 13t.h Avc too. Hopkins, Minnesota 5534) 612 ) ;-)1'-"5i--,?F)56 05/29/93 Stodola Well Drilling 15306 Hwy 7 Minnetonka, MN 55345 938-2111 Lab #: 19883 REPORT OF WATER ANALYSIS Our laboratory reports these analytical results, determined on a sample taken by YOU on 05/227/93 from the following location: William Martin Unique u 526431 2380 Watertown Rd Orono, Mn Coliform Bacteria <1/100 ml Nitrates Nitrogen <1.0 Mg/1 The results of these tests indicate th,'At this well is producing water that meets the standards for F.H.A. . V.A. , or conventional loans. ater Clinic . Inc . Bil V e Bria B r' r Minnesota Well and Boring u WELL OR BORING LOCATION MINH NESOTA DEPARTMENT OF HEALTH Sealing No. 40262 County Name WELL AND BORING SEALING RECORD Minnesota Unique No. iknnl )ln Minnesota Statutes.Chapter 1031 or W-series No. (Leave blank if not known) Township Name Townshi No. Range No. Section No. Fraction Ism. -Ig.) Date Sealed Approximate Date Well CIrC 20 & LJ 24 t 0 {rt or Boring Constructed to la to Numerical Street Address or Fire Number and City of Well or Boring Location c 6 q r 2JGGGo Watertown own RoadO Croon �. 553!.& Depth Before Sealing �`�1 ft. Original Depth y ft. Show exact location of well or boring Sketch map of well or boring Static Water Level Accurate in section grid with X. - location.showing property lines, .. road an buildings. ❑Approximate N r I I I I Single Aquifer ❑Multiaquifer ft below above land surface CASING TYPE W E -r -�- -r- -r t ) Steel ❑Plastic ❑Tile ❑Other b mde Screen from to ft. Open Hole from to ft. S I mile -D OBSTRUCTION/DEBRIS/FILL PROPERTY OWNER'S NAME - El Obstruction El Debris ❑Fill & ftimal Marti,! Type of debris/obstruction G Mailing Address if different than property address indicated above. Obstruction/Debris/Fill removed? Yes ❑No ' .. 011111m,,iiii ... PUMP ❑Removed Not Present ❑ Other CASING GEOLOGICAL MATERIAL COLOR HARDNESS OF FROM TO FORMATION Diameter Depth Set in oversize hole? Annular space initially grouted? If not known,indicate estimated formation log from nearby well or boring. .. in.from to �- ft. ❑Yes L]J�lo El Yes EJ No El Unknown drift in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: X. Annular Space Exists ❑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 1 Grouting material ``V'd fromto /.1 / ft. yards bags from to ftyards bags REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING -- from to ft. yards bags Grouted 4" well 90' 8 bags C1L'Tlt from to ft. yards bags d{. 10 lbs bentonite ., UNSEALED WELLS AND BORINGS ;yen labor, rig & ;� C g property? Other unsealed well or born on ❑Yes o LICENSED OR REGISTERED CONTRACTOR CERTIFI ATION 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. i,; '� WE.L R1t�L NG (X,. INC. 2717� Contractor Business Name License or Registration No. &-11-93 Aut- hod Represen ative Signature Date LOCAL COPY Fi tim 141" Name o/Person Sealing Well or Boring HE-01434-01 '-"""*""•