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HomeMy WebLinkAboutwell and boring MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. ifennepinWELL RECORD 5484 6 5 Minnesota Statutes Chapter 1031 .yip Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed + t 117 23 06 34-Uj01 132' n. 6-29-94 Numerical Street Address and City of Well Location or Fire Number DRILLING METHOD 4580 Vilest Branch Road Nano, Mn. 55364 0 Cable Tool 0 Driven 0 Dug 0 Auger [Rotary 0 Jetted Show exact location of well'in section grid with"X". Sketch map of well location. 0 Showing property lines, N roads and buildings. DRILLING FLUID I Bentonite , , ,USE 0 Heating/Cooling +_ _ _ .,__ _ ja Domestic 0 Monitoring 0 Industry/Commercial W I , I E i f. 0 Irrigation 0 Public T �V 0 Test Well 0 Dewatering ❑ Remedial 0 I 2'mi. CASING Drive Shoe? 0 Yes 0 No HOLE DIAM. --I- --1- ———r- 1L----A ❑ Steel 0 Threaded 0 Welded I r milr X Plastic 0 ✓ f c-S Lc f J�e A � 'Ac (---i� CASING DIAMETER WEIGHT PROPERTY OWNER'S NAME 4 in.to 128 rt. lbs./ft. 7 7, 4, 34. Dam Hager in.to ft. lbs./ft. 6 1)44013a. Mailing address if different than property address indicated above. in.to ft. lbs./ft. n.to ft. SCREEN OPEN HOLE Make Stainless Steel S=enia. 4" t Slot/Gauze 10/10 Length _ 4 Set between 128 ft.and 132 ft. FITTINGS: 4' NN V JI- STATIC TER LEVEL GEOLOGICAL MATEFtIoALS COLOR HARDNESS OF FROM TO ft. [below 0 above land surface Date measured 6-29-94 MATERIAL 87 r PUMPING LEVEL(below land surface) S 0 Clayft after hrs.pumping g.p.m. Sand _---- ) S 87' 132 t I WELL HEAD COMPLETION --- r-- t L,,. [ Pitless adapter manufacturer tLii E'.r Model 117•,' ,; — _, iii 0 Casing Protection 1:X12 in.above grade t�.= '- GROUTING INFORMATION .. Well grouted? EXYes ❑ No Grout Material 0 Neat cement L Bentonite from o 30ft. 2 0 yds. I](bags from to ft. 0 yds. 0 bags from to ft. 0 yds. 0 bags NEARES�ICNOWN SOURCE OFC TAMIN/�JONr C--Y(1'?:( rf . feet S direction r type Well disinfected upon completion? X Yes 0 No PUMP 0 Not installed Date installed 7-1-94 Manufacturer's name Myers Model number HP 3/4 Volts230 Length of drop pipe 84' ft. Capacity 12 g.p.m. Pressure Tank Capacity Challenger PC122 Type: x Submersible 0 L.S.Turbine 0 Reciprocating El Jet 0 ABANDONED WELLS Does property have any not in use and not sealed well(s)? 0 Yes 0 X 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. Use a second sheet,if needed DON S'IODtA.A WELL MILL= CO., INC. 27172 REMARKS,ELEVATION,SOURCE OF DATA,etc. Licensee Business Name Lic.or Reg.No. 6-29-94 Autho ed Representative Si at e'' Date F.P. MIl+lahon 6-29-94 Name of Driller Date LOCAL COPY 5 4 8 4 6 5 HE-01205-04(Rev.5/92) . Twin City Water Clinic, Inc. 617 13th Ave So • Hopkins, Minnesota 55343 • (612) 935-3556 07/01/1994 Stodola Well Drilling 15306 Hwy 7 Minnetonka MN 55345 938-2111 REPORT OF WATER ANALYSIS Lab#: 23274 Our Laboratory reports these analytical results, determined on a sample taken by YOU on 06/30/1994 from the following location: Donna Hager 45801Mest Branch Road Orono,Mn U rt quRi# 548465 Coliform Bacteria <1/100 ml Nitrates Nitrogen <1 .0 mg/I 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). T r Water Clinic, Inc. Bill Va Brian BIS Analyical laboratory Consulting Engineer Water Analysis Reagents Boiler Water Chemicals MinnesotaWell and Boring 6 0 93 CJS` 9 WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH SealinggNNo. H County Name WELL AND BORING SEALING RECORD Minnesota Unique No. Hennepin Minnesota Statutes.Chapter 1031 or W-series No. • (Leave blank it not known) Township Name Township No Range No. Section No. Fraction(sm. •lg.) Date Sealed Approximate Dale Well Orono 117 23 06 314-- 1 31 OCT c. or Boring Constructed Numerical Street Address or Fire Number and City of Well or Boring Location a/ 4580 West Branch Road Orono, Mn. 55364 Depth Before Sealing ea ft. Original Depth � It. 77��[[ Show exact location of well or boring Sketch map of well or boring Static Water Level . Accurate in section grid with'V. location.showing property lines. ° 41 roads.and buildings. 0 Approximate N ..�4- Single TYPAquEder 0 Multiaquifer fl. r below above land surface 35i a . -L W E 'IT` i CASING '.� JCF Steel ❑Plastic 0 Tile ❑Other S i W I,...)S =^'_ C:..-4\ d. Screen from 7(2, to SV ft. Open Hole from to _— ft N--r mile—11.1 OBSTRUCTION/DEBRIS/FILL YObstruction 0 Debris ❑Fill PROPERTY OWNER'S NAME DaHa nn<� �r p O Type of debris/obstruction 7:4.)A)4.--R )rr l 51 atf r Mailing Address if different than properly address indicated above. Obstruction/Debris/Fill removed? Yes ❑No PUMP ❑Removed ye Not Present 0 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. 3 in.from Q to 743 It. 0 Yes 15(No 0 Yes 0 No ❑Unknown aC".c•1 © do in.from to ft. 0 Yes ❑No ❑Yes 0 No 0 Unknown in.from to ft. ❑Yes ❑No 0 Yes 0 No 0 Unknown METHOD� USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: ri//No Annular Space Exists ❑Annular space grouted with tremie pipe ❑Casing Perforation/Removal in.from to - ft. ❑Perforated ❑Removed in.from to ft. 0 Perforated 0 Removed Type of perforator ❑Other GROUTING MATERIAL f Grouting material A3‘-‘7,-[A/!'J6,t1j from 0 to 63 4 ft. yards 4 bags from to ft. yards bags REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING from . to ft. yards bags from to ft. yards - bags UNSEALED WELLS AND BORINGS Other unsealed well or boring on property? ❑Yes Xo LICENSED OR REGISTERED CONTRACTOR CERTIFICATION 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. DON STODOLA WELL DRILLING CO., INC. 27172 Contractor Business Name _ License or Registration No. uth epresentative Signature Date ,i g;. i ::, H Name of Person Seal Well or Boring