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Home My WebLink Aboutwell record STATE OF MINNESOTA DEPARTMENT OF HEALTH I.LOCATION OF WELL I MINNESOTA UNIQUE WELL NO. County Name WATER WELL RECORD 478365 Minnesota Statutes 156A.01-.08 for Wafer Sample Township Name Hennepin Township Number Range Number Section No. Fraction 4.WELL DEPTH(completed) Date of Completion O 118N °s` 23W w 33 SE ICE SE''' 167, 05/14/91 NumericalStreet yAdddretss7�an'd7Cittyy-oftWell Location or Distance from �Road ,Intersection. 5.DRILLING METHOD 225 Not. h Willow Drive Long Lake, MN 55356 0 Cable•fool ❑Reverse ❑Driven ❑Dug Show exact location of well in section grid with"X.•' Sketch map of well location. 0 Hollow Rod 0 Air ❑Bored ❑ N t i Addition Name [Rotary ❑Jelled ❑Power Auger "_r--7- -1--1-I I 6.DRILLING FLUID I H • I Water t I I Block Number -+- - - -- - 7. USE IN I i I • E ' i ' XDomestic 0 Monitoring ❑Heat Pump ILot Number 0 Irrigation 0 Public 0 Industry f•mi. 0 Test Well Cl Municipal 0 Commercial --1- _,_ - 1 --r- I ❑Air Conditioning ❑ � I--1 mile 8.CASING HOLE DIAM. 2.PROPERTY OWNER'S NAME Mailing Address if different thanpropertyaddress 0 Black 0 Threaded HEIGHT:Above/Below Jim Dittman indicated above. Surface ft. 0 GaIv. 0 Welded Drive Shoe? Yes_No— A Plastic R 4 in.to 162 ft. Weight 1.99 lbs./ft. min. to]67ft. 3. FORMATION LOG COLOR HARDNESS OF FROM TO in.to ft. Weight lbs./ft. ._in. to_ft. - FORMATION • in.to ft. Weight lbs./ft. Win. to_ft. moil Black 0 2 9.SCREEN Or'open hole • - • �t Make 4.-ilia—tel Japoo , from ft.to. ft. Clay Yellow 2 18 Type' PVC Dtam.4 ]11. t�?l. Slot/Gauze 15 blot Length 5 ft- Clay Blue 18 37 Set between 162 ft.and 167 ft. FITTINGS: MM, Blue icier yLg7'ER LEVEL 3x4 K packer CIVGi .raan 37 62 (Jjj f�- ft.N below ❑above Date Measured 05/1_4/91 land surface 11.PUMPING LEVEL(below land surface) 40 Clay Blue 62 67 ft.after hrs.pumping g.p.m. ft.after hrs.pumping g.p.m. Gravel Brawn 67 72 12.HEAD WELL COMPLETION ��` XPitless adapter manufacturer Maass Model Clay Blue }Maki 72 112 '❑Ba stir ,offset ❑At least 12• above ground •G 0 Plastic casing protection _ 13.WELL GROUTED? M Yes ❑No Clay-Sandi Blue 112 138 . Neat Cement 0 Bentonite ❑ Clay Blue }'ckir 138 150 0Grout material from to 30 ft.cu.yds. araW-21 -131igslack • 1 167 14. NEAREST SOURCES OF POSSIBLE CONTAMINATION feet direction type Well disinfected upon completion? *Yes ❑No 15. PUMP �y Date installed Tc/16/91 ❑Not installed gI 's name t'ae1746111�x 1 oORONO Model fi HP 3/4 Volts 230 fid pipe 140 ft. Capacity 12 g.p.m. / 1" PE a e a rop pipe Type: (Submersible ❑L.S.Turbine 0 Reciprocating ❑Jet ❑Centrifugal ❑ JUL 1. 1tQ�(p�116. ABANDONED WELLS 1nsi well on property? B Yes 0 No Use a second sheet,if needed Sealed R Permanent ❑ Temporary 0 Not sealed 17.REMARKS,ELEVATION,SOURCE OF DATA•etc. • 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. Stern- Well --)rill i ncs .n., The_ 27194 Licensee Business Name License No. Addres4240�Hwy 12 fe„../Mapt Plain, NI55159 Signed 1 `�J-'°'N�"L�-�-^e •-�'� Date 05/14/91 Authorized Representative mike Rivers DateO5/14/91 Name of Driller 1478365 5/74 7/766NW LOCAL COPYE-01205-03(Rev.9/88) 2/8210M H STATE OF MINNESOTA DEPARTMENT OF HEALTH ABANDONED WELL RECORD 1. LOCATION OF WELL MINNESOTA UNIQUE WELL NO. (leave blank if not known) County Name Hennepin - Township Name Township Number Range Number Section No. Fraction 4. WELL DEPTH (completed) Date sealed N E 4 4 of 4 or or ft. Orono 118N s 23W V 33 SE NE SE 157 06/07/91 Numerical Street Address and City of Well Location or Distance from Road 5. DRILLING METHOD (if known) Intersection 10 Cable tool 40 Reverse 70 Driven 100 Dug 225 North Willow Drive Long Lake 20 Hollow Rod so Air 40 Bored 110 30 Rotary 60 Jetted 90 Power Auger Show exact location of well (In section grid with 'X') Sketch map of well location 6. OBSTRUCTIONS N Well obstructed 0 Yes ® No Obstructions removed 0 Yes O No If obstructions cannot be i removed, contact MOH before sealing. W _ i. - - • - - - -1 - E : : 1 `X r 7. USE - • - 7 ,•- -i y In Domestic 43 Monitoring 80 Heat Loop 2J irrigation 5J Public 90 Industry 30 Test Well 60 Municipal 100 Coammercial - t SL 70 Air Conditioning 110 2. PROPERTY OWNER'S NAME Mailing Address if different than 8. CASING(S) property address indicated above 0 Black 40 Threaded 70 Jim Dillman 2ti Gals. 50 Welded 30 Plastic 613 Stainless Steel HARDNESS OF 3 1n. to ft. 3. FORMATION LOG COLOR FORMATION FROM TO If not known, indicate formation log from new well or nearby well. in. to ft. Topsoil Black 0 2 9. SCREEN 0 Screened well from_ ft. to ft. Clay Yellow 2 18 0 Open Hole from_ ft. to_ ft. (If known) Clay Blue 18 37 10. STATIC WATER LEVEL e Clay/Gravel Blue/Bra-in 37 62 lOQnd surface )Date Measured 06/07/91 Clay Blue 62 67 11. WELLHEAD COMPLETION Gravel Browr. 67 72 10 P,tle:. Adapter 40 Found Buried 20 Basement offset 50 Clay Blue_ 72 112 30 Well Pit 16. REMARKS. ELEVATION, SOURCE OF DATA - CASINGS REMOVED. CASINGS PERFORATED, ETC. 12. GROUTING INFORMATION Clay/Sand Blue 112 138 i®Neat Cement 20 Bentonite 30 Clay Blue 138 150 Grout material 5 bags from 0 to 1571. cu. yda,28 Gravel Red/Black 150 157 13. NEAREST SOURCES OF CONTAMINATION feet direction type Well disinfected before sealing? 0 Yes Formation log taken frcan new well drilled 14. PUMP ®Removed _0 Not Present 05/14/91. Unique Well # 478365 Type: 10 Submersible 30 L.S. Turbine 13 Reciprocating 20 Jet 40 Centrifugal 60 15. EXISTING WELLS (Please sketch locations of abandoned and active wells in remarks section or on back.) Other unused well(s) on property? 0 Yes E0 No Abandoned: J]Permanent 0 Temporary 0 Not sealed 17. WATER WELL CONTRACTORS CERTIFICATION This well was sealed under my Jurisdiction and this report is true to the best of my knowledge and belief. Stevens TTA11 nri11ing 27194 624LoCe ignway "17 West License No. Addre_ _T__1 ple P in, DIN 55359 Signed / IL✓i Date 06/07/91 Tim Stevens Date 06/07/91 ,FFicIAL ABANDONED WELL RECORD (May be used for Property Transfer) Name of Driller rip ' rrt r1L2 NTTMT VI=