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Home My WebLink AboutWell Record WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. County Name WELL RECORD 4 8 0 2 9 2 "e`z t jn Minnesota Statutes Chapter 1031 Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date of Completion It. Orono 117N 23W 10 NE,,,SE,,, NW,,, 125 05/23/92 Numerical Street Address or Fire Number and City of Well Location DRILLING METHOD 1120 Ws 1 1 o i rive South � 0 Cablee Tool 0 Driven ❑ Dug 111AJW South 0 Auger X 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 •_ I ir__7_ _.1__1_ None 1 1 - 1 1 i 1 USE W i i E ;i . K Domestic ID Monitoring 0 Heating/Cooling 1 0 Irrigation ❑ Public 0 Industry/Commercial 0 Test Well 0 Dewatering ❑ r Ib mi. CASING Drive Shoe? 0 Yes Sri No I HOLE DIAM. 1 __ _-— ——_r.. I 0 Steel 0 Threaded 0 Welded 1 r I--t milt Plastic glue Aum �p8 S '% CASING DIAMETER WEIGHT PROPERTY OWNER'S NAME -1, 4 in.to 115 ft. lbs./ft. 8 in.425 ft. Tan Vi; -_. rrn in.to ft. lbs./ft. in.to ft. Mailing address if different than property address indicated above. in.to ft. lbs./ft. in.to ft. SCREEN OPEN HOLE Make j'rP$�it from ft.to ft. 3065 Lab* Shore AvenueMake PVC SIA+' CAS1tY�Diam. 4 in,, Maple Plain, F 55359 Slot/Gauze 7�s� Length 10 ft.. 1 Set between 115 ft.and 25 ft. FITTINGS: STATIC WATER LEVEL FORMATION LOG COLOR HARDNESS OF FROM TO 41 ft.jj1 below ❑ above land surface Date measured 06/23 FORMATION / PUMPING LEVEL(below land surface) ft. after hrs.pumping 50 g.p.m. Fill & Topsoil Mii3 0 15 WELL HEAD COMPLETION X Pitless adapter manufacturer Maass Model Clay & Sand Gray 15 40 li'"Casing Protection n GROUTING INFORMATION Clay y 40 1.00 ._. Well grouted? (X Yes 0 No Grout Material k Neat cement 0 Bentonite Clay & sand Gray 100 112 from _to 30_ft. 0 yds. 0 bags Clay with strip., from to ` ft. 0 yds. ❑ bags Of gravel strips110/1 112 1.25 from to ft. 0 yds. 0 bags ii7 NEAREST SOURCE OF POSSIBLE CONTAMINATION feet direction type Clay Blne 125 - Well disinfected upon completion? x Yes 0 No PUMP 0 Not installed Date installed 7/22/92 • Manufacturer's name Goulds pie Model number HP 1/2 Volts 230 Length of drop pipe 60 ft. Capacity 10 g.p.m. Pressure Tank Capacity20 Type: Jg Submersible ❑ L.S.Turb O Reciprocating ❑ Jet 0 ABANDONED WELLS Not in use and not sealed well on property? 0 Yes ii No WELL CONTRACTOR CERTIFICATION This well was drilled under my jurisdication 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 _ r. REMARKS,ELEVATION,SOURCE OF DATA,etc. .t.... /�`' or �. ` 1 .xtl"--�_ _ 06/23/92 Authorized Representative Siganture Date Randy ?MAW A6/23/92 LOCAL COPY 4 8 0 2 9 2 HE-01205-03(Rev.9/91) STATE OF MINNESOTA DEPARTMENT OF HEALTH ABANDONED WELL RECORD 1. LOCATION OF WELL MINNESOTA UNIQUE WELL NO. (leave blank if not known) H 24 5 2 2 County Name Hennepin Township Name Township Number Range Number Section No. Fraction 4. WELL DEPTH (completed) Date sealed N E 4 4 of y Orono 117N Sr 23W wr 10 NE SE NW 122 ft. 7/20/92 Numerical Street Address and City of Well Location or Distance from Road S. DRILLING METHOD (if known) • intersection 10 Cable tool 40 R 13 Driven 100 Dug 1120 Willow Drive S. Wayzata, MN 55391 20 Hollow Rod 50 Air 80 Bored 110 30 Rotary 60 Jetted go Power Auger Show exact location of well (in section grid with 'X') Sketch map of well location 6. OBSTRUCTIONS N Weil obstructed 0 Yes ® No Obstructions removed 0 Yes 0 No If obstructions cannot be removed, contact MEIN W - ! - - x - • -I- - E before sealing. 7. USE Domestic 40 Monitoring BO Heat Loop - 20 Irrigation S0 Public 90 Industry S 30 Test Well 60 Municipal 160 Commercial 1 S1. in Air Conditionina 1lf_i 2. PROPERTY OWNER'S NAME Mailing Address if different than 8. CASING(S) property address indicated above 10 Black 40 Threaded 70 3065 Lake Shore Drive 212 Gal v. 50 Welded Tom Vickerman Maple Plain, MN 55359 3E]Plastic 60 Stainless Steel HARDNESS OF 2 in, to ft. 3. FORMATION LOG COLOR FORMATION FROM TO If not known, indicate formation log from new well or nearby well. in. to ft. 9. SCREEN ®Screened well from ft. to ft. (if known) 0 Open Hole from_ ft. to_ ft. 10. STATIC3WTER LEVEL 44 ft. ®below 0 above land surface Date Measured 7/20/92 11. WELLHEAD COMPLETION 10 Pitless Adapter 4Q Found Buried 20 Basement offset 6J 30 Well Pit 16. REMARKS. ELEVATION, SOURCE OF DATA - CASINGS REMOVED. CASINGS PERFORATED, ETC. 12. GROUTING INFORMATION 1®Neat Cement 20 Bentonite ?D Grout material 21/2 bags from 0 to122ft. cu. yds•10 New well was drilled 6/23/92 — Unique well #480292 — 13. ."IC.YCST 4OJGCCG Cr CGFTAAlhATIUN feet direction type Well disinfected before staling? 0 Yes 14. PUMP ®Removed 0 Not Present Type: ID Submersible 30 L.S. Turbine SJ Reciprocating 22;Jet 4:3 Centrifugal 60 CITY Oc 15. EXISTING WELLS (Please sketch locations of abandoned and ORONC _ active wells in remarks section or on back.) l5 1 E 0_'1l_ Other unused well(s) on property? 0 Yes ®No Abandoned: 0 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. S F(' 2 5 1992 Stevens Well Drilling Co. 27194 L,canm1 Highway 12 WeNome slten:e No. Address Ma le P1 NN 55359 Signed / ate 7/20/92 Joe Stevens ate 7/20/92 OFFICIAL ABANDONED WELL RECORD (May be used for Property Transfer) Name of Driller IMPCPTART: rlla WITH DIKED