HomeMy WebLinkAboutWater Well Record STATE OF MINNESOTA DEPARTMENT OF HEALTH
h1.LOCAT F LCI 1• WATER WELL RECORD MINNESOTA UNIQUE WELL NO. 475707 75707
County for Water Sample
Minnesota Statutes 156A.01-.08
Township Nat, ' Township Number Range Number Section No. Fraction 4.WELL DEPTH(completed) Date of Completion
117 °s` 23 w 02 NE SE NE 166' ft. 1-30-91
Numerical Street Address and City of Well Location or Distance from Road Intersection. 5.DRILLING METHOD
0 CableTool ❑Reverse 0 Driven ❑Dug
1250 4111 Avenue Orono, Minn.
Show exact location of well in section grid with"X." Sketch ma of well location. ❑Hollow Rod 0 Air 0 Bored ❑
N
1 t Addition Name ]Rotary ❑Jetted 0 Power Auger
-_r__y_ _' __t_ 6.DRILLING FLUID
t
I
---- -'- '---X Block Number ] 7. lL.
W 1 r E �e'y•C !'�'� Domestic 0 Monitoring 0 Heat Pump
I ' t Lot Number �Y 0 Irrigation 0 Public 0 Industry
1 h mi. •N��P Lt•CI Test Well CI Municipal O Commercial
--1- -�- ---r- w ❑AirConditioning CIt ' I /
I--I mile it,e).>:',:4 +••t i 1, t. sy v w . 8.CASING HOLE DIAM.
2.PROPERTY OWNER'S NAME MailingAddress if different thanpropertyaddress y� HEIGHT:Above/Below
Black [S Threaded
t ca +ion indicated above. Surface y ft. /
4. 1315 Fist Lake� Street C7 O Gal:. O Welded Drive Shoe? Yeses No 61/4
t t it ly Craig Wayzata, Minn. 55391 O PITic ❑
4 - in.to 162 ft. Weight 10.86 lbs./ft. _in. to .
3. FORMATION LOG COLOR HARDNESS OF FROM TO in.to ft. Weight lbs./ft. __in. tort.
FORMATION
in.to ft. Weight lbs./ft. —in. tort.
Gravel 0 65 9.SCREEN Or open hole
from ft.to. ft.
CIII
ClayMake �`'
Cla 65 Zsri Type Stara 1'l akftS SS'fi ll Dtam. 4"
Slot/Gauze Sand 1 2 10 Length FITTINGS:
t! lfi6 Set between 162 ft.and 166 ft.
•-a 10. TIC WATER LEVEL
j� ft.CXelow 0 above Date Measured 1-30-91
land surface
II.PUMPING LEVEL(below land surface)
110 ft.after 4 hrs.pumping 20 g.p.m.
ft.after hrs.pumping g.p.m.
12.HEAD WELL COMPLETION g,�
__ _ ---'` to tet Model
__ X1 Pities adapter manufacturer
r"•l� I CI Basement,offset XI At least 12"above ground
' c j 0 Plastic casing protection
t ti- 13.WELL GROUTED? XYes 0 No
•1
-
0 Neat Cement 0 Bentonite natural atriai1l
Grout material from to ft.cu.yds. _
1291.
IAARZ2 •
^ 14.NEAREST SOURCES OF POSSIBLE CONTAMINATION
- - feet direction type
Well disinfected upon completion? a t'es O No
15. PUMP
Date installed 2-6-91 O Not installed
Manufacturer's name•Ownetrn • arundfo
Model number t HP 3 Volts 230
Length of drop pipe 126 ft. Capacity g.p.m.
Material of drop pipe 11/2" Galy.
Type:Xj Submersible 0 L.S.Turbine 0 Reciprocating
0 Jet 0 Centrifugal Cl
16.ABANDONED WELLS
Unused well on property?erraces
es ❑No
Use a second sheet,if needed Sealed Ai Permanent 0 Temporary ❑ 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.
DON =MLA WELL £9JLL16 co.. INC. 27172
Licensee Business Name y License No.
Addressf
.15306 Highway 77, t14n. 55345
sign er%. ' '7. i).„1-30-91
Authorized Representative
F. P. McMahon Date 1-3((1-91
475707 Name of Driller
LOCAL COPY . 5/7430M
7/78 30M
HE-01205-03(Rev.9/88) 2/82 M
I
T '
?Oat a 'ate' eleale, Tate.
617 13TH AVE.SO. HOPKINS,MINNESOTA 55343 • 935-3556
Stodola Well Drilling February 8, 1991
15306 Highway 7
Minnetonka, Mn. 55345
•
REPORT OF WATER ANALYSIS
received from you
Our laboratory reports these analytical results,determined on a sample on Janua 31, 1991
tam- oyrs �'!'
well water
from
Burnet Realty
1250 Woodhill Ave. '4
Orono, Mn.
Unique Well # 475707
Bacteria (Coliform group) less than 1/100 ml
Nitrate nitrogen less than 0.1 mg/1
The results of these tests indicate that this well is producing water
that meets the standards for F.H.A., Y.A., or conventional loans.
Water Clinic, Inc.
Analytical laboratory Consulting engineer
Water analysis reagents Arsdale Boiler water chemicals
17.1 partslmillion equals 1 0 grainigallon
SIAIL UI- MINNLSUTA IJ&AHIMtNI OF H&ALiH
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 y yof 4
Orono 117 or 23 ur 02 NE SE NE 3 ( 0 ft. 3 l 5 / 9 i
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
1250 Woodhill Avenue, Orono, Minn. X20 Hollow Rod 5D Air 40 Bored 110
.iry3((Rotary 60 Jetted 9Power Auger
Show exact location of well T`
(in section grid with "X") Sk-t h m.. . w•l location 6. OBSTRUCTIONS
N Well obstructeYes 0 No
L Obstructions re ved Y,es 0 No If obstructions cannot be
removed, contact MOH
_I_ A E before sealing.
, 17. USE
`- • '-'-` - y„i, ,c, 7.
)4 Domestic 40 Monitoring 60 Heat Loop
Lk &�yeu. 20 Irrigation 50 Public 9[] industry
1 •• Nea�y 30 Test Well 60 Municipal KO Commercial
h'-1 SL A30c'd {moi 11 OVe-, 70 Air Conditioning 11[]
2. PROPERTY OWNER'S NAME Mailing Address if different than B.'CCA�q A. _\
S�ING(S) "�
[]
property address indicated above l[ Black 4171 Threaded 7
315 East Lake Street T20 Galv. TS[]Welded
Wayzata, Minn. 55391
Burnet Realty 30 Plastic 60 Stainless Steel
HARDNESS OF in. to j c4. 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
De i Fr 61 �/6 yl Screened well froeL ja ft. to.3/c ft.
(If known)
['Open Hole from ft. to_ ft.
10. STATfC, 15R LEV ••`
QQ fbelow 0 above
land sur ace Date Measured 3/5 (q/
11. HEAD COMPLETION
1 Pitless Adapter 40 Found Buried
2(] Basement offset 50
30 Well Pit
16. REMARKS, ELEVATION, SOURCE OF DATA - CASINGS REMOVED, CASINGS PERFORATED, ETC.
12 ROOTING INFORMATION
Neat Cement 20 Bentonite 30
Grout material from,liatoQ ft. cu. yds
Grout 4" Well 310' Deep.
27 Bags Cement
28# Bentonite 13. NEAREST SOURCES OF CONTAMINATION
_ feet direction type
2 Men, Rig, Labor & Cement Grout Pump. Well disinfected before sealing? 0 Yes
14. PUMP Removed 0 Not Present •
Type:)1N)Submersible 30 L.S. Turbine ID Reciprocating
20 Jet 40 Centrifugal 60
15. EXISTING WELLS (Please sketch locations of abandoned and
active wells in remarks sec on or on back.)
Other unused well(s) on property? 0 Yes No
Abandoned: 0 Permanent 0 Temporary 0 N t s led
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.
DON STODOLA WELL DRILLING CO. INC.
Licensee Business Name Licens llo.,7 2
Address 15306 Hi.hwa 7 Mtka, Mn. 5E345
sign, Date 3-8-91
Mark Stodola oat.3-8-91
OFFICIAL ABANDONED WELL RECORD (May be used for Property Transfer) Name of Driller
IMPORTANT: PILE WITH DEED
• 1