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Home My WebLink Aboutwell info MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Bonng � � WELLORBORINGLOCA710N yyELL AND BORING SEALING RECORD SeaungNo. H 1415�J� 1�- Counry Name Mmnesota Urnque No- — �$i1i�2�?@n Mmnesota Statutes,Chaprer 1031 or W-serles►vo. r-' '" � ' r� 7 Ileave blank A no�krawn� ��' Township Name Township No. Raryge No. Section No. Fracbon�sm.-►iq.) Date Sealed Date Well or Bonrg Constmctetl � C�r.onc� 1 i 8 13 3 6 ... H � r, Numencal Street Address o�Fire Number and Gty of Well or Bormg Location � � . �7� N(�gr.�i Fernczale Raad, CrQ�7Q Depth Before Sealing � N. Onqinal Depth_��Z h. Show exad locatlon of w�ell or boring Sketch m qof well o�oring AOUIFEF�S) STATIC WATER LEVEL io section gnd wrth'X'. J[��(�'� locati�flowing p perty Single Aywfer � Multiaqwfer linba; ads,and buil nf�g. ry � rC WELUBORING Measured ❑Estimated � Water Supply Well ❑Monit.Well / - - - - - -- - — ' � �Q � � � � � � � ❑ Env.Bore Hole ❑Other _ ry. pe�pN, ❑apa,e IarM yiAace � � � � , , �f W --�- - -- - -- --'-- E � CASING TVPE(S) � � � � ; ; � � � � � ti. ' 'd : —�� i r ' '�-' -i'- --�-- � } .�.� Steel ❑ Plastic �Tile ❑Other !�mrle ; $ � t_ � � ^' CASING —�- -�-- -i-- --�-- i . , � �-�"' � Diameter Depth � Set m oversize hde? Ar�alar space nypally yrqAeC? �t mxe—�w t_.,_.._.._......� ,,� �/m.irom� to� R. ❑Ves �No ❑Yes ❑No ❑Unkrwwn � I f-� PROPERTY OWNER'S NAME in.from to ft. ❑ Yes ❑No ❑Yes ❑No ❑l�Yuw� ruce Htren Ha�neS P� er's mailing address ii diHerent than well location address indicated above. in.from to R. ❑Ves ❑� ❑r� ❑� ❑�� i� S. BYC1t3C�W�aY SCREEWOPEN HOLE �I� Wayzat�, MN 55�9� /c� ' i Screen from to ft. Open Hde from�b�� R. OBSTRUCTIONS WELL ONMER'S NAME ❑ Rods/Drop Pipe ❑Check Valve(s) ❑Debris ❑ Fill No Obstn�ction WeN ownels msiling address it dilferent Man p/operty owner's address indicated above. Type of Obslrudions(Describe) Obstructions removed? ❑Yes ❑ No Describe PUMP Type (iEOLO(i1CAL MATERUL COLOR HARDNESS OF FROM TO � Removed Not Present ❑ Other FORMATION tl na krawn,w�dicete estimated formauon log Irom nearDy well or bonng. METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASNK'AIO BORE HOLE: � ,-,.f; �1..=+ _ � No Annular Space Exits r�,� ... . '- <�� "��`�''''� / / �`� �' ❑ Annular space grouted with tremie pipe ,':i� ��,� 1,- � ❑ Casing PeAoratioNRemoval � ,c..,.. -•.�.,� ,_i I� � �� in.from to fl. ❑ PeAaaled ❑ Renprsd ,;:..t..,-_ ^..3� .:> y_1 �l.= _ ., ',; �>-'`� �%� : a �� .+�.• /� l/�j 1 f'r in.from to iL ❑ Parbwbd ❑ Ranwved L 1�-.:. � �_.�..ctJ�r..` „_A�. M rype or perforecor ❑ Omer GROUTING MATERIAL(S) .,r �L �,,,.' /�j �� Grouting Material!{�/r�L f'�j/•!�an v ro 5 '� 1l. yardg?� trps from to R yards baps irom m R yar�ds b�ps from to R yardy bsp� REMARKS,SOURCE OF DATA,dFFlCULTIES IN SEALING OTHER WELLS AND BORINGS Other unsealed and unused well or boring on praperty? ❑Yes No How ma� UCENSED OH REGISTERED CONTRACTOR CERTIFICATION This well or boring was sealed in accordance with Minnesota RWes,Chapter 4725. The irrorma0m oontained in trs�apat is true to the best of my knowledge. DtJN STf3UUL�, WELL 8lRILLIIdG CO. , INC. 271 I z Conhactor Business Name �' . Lioses or Repsha�pn fio. J Y /7!/�, �1' / �V .� /� j u epresenfative Signature DWs S ,,,,1,.,r.. i„�,.�.�~". LOCAL COPY H ��O� Name ol Person hg Well a Boring � -01030-03 2/87 R WE�L LOe,ATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. .•^c�ityName WELL AND BORING RECORD 5 g ��j � 7 FT�nnepin Minnesota Statutes Chapte�103/ Tota��p�f�� Township No. Range No. Section No. Fraction WELL DEPTH(completed) ; � Date Work Completed � 7 � L� .�iFi 41r, n �l.—� �--�+:> v. v. v. House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD 3�r N�z'�h �'�T'Ilrlctic? 12U�d Ci2'�'s t;� Ail��.�v� 1 ❑ CableTool �Driven ❑ 0�9 ❑ Auger Rotary ❑ Jetted Show exact location of well in section grid.with"X". � Sketch map of well location. ❑ _ Showin�property lines, , �� roa� and buildings. DRILLING FLUID WELL HYDROFRACTURED? ❑YES O N N�tural _i i i i_ M� 4� FROM tt.to ft. � -�' -�_ _� V USE 1 ❑ Monitoring ❑ Heating/Cooling i i i i e �}'Domestic _i_ _�_ _i_ _i_ �� O ❑ Community PWS ❑ Industry/Commercial i � � i ❑ Irrigation ❑ Noncommunit PWS w E ❑ Test Well Y ❑ Remedial i i i i T ^1 ❑ Dewatering ❑ -r -�- -r- -r � i � � � �/ZM11e � � CASING Driye Shoe? �F Yes ❑ No HOLE DIAM. _i i _i_ _i_ � (�, C't Steel C�Threaded ❑ Welded i -i- i i � ❑ Plastic ❑ S �-1 Mile-� CASING DIAMETER .��J L WEIGk{T} � 5(,., 1 � PROPERTY OWNER'S NAME in.to ft. Ibs./ft. �Szuc� Bren Hc,In�� to Property owner's mailing address it different than well location address indicated above. in.to �ii E) S BrC?ttCiWc�L�J SCREEN . .__ OPEN HQI�,, e �,� '., i , �c:yz�ir� , �112. :.��1�� Make—_� �.__ __ . ..... . � from � ��, n.co � n. - Type �,j��{ Diam. SIoVGauze Length Set between ft.and ft. FITTINGS: STATIC yVATER LEVEL �{ WELL OWNER'S NAME ��t ft. Q'below ❑ above land surface Date measured �� "�� PUMP�P{.G�EVEL(below land surface) Well owner's mailing address if different than property owner's address indicated above. � ft. after 'j •c� hrs.pumping ��` �3 r g p m WELL HEAD COMPLETION ❑ Pitless adapter manufacturer Model ❑ Casing Protection ❑ 12 in.above grade ❑ At-grade(Environmental Wells and Borings ONLY) GROUTING INFORMATION Well grouted? -�5 Yes ❑ No HARDNESS OF Grout Material ❑ Neat cement ❑ Benroni ❑ Concrete i h Solids Bentonite GEOLOGICAL MATERIALS COLOR FROM TO � . �':F1�9 4 MATERIAL from_ t` to ��ft. = • 5� yds.t3 bags '� " � i � r�'� � from to ft. ❑ yds. ❑ bags C3.G..y/lt�r �r,�l �X�� : � ��-�` .�Z� t from to fl. ❑ yds. ❑ bags Glay Gr�v� ;; ✓�� t ��' i NEARE N60URCEOFCO INATI C ,3" ' feet � t..�� direction �+��.�. type Well disinfected upon completion? �Yes ❑ No ...� Sanc� Grey 5 9�. ` 1 15 PUMP f�Not installed Date installed �lay/cr�u�1 Br�:�•�a�k M 11!� �� ManufacWrer's name . .s'�"r3T1C2St.C7IlE' (jp'e (q)� i;��. �l �t'. � 1 '��- Modelnumber HP Volis �Tr Length of drop pipe ft. Capacity g.p.m. Type: ❑ Submersible ❑ L.S.Turbine ❑ Reciprocating ❑ Jet ❑ ABANDONED WELLS y[ Does property have any not in use and not sealed well(s)? ❑ Yes ❑l�o VARIANCE � Was a variance granted from the MDH for this well? ❑ Yes �No WELL CONTRACTOR CERTIFICATION Use a second sheet,if needed This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. REMARKS,ELEVATION,SOURCE OF DATA,etc. The information contained in this report is true to the best of my knowledge. G��?� ��`.f.'G�i;_�Lt1. Yr�.I.,L r7RILI.iIvG �_:t:?. , IATC. L��see Business Name � Lic.or Reg.No. � � "� � - _j,�/�. . . . .. Authorized Representative Signature Date �..'`i?i.1C:ri> �$(�ii1� ,L—� 1--�� Name of Oriller Oate t� " 5966 � 7 ��°�� L'�'Y HE-0720506(Rev.9/96) � , � , � Jwin C�itc� UVater ��inic, J�rcc. 617 13th Ave So • Hopkins, Minnesota 55343 • (612) 935 - 3556 02/16/1998 Stodola Well Drilling 15306 Hwy 7 Minnetonka MN 55345 938-2111 REPORT OF WATER ANALYSIS Lab#: 34429 Our Laboratory reports these analytical results, determined on a sample taken by CLIENT on 02/11/1998 from the following location: Bruce Bren 395 Ferndale Rd. N. Orono,Mn Unique Wiell#596687 Coliform Bacteria <1/100 ml Nitrates Nitrogen <1.0 mg/l The results of these tests indicate that this well is producing water that meets the standards for F.H.A., V.A., or conventional loans. This repo►t is an analysis for coliform and nitrate only and does not include analysis of Lead and other contaminants. (Unless as specified by client). i Water Clinic, Inc. �� Bill n r ale , Ao.�r�,t�.bor.wn coreW�iog E,og;nae� Water Amlycis Reagewa Boiler Water C6cmicale Lab Ccrtitication M 027-033-119 R�+�E9�3�� `� MINNESOTA DEPARTMENT OF HFA�TH Minnesota Well and Boring ��0�� WELL OR BOFING LOCATI . Sealing No. H County Name WELL AND BORING SEALING RECORD Minnesota Unique No. �- Hennepin CITY 0�=(�� i'�i� Minnesota Statutes.Chapter 1031 or W-series No. :�J (Leave biank if not known) '�'� � Township Name Township No. Range No. Section Na FracUon(sm.�Ig.) Date Sealed Date Well or Boring Consiructed Oraao 118 23 36 41„-�4�Oi,. �,�/ �- Numerical Street Adtlress or Fire Number annd City of Well or Boring Location '' � 39 5 N Fe rndale ild] �rd�� 5 5 39 Depth Before Sealing � � tt Original Depth "� ft Show exact location of N•ell or bonng Sketch map of well r boring A UIFER(S) STATIC WATER LEVEL in section grid with"X". � location, showing ra�rty Single Ayuifer ❑ Multiaqwfer lines,roads, Rd$ IcMgs. N . � WELUBORING Measured ❑ Estimated � � � � ,✓ ,.,.� Water Supply Well ❑Monit Well � i i '_i_" __� ...i �s �L � : �•- �* � ❑ Env.Bore Hole ❑Other _ ` fl. �G below ❑ above land surface I I I I — ! yy -- - - -- - -- -- -- E � ' CASING TVPE(S) � � � � � � � � � � � V � � -�-- -�- -�-- --�-- � 'i � � Steel ❑ Plastic �Tile � Other � � � � j z � , �.m�le `? -- ' ' ' ' ''�� ` CASING __L_ __i_ __J__ __J__ � ..... .�-.._ \ ` - � Diameter ,� Depih e Set in oversize hole7 Annualar space initially grouted? ,`.\ t '�� r mne� �� .�,�l�t \' t�� in.from f-� to �� ..i ft. ❑Yes �No ❑ Yes ❑No ❑ Unknown PROPERTY OWNER'S NAME in.from to ft. ❑ Yes ❑ No ❑ Yes ❑No ❑ Unknown Bruce Bren Ii m Property owner's mailing address if ditterent than well location address indicated above. in.from to ft. ❑ Yes ❑No ❑ Yes ❑No ❑ Unknown 10V S Broadrap SCREEWOPENHOIE � � WByZa ta� MN 5 5 391 Screen from C� � to ~� � ft. Open Hole from to ft. 4��-091$ OBSTRUCTIONS WELL OWNER'S NAME Rods/Dro Pi e ❑ Check Valve(s) ❑ Debris p p ❑ Fill ❑No Obsiruction Well owner's mailing address if different ihan property owner's address indicated above. Type of Obs�ruCtions(DesCribB) ��j�f l��f � r-f/��! ��- �`�r'f f��I` Obstructions removed?,,�Yes ❑ No Describe PUMP i-.� _ ,,� .-,.`�. TYpe !�'�?r�,/� f.,s,.'1� I`: . GEOLOGICAL MATERIAL COLOR HARDNESS OF FROM TO Removed ❑ Not Present ❑ Other FORMATION It not known,indicate estimated formation log from nearby well or bonng. METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: dr i f t O ^A , No Annular Space Exits f� ❑ Annular space grouted with tremie pipe ❑ Casing PerforatioNRemoval in.trom_ to ft. ❑ PeAorated ❑ Removed in.from to ft. ❑ Pertorated ❑ Removed Type ot pertorator ❑ Omer GROUTING MATERIAL(S) .. ,.��1.�.. ' � �-.. .if,"i1 i :, . . �,«% � i GroutingMaterial� from to .�`!t fl. yards bags from to fl. yards bags from to fi. yards bags from to__ ft. yards bags REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING OTHER WELLS AND BORINGS Other unsealed and unused well or boring on property? ❑Yes No How many? LICENSED OR REGISTERED CONTRACTOR CERTIFICATION This well or boring was sealed in accordance with Minnesola Rules,Chapter 4725. The information contained in this report is true to the best of my knowledge. Don Stodola �Tell Drillin� Ca., Inc. 27172 Contractor Business Na e .. License or Registretion l�o. --.__ .. �- :'" .:.: . �i'�'�-- .,�>' ,-- ,�/,f. __. 10-15-97 ^�uthOAz'ed Representative Signature Oate Ji� Antonson LOCALCOPY H 12 9 0 5 3 Name ol Person Sealing Wel1 or Boring HE-01434-03 2/97 R