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Home My WebLink Aboutwell info .�.�.-�.." "�"WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIOUE WELL NO. CounryName WELL RECORD 4 7 9 3 6 � i�t=�`Cft'i�_-; 11' Minnesota Statutes Chapter f031 Township Name Township No. Range No. Section No. Fraction WELL DEPTH(comple[ed) Date of Completion n. 'Y'.(',1" 1�3 '/. '/� ' '/. � } "L[ Numerical Street Address or Fire Number and City of Well Location DRILLING METHOD , . . ... . f I Cable Tool C Dnven � Dug �€>" - ��' , r�r; = Auger Rotary C Jetted Show exact locatian of well in section grid with'X'. Sketch map of well location. --, �� Showing propertylines, N roads and buildings. DRILLING FLUID I � � ' ;!-; 'r_ �_ _1 _1_ . ._. . .,..... � � i i i i USE "i' ';' i- �' � Domestic i_ Monitoring ❑ Heating/Cooling W i � ET r/g'j� �._�Irrigation f I Public '-1 Industry/Commercial _1_ _1_ __ 1_ I ,r ❑ Test Well .-! Dewatering I_] I ; ' ' f-mi. � , CASING Drive Shoe? Q�Yes ❑ No HOLE DIAM. --i- �- - -� 1 7 Steel J Threaded - Welded H—/mile,—� =`j.PIaStIC - No��7lJ f�t N4�4 .� CASING DIAMETER WEIGHT PROPERTY OWNER'S NAME 5;'; ' '' in.to i� :_ft. , :'i. Ibs./ft. �in.to�it. �.� in.to ft. Ibs./ft. �,�n.ro�. Mailing address if different than property address indicated above,, in.to ft. Ibs./ft. =in.to ft. SCREEN OPEN HOLE . _, VS.��`:�s_.i r�`..�`"_. �.a .t.!�. '� -_... .. S. w;`; Make from ft.to �- ft. . .">A'�r�i L`.ct� :�!i'-' - .....'1 TYPe Diam. s,. — SIoVGauze Length � Set between ft.and ft. FITTINGS: STATIC WATER LEVEL FORMATION LOG COLOR HARDNESS OF FROM TO ''`'� ft. below ❑ above land surtace Date measured - FORMATION �. � PUMPING LEVEL(below land surtace) ..�_ ft. after hrs.pumping �c`.i o.p.m. . � WELL HEAD COMPLETION �Pitless adapter manufacturer {�Y[�?{-�i,v'r^r'Ce :' Model j. ' ._ .. _ . ��; Casing Protection GROUTING INFORMATION Wellgrouted? C7 Yes p- No Grout Material ;_] Neat cement C Bentonite from to ft. � yds. ❑ bags from to tt. ❑ yds. ❑ bags from to fl. ❑ yds. ❑ bags NEAREST SOURCE OF POSSIBLE CONTAMINATION feet direction rype Well disinfeded upon completion? C1-Yes ❑ No PUMP J Not installed Date installed �,_.;�--'-`. ManufactureYs name - .. :.��1`'—i'�!:''��E? : Model number HP ? Volts G:'i' Length of drop pipe �1r,s ft. Capacity � a.p.m. Pressure Tank Capaciry ��. y : ��. t: Type: L1:;Submersible IJ LS.Turbine I_l Reciprocating� - Jet �_. ABANDONED WELLS � Not in use and not sealed weA on propeRy? !' Yes ��, No WELL CONTRACTOR CERTIFICATION This well was drilled under my jurisdication and in accordance with Minnesota Rules,Chapter 4725. The information corrtained in this report is true to the best ot my knowledge. Use a s��eet '/n ed L:�. ' __x�1_i', t _ L�s`�1 i 3�ti(:; �. a t',w- f i ' M REMARKS,ELEVATION,SOURCE O A A,etC�''"- Licensee Business Name Lic.or Reg.No. r r n � -._ ''� sv°` % i �7�""^r,-. i,; ,. .f f�! � %r � �-� ,:-�: ;--�:�:� - ` �'� Ali�hohie�Repiesentat�Je S�ganture Date r, � � :'f`� k ,:t?2' .. -�L Name ol Driller Date LOCAL COPY 4 7 9 � � � HE-01205-03(Rev.9/91) t r -ti . TWIN CITY WATER CLINIC, INC. 61? 13th Ave. So. Hopkina, Minnesota 55343 (612) 835-3b56 07/O1/82 Stodola Well prillin� 15306 Hwy 7 Minnetonka, MN 55345 938-2111 Lab #: 16774 • - - -- _ - - - - RBPORT Oi? WATHR ANALYSIS Our laboratory reporta theee analytical results. determined on a sample taken by YOU on 06/29/82 from the following location: 8d Bierman Unique it 979365 505 North Ferndale Rd Orono. M�n Coliform Bacteria <1/100 ml Nitrates Nitrogen 1.45 mg/1 The resultg of theae teets indicata that this well is producin� watar that meets the standarde for F.H.A. , V.A. , or conventional loans. v Wat r ic. Inc. � � Bill a Arl dal � Brian Blair Minnesota Well and Boring ��111 -- � WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Sealing No. H � � � �o��YName �.. WELLANDBORINGSEALINGRECORDMi��eso�a��iqUeNo. .;� 1.1,I iri�'�_:=i: or W-series No. rs�'�.� Minnesota Statutes.Chapter 103! � �Le2ve blank if not known� Township Name Township No. Range No. Section No. Frac�ion(sm. �Ig.� Da�e Sealed Approximate Da�e Well � ' � � or Boring Construc�ed �_,_L.�L: �� 2�4 � s� s�n sB,� ` ' �� `i 3 Numerical Street Address or Fire Number and City of Well or Boring Location —/t ��'t �'��+�-��-'��x Depih Before Sealing � � • fL Onginal Depth � � � ft. Show exact locahon of well or boring Sketch map of well or bonng Static Water Leve� ccurate in sec�ion gnd wdh��X��. Iocaiion.showing property lines. ' � roads.and buildings. ❑Approximate N � � � � � __ ___ _-_ __ Single Aquder ❑Multiaqui(er ft. � below above land surface i i i i �� >1�\ �,i1!.;��'"-. _i_ _�_ _i_ _i_ � �"`�'� CASING TYPE W i i i i E �.. . . �� i � � _i_ _�_ _r_ _i_ ,, i i i i � � � Steel ❑Plas6c ❑Tile ❑Other hmile i K•� _i_ _i_ _i_ _i '_ / .__..-� �] S � Screen from � ` to t � ft Open Hole from to 1t. �--imi�e--►I , � OBSTRUCTION/DEBRIS/FILL Obstruction ❑Debris ❑Fill s� PROPERTY OWNER'S NAME Bietmsn tJ c� b b;t r i,,�� ;c��,-� Type of debris/obsiruction Mailing Address�f ddferent than property address indicated above. Obstruction/Debris/Fill removed7 Yes ❑No PUMP ❑Removed Not Present ❑ Other CASING GEOLOGICAL MATERIAL COLOR HARDNESS OF FROM TO FORMATION Diameter Depih Set in oversize hole? Annular space initially grouted? If not known,mdicate estimated formation log from nearby well or boring. �ift � !7'1 � in.from v to � � fl ❑Ves L.�No ❑Yes ❑No ❑Unknown i� in.from to fl. ❑Yes ❑No ❑Yes ❑No ❑Unknown in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: No Annular Space Exisis _- ❑Annular space grouted with tremie pipe -� � ❑Casing PeAoration/Removal � �'�� in.hom �o fl. ❑PeAorated ❑Removed � in.from to fl. ❑Perforated ❑Removed �A�,� ,� .2 J Type of perforaror ❑o�he� GROUTING MATERIAL � Grouting material N�C�� L'y.dv�.��rom �` to i 1 7 it. yards ��bags from to fl. yards bags REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING (rom to ft. yards bags V��,t� �t~ �l„1 1,77� LLCcP from to ft. yards bags 1V �� t UNSEALED WELLS AND BORINGS � 1� 1� d/Ciit�� Other unsealed well or boring on property? ❑Yes No 2 P.�n 3.�SW=� r��j� C� C�I� ��'Q(,at '� LICENSED OR REGISTERED CONTRACTOR CERTIFICATI N � This well or boring was sealed in accordance with Minnesota Rules,Chapter 4725.The information conlained in this report is true to the best of my knowledge. ��;�� ic��r.��x �,�°�1t., �:�:�.a;�:.� �:;., :�.x�.:. '��;�� Contractor Business Name License oi Registration No. �-- � �' 4-19-93 a ,�.�-�_..� �..�..��-�'..;: Authorized epresentative Signature Date LOCAL COPY �„I A Q .�� Tj.ID I�[� LQ p Name ol Person Sealing Well or Boring H E-01434-01 -.-_.—.�__