The URL can be used to link to this page

Home My WebLink Aboutwell info WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. CountyName WELL AND BORING RECORD �, � 2 6 8 2 H e n n z�i n Minnesota Statutes Chapter 103/ Township Name Townshi No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed Orono 117 23 7 SW SW SE 111 " lU/18/36 ��. ��, �� House Number,Street Name,City,and Zip Code ot Well Location or Fire Number DRILLING METHOD 4174 Hit�.hwood Road ❑ CableTool Q Driven ❑ Dug ❑ Auger L�'Rotary ❑ Jetted Show exact location of well in section grid with"X". Sketch map of well location. ❑ /� j� Showing property lines, / �� roads and buildings. DRILLING FLUID " r-�-�� water � � � � � � -,-- -,- USE ❑ Monitoring ❑ Heating/Cooling _i_ _�_ _i_ _i_ [�Domestic ❑ Community PWS ❑ Industry/Commercial � � i i , ❑.1�rrigation ❑ Noncommunit PWS L�`��`t�L�_ Y ❑ Remedial vd i i i e � ��West Well ❑ Dewatering ❑ -r -�- -r- -r T i � i i �/2M.ia �/ �� " CASING ^ . Drive Shoe? ❑ Yes o HOLE DIAM. _i_ _i_ _i_ _i_ � ^ " � ❑ Steel ❑ Threaded ❑ Welded i i i i C�Plastic ❑ S �1 Mile� .�....�. CASING DIAMETER WEIGHT PROPERTY OWNER'S NAME `� in.to 1�� ft. �� Ibs./ft. �a��o_6�. ��r k` �� in.to ft. Ibs./ft. v"� in.to j 1�. Property owner's mailing address it different than well location address indicated above. in.to ft. Ibs./ft. in.to ft. 17605 Susan Driv� SCREE OPENHOLE Mif'netonk�, M� ��4�J Make aY from ft.to ft. Type Diam? SIoUGauze Length � Set between tt.and it. FITTINGS: STATIC WAT�i�EVEL 7� WELL OWNER'S NAME � ft.-�I below ❑ above land surface Date measured PUMPING LEY�,6,(below land surface) 3 �� Well owner's mailin address if ditterent than ro e �V g p p rty owner's address indicated above. ft. after hrs.pumping g.p.m. �LLHEADCOMPLETION whitevater S�LJ�4 Pitless adapter manufacturer Model ❑ Casing Protection ❑ 12 in.above grade ❑ At-grade(Environmental Wells and Borings ONLY) GROUTING INFORMA1TION Well grouted? V Yes ❑ No HARDNESS OF Grout Material ❑ Neat ce e C'xBen onite ❑ Concrete ❑ Hi h Solids eentonite GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO �� 9 from to ft. ❑ yds. ❑ bags c 1 a y L r u w n _r.��. 0 3 6 ''°"' _�� n. ❑ vds. ❑ bags from to ft. ❑ yds. ❑ bags NEAREST KN �jN SOURCE OF CONTAMINATION �li�:� "`lU:-' I:1�C�. 3�1 �5 �" feet 7� N direction �e��'r type ��X Well disinfected upon completion? '2J Yes ❑ No a i r t e$t�� sand brown fiii� 6� I11 PUMP 10/24/56 ❑ Not installed Date installed ManufactureYs namg �t r3—R 1�t� Model number 1�� HP ioSs � Length of drop pipe ft. Capacity U g.p.m. Pressure Tank Capacity Type: C�Submersible ❑ L.S.Turbine ❑ Reciprocating ❑ Jet ❑ _ ABANDONED WELLS y Does property have any not in use and not sealed well(s)? ❑ Yes 'fl No 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. 12.E.5. Wel.l Drillin� 27"L76 Licensee Busmess Name , Lic.or Re .N. r 2�-r�' �. ��'�_.,/� �.�d_f<-._ rf �`/17 G Authorized Representative Signature Date Robcrt �,. Stodala, Jr. 10/24/95 Name of Driller HE 01205-OS(Rev.1/95) LOCALCOPY 5726 �2 ST'l�TE OF MINNESOTA DEPARTMENT OF HEALTH ABANDONED WELL RECORD � 1. LOCATIOX OF WELL MINNESOTA UNIQUE wELL N0. �j� � ' „ (leave blank tf not known) � ICounty 9ame ��^ n✓�� I 'ovnship Hame Townshi NumDer Rangc NumDer Section No. Fraction 4. WELI. �EPTH (completed) Date sealed ry E ; 4 of y I G�I,�F?�1/�rl� / � 1 Sr �%J Nr '� � �� ft. � '�/�C/ I L / NURer cal Street Address ana City of Well Location or Distance from Road 5. ORILLING METH00 (if known) I Incersec:ion 1�Cnble tool 4[J Reverse 7(]Driven 1C�Dug I L _/ (�� /' 20 Hol lav Rod 5[�Air 8[]Bored 110 �_ / � � �� / ��-tiZ"'"G" �C.L?' r �—--� 3� Rotary 60,)etted 90 Power Auger iShow exact lecat!on of well ✓ I (in zection grid ri[h "X") /�,, Sketch mnp of well location 6. OBSTRUCTIONS M � Well obstructed�Yes � No _ � _ _ ; _ , �� / Obstructlons removed�Yes [�No If obstructions caanot be _I._. _ I i l,C-�� removed, contact MDH � _ ' � _ �� before sealing. -I- - E , . , . � _ L _i : , , , r � � .� � �. �sE - l / I�Domestic 40 Monitaring 80 Heat loop ! i_- �..' y��. _�_�j Z� ;rr;ya.�„�� :uoiic '� lnaustry I �I i I I 3�Test Nel l 60 Munit1021 1�Comwrcial i � SL— 7�Atr Conditioning :1Q � ', 2. PP.OPFRiY OLINER'S NAME Mailing Address if different than 8. CASING(S) ' �_/��L�- Droperty address i icated above t� I(� Btack 4�Threaded 7(] � � �i f / ;��L'"L L " i C` � L7 n 'r �''� 2[�Galv. 5[]Welded �� ) �,�-• �' `��v ��'�� ' ��/�- S � � Y-�� 3[�Ptastic 60 Stainless Steel � I HARDNESS OF ) in. to J •J ft. ' . fORMAT:QY LOG COLOR FORMATION FRON TO � .. not kaowr�, indieate formation log �rom new well or nearby well. 1n, to ft. I ; 9. SCREEN L_ �Screened wel l from%'rft. to �<2�f*.. J (I` knexn) � � I LJ � G'G� �Open Hole from� ft. b � ft. I I10. STATIC NATER LEVEL I 7� ft. � below �above land surface Date Mensured �-� `�� Il I I 11. WELLHEAD COMPlETION I � 1� P1Uess Adapter a�Faund Buried � 20 Basement offset 5� � t 30 Well P1t i 116. REFVRKS, ELEYATiON, SOURCE OF OATA - CASINGS REMO4E�. CASINGS PERFORATEO, ETC. I 12. GROUTING INFORMI;iION � 1[�i Neat Cement 2�Bentonite � i . r^_.� ._._�..� �, '_/ J� ._. .'� j�,� � - _, 13. NEAREST SOURCES Of CONTAMINATION /l / L,; feet �_ direction ,-�Sd'•—f�n�-�_ type Well dlsinfected before sealing7 � Yes I � 14. PUMP �Removed �Nat Present I I � __ . ' Type: 1[l Submersible � L.S. TurEine � Reciprocating � � 2�Jet 40 Centrifugal 60 15. EXISTING WELLS (Please sketch locations of abandoned and i � attive wellt in remarks sectlon or on back.) '; Other unused well(s) an prooerty7 �Yes .�No i Abandoned: [� Permanent �Temporary �Not sealed i � i7. uATER WEIL CONTRA.CTORS CERTIFICATION i Z1�'.C�. This well was sealed under my jurisdiction and this repurt � ,APR �'°'jJy, is [rue tu the bes[ of my knowledge and belief. i ; �c �_ f;`;�� , � �� i � � U r.ensee Business Name „ Ltcense No. � � � � .(' 7 C� -�L'- % Address ?✓27ic--< ---�- Signed �L;�L,�-��'�-t_,L.�C�. �ate 1 1 -/j' � �4- ��s.- Date �� ' �� f L �FFICtAI aBANDOHEO V�ELL RECORD (May be used far Property Transfer) � ame of Dr117er ` Z1�pRTANTt PILS SeRTH D%SD