HomeMy WebLinkAboutwell info s�n�t ut- r�rnntsu ia utrat i ritn t � �nt,.r�
ABANDONED IrELI RECORD
i. LOCATION 0I YEII• __•_^ M(��E� plank N1W t knoLw`i)N0.
County Nue Hennepin
Tormship Naw Tmmshtp Nwiber R�nyt Nu�ber S�ttton No. Fractlon 4. MEII DEPTN (co�pl�t�d) Oate seal�d
N E 4 Yof y
(7r'Ori0 117 s� 23 N' OS NW SW NW � 3 ft. � ( (p l �
Nwaerical Str�et Address �nd C1ty of W11 loc�tton or Dtatanc• frow qoad 5. IL IN6 IETH00 (tf known)
lntersection �Csbl� tool 1�Wrtrs� 7�]Driven 1�Duy
255 Landmark Drive Orono, MN.
Hol low Rod 5C1 Mr �Bond 11Q
Show exact lattion of.w�11
3Q Rot�ry 60 J�tt�d �Pore�Auy�r
(tn s�ctton grld �ith 'X•) Skttch Mp of r»11 lx�tton
p� 6. OBSTRUCTfONS
N 'S INiI obstruct�d l�s f� No
_ � . _ : ._ .: 1�, � oestruce,on: �.e�rY�s �No It obstructions unnot be
' . � ' ��'� ►�wwd. contsct I�N
M - � - � -� •�- - E � �ts+ t�,s.,i��9.
. ' �
. , : ` T � �. e
' y,R. C 1�Do�esilc �Montto�iny �FNat Loop
�
..�_ . ._�.. _.,.. --,•- I � 2[�Irriyation 5�Publlc 90 Industry
� 1 Q U/�� � . �T�sL Wil 6�Municlp�l 1fQ Cc�rc1a1
�--i SL-.� y �p�,� w�a,cio�,�y i�p
2. PROPERTI' OWNER'S NAME Ma111ny Address if dlfferont than 8. GlSIN6(5) \ ,
property addnss indle�t�d abov� 1C1 Black �7Thn�ded 7(]
% Paul Swanson SAME �s.i�. �wiaa
�]Piastic 6p sa��i.:: sa.i �
HARDNESS OF �
3. FOAIYITION �OG COLOR FOf!lNTION FROM TO ���• � ft.
If not knwm. tndlute fonrtton loy fro�new wil or nearby wil. in. to ft.
Drift 0 83' 9.�k,.�«�w w.n rro. 79 rs. co 83 re.
� (tt tnorn)
❑Op�n Fb1• frro�_ft. to_ ft.
10. STATIC TEN LEYE
� ft�b�low �abow
l�nd u ac� Oat� qusured � L �
11. YELLHEAO COIiLETION
10 P1tl�st Adapt�r �Found Buriad
8as�nt offs�t 5�
Wll Pit
16. REMARKS, ELEYATION, SOURCE OF DATA - CASIN65 RElqVEO. G15IN6S PERFORATEO. ETC.
12.Y�RqUTIN6 INFORlNTION
;k,�IN�t C�nt 2�9�ntoait� �
Grout 2" Wel l Approx. 83' Deep �,,,,,t ,�u�1,i �,.,.$3 w C�fc. tu. yds
2 Bags Cement
4 Lbs. Bentonite — —
2 Men, LAbor, Rig and Cement Grout P�unp 13. NEAREST SOURCES Of COIITAMIWITION
_ rne a,nccton cyp.
W11 disinf�ct�d b�ton sNilnqt ❑Y�s
14. VIIM RMpv�d �Npt Insent
Typ�: 10 Suhrntbl• �]L.S. Turbin� ;�R�ciproc�tinq
�J�t �CentHfuqai 6�
15. EXISTING IIELIt (Pl��s� fk�lcb loeallons of abanbn�d and
aetiw Nits tn rawrks s�et o� oa b�ck.)
OtMr unu• 1(s) on prop�MyT �1'�s No
AbanEon�d; V�r�an�nt �Ta�porary �] t sal�d
11. WTER YELI CONTRACTORS CERTIFICATION
TAts r�ll ws s�a1W under q �urlsdiction �nd this nport
n� � is trw W th� p�st of q knowlWye and b�lt�f.
�ry:j � � "v`�� DON STODOLA WELL DRILLING C0. , INC.
Ltcens�� Sustmss Nu� Ltcens� No.27172
Address 15306 H . 7 M1T1I1EtOTllCa �},�j
519� Dat� — —
ark . Stodola o,a - -9
FFICIAL ABAMDONED YELL RECORO (q�y b� us�d for irop�rty Tr�nsf�r) . Il��t of pM11t�
I�QtT.I/'!'r dZLt �TH A�p
... .
WELL LC"AT%rvN��, MINNESOTA DEPARTMENT OF HEALTH
MINNESOTA UNIQUE WELL NO.
County Name WELL RECORD 5 3 6 2 7 3
���'��� Minnesota Statutes Chapter f 031
Township Name Township No. � Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed
�f7Xtt; ��� i._i �.�;� .���-�i{f��:i�': � ��`Iy� n. _..y?Gjr.��.
Numerical Street Address and City of Well Location or Fire Number DRILLING METHOD
G�:�i �lA:�,C��'.�,k L1�..S�� ��L�IQ� 0�3.�. ❑ CableTool ❑ Driven ❑ Dug
❑ Auger �] Rotary ❑ Jetted
Show exact location ot well in section grid with"X". Sketch map of well I�cation. L
N i�howing prope lines,
roads and b 'Idings. DRILLING F�,l�I�D�
I � ' � ,jy C��T1�.C.�1�.'�.�-��.
--r--7- _t _1_ ♦�" (
�
� � i i _ ,USE � Domestic ❑ Monitoring � Heating/Cooling
��a- --- �- �- � ❑ Industry/Commercial
yy i ; � , E � ❑ Irrigation ❑ Public
_1_ _�_ _,_ __ �, ❑ Test Well ❑ Dewatering O Remedial
, ; � T � � �
' r•mc _ _ - '� CASING Drive Shoe? ❑ Yes ❑ No HOLE DIAM.
--�- -i- ; -r- I �' ❑ Steel ❑ Threaded ❑ Welded
1 s
,4 }Q7 Plastic C
�1 mile-�
� CASWG DIAMETER WEIGHT
PROPERTY OWNER'S NAME �it E� l /���5' �E5
`iLT.�'�' VC� �;.t:}1'�t,t`_J.`LI£:�` �n.co .9� n. ibs.in. � �o n.
'�,. �{:�
in.to ft. Ibs./ft. 1 irf?to - ft.
Mailing address if different than property address indicated above. � __ in.to ft. Ibs./ft. in.to ft.
��� � �(��'�; SCREEN��,"��� �t OPEN HOLE .
�•}y�.��.����' �� -�s�.��� Make '^ C` 1 � � "����"' from ft.to ft.
Type Diam. r�
SIoUGauze Length
Set between ft.and � ft. FITTINGS:
STATIC N(A ER LEVEL
HARDNESS OF !}�j ����'1--��
GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO ft�i0 below ❑ above land surface Date measured
PUMPING LEVEL(below land surface)
�3=�� � {�'� ���i ft. atter hrs.pumping g.p.m.
WELL HEAD COMPLETION
�'Jc�:�.Y1C�i � ��-�! ���� �Pitless adapter manufacturer �����. Model
❑ Casing Protection C�:12 in.above grade
GROUTING INFORMATION
Well grouted? �] Yes ❑ No
Grout Material ❑ Neat ceme I�Bentgni(e ,
>
from � to ''�" ft. t ❑ yds. C�A bags
from to ft. ❑ yds. ❑ bags
from to ft. ❑ yds. ❑ bags
NEAREST KNOWN SOURCE OF CONTAMINATION
�"�.:;a feet i.��� direction �:.a�r�.i�.��i.T,►�pe
Well disinfected upon completion? .�I Yes ❑ No
PUMP R
❑ Not installed Date installed �!�'��*
Manufacturer's name �:clIZ2E:�1C3�� .�,-,�..
Model number_ HP - Volis � �
Length ot drop pipe �_tft�...��C�a�p�acity � g.p.m.
Pressyure Tank Capacity �1tLt�LC.� �Ic�4..�{
Type.'"L7 Submersible ❑ LS.Turbine ❑ Reciprocating ❑ Jet ❑ __,
ABANDONED WELLS
Does property have any not in use and not sealed well(s)? ❑ Yes I�No
WELL CONTRACTOR CERTIFICATION
This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725.
The information contained in this report is true to the best of my knowledge. 7 }
WL�C r7�iLK1 TYi:tl.LLa Lfl�i.'R7 ��e� .Lk'0.-. G!�/i
Use a second sheet,if needed ,��,��
REMARKS,ELEVATION,SOURCE OF��T�etp� n _ Licensee Busmess Name Lic.oi Reg.No.
G L i994 - �-;��--��
-����-.,���-�
Authorized Representative Signature Date
�"e P• I�lr�=xllC3l� �,_Fl�_,�4
Name ol Driller� Date
� ��V�� lsQ�� '��" �6� 7 3 HE-01205-04(Rev.5/92)
• � ` 2'zvin City �Nater Clinu, Inc.
61713th Ave So • Hopkins,Minnesota 55343 • (612)935•3556
OS/27/1994
Stodola Well Drilling
15306 Hwy 7
Minnetonka MN 55345
938-2111
REPORT OF WATEIt ANALY5T5
Lsb t. 22975
Our Laboratory reports these analytical results, determined on a sample taken
by YOU on OS/24/1994 f�om the following location:
Terry Vo�t
265 Landmark Driw
Ofo110,M11
iLniqt�i* 5362T3
Coliform BacteNa <1/100 ml
Nitrates Nitrogen <1.0 mg/I
Total Ha�dness 440 mg CaCO3
The results of these tests indtcate that this well is producing water that meets the
standards for F.H.A., V.A., or conventlonal loans. This report is an analysis for coliform
and nitrate only and does not Inciude analysis of Lead and other contaminants. (Unless
as speclfied by cNent).
' ' Water Clinic, Inc.
Bil e
Brian
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