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Home My WebLink Aboutwell info Minnesota Well and Boring WEIL OR BORiNG LOCA7iON MINNESOTA DEPARTMENT OF HEALTH Sealing No. H C WELL AND BORING SEALING RECORD^^��esota u��q�e No County Name Or W-SefieS NO. Il(:11I'lE:��3.t: Mmnesota Statutes.Chapter 7031 ��ea�e eia�k�i�oi k�ow�i Township Name Townsh�p No Range No Seclion No Fraction(sm �Ig� Date Sealed Approximate Dale Well or Bonng Consiructed i�rcr.�: !17 ��? i;is '?�_;ct,�t��'�a Z �''j Numencal Street Address or Fue Number and Cay ol Well or Bonng Location � f ��S1' 1��i�[: ��.�i: �-:V�-'. i�� ':�.i� 1".il'l. i ' ��f?f! Dep�h Before Sealing /�� fl. Onginal Depih �� ft. Show exact locatwn ol well or bonng Sketch map of well or bormg Static Water Level ccurete m section gnd with��X location.showmg property hnes. roads.and bwldings ❑Approxima�e N _ � . . �,t �,1 _�_ ingle Aquder ❑Muhiaquder � fl. � below aboe�e land suAace i W �_ _�_ -�- -i- CASING TVPE i i i � i _i'• �� . i i i i _ -. -r -�- -r- -r i i � i � ! Steel ❑Plastic ❑Tde ❑Other •m��e __ _ �_ 'i _ __ � ....-..._�.�.._�.�.._..__� / _ ' / Screen from� to � it. Open Hole from to ft S r-- im�ie-� OBSTHUCTION/DEBRIS/FILL Obsiruction ❑Debns ❑Fill PROPERTY OWNER'S NAME f`►c::L C �3L�r;1:'� / wI! � Type ol debris/obstruction �L_1�L/YS� "�� f/ Maihnq Address il ddlerenl than prope�y address indicated above. Obstruction/Debris/Fdl removed? Yes ❑No PUMP �Aemoved ❑Not Present ❑ Other ��f / �� CASING GEOLOGICAL MATERIAL COLOR HARDNESS OF FROM TO • FORMATION Diameter Depih Set in oversrze hole7 Annular sp2ce initially grouted� If not known.indicate esOmated brmahon log irom nearby well or boring. � �// /�� _ in.from � to �Ln� f�. ❑Yes �No ❑Yes ❑No ❑Unknown :.� r `1 ' i�� m.irom to ft. ❑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 BOHE HOLE: No Annular Space Exisls ❑Annular space grouted with�remie pipe ❑Casing Perfora6on/Removal in.irom to ft. ❑Perforated ❑Removed in.from lo fl. ❑Perforated ❑Removed Type ol peAoralor ❑Other GROUTING MATERIAL r�+ ../...-� ,.� t Grouting material/��C_.�'��/'�+jlrom �_to ,�Q�ft. yards �bags from to ft yards bags REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING from to ft yards bags from to ft yards bags UNSEALED WELLS AND BORINGS Other unsealed well or boring on property? ❑Yes o LICENSED OR REGISTERED CONTRACTOH CEHTIFICATION This well or boring was sealed in accordance with Minnesota Rules,Chapter 4725.The information contamed in this report is - irue to the best of my knowledge. 1,7(_%� :��{.��.'a�:l�', �Y�'.�.-�. �.�Y�.1��..f� �.;;:'.� 1.1`tl.. ::�� /.:: Contractor Business N e ' �' i, License or Reg�stra6on No. J �- ^'"",�-.' � 'Y/�Y� �' orucsdRepresenfatrve Signafure' Dafe .-� F.�� i _ �� n 7�7�9 Name o!Person Sea6ng Well or Bonng � HE-01434-01 -��■.� WELL LOCATION � MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNlQUE WELL NO. CounryName WELL RECORD 5 61 ��1 ��'-�'�=i'�'' Minnesota Statutes Chapfer 7031 Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed tt. ( C�f'ii.i �( i r� t�J `,�v e'L--��I. C�t i. !,;(; ry; c"- Numerical Street Address and City of Well Location or Fire Number DRILLING METHOD � �� • -- ❑ Cable Tool ❑ Driven ❑ Dug ��.. � �'Sl' � . t� .:slt �r,: t�s�.E'. �.�"C�11�' �'.�:. . C ��7 ��-' ��' ❑ Auger ❑ Rotary ❑ Jetted �i Show exact location of well in section grid with'X". Sketch map of well location. ❑ _ � Showing property lines, N roads and buildings. DRILLING FLUID I � � � �[ � --r---Y -1 -1- ' ..`� + . .�! �� ---- i � i � ♦ y .USE ❑ Heating/Cooling __+_ ___ �_ �_ 3 f� [] Domestic ❑ Mo�itoring W � � E �] Irrigation ❑ Public ❑ Industry/Commercial _1_ _i_ __ __ T 4 ❑Test Well ❑ Dewatering O Remedial I • i � � � f-mi. CASING Drive Shoe? ❑ Yes ❑ No HOLE DIAM. --;- ;- ' -�'- j = ❑ Steel ❑ Threaded ❑ Welded �--_- � � Plastic ❑ � I milr� CASING DIAMETER WEIGHT PFi'4PERTY OWNER'S NAME in.to ��! � ft. �tnh2-i� Ibs./ft. �y�„� �-�h. � ,s'; ± 1.iLiI.;2 in.ta tt. Ibs./ft. i .eW R �-�f -��-i Mailing address if different than property address indicated above. in.to ft. Ibs./ft. in.to_ft. SCREEN U-,'1 i i-,,,-.»�.-a� OPEN HOLE Make � � l from ft.to ft. .C�'�L TyPe ._.....� i_ ..:., .. Diam. SIoUGauze - Length �A "� Set belween �E%,'. tt.and �f�k; ft. FITTINGS: f STATIC WATER LEVEL GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO i��i �� . MATERIAL ft. C�below ❑ above land surface Date measured T t:--::�-,,_. r 1 PUMPING LEVEL(below land surface) � �� 1`:�� ft. atter i.1��.��' �i��:Ii .. t: �.,;. �='.` hrs.pumping �_i. 9.p.m. WELL HEAD COMPLETION {,..�.'�j ti1:E'1� :� °+� �l` ° �-;Pitlessadaptermanufacturer �`J�ll#'E'F�;�3'f`f-�? Model ' ❑ Casing Protection �1 12 in.above grade C.�;``T-(.it.,"-�."f`.'�.. GL`�� I�i C;`._�� S��'� i GROUTINGINFORMATION - Well grouted? ;{1 Yes ❑ No � , C'. I� Grout Material ❑ Neat cement �,Bentonite . . ii(:� '1:��.';1:. .. �:,, �f:�i:. from to ' R �� O yds.;�l bags from to ft. ❑ yds. ❑ bags from to ft. ❑ yds. ❑ bags NEAREST KNOWy$OURCE OF CONTAMIN�TION � ��;`'�_feet ��direction �! > � tyPe Well disinfected upon completion? Q Yes ❑ No �� ti,.. � ',! �. PUMP � ❑ Not inslalled Date installed � - � Manufacturer's narqe � � �i . -- Modet number � - ��`' '�`'-�� HP ��i��" Volts �ength of drop pipe t ft. Capacity g.p.m. Pressure Tank Capacity •��: , �,: j Type: O'Submersible ❑ L.S.Turbine ❑ Reciprocating ❑ Jet ❑ ABANDONED WELLS Does property have any not in use and not sealed well(s)? ❑ Yes !.l.�;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. �� <:-�i �r - ' 7'� I)11��..�sLa�!�'�: �..:.. .� �.Td�.. �.. i l / ....� .1.�.il�%1 YI�: 1`^�.l:.E��.! r Use a second sheet il needed REMARKS,ELEVATION,SOUR�E OF DATA,eta LicenseeBusinessName lic.orReg.No.. �� .. /-''' � '� '�`' -��-` � 5 p � Authonzetl Representative Signature Dafe ;'Y:-''C: .�F'_:i�3�r �ii-�--�':: i Name o/Driller Date LOCAL COPY 5 614 O 1 HE-01205-04(Rev.5/92) �� ' �I'zvin City 7Nater Clinic, Inc. 61713th Ave So • H�kins,Minnesota 55343 • (612)935-3556 10/05/1995 Stodola Well Drilling 15306 Hwy 7 Minnetonka MN 55345 938-2111 , REPORT OF WATEIt ANALYSLS Lab�: 27570 ._ . Our Laboratory reports these analytical results, determined on a sample taken � by CL�ENT on 10/02/1995 from the following location: Matt Burns 1180 Loma Linda Ave Mound,Mn Unique 1Me11�661401 Coliform Bacteria <1/100 ml Nitrates Nitrogen <1.0 mg/) 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 report is an analysis for�coliform and nitrate only and does not Include analysis of Lead and other contaminants. (Uniess as speclfied by clienta. , ,\ Tw r (inic, Inc. Bill Van �� wu«ao.ty.�.x�a s�wu«caeo�.r i.,e c«�.u�r aa�-0s�-i i9