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Home My WebLink Aboutwell info WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring H 12 7 9� 4 County Name WELL AND BORING SEALING RECORD Sealing No. �1L�IIT1� 71I1 Minnesota Unique No. r Minnesota Stafutes,Chapter 1031 or W-series No. (Leave blank if not known) Township Name Township No. Range No. Section No. Fraction(sm.-►Ig.) Date Sealed Date Well or Boring Constructed G�-c�r�� 117 �3 C;6 � v � �-� :�._: f_ Numerical Street Address or Fire Number and Ciry of Well or Boring Location � � `�1(' MC'��1 i �.�1 ��1.Ve drE.1IlC.:� �i�i. � ' �efore Sealing J�� ft. Original Depth �� fl. Show exact location of well or boring - oring ApUIFER(S) STATIC WATER LEVEL in section grid with"X". location, showing pr�perty Single Aquifer ❑ MWtiaquifer lines,roads,and build' gs. N WELUBORING �Measured ❑ Estimated � � �Water Supply Well ❑Monit Well � _T_ _ _ __ __ __l__ _.�..�.�..�_�.�.�._..��..,� ' ❑ Env.Bore Hole ❑Other t"-l.` ft. �below ❑ aboveland surface W --�- -�-- -i— --i-- E ._.___ CASING TVPE(S) _ . -Y- -�-- -'�-- --�-- � � �� Steel ❑ Plastic ❑Tile �Other W mile -�- -.�-- -�-- --i-- � CASING Diamet�� Depth � Set in oversize hole? qnnualar space initially grouted? S ",� / P"� /� / �r miie—�x �tf '�_.+,✓��'�-�- t-�-.1.� . � in.from s,,.�_ ro I�5�1. tt. ❑ Yes �No ❑ Yes ❑No ❑ Unknown I PROPERTYOWNER'SNAME Gh�3.r1ES CuCY�! �Q. in.from to tt. ❑ Yes ❑No ❑Yes ❑No ❑ Unknown Properry owner's mailing address if diNerent than well location address indicated above. in.from to ft. ❑Yes ❑ No ❑ Yes �No ❑ Unknown �p l�L �MC?L.iC�Clcl�E� D.r].V E' SCREEWOPEN HOLE W��c3bury Mr�. �_>1 �_> • � /��J 1 J,'r Screen from �� to j?'� ft. Open Hole from to R. OBSTRUCTIO WDEBRIS/FILL WELL OWNER'S NAME �Obstruction ❑ Debris ❑ Fill ❑ No Obstruction Well owner's mailing address if diHerent than property owners address indicated above. Type of ObstructioNDebns/Fill �d!/i�f //��'�'� �" v �>>!�s/� Obstruction/Debris/Fill removed? f�Yes ❑ No PUMP Type ��'d� �'G�/�� GEOLOGICAL MATERIAL COLOR HARDNESS OF FROM TO �Removed ❑ Not Present ❑ Other fORMATION If not known,indicate estimated formation log from nearby well or bonng. METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOIE: j " �No Annular Space Exits �'�.. �>. ❑ Annular space grouted with tremie pipe I,i ❑ Casing Perforation/Removal in.from to ft. ❑ Perforated ❑ Removed in.from to ft. ❑ Perforated ❑ Removed Type of peAorator ❑ Other GROUTING MATERIA�(S) / Groutin Matenal d,�.��/'� �'�✓�r.�� rom � t � g , � _i� to�` fl. yards� bags from to ft. yards bags from to ft. yards bags from to ft. yards bags REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING UNSEALED WELLS AND BORINGS Other unsealed well or boring on property? ❑ Yes �No LICENSED OR REGISTERED CONTRACTOR CERTIFICATION � This well or boring was sealed in accordance with Minnesota Rules,Chapter 4725. The infortnation contained in this report is ..,e,�:`_. . true to the best ot my knowledge. DON ;.�:'�DOLF� t�ELL DRILLING CU. , IIVC. ?..71 ;< ' � � `sy; Contrector Business Name License or Registrallon No. � � _ F 'y ��' ,�-� J! / � ut ed epresentative Signafure � Date `�tr�..;.� �t.�„_,� v-� LOCAL COPY H 12 7 9 � 4 Name o/Person Se qg Well or Bonng HE-01434-02 10KJ5R � � . i WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. CountyName WELL AND BORING RECORD � �� -�- � �� n Minnesota Statutes Chapter f03/ Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed � 0 no I 1 2 3 b ��, �. �. ry 158 II-5-97 House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD 7gQ j� pj� �Z� QCpn�y � Cl Cable Tool ❑ Dyven ❑ Dug ❑ Auger L�Rotary ❑ Jetted Show exact location of well in section grid with"X". Sketch map of well location. ❑ Showing property lines, � roads and buildings. DRILLING FLUID WELL HYDROFRACTURED? ❑YES ❑NO " t�ater , , , , FROM n.to n. -; -;- -r- -,- j � USE ❑ Monitoring ❑ Heating/Cooling �omestic ❑ Communit PWS _I_ _J_ _�_ _I_ �E�� Y ❑ Industry/Commercial i i � i ❑ Irrigation ❑ Noncommunity PWS ❑ Remedial 'N E x ❑ Test well i � i i T ❑ Dewatering r7 -r -�- -r- -r i i i � �/2M.1e CASING Drive Shoe? ❑ Yes o HOIE DIAM. i i i i � ❑ Steel ❑ Threaded ❑ Welded -� - �- _� - -� l C�lastic ❑ S �-1 Mile-� �. m CASING IAMETER WEIGHT PROPERTY OWNER'S NAME � �4g g�r'�I 7 ��S 30 ; in.to ft. Ibs./ft. �in.to C Charles �illd� C� in.to ft. Ibs/ft. `�4in.to fL "�� Property owner's mailing address if different than well location address indicated above. in.to ft. Ibs./tt. in.to ft. i 802 Wooddale �r SCREEN OPEN HOLE i�oodbury, I�'!rT 55225 Make Johnsor� from h.�o h. Type_ Diam. SIoVGauze �A�1 A Length R � „M�_ .� Set between ft.and ft. FITTINGS: STATIC WATER LEVEL WELL OWNER'S NAME 7� ft. �elow ❑ above land surface Date measured I1-5— 7 PUMPING LEVEL(below land surface) 1 C Well owner's mailing address if diNerent than property owner's address indicated above. 1�6 ft. after i�J _hrs.pumping �� g.p.m. WELL HEAD COMPLETION a��w�t e r C-�itless adapter manufacturer Model - ❑ Casing Protection �(12 in.above grade ❑ At-grade(Environmental Welis and Borings ONLY) GROUTING INFORMATION Well grouted? �Yes ❑ No HARDNESS OF Grout Material ❑ Neat cement C�`8entonite ❑ Concrete C3'9di h Solids Bentonite GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO 9 from�to�ft. �� ❑ yds. ❑ bags C� v v /� from�_to t L Q R. �►��_��cf e�yds. ❑ bags SJ l��Qp '"4�� v �� from to ft. to�yds. � bags � NEARE6F1 h N'tliV,SOUACE OF CONT INATIO e I%� Clay/gravel. �rap �oft 3� 108 -� feet ,�i`,DtG�� direction rype Well disinfected upon completion? L�4Yes ❑ No � w 4- .� � Sand tan soft �i38 258 PUMP t n ❑ Not installed Date installed 2��`_�� Aer�otor Manufacturer's name Model number PN:�,/26Q� HP_��_ Volts Z�� Length of drop pipe �� ft. Capaciry g.p.m. � Type: �Submersible ❑ LS.Turbine ❑ Reciprocating ❑ Jet ❑ ABANDONED WELLS Does property have any not in use and not sealed well(s)? ❑ Yes C�No VARIANCE Was a variance granted from the MDH for this well? ❑ Yes C�lo 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. _ _ -:.,., _ . ._.- Don Sto�ola Well Drillin� co. ,I�c. 7172 Licensee usiness N e Lic.or Reg.No. '.��'R 1 3 ��: ; :.---- _ , , ., � � .- . �; (,� y � ��Authorized Repr2sentati e Signature Date � __ ' r/�' ,¢'1��..,t,^!�_.i �� f �`f , . _ .^r- � / LOCAL COPY � C�C C �(� � NameofDril/er �: `T . f Date ''�U �.� U , � � HE-01205-06(Rev.9/96) - �. Juiin �it 1/Vater �`inic, J�ric. � ' 617 13th Ave So • Hopkins, Minnesota 55343 • (612) 935 - 3556 11/10/1997 Stodola Well Drilling 15306 Hwy 7 Minnetonka MN 55345 938-2111 REPORT OF WATER ANALYSIS � Lab#: 33911 Our Laboratory reports these analytical results, determined on a sample taken by CLIENT on 11/05N997 from the following location: Gharles Cudd Co. 790 N.Arm Dr. Orono�Mn Unique 1Mall#6966b6 Colifam Bacteria <1/100 ml Nitrates NiVogen <1.0 mgfl The resutts 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 inGude analysis of Lead and other contaminarrts. (Unless as specified by dierit). C� ater Clinic, Inc. � n°�tyi°'i ww„w�y �� wuer Aoalysis Rasad� suiler wu«c.he�oaV L�b Certifiaation/027-033-119