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Home My WebLink Aboutflood zone info . �:;:.._ . . __ _ �--,-- .. :��:.. _�� _ _ > „��' . .... . � • ' WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. `� CountyName WELL AND BORING RECORD� 6 4 g 212 � H Minnesota Statutes Chapter 103! Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed v. i. v. Z�$ n 6�1.9"�� House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD ❑ Cable Tool ❑ Driven ❑ Dug ❑ Auger �otary ❑ Jetted Show exac�location of well in section gri with"X". Sketch map of well iceation. f-] _ � Sh wing prope, lines, �oads antr��u dings. DRILLWG FLUID WELL HYDROFRACTURED? ❑YES �NO N /' �.,. ; �.�,,, bentonite FROM h.�o h. � , � � -; -,- -r- -,- '_ .� USE ❑ Monitoring ❑ Heating/Cooling i i i i � 1a�Domestic ❑ Communit PWS _i_ _a_ _�_ _i_ ❑ Irrigation Y ❑ Industry/Commercial i i i i � ❑ Noncommunity PWS ❑ Remedial yy E T � � ❑ Environ.Bore Hole ❑ Dewatering ❑ i i i i ,� i i i r +2IM1e � CASING Drive Shoe? Yes ❑ No HOLE DIAM. _i _i_ _L_ _i_ I ';� �+Steel pl(Threaded ❑ Welded i i i i 1 ;�� kl ❑ P�astic ❑ s '' ) `�. �—t Mna—� 6 CASINtG DIAMETER �y WEIGHT ` PROPERTY OWNER'S NAME ' �i in.to 217 ft. 1 I _ Ibs./ft. 7 7�(ty �. 8 . �y . _ m.to ft. Ibslft. in.to n. Property owner's mailing address if fferent than well location a ress indicated above. --�--. _ in.to____ft. _ _____Ibs./ft. in.to ft. 2245 French Lake AQ SCREEN�RSQn OPEN HOLE Make from ft.to ft. � Wapzata, �iN 55391 Type stainless atee Diam. SIoVGauze__.__._____Tn� � Length�� ♦�+� Set between _____._�_}j3_ft.and�_�_ft. FITTWGS: « ST I WATER LEVEL n WELL OWNER'S NAME �� ___ _h.�below ❑ above land surface Date measured ��1 7� 0 PUMPING LEVEL(below land surtace) Well owner's mailing address if different than property owner's atldress indicated above. _°�8_3___ ft. atter� __hrs.pumping�g.p.m. WELL HEAD COMPLETION `��,,�♦w�� Pitlessadaptermanufacturer�i�iy,_C�$ter Model ❑ Casing Protection �j r 12 in.above grade ❑ At-grade(Environmental Wells and Borings ONLY) GROUTING INFORMATION Wellgrouted? f�YYes ❑ No GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO Grout Material ❑ Neat cement ❑ Bentonite ❑ Concrete �High Solids Bentonite MATERIAL from to_ ft. ❑ yds.�bags �— �� from to__._ ft. ❑ yds. ❑ bags � fillJwood black aoft 0 30 from �o n o Yds. o bags NEAREST KNOWN SOURCE OF CONTAMINAT ON �� clay/silt gr8 $Oft �Q 1,40 �.�' �eet �_____direction `�J.-�`-''--� rype Well disinfected upon completion? QT Yes ❑ No boulders/sand black hard 140 150 PUMP ❑ Not installed Date installed. 7+�+�_ mudd eg8�d ra ��l t �5� L1�7 Manufacturer's name ��rffiQ�s��_---- Modelnumber__ . __..,____.__. HP 3/4Volts L3ll �' w� p r > sand coiored S�f� 616 220 Length of drop pipe_ �Z_ _ _ __ ft Capaciry g.p m. Type:y�Submersible C LS.Turbine ❑ Reciprocating ❑ Jet ❑ ABANDONED WELLS Does property have any not in use and not sealed wel�(s)? ❑ Yes �No VARIANCE Was a variance granted from the MDH for this well? Ji�'Yes ❑ No TN# --�!� WELL CONTRACTOR CERTIFICATION �"' Use a second sheet,il needed This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. REMARKS,ELEVATION,SOURCE OF DATA,eta The information conlained in this report is true to the best of my knowledge. on _Stodole Well Drillin Co., I��c. __� 172` Licensee usiness me Lic.or Reg.No. _ 7-2�-nn horize epr tive Signalure Date Dnane Mathevs 6-19-flQ , _ _---- - __ 6 4 9 212 Name ol Driller Date LOCAL COPY HE-01205-07(Rev.2/99) � � rw%w C i,t 1 N at�' C ' ' , I v��,c� . y 617 13th Ave So � Hopkins, Minnesota 55343 � (612) 935 - 3556 06/73/2000 Stodola Well Drilling 3841 North Main Si. Boni facius MN 55375 938-21 1 1 REPORT OF WATER ANALY5IS ( Lab #: 39292 Our Laborarory reporis [hese analytical resulis, decermined on a sample iaken by QIENT on 06/20/2000 from the following location: 3645 N. Shore Dr. Orono,Mn Unique Well #649212 Coli form Bacreria <1/I 00 ml Nitrates Nitrogen <1.0 mg/1 The resulis of these tests indicate that rhis well is producing wacer ihar meers the standards for F.H.A., V.A., or conventional loans. This report is an analysis for coliform and niirate only and does not include analysis of Lead and other contaminants. (Unless as speci�ed by client). �w�n i N�ater Clinic, Inc. \ �� Bill ►�4 sdale Analyical laboratory Consulting Engineer Water Analysis Reagents Boiler Water Chemicals Lab Certification#027-053-119 � � • MINNESOTA DEPARTMENT OF HFALTH Minnesota Well and Boring � WELL OF 80RING LOCATION yyELL AND BORING SEALING RECORD Sealing No. �H �,'�QO1,� County Name � Minnesota Unique Well No. /� Minnesota Statutes.Chapte�1031 or W-series No. ��li�� (�eeve Hank M nW krqwn) �_--__... � Township Name j Township No.Range No Sectlon No. Fraction(sm.-i Ig� Date Sealed Date Well or Boring Constructed i tft�or�� I1 fi 23 Oa �4-aQ0 �.7 ` Numerical Sireet Adtl�ess or Fire Number and Ciry of Well or Bonng Locahon .�. 3y{, g �rp /�t � , h V9� t� ai'b(3s"E �_'j �t�QQ �j��l Depth Before Sealing��S„/ M. Original Depih v Show exact bcation of N•ell or bonng Sketch map of weli or bonng AOUIFER(S) STATIC WATER LEVEL insection grid with"X". location, sh g propeny Single Aywfer � MultiaquRer - I es,road buildings N AI_ , '�� WELUBORING � �Measured ❑ Estimated .�ly.�.�� Water Supply Well ❑Monit Well � ❑ Env.Bore Hole ❑Other _ � R. �I below ❑ above land surface W -- - -i-- -i-- --i-- E � CASING TVPE(S) ' I I � � � � � �G -�-- -�- --i-- --�-- � ❑Steel ❑ Plas6c ❑Tile � Other c � (��_�� I I � Ylmile —�- -i— -.�-- --�— � CASING(S) \ Diameter Depth Set in oversize hole? Annular space initially grouted7 S �M ♦/ �,�/ �i mae� � � in.irom� to�v ft. ❑ �es �No ❑ �es ❑No ❑ Unknown PROPERTV OWNER'S NAME in.from to k. ❑ Yes ❑ No ❑ Yes ❑No ❑ Unknown Prope wners a n res � itterent th ti ess a bove. in.from to k. ❑ Yes ❑No ❑ 1'es ❑No ❑ Unknown 2Z45 French Lake A� SCREEWOPEN HOLE ��p�S t 8� i4i� S 5 J 7� Screen from to ft. Open Hole from �to k. OBSTRUCTIONS WELL OWNER'S NAME Rods/Drop Pipe ❑ Check Valve(s) ❑ Debris ❑ Fill ❑ No Obstruction Well owners meiling adOress if diHarent then property owner's adtlress indicated above. TypB oi ObSlfuCtiOnS(DeSClibB)1(/�l�� 1�L � �y� ��`"G�/�� Obstruclions removed? �,'Yes ❑ No Describe PUMP Type 6EOLOOICA�MATERIAL COLOR HARDNESS OF FROM TO � Removed Not Present ❑ Other FORMATION If not known,indicate estimated formatbn log from nearby well or bonng. METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OF CASING AND BORE HOLE: �il'tJo Annular Space Exists I"` ❑Annular space grouted with tremie pipe ❑Casing Perforation/Removal in.from to ft. ❑ Perforated ❑ Removed in.from to tt. ❑ PeAorated ❑ Removed Type of peAorator ❑ Omer GROUTING MATERIAL(S) (One bag of cement=94 Ibs.,one bag of bentonite=50 Ibs.) Grouting Material pn-�T`�//�"�Trom �_ to� Ft. yards � bags from to ft. yards bags from to ft. yards bags from to__ ft. yards bags REMARKS,SOURCE OF DATA,DIFFlCULTIES IN SEALING OTHER WELLS AND BORINGS Other unsealed and unused well or boring on property? �Yes o How many? LICENSED OR REGISTERED CONTRACTOR CERTIFICATION This weli or bo�ing wav sealacl in acrordance with Minneso!a Rules,Chapte�"-725. '?�e In'orma?Io�conta�n�in Lhis re�rt is true to ihe bes!o`my knowledge. Don Stodols �tell Ur3liing C+�. I�+c 271T2 , ----_ -- - — � Conhactur Busrn�ss Nam- Lrcense or RegistreNon l�io. ' '/�'- �:.� :J�:J thori R enta ive Signature Dete \ `,y �w, l ,J�-"�-v�.�✓`/ :_��(Y"�.r "—_-- ,.__ , � LOCAL COR`Y ��Q�� Name o�Person SZ lin�Well or Bodng H ..��