The URL can be used to link to this page

Home My WebLink Aboutwell info .. � p: F WELL LOCATION � MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. � CountyName WELL AND BORING RECORD �� ' S $ � � Q � �E..'t111P.�31T2 Minnesota Statutes Chapter 1031 Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed .��j . �i�._ i � - - fl. . !�� . y. '/. '/. � , _ - � � House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD �_ - "j�+ {. y ,� - . �� : ❑ Cable Tool ❑ Driven ❑ Dug jiiC�t��"1 rlt�I G B�'1 Z� (JI'Clj2(_�� t�. _`��_ J/% ❑ Auger I$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 i�7 � N YVii�e(�S 1 I I I 1 I I I USE � Monitoring ❑ Heating/Cooling i i � � �Domestic ❑ Community PWS ❑ Indust /Commercial � i + i ❑ Irrigation ❑ Noncommunit PWS ry - w E T M � ❑ Test Well y ❑ Aemedial i � � i ❑ Dewatering ❑ -r -7- -r- -r ��/ i i i �� i �ZIM.10 `+�� CASING Drive Shoe? ❑ Yes ❑ No HOLE DIAM. _i i_ L_ _i I �i ❑ Steel ❑ Threaded ❑ Welded � � � � 1 E�?Plastic ❑ S �1 Mile� ,r;' c-'f. . ,s�� CASIN.G DIAMETER WEIGy�j PROPERTY OWNER'S NAME f' � C}�' �"�L'� � � �� = �n.co ft. Ibs./ft. � t DL uy ;;t r'e 1 t;s�a m.�o ft. Ibs./ft. �ihlto`�ft:= Property owner s mailing address if different than well location address indicated above. in.to ft. tbs./ft. in.to ft. SCREEN C;f.:y i n 1�c s� C�� OPEN HOLE Make from tt.to ft. 0 Type Diam. SIoUGauze �� Length ^ � �` Set belween �� ft.and ��.=�ft. FITTINGS: STATIC WATER LEVEL WELL OWNER'S NAME f'�• ft. C�below ❑ above�and surface Date measured �-�{J-� / PUMPINGLEVEL(below land surface) Well owner s mailing address if different than property owner s address indicated above. Z �� ft. after � hrs.pumping [.L� g.p.m. WELLHEADCOMPLETION ��-� ,Gati,.yu��e� ;"�'�:'F� � Pitless adapter manufacturer Model ❑ Casing Protection � 12 in.above grade � ❑ At-grade(Environmental Wells and Borings ONLY) GROUTING INFORMATION Well grouted? C�'es ❑ No GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO Grout Material O Neat cement R eentonite ❑ Concrete CfiHigh Solids Bentonite MATERIAL from i 7 to _�`,Ut. L ❑ yds. L�bags irom to fl. ❑ yds. ❑ bags �,-�.a y ��.t`;' v (.r '1 � � irom to ft. ❑ yds. ❑ bags NEARESS�WN SOURCE OF CO�Tqqq N�Q(J,,, � -T'�✓ "�-C � / �° - �1�� E, �� , x �.: � , feet � direction �y'� , : type �, Well disinfected upon completion? j�Yes ❑ No `�� C1T1C!-.�.71.1.L '1'ci It �1 �j ' � ��1: PUMP ❑ Not installed Date installed f)—��U—y 7 Vy��1rc��'1 �rC'��1.�'! � '� �F�} 1� tulanufacturersname / i`: ., ��,, Model number �F' Volis ��% Length of drop pipe 1 U�'' ! ft. Capaciry �� g.p.m. ��iiY�.l `?'c:lli �-�'i � yJ L�.. �ressureTankCapacity g��;y ys_.��'T � Type: t9 Submersible ❑ L.S.Turbine ❑ Reciprocating ❑ Jet ❑ ABANDONED WELLS Dces property have any not in use and not sealed well(s)? ❑ Yes C�2{lo VARIANCE Was a variance granted from the MDH for this well? ❑ Yes �►Jo a 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,etc. The information contained in this report is true to the best of my knowledge. Dl:1V �`�'r�>L:�:T,�� ,'�.LL DI�tZLLI�iG C(t. , Tr�C`. L�censee BusinessName - Lic.or Reg.No. r, ._ � � � �c. _ . j' - /`� � ` " ' �--1 �—�3? _ .�>:s�' _. � Aufhonzed Repre5eM3tive Signature Date L`t-ecz la�iby �;_13...c��; Name o/Driller Date . �J � �'� �� 9 '' p �'� HE-01205-05(Rev.1/95) � � � �l�f/6I'Z ��u V V Q�P �66�Z(C� JI?C. . 4 61713th Ave So • Hopkins, Minnesota 55343 • (612) 935•- 3556 06/24/1997 St�ola Well Drilling 153�Hwy 7 Minnetonka MN 55345 938-2111 �FtDR��P'fR'ATF.R�T�II.YSI5 Lab#: 32851 Our Laboratory reports these analytical results,deternnined on a sample taken by CLIENT on 06/16/1997 from the following location: 4330 N.Shore Dr. Orono�Mn Unique W►ell#686600 Caliform Bacteria <1N00 ml Nitrates Nitroeen <1.0 mg/I The results af these tests indicate that this well is produc�ng water that meets the standartis for F.H.A., V.A., or conventional loans. This re�rt is an analysis for coliform and nitrate oNy and does not inGude analysis of Lead and other ca�aminants. (Unless as specified by client). , � T'� ' i er Clinic, Inc. , � Bill V ^°.�r°a w�°�°'y c�s� w.�a�;�xe.s� so�w,mrc�t. Lb Cert'6ioationi 027-033-119 wE�i U�BORING LOCA7iON MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring H 1_ 2 6 5�5 Counry Name , WELL AND BORING SEALING RECORD Mennle9oNaUniqueNo. I��t1ii��)1I: Minnesota Statutes,Chapter f031 or W-series No. (Leave blank if not known) Township Name Township No. Range No. Section Na Fraction(sm.-►Ig.) Date Sealed Date Well or Boring Constructed Grc:n� i i i �3 ['7 ''') % '/a '/a �:e �(. �J l' / Numerical Street Address or Fire Number and City of Well or Boring Location V� � (�5 ��S �ry�^�p1��Idre ��1�7� C'Jr -L.,��1� � Depih Before Sealing �1� ft. Original Depih r•� R. Show exact location of well or boring Sketch map of well or boring AOUIFER(S) STATIC WATER LEVEL in section grid with"X". 5��j 4 location, showing property Singie Aquifer ❑ Multiaquiter � lines,roads,and buildings. N WELUBORING Measured ❑ Estimated � � � �--�� '�-��- Water Supply Well ❑Monit.Well i � � � � � -T- -T- -�-- --�-- �l� �/ I I I I _ . _ � � _._.. . ❑ Env.Bore Hole ❑Other ft. ,e9�pelow ❑above land surface W --�- -�` -�-- --i-- E . CASING TVPE(S) \ ' ' ' E � � K . � � � � � —�' -i-- -i-- --�-- � 4I" . � Steel ❑ Plastic ❑Tile ❑Other ,�_ Y.mile _.__._..._�i�.__ . � � i i "`. -�-- -�-- -�-- --�-- � - /"_,� -'.,.. CASING �.. Diameter Depth � Set in oversize hole? Annualar space initially grouted? � S /:� i "� �/ C� �� Yes �No ❑ Yes No Unknown t mi�e� .. -.. .- -- _.. . in.from to - ft. ❑ ❑ ❑ PROPERTV OWNER'S NAME p�ug ��ei�� in.from to ft. ❑ Yes ❑No ❑ Yes ❑No ❑ Unknown Property owner's mailing address if diHerent than well locatiopn address indicated above. in.from to R. ❑ Yes ❑ No ❑ Yes ❑ No ❑ Unknown li�G—��'fC� SCREEWOPEN HOLE , ? Screen from �''�- to � � ft. Open Hole from to ft. OBSTRUCTIO WDEBRIS/FILL � WELL OWNER'S NAME Obsiruction ❑ Debris ❑ Fill ❑ No Obstruction %�_,_ - Well owner's mailing address if different than property owner's atldress indicated above. Type of Obstruction/Debris/Fill -1'��"�F lt- �"�/./��l � ,a� � Obstruction/Debris/Fill removed? r]•Yes ❑ No PUMP / TY� �f!� /�.f i�]t..l GEOLOGICAL MATERIAL COLOR HARDNESS OF FROM TO Removed ❑ Not Present ❑ Other FORMATION If not known,intlicate estimated tormation log from nearby well or boring. METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: � _ ,� ,�No Annular Space Exits ` '�...._-� ---=...! ,' � ; � ❑ Annular space grouted with tremie pipe ,".�1 ❑ Casing Perforation/Removal in.from to k. ❑ Pertorated ❑ Removed in.from to ft. ❑ Perforated ❑ Removed Type ot pertoretor ❑ Other GROUTING MATERIAL(S) B�,,.h,��,�1�� ,��. � r,. '� , Grouting MateriaV"�� - "ffom to�_ ft. yards bags from to ft. yards bags from to ft. yards bags t 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 i -� This well or boring was sealed in accordance with Minnesota Rules,Chapter 4725. The information contained in this report is true to the best ot my knowledge. Di>I�T S'T�DGLA W'ELI. DRILLIAIG Ci;. , ilvC. "1.%1!'t Contrador Business Name > � License or Regisfrefion No. "�i� %' / "` �� / � Authonzed Representative Signatuie` Date �.- � ��` .1:� � LOCALCOPY H 12 6 5 6 5 Name o/Person S@aling Well or Boring .HE-01434-02 10/95R