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Home My WebLink Aboutwell info wELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring CountyName WELL AND BORING SEALING RECORD Sealing No. H 10 6 6 7 3 Minnesota Unique No. � ��jZi1 Minnesota Statutes,Chapter 1031 or W-series No. (Leave blank if not known) Township Name Township No. Fange No. Section No. Fraction(sm.-s Ig.) Date Sealed Date Well or Boring Constructed t7ronr 31 J 2 i p7 � � � ,� Numerical Street Address or Fire Number and City of Well or Boring Location � �((�) j1](jY'�t;r.��jr�.a �� .c��j� epthBetoreSealing ��_ ` ft. OriginalDepth �_R. Show exact location of well or boring Sketch map of well or boring ApUIFER(S) STATIC WATER LEVEL in section grid with"X". location, showing property . ingle Aquifer ❑ Multiaquifer �„_` lines,roads,and buildings. N ELUBORING ❑ Measured �stimated � � � � 1�JIOater Supply Well ❑Monit.Well -- - - -- -- -- -- - 7L ! ❑ Env.Bore Hole ❑Other �ft. �below ❑above land surface W --�- -�-- --�-- --�-- E CASING TYPE(S) � � ,._.,._.......�_._ � � � ` ' --�-- -�-- -�-- --�-- � � teel ❑ Plastic ❑Tile ❑ Other � � � � � '/<milek -'-- -=-- --�-- --�-- � � CASiNG � � � � . � Diameter Depth Set in oversize hole? Annualar space initially grouted? �w--t mi�e�, � ��"��t " � �sin.from� to��ft. ❑Yes �o ❑ Yes ❑No ❑ Unknown � PROPERTY OWNER'S NAME ^ in.trom to ft. ❑ Yes ❑No ❑Yes ❑No ❑ Unknown ��.�laerlar�G Buililer� Property owner's mailing address if different than well location address indicated above. _ in.f rom to ft. ❑ Yes ❑No ❑Yes ❑No ❑ Unknown 1�,)�37 �J]„j,'[��Z� �'�,�,(� SCREEN/OPEN HOLE �� B��'��r �' S��'��' Screen from��to�� it. Open Hole from to ft. 6�3-1,�i��i'� OBSTRUCTIOWDEBRIS/FILL WELL OWNER'S NAME �bstruction ❑ Debris ❑ Fill ❑ Na Obstruction Well owner's mailing address it diHerent than property owners address indicated above. Type of Obstruction/Debris/Fill ,�(,/��`��/�'d�� Obstruction/Debris/Fill removed? es No PUMP 1 TYPe�,��R� GEOLOGICAL MATERIAL COLOR HARDNESS OF FROM TO emoved ❑ Not Present ❑ Other FORMATION . If not known,indicate estimated formation log from nearby weli or boring. METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: o Annular Space Exits !' �� , . �� - Annular space grouted with tremie pipe ._. �.' i� ` ❑ Casing Perforation/Removal in.from to ft. ❑ Perforated ❑ Removed in.from to ft. ❑ Perforated ❑ Removed Type of perforator ❑ Other GROUTING MATERIAL(S) Grouting Material � �(pf�_� to��ft. 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 welf or boring on property? ❑ Yes o LICENSED OR REGISTERED CONTRACTOR CERTIF C ON This well or boring was sealed in accordance with Minnesota Rules,Chapter 4725. The information contained in this report is , true to the best of my knowledge. .� TY��1 4'fifliYT_t.l WC.TY_ �c��y�a ��—� � Cont�actor Bus�ness Name Lic n e oR �g�strahon No. � iyi��.-. ✓' ,�'� � eArdN6 ature •--`�� -'G� Date _.r--- ; f �L� ,� ti Name ol Person Se`&ttng Well oi Boring � LOCAL COPY H � � �j �j �f � HE-01434-02 10/95R � 1 WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. ' CountyName WELL AND BORING RECORD �- - HPJ1T2Ej�lI2 Minnesota Statutes Chapter 103I J � 6 4 5 3 Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed �.�'(.-"'IiC> �� c�_i �1 St` �.,�,�(;�,i. ��S' n �—��3—y�i � � r House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD r1�L3 �C3��tL51X�3.'e' �1VE-'`� �'[�Ik:3� �l. Jt..�.5�`J�; ❑ CableTool O Driven ❑ Dug ❑ Auger Q�Rotary ❑ Jetled Show exact location of well in section grid with'X". Sketch map of well location. ❑ .� - Showing property lines, .. roads and buildings. DRILLING FLUID N .FS2Z1�QF11.j�C' � � � � � -,- -;- -;- -; USE ❑ Monitoring ❑ Heating/Cooling � � � i �Domestic ❑ Communi PWS _i_ _a_ _�_ _i_ -------- ❑ Irrigation � ❑ Industry/Commercial i i i i ❑ Noncommunity PWS ❑ Remedial y� I I I I E . ❑ Test Well ❑ Dewatering ❑ i i i i ,�'M e CASING Drive Shce? ❑ Ves �Q90 HOLE DIAM. _� i _L_ _i_ � � ;, ��t ❑ Steel ❑ Threaded ❑ Welded I I I I Q�Plastic ❑ S �-1 Miie—� CASING DIAMETER WEIGHT PROPERTY OWNER'S NAME �:+' � ��' i•fA �' ��-' i]s`12L7G��:iI1C1 ��.C3�Y�:i in.to ft. Ibs./tt. in.;o tt. in.to ft. Ibs./tt. �'-j�,�o_�^�. Property owners mailing address if different than well location address indicated above. in.to ft. Ibs./ft. in.to ft. �t'J-�f� �1��3-� �� SCREEN_��_ OPEN HOLE 8��:�CdTll.72fy'�.C?21��1.�.`✓�{f7 Make from ft.to ft. Type `'�'¢ �� Diam. "n SIoVGauze �� V � Length � Set between �� ft.and t ' tt. FITTINGS: '� ^{ �� STATIC WATER LEVEL WELL OWNER'S NAME �i'fs' ft. C�below ❑ above land surface Date measured 7—�f5—��j PUMPING LEVEL(below land surface) Well owner's mailing address if different than property owner's address indicated above. tt. atter hrs.pumping ?i��Y g.p.m. WELI HEAD COMPLETION �11�E��1,t�,�„�Z, C�{Pitless adapter manufacturer Model ❑ Casing Protection C�12 in.above grade ❑ At-grade(Environmental Welis and Borings ONLY) & GROUTING tNFORMATION Well grouted? C�`Ves ❑ No GEOLOGICAL'MATERIALS COLOR HARDNESS OF FROM TO Grout Materia� ❑ Neat cement C�Bentonite ❑ Concrete ❑ High Solids eentonite MATERIAL from i� to �ii ft. ❑ yds. q;bags '��E�.1C�y; �i..�� '�f�1�.C�1 H {� �cr, from to R. ❑ yds. ❑ bags from to ft. ❑ yds. ❑ bags � NEAREST KNOWN SOURCE OF CONTAMINATION (;]��T ('j�`-L�� ;j j j '�2�� feet direction type Well disinfected upon completion? ❑1�Ces ❑ No �71csVE:�. `��cill 1-� u.i S`� PUMP 1`-�J"��1 ❑ Not installed installed . �.��! Ure�, � C�"� 'c�y Manufacturersname �'��'E�` ��"' �-'"' rl:i_,st f,.'Ca � Model number HP -5,� Volts Length of drop pipe t ft. ,Cap,�ci g.p.m. Pressure Tank Capacity :�owrz�r.�;-";�:l.�,� `�=fir�- Type: C�aSubmersible ❑ L.S.Turbine ❑ Reciprocating ❑ Jet ❑ ABANDONED WELLS Dces 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 O'Itlo WELL CONTRACTOR CERTIFICATION Use a second sheet,il needed This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. .k' REMARKS,ELEVATION,SOURCE OF DATA,etc. The information contained in this report is true to the best of my know�edge. � ��i;ix;LF? 4�3� DRILL�P+�G C.�;,, I1�C:.. Licensee Business Name - Lic.or Reg.No. 4/ �. �--'- � �{t'i-Q�T ��:�f�'�� Authonzed Representafive Signature Date �:Y�UC'}C MC'�(}L�f? /`^��i—�' �''' � �a , Name ol Dnller Date `...i�l.-l�� °-��[�'i` � � � ,�!. �r v ' HE-07205-05(Rev.1/95) .� . . - . , � Juiirc �itc� 1/Va�er �6irtic, J'`izc. 617 13th Ave So • Hopkins, Minn�sota 55343 • (612) 935 - 3556 07/23/1996 Stodola Well Drilling 15306 Hwy 7 Minnetonka MN 55345 938-2111 REPORT OF WATER ANALYSTS Lab#: 30303 , ,..�� Our La�ratory reports these analytical results, determined on a sampie taken by CLIENT on 07/18/1996 from the following location: Timberland Builders 4423 Northshore Dr Orono�Mn Unique Well#586�4b3 Coliform Ba�teria <1/100 ml Nitrates Nitrogen <1.0 mg/I The results of these tests indicate that thls well is producing water thet meets the stendards for F.H.A., V.A., or conventional loans. This report is an analysis for coliform and nitrate only and • , \es not includ,e analysis of Lead and other corrtaminants. (Unless as speafled by clferrt). � � , �' t r CI 'c, Inc. .� Bill �� w.�� wu�c�. Lab Ca�wtioni 027-073-119