well info - Laserfiche WebLink

Home Browse Search

WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. County Name +�, WELL AND BORING RECORD 8 0 1 'Hennepin Minnesota Statutes Chapter 103/ Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed .Township 11? C910)1 h. 4-11-96 i, House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD 1J U N 3 •1 qc4, O Cable Tool 0 Driven. ❑ Dug phei"kieen 870 & 89"( Old (y.ys-. 1 Bay Rd. 0 Auger CLxBotary ❑ Jetted Show exact location of well in section grid with"X". Sketch map of well location. ❑ Sowing property lines, Or-coo, mi- •roads and buildings. DRILLING FLUID N , 'r\i'V Ben{: , I '4..r ti USE ❑ Monitoring ❑ Heating/Cooling ❑$omestic ❑ Community PWS ❑ Industry/Commercial A i y ❑ Irrigation ❑ Remedial Q y ❑ NoncommunityPWS w 1 e T w ❑ Test Well 0 Dewatering 0 r zMoe T �} CASING Drive Shoe? 0 Yes ❑ No HOLE DIAM.,.�� i ❑ Steel 0 Threaded ❑ Welded �1�}.. EN Plastic ❑ S I Mile CASING DIAMETER WEIGHT ,7�8 �a PROPERTY OWNER'S NAME J` in.to 93 ft. lbs./ft. 7 in.to ft. LakeCSOOC1EZtes in.to ft. lbs./ft. Property owner's mailing address if different than well location address indicated above. in.to ft. ___lbs./ft. in.to ft. 1212 E Wayzata Blvd. SCREEN OPEN HOLE Wayzata, Mn. 5,5391 Make �lClrit3 CII from ft.to ft. Type Stainless Stc,,e1 Diam. 7' Slot/Gauze 11_;/10 Length 6' Set between 9:: ft.and 1(.1 ft. FITTINGS: STATIC WATER LEVEL aa�� WELL OWNER'S NAME 38 ft. D elow 0 above land surface Date measured 4-'11-96 PUMPING LEVEL(below land surface) Well owner's mailing address if different than property owner's address indicated above. ft. after hrs.pumping g.p.m. WELL HEAD COMPLETION N/A ❑ Pitless adapter manufacturer Model ❑ Casing Protection 0 12 in.above grade ❑ At-grade(Environmental Wells and Borings ONLY) GROUTING INFORMATION Well grouted? 1 Yes ❑ No HARDNESS OF Grout Material ❑ Neat cement Bentonite 0 Concrete 0 High Solids Bentonite GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO do from 3 6 to ..fill ft. 3 0 yds. EXbags TopSoil Black1 f 1 v r from to ft. 0 yds. 0 bags from to ft. 0 yds. 0 bags NEARESS1�NOwjI SOURCE OF CONTAMINATION �� C Clay 1Yark Grey Ni 16 30I 7> feet -""->Uv/ /Y direction type Well disinfected upon completion? Des 0 No Gravel Black/Tan H 3i1 4c:' PUMP ❑ Not installed Date installed 4-16-96 Clay-mixed W/Gr:1VeZ Grey 410 6,L. Manufacturer's name Red Jacket Model number -er HP G Volts iZ-10 80 �� Len Length of drop 63' G� g.p.m. Sand-fine GreyN/A Pressure Tank Capacity Type: Submersible 0 L.S.Turbine O Reciprocating 0 Jet 0 Water Sand Colored 90 1 1( i ' ABANDONED WELLS X i Does property have any not in use and not sealed well(s)? ❑ Yes LI No VARIANCE Was a variance granted from the MDH for this well? El Yes 13)(7,10 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 STODOLA WELL DRILLING CO., INC. 2:7172 Licensee Business Name Lic.or Reg.No. -, 4-11--96 Authorized Representative Signature Date dark Stc&'la 4-11-96 Name of Driller Date !,.0001. COPY HE-01205-05(Rev.1/95)