Well Record - Laserfiche WebLink

Home Browse Search

. _. . - . . ;. . . _ . .. � � � � _ � ` �a ��r�(��,�� �� ,��3a�� --� 61 t�' �"y t ? � MINNESOTA UNIQUE WELL WELL DR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BOR/NG NO. �� County Name WELL AND BORING CONSTRUCTION RECORD �� 4 4 2_ � Minnesota Statutes,Chapter 103I — � Town Township No. Range No. Section No. Fraction WELUBOAING DEPTH(completed) DATE WORK COMPLETED v< /. n. } GPS LOCA ON—decimal degrees(to four decimal places). RILLING METH D Latitude longitude ❑Cable Tool ❑Driven ❑Auger �Rotary House Number,Street Name,City,and ZIP Code of Well Location ❑Other 1W B�$ sic�e Trl UCOTKI 5535b DRILLING FLUID WELL HYDROFRACTURED? ❑Yes o Show exact location of well/boring in section grid with"X:' et h map of well/boring location. �j')tonite r ft.To ft. � Showing property lines, N l� ads,buildings,and direction. USE r�(Domestic � oni onng �Heating/Cooling � ______ ______ __?_____;__ � �Noncommunity PWS ❑Environ.Bore Hole ❑Industry/Commercial �� J Community PWS ��9�n� ��7 �Remedial --- -- -- � ❑Elevator �Dewatering �' W ; ' ' E �' ASIN RIAL � HOLE DIAM. , , � C G MATE f rive Shoe.^ Yes o � ------ --=--- --�-- --:- T � c o h� �� I I I I '/ ❑Steel �tlV . � ; ; � z Mile � ' lastiC �` � --,-----,-�- ---�-- --.- 1 � CASING S � Diameter Weight Specifications �1 Mile� �in.To�ft. Ibs./ft. �in.To�ft. - PROPERTY OWNER'S NAME/COMPANY NAME in.To ft. Ibs./ft. Vil in.Toi�tl ft. t'�St � x�� in.To ft. Ibs./tt. in.To ft. Property owner's mailing address if different than well location address indicated above. t SCREEN OPEN HOLE 1Q425 Bluff Rd Make J�n�� From ft. To ft. Eden Prairie MN 55347 TYPe �'A{^le.as ster�l o� � SIoUGauze �1 f1 Lengtt�f ,k )t Set between ft.and ft. FITTINGS M STATIC WATER L V L � �} Measured from 7/ ft. elow �Above land surface Date measured � �` WELL OWNER'S NAME/COMPANY NAME � PUMPING LEVEL(below land surface) 1'f� ft.atter G hrs.pumping 3V g.p.m. Well/boring owner's mailing address if difterent than property owner's address indicated above. WELLHEAD COMPLETION .t �itless/adapter manufacturer�1t�te� Model ❑Casing protection �'12 in.above grade ❑At-grade ❑Well House ❑Hand Pump - GROUT INFORMATION(specify bentonite,cement-sand,neat-cement,concrete,cuttings,or other) Material �l1�(3!'11 tP�om_�_To_��ft. _�_ ❑Yds. �Bags Material [M1�}t��From_�__To 7 SG ft. �Yds. ❑Bags HARDNESS OF Matenal From To ft. ❑Yds. ❑Bags GEOLOGICALMATERIALS COLOR MATERIAL FROM TO Dnvencasingseal From To _Bags NEAREST KNOWN SOURCE OF CONTAMINATION �O 11 R118ClC sQ3.� Q 5 '"')'� ___feet _ direction - ---� type Well disinfected upon completion7 �'Yes [No cls bro�m med3u� 5 2C PUMP ❑Not installed Date installed ��G�"1 1 5�323C� L'1-8 l rtlVE' 'La t1��11flI 2�3 �7 Manufacturer's name ��"�/ Model Number HP �y S Volts I ratvel/sarxl 111�.X L`OLICS£ 8? ��' Len th of dro i e 1n C ft. Ca acit m f� .X 9 P P P L1J.7 P Y 9 P `—_� �r� �O�t ��t ��h Type:; ubmersible ❑LS.Turbine �'.Reciprocating �Jet �] "�st��'� �' � ABANDONED WELLS Does property have any not in use and not sealed well(s)? ❑Yes o VARIANCE r Was a variance granted from the MDH for this well? �Yes o TN# s WELL CONTRACTOR CERTIRCATION � This well was drilied under my supervision and in accordance with Minnesota Rules,Chapter 4725. The information contained in this report is true to ihe best of my knowledge. f Use a second sheet,if needed. � REMARKS,ELEVATION,SOURCE OF DATA,etc. Ibn 5todola Well Drilling Co,. Inc. 1691 Licensee Business Name Lic.or Reg.No. � ._._.- -.f f�f ^�:��. r�Ettfi� , �Sr��enta ve Signafur � Ceriifie ep. o. Date Rt)b S#Of�OlII LOCAL COPY 8 2 3 4 � 2 Name of Driller ID#52603 HE-01205-15(Rev.6/13)