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Home My WebLink Aboutwell info MINNESOTA UNIQUE WELL f WE�L�fBORING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. County Name � WELL AND BORING RECORD 7 3 917 5 �p�� Minnesota Statutes,Chapter 103I Township Name Township No. Range No. Section No. Fraction WELL/BORING DEPTH(completed) DATE WORK COMPLETED 4tu[�o I18 23 36 ,i, ,�, ,i, I49 n &-31—Ofi GPS DRILLING METHOD Latitude de rees minutes seconds A LOCATION: 9 - !:Cable Tool I I Driven ❑Dug Longitude degrees_ minutes seconds I��.Auger �otary f_!Jetted � House Number,Street Name,City,and Zip Code of Well Location or Fire Number � 35t} Rciac�n Rd, vLCAlV SJ�l DRILLINGFWID WELLHYDROFRACTURED? ❑Yes o Show exact location of well/boring in section grid with"X." lt_. Sketch map of well location. �Zt�lt� From fl.To ft. �T Showing property lines, N roads,buildings, USE i omestic �. I Monitoring L I Heating/Cooling '��; � ; � ; � and direction. � � �Y � I Industry/Commercial �� ' --'-----'--- --`-----'-- � : . �: oncommunit PW . Environ.Bore Hole "�:Commundy PWS '�� I Irrigation '�. I Remedial � I !Elevator I 1 Dewatering �' --'-�---'--- --'--- ---�-- � CASING MATERIAL Drive Shoe? ��Yes � o HOLE DIAM. ' '•�� W � � � � E hreaded Welded ,. , , , , �,M _ _ C 7 Steel '1 T ' --�--- � --'--- '—�-- --'— �: �Plastic - y� �e �',' --�--- --'---—�-- ---'-- CASING '�.: 3 � Diameter -�- Weight Specifications 5 � � S � � 4 140 2.li astm 8 3fl �1 Mile� �� in.to ft. _ IbsJft. __ �y in.to ft. � in.to .. . _.__ft. Ibs./R "i in.to�ft. PROPERTY OWNER'S NAME/COMPANY NAME in.to ft. Ibs./ft. in.to ft. � �� SCREEN i..t..._.�...... OPEN HOLE �t, �[7i7�[I—"- Property owner's mailing address if different than well location address indicated above. Make From t.To ft. � � BWYC TYPe . Diam. ..__ _ � Slot/Gauze ��_� Length ___,—v_�� . Set between ft,and FITTINGS 2� >� STAT�INATERLEVEL �� 6_�� , `77 ft.�Below �. I Above land surface Date measured �l _. _ . PUMPING LEVEL(below land surface) WELUBORING OWNER'S NAME/COMPANY NAME �� ft.after_ 2 hrs.pumping_ � g.p.m. L HEAD COMPLETION t ��Q � � �n� Well/boring owner's mailing address if different than property owner's address indicated above. �tless Adapter Manufacturer �.+�'"""'--'�"'�'—Model._____ � I Casing Protection �.12 in.above grade _7 At-grade(Environmental Well and Boring ONLY) GROUTING INFORMATION Well grouted? �Yes ❑No Grout materials 1.7 Neat cement�Bentonite '� �.Concrete I �.Other_ � From _a_To.�_ft. � ��!Yds. �Bags From�' To��ft. �� I�'�d� ��Bags GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO From To ft. I I Yds. I i Bags MATERIAL NEAREST KNOWN SOURCE OF CONTAMINATION topspfl black �ft t3 4 �'=� `.' � �.:��" �; :._''". ' feet direction `fype Well disinfected upon completion? Yes �I No -. � �tL�l U� �ft 'T �� PU oPinstalled Date installed �" ' -� �� CI$v g�$y �s•t �fE 1 1£ Manufacturer's name_�"J �`-'`�'�� ! i �R LiJ (�� -}�� Model Number HP � � Volts ly �iDLL��r��l �$y a�it 11� Zy9 Length of drop pipe r O�`� ft. Capacity g.p.m. Type: ubmersible _]LS.Turbine I._'�:Reciprocating i.I Jet ��. I ABANDONED WELLS Does property have any not in use and not sealed well(s)? L-Yes �� o VAAIANCE � Was a variance granted from the MDH for this well? -Yes ��o TN# WELL CONTRACTOR CERTIFICATION This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. The information contained in this report is true to the best of my knowledge. Use a second sheet,if needed. - �� REMARKS,ELEVATION,SOURCE OF DATA,etc. � SL�1S �Ci� �ZI1I� 4V�� ILICs 1�� —� -- -------- -- ---- Licensee Business Name - Lic.or Reg.No. .__- - /G _,.��_�� ; ; � - 1 -- � Y�Cd e fes ntative Sig��u Date Ctxick Moore 7 3 9�7 5 Name ot Driller LOCAL CG�`r ` HE-01205-09(Rev.9/05) ic iao-oozo � . rw�• c�-y w�-� c � � , r�. 617 13th Ave So • Hopkins, Minnesota 55343 � (612) 935 - 3556 09/05/2006 Si-odola Well Drilling 3841 North Main St. Bonifacius MN 55375 938-21 1 1 REPORT OF WATER ANALY5IS Lab #: 5766N Our Laboratory reports these analytica/results, derermined on a sample taken by CLIENT on 08/31/2006 from the following location: Tom Pearson 350 Ruann Rd Orono,Mn Well#739175 Coliform Bacteria <1/100 ml Nitrates Nitrogen <1.0 mg/1 The results of these tests indicate thar this well is producing water that meets the standards for F.H.A., V.A., or conventional loans. This report is an analysis for coliform and nitrate only and does not include analysis of Lead and other contaminants. (Unless as speci�ed by clieni). in City. Water Clinic, Inc. t � Bill sdale Lab Cert�cation#027-053-119 � .. . WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring F„' Counry Name WELL AND BORING SEALING RECORD Minnle ota Unique Well No. �i�� Minnesota Statutes,Chapter f031 or W-series No. 0.e.�o m�,x n no�wqw�l Township Name Township No. Range No. Section No. Fraction(sm->Ig) Date Sealed Date Well or Boring Constnicted oro�o 1�� z � �z-cx��.o ,. o� GPS La►itude degrees minutes seconds L � LOCATION: Depth Before Sealing � ft. Original Depth k. Longitude degrees minutes seconds ppUIFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location Single Aquifer ❑Multiaquifer s�C� ��,p�' �� +�� WELUBORING �Measured ❑Estlmated '�'� s� '� �Water Supp�y Well ❑Monit.Well � Show exact location of well or boring Sketch map of well or boring in secGon grid with"X" location,showing property ❑Env.Bore Hole ❑Other �ft. �below ❑above land surtace N lines,roads,and buildings. CASING TYPE(S) - - - - - -- - -' '.i C'��- Steel ❑Plastic ❑Tile ❑Other O W --�- -;-- -;-- --,— E ,�� WELLHEAD COMPLETION � �y �'y Outside: ❑Well House Inside: ❑Basement Offset _Y_ _i__ '1__ _j__ ? I r�w1 1�� itless Adapter/Unit ❑Well Pit --;- -i-- -�-- -�-- � � ❑well Pit ❑Buried S � �—�'"��" ❑Buried PROPERTY OWNER'S NAME/COMPANY NAME CASING(S) Diame er � Depth � Set in oversize hole? Annular space initialty grou[ed? Property owner's mailing add�ess"rf di8erent than well location address indicated above /� � in.f�Om� t0�..�ft. ❑Yes �No ❑Yes ❑No ❑Unknown in.f�Om t0 ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown in.from to ft. ❑ves ❑No ❑ves ❑No ❑Unknown WELL OWNER'S NAME/COMPANY NAME SCREEWOPEN HOLE + r Well owner's mailirg address if diBerent ttian property owners address indicated above Scfeen f�om /�0 to �`� ft. Open Hole ffom t0 ft. OBSTRUCTIONS ❑ Rods/Drop Pipe ❑Check Valve(s) ❑ Debris ❑ Fill �No Obstruction Type of Obstructions(Describe) GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? ❑Y@S ❑ NO Describe FORMATION It not knpwn,indicate estimated fortnation log from nearby well or boring PUMP �. Type � ' ��~r ❑ Removed Not Present ❑Other METHOD USED TO SEA ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: � �No Annular Space Exists ❑ Annular space grouted with tremie pipe ❑ Casing Perforation/Remrnal in.from to ft. ❑ Perforated ❑ Removed i in.from to ft. ❑ Perforated ❑ Removed Type of perforator ❑ Other GROUTING MATERIAL(S) (One bag of cement=941bs.,one bag of bentonite=501bs.) < ' ,,• ` / Grouting Material�/��'from��to L.SL�L ft. yards �_ bags � � � from to ft. yards � bags from to ft. yards bags OTHER WELLS AND BORINGS REMARKS,SOURCE OF DATA,DIFFlCULTIES IN SEALING Other unsealed and unused well or boring on property? ❑ Yes No How many? LICENSED OR REGISTERED CONTRACTOR CERTIFICATION This well or boring was sealed in accordance with Minnesota Rules,Chapter 4725.The infortnation contained in ihis report is true to the best of my knowledge. Dan 5tod41a We12 Dcillin;; �o,. Tnc, 169I Contractor Business Name License or Regisha6on No. , r .. s� I_�' ��'' .,Eo A o d �'e �gnatu Date H 251768 � � ,� .,� � : � ,r.��,._ LOCAL COPY '. ` Name ol Person Sealing Well or Boring