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Home My WebLink Aboutwell info WFL�"�!OCATION MINNESOTA DEPARTMENT OF HEALTH M/NNESOTA UNIQUE WELL NO. County Name WELL AND BORING RECORD 6 4 9 2 2 2 Hennepin Minnesota Statutes Chapter 103/ Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed Orono 117 23 03 , ,. ,. 165 ry 7-7-d0 House Number,SVeet Name,City,and Zip Code of Well Location or Fire Number DRILLWG METHOD 2150 Shevlin Dr, �roao 553 1 ❑ AugeeTool �otary ❑ JDett d Show exact location o(well in section grid with"X". Sketch map of well Iocation. Cl Showing property lines, roads and buildings. DRIILING FLUID WELL HYDROFRACTURED? ❑VES ❑NO N _, , , ,_ � bentonite FROM � to _ h. ; -,- -;- -, USE ❑ Monitoring ❑ Heating/Cooling i i � i �Domestic _i_ _a_ _i_ _i_ ❑ Irrigation ❑ Communiry PWS ❑ Indusiry/Commercial i i i i ❑ Noncommunity PWS ❑ Remedial w e � � , !�C(,,� ❑ Environ.Bore Hole ❑ Dewatering ❑ i i i i -r -�- -r- -r T `V W i i i i +/2M e � CASING Drive Shoe? ❑ Yes ❑ No HOLE DIAM. , � L i � ❑ Steel ❑ Threaded ❑ Welded i- l i i 1 � �Plastic ❑ _ _ _ _ S �,M��e—� � CASING DIAMETER WEIGHT PROPERTY OWNER'S NAME ! in.to�ft. _ �dl'�� Ibs./ft. � �i�$ �. Je t se Po t t in a ______ in.to ft Ibs/ft �in.to��. Property owner's mailing address i(different than well location address indicated above. __— __in.to ft. __ ____ Ibs./fl. in.to__ft. SS�A'e aS above SCRE�ETN OPEN HOLE Make"0$n from tt.to ft. " -�--�j—._ --. �?. Type��$,�(�le.�a $tt Diam. � SIoVGauze_._y_�_��_.__..__ ,.,___.Length_��i.�� ;. Setbetween _ 1 G�J�ft.and !LG ft. FITTINGS:�M��.,_)� iVJ �7� ST TI WATER LEVEL y� WELL OWNER'S NAME �� ___ h..�below ❑ above land suAace Date measured 7�'7"VD PU PING LEVEL(below land surface) +� Well owner's mailing address if different than property owner's address indicated above. 1��_ ft. after_._____ 4�5_.. hrs.pumping 30 g.p.m. WELLHEADCOMPLETION �hi.tewater " �Pitless adapter manutacturer_ _____ Model . ❑ Casing Protection _ Rr12 in.above grade ❑ At-grade(Environmental Wells and Borings ONLY) GROUTING INFORMATION Well grouted? J�Yes ❑ No GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO Grout Material f 7 Neat cement ❑ Bentonite ❑ Concrete �High Solids Bentonite _ , MATERIAL from�to��ft. � rl yds. ❑ bags from to ft. � ,�y�ls�❑ bags � to soil llow aoft 0 f�om��o�37-n natuta�- y�� bags ' NEAR T KNOWN SOURCE OF CONTAMINATIO� „� . �J��(�/ � C 7 S r� 90f t 1 w� O _ feet �/�C''��S� __ direction�� f type 1 1 f ��.[��`� Well disinfected upon completion? �YYes ❑ No C18 sand nr$ $Q,f PUMP ❑ Not installed Date installed �_10�0 ravel �� Y8 SOft 8 Manutacturersname ____�uj,$g___ _ Model number_._____ _____ _ __.__ HP_j�____ Volts �� C18 rave 1 brov �edium � Length of drop pipe_. __ =�________ tt. Capacity __ __ _ g.p.m. Type: �ubmersible �*LS.Turbine ❑ Reciprocating ❑ Jet Cl SBnd b d�n �I�d IS� ABANDONED WELLS Does property have any not in use and not sealed well(s)? ❑ Yes �No VARIANCE Was a variance granted from the MDH for this well? ❑ Yes I�No TN# WELL CONTRACTOR CERTIFICATION Use a second sheet,il needed 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. ; REMARKS,ELEVATION,SOURCE OF DATA,etc. on Stodola Well D�lling Cos,__I�c ��_ZZ 72 ; Licensee Business Name ,- Lic.or Reg.No. �/�� -- " 1-2 7-t30 -- - . � - � G�' '� Authorized RepreseM tive Signature Date �I18IlE__MBL�le�i8- 7"?��n '; 6 4 9 2 2 2 Name of Driller Date LOCAL COPY HE-01205-07(Rev.2/99) �' rw� c�y w�� c � � � r�,� 617 13th Ave So � Hopkins, Minnesot� 55343 • (612) 935 - 3556 07/13/2000 Siodola Well Drilling 3841 North Main St. Bonifacius MN 55375 938-21 1 1 REPORT OF WATER ANALYSIS Lab#: 39412 Our Laboracory reports these analytical results, derermined on a sample taken ��y CLIENT on 07/10/2000 from the following locarion: Jesse Pottinga 2150 Shevlin Dr. Orono,Mn Unique Well #649222 Coliforrn Bacteria <1/100 ml Nirraies Niirogen <1.0 mg/1 The resulrs of these rests indicate that this well is producing waier that meers the rtandards for F.H.A., V.A., or cor+ventional loans. This report is an analysis for coli form and ni[rare only and does nor include analysis of Lead and other . conraminants. (Unless as speci�ed by client). -Twir�City Water Clinic, Inc. ,, '.\� Bill Va `��'�^ �`'� � Anal��ic;d I:ih��ra��n' ConsultingEngineer L1';�tcr:\n,lv�;c;Rr,igcnis I3oiler Waler Chemicals Lab Certification#027-053-119 wELL oR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring i �c�� County Name -- WELL AND BORING SEALING RECORD Me��lesota Unique WeII No. ��i H v � M�nnesota Sfatutes,Chapter 1031 or W-series No. ��A�p�� 0..m.um�xr�axrww�l - -- �� Townshlp Name Township No Range No Section No. Fracuon�sm.-i Ig.) Date Sealed Date Well or Boring Consiructetl . �}t'0IlO ��.� �3 �� 1'*QQ'�� '� Qr} N+u�mencal Sireet Adtlress or Fire Number and Ciry ol Well or Boring�ocauon /,�� / � L.��d +7��Q1.R� �.�� Or��Q: 55391 DepthBefore5ealing�S��n. OriginatDepih__J.�Q�_ h Show exact location of v.•ell or boring Sketch map of well or bonng O IFER(S) . � STATIC WATER LEVEL in section grid with"X". locahon, showing property Single Ayuiter � Mult�aquder lines,roads,and buildings. ��- N , ,,,W,,,---///E��LUBORING Measuretl �❑ Estimated ,//,� �p Water Suppiy Well ❑MoNt.Well / -- - - -- - -- -- - J �� /�y t� ❑ Ern.Bore Hole ❑Other L��R. �below ❑ above land surface W —'r-- -i-- -;-- --i— E .. � CASING TVPE(S) � � � � � � � � � � -�-- -�-- --�-- --�-- � - Steel � Plastic �Tile � Other }1 mile � —�- -�-- -�-- --1— � CASING(S) Diameter Depth � Set in oversize hole9 Annular space initially grouted? S ..JJ�� ,r f�`1� �l �1 mae—a. ��A.,,� � in.hom �✓ to /� k. ❑ Yes �No ❑ Ves ❑No ❑ Unknown I PROPERTV OWNER'S NAME in.from to ft. ❑ Yes ❑No ❑ �es ❑No ❑ Unknown P�operty owner's mailing address if rem than well lor.a ion address�n iwte above in.f�om to fl. ❑ Yes ❑ No ❑ �e5 ❑No ❑ Unknown SCREEWOPEN NOLE , Screen from�to�� ft. Open Hole from to k. OBSTRUCTIONS WELL OWNER'S NAME ❑ Rods/Drop Pipe ❑ Check Valve(s) ❑ Debris ❑ Fill �No Obsiruction Well owner's meiling address il diflerent than property owner's adtlress indicated above. Type ot ObSlruction5(Describe) Obstruclions removed? ❑Yes ❑ No Describe PUMP Type GEOLOGICAL MATERIAL COLOR NARDNESS OF FROM TO � Removed Not Present ❑ Other FORMATION N not known,indicate estimeted formatbn log from nearby well or bodng. METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: _ . � �� No Annular Space 6cists ❑Annular space grouted with tremie pipe ❑Casing Perforation/Removal in.from to ft. ❑ Pertoraled ❑ Removed in.from �p n. ❑ PeRorated ❑ Removed Type of perforator ❑ Omer GROUTING MATERIAL�S) (One bag of cement=94 Ibs.,one bag of bentonite=50 Ibs.) Grouting Material I�EA��1 +�.�// irom � to�� h yards � bags from to ft. yards bags - from to ft. yards bags ' trom to—_ R. yards begs REMARKS,SOURCE OF DATA,DIFflCULTIES IN SEALING OTHER WELLS AND BORINGS 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 information conlained in Mis report is true to the best of my knowledge. Don St€�dola �t,�l� I3filli�g Cr�., Inc. Z7i72 Contrador Business Name License a Repishation I'ro. � /, ` r ��"..�- �..•,/ :..J- �`'`...� utho ed presentative Signa Dete `,�: v.,._, �;..�.�. .,J�.,,,�,:iti,.�,a1•.�,�. t.�� J,��'y H 169316 NemeolPersonSeeli `WelloiBonng \.,�