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Home My WebLink Aboutwell info _ _ ___ _ � �� _ _ _. � _ , , MINNESOTA DEPARTMENT OF HFALTH M�nnesota Well and Bonng � j�� y�/j� WEIL OR BORING LOCATION Sea��ng No. H �"T.,/ F Counry Name WELL AND BORING SEALING RECORD Mmneso'a Unique No. — Hennep�a Minnesota Statutes,Chapter 1031 or W-senes No � ILeave Dlank i�nut known� Township Name Township No. Range No Sec6on No. FracUon(sm.i Ig.) Date Sealed Date Well or Boring Constructed OrOI30 1.�7 2.":; 03 ��+'+fl� � �-i.. �c �'f� Numencal Street Address or Fire Numbe�ryand Gry ol Well or 8ormg Locauon t / , I� f 21�IA Shevl in IJr� 0��0 5 5 39I Depth Before Sealing /r � R Original Depih f ft Show exact location of well or boring Ske[ch map of well or bonng A U ER(S) STATIC WATER LEVEL in section gnd with'X'. location, showing property r��91e Aquder ❑ Multiaquder lines,roads,.end,bwldmgs. N ,_)r EIUBORING �AAeasured ❑ Estimated � ! �ater Supply Well ❑Monit.Well � � -i-- -- -- j � ❑ Env.Bore Hole ❑Other _ � h. ❑,�Iow ❑above land surface W r � �-- --�-- E ING TY E(S) , , , , • CAS P _.._.�_____:__. , --F- --- i �-- � ; '�� ❑�ee� ❑ Plastic ❑Ti�e ❑Other � � u mrle � _,r � i `- -�-- -�-- --i-- � ._....,�.,...., � ... _. � CASING Diamet�er Depth ! Set in oversize hde? q��e NtipaYy groulEy? S y` � /� �—�^';�—.�+ l��.(� _l_ n.trom S� to /��ft. ❑ Yes ❑� ❑ves Q No ❑Unknown PR LCL7TJ�Y'lGIIlSE �}��7g�V in.from �o fl. ❑ Ves ❑No ❑Yes ❑No ❑Unlv�own Property ownei s mailirg a0tlress B tliHerent than well locat�on address mdicated above. in.f rom to R. ❑ Ves ❑No ❑Y� ❑� ❑�� SCREEWOPEN HOLE � /�/ Screen from�..,,j_to�� ft. Open Hole from to (L OBSTRUCTIONS WELL OWNER'S NAME [�ods/Dro Pi ( ) ❑ Debris ❑ Fill �Obstruction p pe ❑ Chedc Valve s WeN owners rtiaYing eAdress it Aiflerent than propeAy owner's adtlress indicated above. Type of ObstruCtions(Describe) � � Obstructions removed? ❑Yes ❑No Describe PUMP Type 6EOL061CAL AIATERUL COLOR HARDNESS OF FROM TO � Removed ❑�ot Present ❑ Other FORMATION METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASMIG AND BORE HOIE: II rqt krqwn,indicate eatimeted formation log from neerby well or boring. , ��Annular Space Exits �.� e i ❑ Annular space grouted with tremie pipe (�� ❑ Casing Pertoration/Removal in.from (o tt. ❑ PeAorafed ❑ Ranwred E in.from to tt. ❑ �aEad ❑ Remwsd Type of peAorator ❑ Other GROUTING MATERIAL(S) Groutlng Matenal �`�� r6m � to�L R yards �, ba� from to H. yards bape from to R. yards bass from to_ R. ya� Wps REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING OTHER WELLS AND BORINGS Other unsealed and unused well or boring on properlyl ❑Yes ❑No Fiow marq/? UCENSED OR REGISTERED CONTRACTOR CERTIFICATION This well or boring was sealed in accordence with Minnesofa Rules,Chapter 4725. The inlomy0m cawaiisd ii wis�eport is true to the best of my knowledge. Don 3todola �Iel,I Dci311ng Co. , Inc. ?.7172 Contredor Business Name �, % �y. Lir,�snss or Aispis6a%m r'+o. �...-- i.'1.j'i� �� r" '' 1 AuMonzed Represenfative Signafure Orr , t. _;�.. ,.�.,_�,��.,� LOCA�C�'P'Y H 14 9 7 8 3 Name o/Person See�Yng WeN a Boring HE-01434-03 �R r � � WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. County Name WELL AND BORING RECORD 6 2 3 5 � 9 Henne i n Minnesota Statutes Chapter 103/ Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed n. Orono 1 Z 7 23 03 ��. �. ��. 100' 2-1�-99 House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD ❑ Cable Tool ❑ Driven ❑ Dug 217Q Sh�V21A Driwe Or0�3O I�1N' S5391 ❑ Auger .�7 Rotary ❑ Jetted Show exact location of well in section grid with"X". � Sketch map of well location. ❑ A � - ! � wing property lines, � J�,W roads and buildings. DRILLING FLUID WELL HYDROFRACTURED? ❑YES NO N � Bentonite _, , , ,_ �N FROM h.ro n. � -�- -�- -, .i� ..� USE ❑ Monitorin i � i i [�Domestic 9 ❑ Heating/Cooling ❑ Community PWS ❑ Indust /Commercial - i a i i C Irrigation ❑ Noncommuniry PWS ❑ Remed al w E ❑ Environ.Bore Hole � i i i ❑ Dewatering ❑ , I r r '/ZMi1e � CASING Drive Shoe? ❑ Yes �l No HOLE DIAM. j _i_ _ i_ _i _ _i_ ❑ Steel ❑ Threaded ❑ Welded � , � � g 1 �Plastic ❑ Ij2e s �—,M��e� �,y�t L CASING DIAMETER WEIGHT PROPERTY OWNER'S NAME � �Z h. 1.� ibs.in. $ �� Wi ens in.to in.t ft. in.to ft. Ibs./ft. _1��_Q� Property owner s mailing address if different than well location address indicated above. in.to ft. Ibs./ft. in.to ft. SCREEN OPEN HOLE x Make_ from ft.to ft. TYPe— ..—t—+ � Sti a i rrs�g��-��' SIoUGauze Length � �._ Setbetween '�2 ft.and ],�� ft. FITTINGS: Z n X 3O" �(� � �� STATIC WATER LEVEL WELL OWNER'S NAME � ft.�9,f below ❑ above land surface Date measured 7—1 n--g PUMPING LEVEL(below land surface) Well owners mailing address if different than property owner's address indicated above. _�_ ft. after 2 hrs.pumping �n a 1.r g.p.m. WELL HEAD COMPLETION Q�Pitless adapter manufacturer Li}.� i-ef.r�}a r Model ❑ Casing Proteclion �1 12 in.above grade ❑ At-grade(Environmental Wells and Borings ONLY) GROUTING INFORMATION Well grouted? �LYes ❑ No GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO Grout Material ❑ Neat cement ❑ Bentonite ❑ Concrete �High Solids Bentonite MATERIAL from�to��ft. 2• �_ ❑ yds.�l bags from to ft. ❑ yds. ❑ bags TOp 503.1 Hla�k S 0' 2 � from co n. ❑ Yas. ❑ bags NEAREST N� yWNfSOUFCEOFCONTAMINA�ICON (r� t� Clay �r�:y � �f �4/ _ � feet G.S� direction��i ! type Well disinfected upon completion? �I Yes ❑ No C�..,� FSrfJWT� S `xV t PV� PUMP ❑ Notinstalled Dateinstalled G"a2�79 Water �dAta f'sL'@ � $�� .fl�� n�anufacturer'sname R�C� Jacket Model number HP 1 voic5 Z 3 Q Length of drop pipe V J� ft. Capacity 1� g.p.m. Type:�1 Submersible ❑ L.S.Turbine ❑ Reciprocating ❑ Jet ❑ ABANDONED WELLS Does property have any not in use and not sealed well(s)? ❑ Yes �I No VARIANCE Was a variance granted from the MDH for this well? ❑ Yes 4 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. REMARKS,ELEVATION,SOURCE OF DATA,etc. The information contained in this report is true to me best of my knowledge. DON STODOLA I�E:.L DRILLING CO. , IA7C. ice e Busines �rne Lic.or Reryg.No. f 2 /172 :!-r Authorized Rep sentative Signature Date Chuck :��ore 2-IO-99 Name ol Driller Date LOCAL COPY 6�3 5 8 9 HE-01205-06(Rev.7/98) . n Jcuin �itc� �ater C,�inic, �nc. 617 13th Ave So • Hopkins, Minnesota 55343 • (612) 935 - 3556 02/15/1999 Stodola Well Drilling 3841 North Main St. Bonifacius MN 55375 938-2111 REPORT OF WATER ANALYSIS Lab#: 36�62 Ou�Labor�tory reports these analytical results, determined on a sample taken by CLIENT o�02/11/1999 from the following location: Rob Weins 2170 Shevlin Dr. Orono,Mn Unique 1Mell#623589 COliform Bacteria <1/100 ml Nitrates Nitrogen <1 . 0 mg/1 The resultS of these tests indicate that 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 specified by client). ��City Water Clinic, Inc. . ��\� Bill Va�Alsdale Aoalyical Iaboraary Conultinig Eaginem W+to+.4o+lys�s Resgonb Bailor Wstor Chomioals Lab CeR�ication M 027-033-119