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Home My WebLink Aboutwell info wELL OR BORING LOCA7iON MINNESOTA DEPARTMENT OF HFALTH Minnesota Well and Boring i ��A�A � Counry Name WELL AND BORING SEALING RECORD Sealing No. �H 3_3 Minnesota Unique Well No. g�IIn`y�� Minnesota Statutes,Chapter 103/ or W-series No. (Leeve Harik M not krqwn) — _—— ____ � Township Name Township No. Range No. Section No. Fracuon�sm.-►Ig) Date Sealed Date Well or Boring Constructed 3 Qt!?1!#} 1}.7 23 (3it 3�#-t�t?]. g tX� OO Numeqncnal Street Adtlress or Fire Number and Gry of W/r�ell or Bonng LocaCuon g/� r � I.7 V� Shnre�i°i�iis �r s 1t,�Q�� J�J 3 Depth Before Sealing iQ J ft Original Depth �V� h Show exact locah o el o o i Sketch map of well or boring AOUIFER(S) STATIC WATER LEVEL in section grid with"X". location, showing property Single Ayuiter � Multiaquder Nnes,-roads. buildings. 1 N ��.u`r-.s.,a.,�-.,_,_,..,. �,h , WELUBORING �Measured ❑ Estimated Water Supply Well ❑MonN.Well / � --------{ ❑ Em.Bore Hole ❑Other i� R `�elow ❑ above land surtace W -- - - -- -�-- --'-- E l� CASING TVPE(S� � ; � � � � � � � � --�� -- -�-- �-�-- � �Steel ❑ Plastic �Tile � Other jzmile -�-- -�-- -�-- --i-- � CASING(S) Diameter Depth � Set in oversize hole7 Annular space initially grouted7 �r mi�e—qr �'r in.irom� b� ft. ❑Yes �lo ❑ �es ❑No ❑ Unknown i �. � PROPERTY OWNER'S NAME in.from to fl. ❑ Yes ❑ No ❑ Yes ❑No ❑ Unknown Property owner's mailmg address il difler t an well location atldress indicated above. in.from to ft. ❑ Ye5 ❑ No ❑ �es ❑ No ❑ Unknown SCREEWOPEN HOLE / � Screen from�to ft3� ft. Open Hole irom to R. OBSTRUCTIONS WELL OWNER'S NAME � �Rods/Drop Pipe ❑ Check Valve(s) ❑ Debris ❑ Fill �o Obstruction �„ Well owner's meiling address it dilferent than property owner's atltlress indicated above. Type of Obstructions(Describe) � � � � _ �— Obstruclions removed? es ❑ No Describe PUMP Type GEOLO(iICAL MATERIAL COLOR HARDNESS OF FROM 70 � Removed Not Present ❑ Other FORMATION If not known,indicate estimateA formation log from nearby well or bonng. METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: � �No Annular Space Exists �� ❑Annular space grouted with tremie pipe ❑Casing Perforation/Removal in.trom to tt. ❑ Perfaated ❑ Removed in.from �o R. ❑ PeAorated ❑ Removed Type of perforator ❑ Other GROUTING MATERIAL(S) (One bag of cement=94 Ibs.,one bag of bentonite=50 Ibs.) �9 / �� Grouting Ma�enal /��q��J�rom .�_ to�� tt. yards � bags from to R. yards bags t` � from ro ft. yards begs from to—_ ri. yards bags 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 contained in this repoA is true to t�e best of my knowledge. llon Stadcla �ell D�rilliQg Co. , Inc. 27I72 Contracror Business Name License or Registrefion Yvo. :_�,___. .. - .. ,,' _ ,,.J f�. _'- � - o sen tive Signefure Dafe � --- , y "�.,.�..��,� q-�.� �t�r-�s '� �w H ��3�3 Name ol Personr ing Well or Bonng �, WELL LOC�TION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. �o�-�Name WELL AND BORING RECORD 6 4 9 2 2 3 Minnesota Statutes Chapter 103! Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed fl /. /. House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLWG METHOD ❑ Cable Tool ❑ Driven ❑ Dug Cl Auger �Rotary ❑ Jetted - Show exact location of well in section grid with' ". Sketch map of well location. fl _ � Showing property lines, .0 � �n L /�N� ��ds and buildings. DRILLING FLUID WELL HYDROFRACTURED? ❑VES �'NO N �..� L. L' , , , , FaoM__ n.�o n. -; -;- -r- -,- USE ❑ Monitoring ❑ Heating/Cooling i i � i �Domestic � _i_ _�_ _�_ _i_ ❑ Irrigation � Community PWS ❑ Industry/Commercial i i i i ❑ Noncommunity PWS ❑ Remedial w e T ❑ Environ.Bore Hole i i i � Cl Dewatering ❑ ' i i i 'ZIM,1e CASING Drive Shoe? y�f Yes ❑ No HOLE DIAM. _i _�_ _1_ _�_ I .�'Steel fd'Threaded — ❑ Welded ' ' ' ' 1 ,.❑ Plastic ❑ S �-1 Mile-{ �G CASING DIAMETER WEIGHT PROPERTY OWNER'S NAME � in.to_!9� n. 11 ___ibs./ft 7 ��08 �(� ____. in.to ._ft. _IbsJft. �in.to�tA Property owner's m i address if different than well location address indicated above. —.—____.—in.to _ft. Ibs./ft. �__�� SCREEN OPEN HOLE Make from ft.to_ ft. $��e �e� above Type Diam. ____ ____ (CARSIAGS HOUSE) Sbt/Gauze Length___ __ Set between R.and ft. FITTINGS: STATIC WATER LEVEL WELL OWNER'S NAME ��o_ _ft.�below ❑ above land surface Date measured 7�� PUMPIt�G�F,�EI(below land surface) � �O Well owner's mailing address if different than property owner's a dress indicated above. _� U _ft. atter hrs.pumping g.p.m. WELL HEAD COMPLETION �Pitless adapter manu�acturer Nhi��NB�e r Model _____ ❑ Casing Protection _ _ �'12 in.above grade Cl At-grade(Environmental Wells and Borings ONLY) GROUTING INFORMATION - Well grouted? �Yes ❑ No GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO Grout Material ❑ Neat cement ❑ eentonite ❑ Concrete �High Solids Bentonite MATERIAL from_._�_to__'�_ft. __�T� ❑ yds.�bags � t trom_�_ to�_p�.—tt.na t��„8� �df. ❑ bags C18y ye110W .gOft � l� trom______toi�u_n. _ � Yd� ❑ bags NEAREST KNOWN SOURCE OF CONTAMINATION 1} /T�` t. ( f ryPe C1'$37 gray 3�ft 1$ 5� �------feet ��l�.r�___direction S-� �ray Well disinfected upon completion? J�!Yes ❑ No claylgravel white aoft 52 6$ PUMP ❑ Not installed Date installed. _��_2_�_.Q�_, SBndY �lay gray 801 t 6� �� Manufacturer's name _._�Qyy�___.___. _ __ o Modelnumber _____ _.__..._ _ _ HP ��_ Volts f�.7� ��8 C�ray� $��t oo �� Length of drop pipe _. ��._ ______ ft. Capacity __._, g.p.m. Type:�'Submersible I7 LS.Turbine ❑ Reciprocating ❑ Jet ❑ � sand /cla �ra soft 115 140 ABANDONED WELLS Does property have any not in use and not sealed well(s)? ❑ Yes �'No _ cla /sand broWn soft 14U 170 VARIANCE Was a variance granted trom the MDH for this well? f] Yes �YNo TN# cla /sand ra edium 170 181 WELL CONTRACTOR CERTIFICATION $8�Qd�'eUse a second��e�ded hard 1 O1 21� 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. � �"" -��e�rfle�..._��. . ic. ef.1'o. 1[i4• G 172 � ,....--�---' �� - --- ----- Z�Z_� � -. Authorized Representahve Signature Date ----- _-��aII��i8��levi�_- 7"1.2�2_ 6 4 9 2 2 3 Name ol Driller Date LOCAL GOPY HE-07205-07(Rev.?J99) � , � - rw� c�y w�� c � � , r�,� 617 13th Ave So � Hopkins, Minnesota 55343 � (612) 935 - 3556 07/15/2000 Srodola bVell Drilling 3841 Norrh Main Si. Boni facius MN 55375 938-Z 1 1 1 � REPORT OF WATER ANALYSi5 Lab #: 39428 Our Labo��arory reporis [hese analytical results, determined on a sample taken hy CUEN! o�� 0?/l2/2000 from the following location: Bill Popp 1305 Shoreline Dr. Orono,Mn Unique Well #649223 Coliform Bacteria <1/100 ml ' Nirvates Nirrogen <1.0 mg/1 The res�rlts of tl�ese rests indicare thar this well is producing warer thar meeis rhe srandarcl� fnr F.H.A., V.A., or conventianal loans. This report is an analysis for coliform and nirrate only and does not include analysis of Lead and other � c.ontaminanrs. (Unless as specified by client'). i C � a e � Clinie, Ine. ., Bill l� � , r e � � .\nnlci�:J i,�n,.�.a��.� ConsultingEngineer \\ui,i �n:dr.�,I:,:��.�,i�i:; AoilerWaterChemicals Lah Certification#027-OS3-I 19