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Home My WebLink Aboutwell info WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NC CountyName WELL AND BORING RECORD �, ;� � g g H�� #� Minnesota Statutes Chapter 103! e.J � i � Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed n. Ocono 117 23 11 �. ,. ,. 22� 20-23-02 House Number,Street Name,Ciry,and Zip Code of Well Location or Fire Number DRILLING METHOD 1G2� Shoceline L� 1� �r�[1Q 5`391 17 CableTool ❑priven ❑ Dug y i-1 Auger ,,,�,"'/4 Rotary ❑ Jetted � ��, Show exact location of well in section grid with"X". �� Sketch map of well location. f7 _____ __L.._.__..___.._ C � Showing property lines, ____ -- .__ . _-------�------__—._-- � roads and buildings. DRILLING FLUID WELL HYDROFRACTURED? ❑YES�O N �vr _� � � �_ � I, ,�� /�-.�. wa t e r FROM---- --n to-----,t. ,- -;- -,-- -, '�/r �� USE � ❑ Monitoring ❑ Heating/Cooling i i � � Domestic ❑ Communit PWS _i_ _�_ _�_ _i_ �� 7 Irrigation Y ❑ Industry/Commercial i i i i ❑ Noncommunity PWS ❑ Remedial w e� ❑ Emiron.Bore Hole ❑ Dewatering ❑ i i i i -- -- i _� r -r '/ZM1e CASING Drive Shoe? ❑ Yes No HOLE DIAM. _� _ i_ � _ _i_ � � ❑ Steel ❑ Threaded ❑ Welded - i i i i ` � .(�Plastic ❑ s / �-t Mile—� CASING DIAMETER WEIGHT PROPERTY OWNER'S NAME �tL _�_in.to____��_z ft. __ ? _(3� Ibs./ft. �in.to��ft. Keith Waters 4 [�.g$OC• _-- in to_.—_—tt' —.- _.—_ _ Ibs./ft. L� in tdZ�ek. V� Property owner's mailing address if different than well location address indicated above. _. ___in.to__ ft. IbsJft. in.to ft. p n 6 216 Bak e r Ad� �t e 1 1� SCREETN�_ __ _. OPEN HOLE Sd�n Frairie M�I 5534fi Makey�(jl1[1SO11 from fl.to tt. � TYPe_��evv-�-}cs----Diam. .—Z� SIoVGauze_... _Length _ • Set be[ween __ _ft.and__ __ft. FITTIN S: -- ;r STATIC WtATCER LEVEL WELL OWNER'S NAME y�_ ft.�elow ❑ above land surface Date measured �n+7�� 2 � PUMPING LEVEL(below land surface) Well owner's mailing address if diffeient than property owner's address indicated above. �_Z_Q_ ft. after � _S hrs.pumping � _g.p.m. S i '� WELL HEAD COMPLETION {,� � �(Pitless adapter manufacturer �1��C eW�t��Model C Casing Protection _ _ __,�/12 in.above grade - � AFgrade(Environmental Wells and Borings ONLY) GROUTING INFORMATION Well grouted? �Yes ❑ No GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO Grout Material Cl Neat cement ❑ Bentonite ❑ Concrete �High Solids Bentonite MATERIAL from_._� to �_ft. _2_�_� ❑ yds. �bags from�A_to�_��ft. �8`"� ��c�.�7 bags clay bro�n $��t � 1 from____to ft ❑ yds. ❑ bags s6 NEAREST KNOWN SOURCE OF CONTAMINATION C��y/r�C�$ gray ��d�ul� 10 ZZ - -. .. � ,..� feet —. .._�� _. . _ direction �.—�i . --. -�yPe y . Well disinfected upon completion? I�'es ;�l No .,. 1y 4 1� SSlltl �L�$y SOl t 1�0 1 3 PUMP � ❑ Not installed Date installed .___..___..____��__,_____ �� CZSy gCBy 1A4C1�llltl �.3� 2� Manufacturer'sname __ _��Lj@Q_t-QL__ _ __ —_.— —�--Q --- ;� Model number_ _ . __.__ _ _ _ HP __2.5 _ Volts_�.�j.�___ sand brown soft 208 22 , Length of drop pipe_._�_�._ ,___.______ ft. Capacity _____.______.__g.p.m. Type: ��. Submersible ❑ LS.Turbine C.7 Reciprocating ❑ Jet ❑ __ ABANDONED WELLS Does property have any not in use and not sealed well(s)? ❑ Yes L�No VARIANCE Was a variance granted from the MDH for this well? C Yes �(No TNN_ ._ f WELL CONTRACTOR CERTIFICATION Use a second sheet,i/needed This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. - REMARKS,ELEVATION,SOURCE OF DATA,etC. The informstion contained in this report is true to the best of my knowledge. j� � fl r__�.,c�_1 7�� --�-�� Licensee Busi ss Name =�, � iCc-or'Reg.�.�C�� r.� � � � �~___�.��=-E1�— — � Authorized Representative S�gnatur�'�� Date - Chuck �[ooce 10-23-OZ , Name oI Driller Date LOCAL COPY 6 7 7�9 9 HE-01205-07(Rev.2/99) IC#1a0-oo20 Tw i�v C i,t" 1N�x�t"e�' C ' ' , I v��,c� y 617 13th Ave So • Hopkins, Minnesota 55343 • (612) 935 - 3556 10/30/2002 Stodola Well Drilling 3841 North Main St. Bonifacius MN 55375 938-21 1 1 REPORT OF WATER ANALYSIS Lab #: 1103 Our Laboratory reports these analytical results, determined on a sample faken by CLIENT on 10/23/2002 from the following location: 1420 Shoreline Dr. N Orono,Mn Unique Well #677899 Coliform Bacteria <1/100 ml Nitrates Nirrogen <1.0 mg/1 The results of rhese tests indicate ihat this well is producing water that meets the siandards for F.H.A., V.A., or conveniional 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). 'ty Water Clinic, Inc. Bill dale Lab CertScetion N 027-053-119 I WELL OR BOFING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Bogt�p. ,� n n O�� WELL AND BORING SEALING RECORD Sealing No �,� � i� ..;.,r County Name Minnesota Unique No ��-- Hennepin Minnesota Statutes.Cha ter 1031 0� p or W-series No. (Leave blank A noi known) Township Name Township No. Range No. Section Na Fraction�sm.-�Ig.) Date Sealed Date Well or Boring Con ructed =,G�'� rono 117 23 11 , � I �.,�CT 7 _��.� UF�O,• Numerical Sireet Address or Fire Number and Ciry of Well or Boring Location / / �4 C Q Shorel ine Dr. �Z'U2I0� MIl.5 5� ��h Before Sealing f�%�/ ft Original Depth /��j n. Show exact location of v,�ell or boring Sketch map�of�weil�or'boryig A UIFER�S) STATIC WATER LEVEL in sec�ion grid with"X". location,�showing propetty Single Ayuifer � Multiaquifer lines,ro�ds.and building�. N .. . � WELUBORING Measured ❑ Estimated � � � � i �� - WaterSupply Well ❑Monit.Well � -- - -r- --,-- --i-- � _' � — '.. � r *,( I 1 7 ❑ Env.Bore Hole ❑Other �a�� N. ,Cy,,below ❑ above land surface � � � � --i-- —r '�-- -r- W E CASING TYPE(S) � � � � � � � I I � _..__ --�- -�-- --�-- --'�-- �, .`` Steel ❑ Plastic ❑Tile �Other '4 m�le y;. --�- -'�-- --�— � ( CASiNG Diameter� Depih , Set in oversize hole7 Annualar space initially grouted? � � � � � � �i r��ie� _ : r.�� J in.from� to/�`"� fl. ❑ Yes �No ❑ Yes ❑ No ❑ Unknown . ..�. . � �-. PROPERTY OWNER'S NAME in.from to tt. ❑ Yes ❑No ❑ Yes ❑No ❑ Unknown 7 Property owner's mailing address if diHerent than well locauon ad ress indicated above. in.from [o ft. ❑ Yes ❑No ❑ Yes ❑ No ❑ Unknown ;;��4 Florida Ave. SCREEWOPEN HOIE � , C�YStc�1� �.J��L l Screen from / ��^'� to r �� ft. Open Hole f�om to ft. ��-�� oesrRucnoNs WELL OWNER'S NAME Rod Dro Pi �p p� ❑Check Valve(s) ❑ Debris ❑ Fill ❑No Obstruction Well owner's mailing address if diflerent than property owner's address indicated above. Type of ObSlfuCtiOnS(D6SCfibB) Obsiructions removed?�f Yes ❑ No Describe ± ��`' �''� fi -� � �- � �`� L�+�� PUMP TyPe .�,�.��' {��..'�)I,'�: GEOLOGICAL MATERIAL COLOR HARDNESS OF FROM TO Removed ❑ Not Present ❑ Other fORMATION If not krwwn,indicate estimated formation log trom nearby well or bonng. METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: " No Annular Space Exits .�r� <::� �y ❑ Annular space grouted with tremie pipe ❑ Casing Perforetion/Removal '� in.trom_ to ft. ❑ Perforated ❑ Removed in.from to tt. ❑ Perforated ❑ Removed Type of perforator ❑ Other GROUTING MATERIAL(S) /�'�/�', ;'�J;�lf-;t!' �� / �< Grouting Matenal �� - from to ft. yards bags from to ft. yards bags from to ft. yards bags from to__ fl. yards bags REMARKS,SOURCE OF DATA,OIFFICULTIES 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 infortnation contained in this repoA is true to the best ot my knowledge. UC>N STC�DOLA WELL DRILLING CG. , INC. �ii"12 Contractor Business Name /' _ , License or Registration Pvo. , / �/�'_..,,'� _s / , . . ._�...f �. .�'` �-"'" ! Authonzed Representative Signature Date �"l,,.r,e„.,, LOCALCOPY H 12 9 019 Name o/Person Sealing Well or Boring HE-01434-03 2/97 R