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Home My WebLink Aboutwell info * ' �Z�CEIVE� WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. ' � County Name ]. 2006 WELL AND BORING RECORD -� � '� Minnesota Statutes,Chapter 1037 ; � c,,�� ,,,? ,� Township Name Township No. g N . Se � ction WELL DEPTH(completed) _ Date Work Completed n. ,i v< v. GPS DRILLING METHOD LOCATION: Latitude degrees minutes seconds � Longitude degrees minutes seconds �� I Cable Tool . �';Driven 'Dug `� �_J Auger �Rotary � Jetted t '; House Number,Street Name,City,and Zip Code of Well Location or Fire Number � /� . � � j DRILLING FLUID WELL HYDROFRACTURED? ^Yes '� No Show exact location o(well in section grid with"X". Sketch map of well location. lJG��=� FROM ft.TO ft. Showing property lines, ', N `� road�d buildings USE � Y '�Mo�nitoring �Heating/Cooling � � J � ' � � j�No cosmmund pWg -�Envaf'�nnBore Hole �!Industry/Commercial ;. ; � � Remedial � ❑Community PWS `J Dewatering ❑ � --'---—i------`-----`— . ' CASING HOLE DIAM. : w e T Drive Shoe� , J Yes �'No �. _,_____ �__ ;__ I '._',�Steei ']Threaded �,.]VJelded .. ? I ; 'h nniie •��_.�._._....,t lastic � --�--- --�-- --�-- ---%-- �i . ----- � � j CASING DIAMETER WEIGHT ; 1 I f I ; Y j �y/� +� ^ p q� y S ` .F. �. .......--"� +} � �GiJ L�ti� (7 � .71J � in.to ft. Ibs./ft. in.to ft. j 1 Mile� .� �.� --... —j— / in.to ft. ____ Ibs./ft. �in.to��'Tft. ; PROPERTY OWNER'S NAME/COMPANY NAME in.to ft. Ibs./ft. in.to ft. SCREEN OPEN HOLE Property owner's mailing address i(different than well location address indicated above. Make �� FROM ft. TO ft. � �$ ailVYe TYPe $t$�tt�,,,p�R�� Diam. _ _ SlotlGauze _ /'�*� Length_ � .. - lt! ----� --- �------- � Set between ft.and it. FITTWGS N STATIC WATER LEVEL � l�o ft. �� elow ,j above land surface Date measured � PUMPING LEVEL(below land surface) WELL OWNER'S NAME/COMPANY NAME ��Q A �j� �� ft.after & hrs.pumping .7t! g.p.m. WELL HEAD COMPLETION `` R-�-.� `�. Well owner's mailing address if different than property owners address indicated abeve. �'—' itless adapter manufacturer �J,`Cif ' Y ^r-- �� asing Protection ��,�^j in.above grade [.Abgrade(Environmental Wells and Boring ONLY) / GROUTING INFORMATION Well grouted ,[3�'Yes ,_No Grou[material ❑Neat cement [�Bentonite � �Concrete �}(gFligh Solids Bentonite from }�� to +�� ft. -7 � yds 1;yrDags from .7� to �L�V ft. �$�� d�. �,,'��bags GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO from to_ ft. �__yds. ]bags MATERIAL NEAREST KNOWN SOURCE OF CONTAMINATION :`1��feet ��.r..� direction �,�type Well disinfected upon completion � es ^No PUMP J Not installed Date installed ,�" �`�� 3 Manufacturer's name �' �� Model number HP 1/�Volts Length of drop pipe 1�-� ! tt. Capacity g.p.m. Type:_�� ubmersible ��LS.Turbine �Reciprocating ]Jet ❑ - ABAN ONED WELLS � Does property have any not in use and not sealed well(s) ❑Yes �;�IVo VARIANCE Was a variance granted from the MDH for this well? ❑Yes o TN# WELL CONTRACTOR CERTIFICATION This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. The information contained in this report is true to the best of my knowledge. Use a second sheet,if needed �-�� REMARKS,ELEVATION,SOURCE OF DATA,etc. _ uV[i .7�(�(jQ�$ ►rC,l� �L.L��it9ty ��• 1I�C• 471/L, "4 Licensee Business Name Lic.or Reg.No. �i �.-... ... �:� /�a G la pre�n ative Sigrfatu Date �+li��[:7C ��' LOCAL COPY � � [,� � � � NameofDriller �1 :;�H601205-OB(Rev.5/02) '. IC 140-0020 � � rw� c�-y w�-� c�;�;� r� 617 13th Ave So • Hopkins, Minnesota 55343 • (612) 935 - 3556 03/03/2006 Stodola Well Drilling 3841 North Main St. Bonifacius MN 55375 938-21 1 1 REPORT OF WATER ANALYSIS Lab #: 1086N Our Laboratory reports these analyrical results, determined on a sample taken by CLIENT on 03/01/2006 from the following location: Michael Davis 2650 Siiver View Dr. Orono,Mn Well #735743 Coli form 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 r�eport is an analysis for coliform and nitrate only and does not include analysis of Lead and other contaminants. (Unless as specifed by client). '��n City Water Clinic, Inc. \ '��1. B►11�\�`�'`rsdale ,. Lab CeRification#027-053-119 t WELL OR BORING LOCArION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring H �, �� WELL AND BORING SEALING RECORD Minn'esota Unique Well No. ' Minnesota Statutes,Chapter 1031 or W-series No. t��.,,� �� Tovmship N Township No. Range No. Section No. Fraction(sm�Ig) Date Sealed Date Well or Boring Constructed �ra�na li�-2 33-4 -� '. '. '. , tG GPS �-alitude degrees minutes seconds /_`, � � LOCATION: Depth Before Sealing �� ft. Original Depth ft. Longitude degrees minutes seconds ppUIFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location ingle Aquifer ❑MuHiaquifer ELLBORING Measured ❑Estimated �Water Supply Well ❑Monit.Well SFaw e loca o of we or onng e ch map of well or boring / in section grid with"X" Ixation,showing property ❑Env.Bore Hole ❑Other i(�I (t �below ❑above land surface lines,roads,and buildings. N CASING TYPE(S) �Steel ❑Plastic ❑Tile ❑O[her W --f- -�-- -�-- --�-- E .,%� WELLHEADCOMPLETION � 47�� `�� Outside: ❑Well House Inside: ❑Basement O(fset -,�- —�- -r- -i-- - 1��M ,J �itless Adapter/Unit ❑Well PR --�- -�- -i-- -�-- I ti .. " � 1 ❑Well Pit ❑Buried S N��'"�'�' . � �y,t-. . ❑Buried L PROPERTY OWNER'S NAME/COMPANY NAME CASING(S) .� Diamete�� t Depth { Set in oversize hole? Mnular space initially grouted? Property owner s mailing address if diNerent than well location address indicated above � in.ffOm� t0��it. ❑Yes QrNo ❑Yes ❑No ❑Unknown 38�� 88 a� �\ in.ffO�T1 t0 ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown in.ffOm t0 ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown 'i WELLOWNER'S NAME/COMPANY NAME SCREEWOPEN HOLE � • � Well owner's mailing address if different than property owners address indicated above Screen from/��t0�[�._ft. Open Hole from t0 ft. - o�c� OBSTRUCTIONS ❑ Rods/Drop Pipe ❑Check Valve(s) ❑ Debris ❑ Fill �No Obstruction Type of Obstructions(Describe) GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? ❑Y0S ❑ NO DOSCfibO FORMATION If not krawn,indicate estimated formation log from nearby well or boring PUMP . , .t Type ''-' r�'"`�� . ❑ Removed Not Present ❑Other i � METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BOHE HOLE: �No Annular Space Exists ❑ Annular space grouted with tremie pipe ❑ Casing Perforation/Removal in.from to ft. ❑ Perforated ❑ Removed in.from to ft. ❑ Perforated ❑ Removed Type of perforator ❑ Other GROUTING MATERIAL(S) (One bag of cement=94 Ibs.,one bag of bentonile=50 Ibs.) Grouting Material/`�L�f�i��/from�to�ft/ yards � bags from to ft. yards bags , from to ft. yards bags OTHER WELLS AND BORINGS REMARKS,SOURCE OF DATA,DIFFICUITIES IN SEALING Other unsealed and unused well or boring on property? ❑ Yes No How many? LICENSED OR REGISTERED CONTRACTOR CERTIFlCATION This well or boring was sealed in accordance with Minnesofa Rules.Chapter 4725.The infortnation contained in this report is true to the best of my knowledge. Ck� Stodala t�el.l Drilliceg Co., Inc. 2717'2 Contractor Business Name License or Registration No. lr.,,,- ..r �,�t �� A r res`e"nta SignaNr Date 0 ��. H 244441 - �,r ,, f � <: , ,� LOCAL COPY ;r-: _ Name of Person Sealing Well or Boring � �_ � _ WELL 1;OCATION MINNESOTA DEPARTMENT OF HEALTH M/NNESOTA UNIQUE WELL NO. CountyName WELL RECORD �q,i n�� ♦ t:="�i?.<.i:�!:_�:: Minnesota Statutes Chapter 1031 ; f' � Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date of Completion n. '!i�°� � v. v. v. � � �� t�- Numerical Street Address or Fire Number and City of Well Location DRILLING METHOD � Cable Tool C] Driven ❑ Dug �'i,,t ;-� 3 ?�_'`�,�' ! C':.�� ' + t'`+?':, r Auger fJ Rotary C Jetted Show exact location of well in section grid with"X".y Sketch map of well location. C p. Showing property lines, N `� roads and buildings. DRILLING FLUID I i � i , � _r•' 1_ _1 —1_ . �-: -.�:`} t . . � i � i i USE --+- --- �- �- �� - !7y Domestic C Monitoring ❑ Heating/Cooling W � ' � ' E � _' Irrigation C i Public ❑ Industry/Commercial � : .i _1_ _1_ __ __ T � �: Test Well ❑ Dewatering . . � � i f-mi. . ._.-_- CASING Drive Shoe? Yes No HOLE DIAM. , , I _.._ •--- '-;- �- - —�' 1 �, , . . G Steel 7hreaded I] Welded h---�,„Jle'� �s � Plastic 7 CASING DIAMETER WEIGHT �':<: �6f to,(��'n. PROPERTY OWNER'S NAME in.to ft. ` '�'� Ibs./tt. � / '�i' � `-�_ � �=�`-" in.to ft. Ibs./ft. in.to ft. Mailing address if ditterent than property address indicated above. in.to ft. Ibs./ft. in.[o ft. SCREEN OPEN HOLE �. 4�l }^,:-' 15 . ,-.�.: � v S . . �f,, Make 1C��„ from ft.to ft. i � � . - ;'3 Type t_ ct �,..a�.. '.E-;°;_i. Diam. •.re _ _r�'�`_ . .� . - - t SIoVGauze 7�' Length Set between ��''''_;ft.and i;- ft. FITTINGS: STATIC WATER LEVEL FORMATION LOG COLOR HARDNESS OF FROM TO E �:i ' tt. �; below � above land surface Date measured —1`---:-1`�_ FORMATION .- ti PUMPING LEVEL(below land surface) � ` � �E .: � ft. after hrs.pumping a.p.m. /.� ,- Tr WELL HEAD COMPLETION � �. Pitless adapter manufacturer i r��.��."+1 �'� '��. �%�_�" Model i ` i �f F' `C] Casing Protedion -� e :..Lc:1` Fc �, t`K' - � i�.`i �"; � GROUTING INFORMATION Well grouted? G1-Yes C No - � �� ;� S � Grout Material f�, Neat cement ❑ Bentonite ,'.i. _,. . _ . from to t:ft. I; yda E; bags from to ft. I] yds. C bags from to ft. � yds. ❑ bags NEAREST SOURCE OF POSSIBLE CONTAMINATION feet direction type Well disinfected upon compietion? Cd,�Yes ❑ No �r� PUMP ❑ Not installed Date installed `y j' r j`�d�;��. ' Manufacturer's name �� Model number HP •1.�.f. Volts�� Length of drop pipe j i,"l i ft. Capacity ,,_ a.p.m. " � Pressure Tank Capacity -�:Tz'�j�-.,�•_� -. Type: ❑ Submersible ❑ L.S.Turbine ❑ Reciprocating O Jet J ABANDONED WELLS � � t�� Not in use and not sealed well on property? ❑ Yes L7.�lo WELL CONTRACTOR CERTIFICATION This well was drilled under my jurisdiration and in accordance with Minnesota Rules,Chapter 4725. The information contained in this report is true to the best of my knowledge. �... -. _ _ , (; .�i.4 r _ 'e�.�__ ^ � . . . . ..,.. � i . ..,. . ��ri_: . ...._ .�...i.+�. . - n . .._.. f i . . Use a second sheet il needed REMARKS,ELEVATION,SOURCE OF DATA,etc. Liaensee Business Name lic.or Reg.No. _ .;/'`��.�' � ' i: - ,�;--./� �-r' `�- ��^�� _ Authonzed Represenfahve Skyanture Date _.,.7_� <:� - 1''-. Name ol Driller Date LOCAL COPY � � �J �� HE-01205-03(Rev.9/91) �', � � �� . . 7Wxl�l C::�7'Y WA'T'k::F� GI...:CN:I:C;p xNCN - f.s:I.I 1:`i'kh �Vt�+u ;ara. F•Ic:��ak:a.n<.:>„ I�lii�i��:��:>c�•l:�:t �i��w��;`i , (fa:l.i•�) ci�.`y;i_.::i:i;.�fa ' 0!/1 J/�i�c'. • a•l•c:�cl�a:I.�:t W c::�:I.:I. I)i••:i:I.:i.a.i�c� 1:+::iUf.r I•�Iwy 1 � I"I�.nnc�•tc>nl.:<a;, IYil�l ;:i;i;;�}w, "�:3f:�...�:'9.:I.:I. La L'� �#a 1 by60 REPORT OF WATER ANALYSIS Our l�boratory re�aarts the�;e an�].y•tical r�sults;,, c��tE_i••mii7�ci csn «t sample tak�n by YOU c�r� U7/15/9�' �frc�m th� fc�llawi.nc;� lc�r•..�t:i.c:�n;, �Tr�l�ri (;i�att�aw lJr�iq4t� # 4793b4 26�+0 Silv�rvi�w Dr � Ui••anca, I*In Coliform Bacte�ia <1/100 nl Nitrate� Nitro9�n <1.0 iap/1 'rhtt re��uYty c:�h� th�� te�►ts indica►t�.• th�►t thi� w�ll i� prc�ducin,y wat�r th.:tt mr��t�s th�� tandard� far �.H.A. , V.A. , c�r conv�ritic,nal laan�;. r ' •i ity Waterr Clinic, Tnc. , � , ti \ �+xx � ��.��.E:a �ra4ar� x{.l<:�i.r . ♦