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Home My WebLink Aboutwell info _ _ _ .�� * MINNESOTA UNIQUE WELL WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BOR/NG NO. CountyName WELL AND BORING RECORD / -� r-� {.�f � �^q�, ��nQe itl Minnesota Statutes,Chapter f037 F t `-- V � o✓ Township Name Township No. Range No. Section No. Fraction WELUBORING DEPTH(completed) DATE WORK COMPLETED I18 23 33 I� 1�W, S�, f� GPS DRILLING METHOD LOCATION: Latitude _ degrees minutes seconds _ Longitude degrees minutes seconds L Cable Tool �Driven ��i Dug ,_',Auger �Rotary _.Jetted House Number,Street Name,City,and Zip Code of Well Location or Fire Number �' ZVW S�1VE�C V��I uL �ra7o 5535 DRILLING FLUID WELL HYDROFRACTURED? �]Yes ��i,iVo 4� 7` Show exact location of well/boring in section grid:with"X" Sketch map of well/boring location. I]G[lt�t� From ft.To ft. ;� f. Showing property lines, — N � , roads,buildings�and direction. USE i�omestic , ��.�. � ' ;,M _. ❑Monitoring ❑Heating/Cooling � � � � \ n� -- ---- -------- - \� � ?. _ ;__ _ J � : [, oncommunity PWS [�Environ.Bore Hole ❑Industry/Commercial -, � � ; ; ..,' r'��Eommunity PWS _�Irrigation ❑Remedial ' ' _-�_ ' '?••� � � r �I levator �]Dewatering ❑ � __ ____'____ ____ __ � p _ W , , , , E T �� CASWG MATERIAL Drive Shoe? ��Yes �'No HOLE DIAM. � � � 'e' �;' . "'�'"'"'�__' _"�_'___i__ .. t,� . . I [j Steel �_,Threaded ❑Welded • , , 'hM�ie � _"-"-' Dameter� Plastic Wei ht� � -- - 1 � � S � � '�. � g Specifications , .,...,- t Q �--iMile—� �.� ` � in.to l�-+ ft. �� Ibs./ft. �� y�—in.to� ft. PROPERTY OWNER'S NAME/COMPANY NAME in.to ft. Ibs./ft. -'` in.��ft. �=t �� ._in.to____ft. Ibs./R. in.to tt. Property owner's mailing address i(different than well location address indicated above. SCREENF.r�� OPEN HOLE Make �R)lAl:tt7[2 From ft. To ft. � Type $a.ain��8$ .�41 Diam. ,' � SIoUGauze__��_____. Length�� '� � Set between ft.and ft. FITTINGS �„ � � STATIC WATER LEVEL Measured from _ft.�Below i_''�Above land surtace Date measured WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) A �� ft,after__ v hrs.pumping `� g.p.m. Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION , . ;�"Pitless/adapter manutacturer ��'� ��-_, � %��a.Mptiel_ ��Casing Protection___ j�12 in.above grade I�I Ahgrade(Environmental Well and Boring ONLY) GROUTING INFORMATION Well grouted ',�Yes I �No Grout materials ��Neat cement ��entonite [j Concrete [�Other From_�'" To_��_ft. �_ �;Yds. ��Bags GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO From To_ it �',Yds. �J Bags MATERIAL From To ft. ��Yds. ]Bags NEAREST KNOWN SOURCE OF CONTAMINATION C�$ � el�� t �� i� �.f}.� feet �✓ direction �-� �L[.�.„��__type Well disinfected upon completion7 es U No ` ci ra aoft 18 7(1 PUMP ` 'Not installed Date installed �/ � t=`-�� .1 j a� Y �+�+ � ��t �� O�Manufacturer's name C*g � �`t ��O ��Q Model Number � � j- HP�Volts �,�,� ��'�7 1 � Length of drop pipe � �/ 1 fl. Capacity g.p.m. �� rg �tt 1�O 1�1 Type: Submersible [j LS.Turbine ❑Reciprocating ;]Jet ❑ L 1 1 x ABAN ONED 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? j__Yes ' �No TNH 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. ik�n Scodola W�11 Dc�tiir� Co,. iric. 26�1 ------------- — --- —_ � Licensee Business Name ��-�� Lic.or Reg.No. � /� 1� . r� � r� presentative Si nat Certified Rep.No. Dat� C�ttC�C �'dOOr� LOCAL COPY ��O� � 3 - Name of Driller IC 140-0020 HE-01205-11(Rev 3/07) , � � Laboratory Test Report Engel Water Testing, Inc. 9300 County R9ss-�goo 1Faxet(952)�95Ms-Ni�o 5359 Phone: (952) Minnesota State Certificd Laboratory#027-003-105 * Wisconsin Statc Certified Laboratory#lt)5-11�l 1 s Dor� Stodola Well Drilling Co., Inc. 3541 North Main Street St. Bonifacius, MN 55375 --- - ----- Re ort Issuc Datc: Septerr�bes•22, 20(➢`; � W ater Test Location: � ------ -- — ---- '---------- 2009 I 2680 Silver View Dr. Ycar: !� Orono, MN Date�me: Sample Collection: 9/16 l pm ; Date/Time: Sample Recd.in Lab: 9/17 3p�m � Well Uniquc Number: 770033 _ _ I Laboratory Test Number(s): 09-7170 & 09-'1`�f�? i --- -- _ 'Rcquircd whcn critical to the validity and application ofthc results _ _ f�aborato .ry Matrix Date/Time Uate/"i'ime Tes�Results �d�,teth.ed Test'�To: > , Sam lePre ,' ;�4nal sis _ ; (u�its) __ _. _ Coliform , stit�z�; ,;��c° i,- 09-7170 9/1� 3pm 9/l8 3pm l�legative c�,t�s�,��<< Bacteria _ - -- <l.0 m L Pcr tsT:�teth�,d S�':4.`,),!- 09-7170 Nitrate 9/17 4pm 9/17 4pm � �os e ;x" r•:��: ------— — 09-7170A **Arsenic 9/18 11:30am 9/22 9:30am <0.002 mg/L SM:��z�5-�`� _ i _____._ Allowable Limits: 'v Nitratc Nitro�en,mg/I, Maximum allowable limit is 10.0 mg/L or Lcss v Caliform Bactcria: Allowsblc Limit is NEGATTVE 'v Lcad,mg/1.:Maximum allowablc limit is 0.015 mg/I,or Less Y Arsenic,mg/i,: Q.O10 mg/i,or Less-(0.010 mg/L or more exceeds the MDH-recommended health limii ti�r!ot��-��,, consumption of arsenic in drinking water. Subcontracted test results: �� o samples were subcontracted;or he ahovc test re�ilt(s)with"**"designation wcre produced by Stearns DI-IIn i.aboratories,A25 12'h St �,S.iui:c ,-: ;�- 1�Ti�I 5637R(MN Cert. No.�27-145-37R).The subcontracted Iahoralory maintains MD1-I ccrtification for thc ficl�lt:. : tcsting performcd. Discussion/Notes: These test results are within the allowable limits. Report authorized by: � _ Date: September 22, 20d9 Kathryn M. Engel, Laboratory Di ector "Chc results listed within the rcport relate only to the sainples received on thc dates indicatcd. '1'his report must not be reproduced,except in full,without the wntten approval from F:ngel Water Test�ng,1nc _ Crcalcd h� f?ngcl VVatcr'I'csling.Inc.Oclobcr,200R F�`i�` ' MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring WELL OR BORING LOCATION Sealing No. H Countyl�a�m�e WELL AND BORING SEALING RECORD Minnesota Unique Well No. Minnesota Statutes, Chapter 103! or W-series No. (Leave blanN�il nol known) Township Nam Township No. Range No. Section No. Fraction(sm.�Ig.) Date Sealed Date Well or Boring Constructed 118 23 33 AiL I� S� � GCT Q�i . GPS Latitude___ degrees minutes___ seconds Depth Before Sealing / �� ft. Original Depth ft. LOCATION: Longitude__ degrees minutes__ seconds UIFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location ingle Aquifer ❑MWtiaquifer ��j� �� 2L,A7t! S�l�r �1�11 � �� 55356 �UB�RING _ Measured ❑Estimated Date Measurecl,J� � S �u�iater-Supply Well �]Monit.Well � Show exact location of well or boring Sketc f well or boring f '� in section grid with"X.° lo i ,sh � roperty ❑Env.Bore Hole �.''�;Other ft. �below ❑above land surface N I� e�d�,and l�ildings. CASING TYPE(S) .: --'--- --i-- --`-- ---'-- � Steel ❑Piastic '_,,Tle �Other --'-----�--- "`"-'->" WELLHEAD COMPLETION W ; ; : ; ET � � � � Outside: ]Well House ❑At Grade Inside: ❑Basement Offset h --�-----�--- --%'— --�-- - � , � 'h nniie �itless Adapter/Unit u Buried ❑Well Pit � � � � ' --;-"—� - —„' --�- - ❑Buried ' �� ❑Well Pit � ❑Other— -- �.f: �—i Mile�� ' ❑Other PROPERTY OWNER'S NAME/COMPANY NAME CASING(S) Diamet�i� � Depth � Set in oversize hole? Annular space initially grouted? Property owner s mailing address if diflerent ihan well location address indicated above `� in.from � to ` ��/ ft. ❑Yes [�o ❑Yes ❑No [!Unknown in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown in.from to ft. ❑Yes ❑No ❑Yes ❑No C]Unknown WELL OWNER'S NAME/COMPANY NAME SCREEN/OPEN HOLE r /� � Well ownePs mailing address if diflerent than property owner's address indicated above SCfeen ffom_ /�/to /�✓ R. Open Hole from to ft. OBSTRUCTIONS ❑Rods/Drop Pipe ❑Check Valve(s) []Debris ,�Fill �lo Obs[ruction Type of Obstructions(Describe) GEOLOGICAL MATERIAL COLOR MARDNESS OR FROM TO Obstructions removed? ❑Yes �]No Describe FORMATION - PUMP If not k�own,indicate estimated formation log from nearby well or boring. - T pe /'� /� �✓ •"� !Removed �Not Present ❑Other __ 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.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 bentonite=50 Ibs.) A` s ,r}� [,� / Grouting Material``��A� �(��j Gom v to �� +.� ft. yards� bags from to ft. _ yards bags from to ft. _ yards bags OTHER WELLS AND BORINGS HEMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING Other unsealed and unused well or boring on property? [J 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 report is true to the best of my knowledge. Dcx� Stodola Well Drfll3ng Cc�., Iric. 1692 Licensee Business Name - License or Registration No. . f� /O /' („/ � i e ative SignatGre�. Certilied Rep.No. Date < � 4 � � , �_^,��Y H 282684 _ ___- - � C�y:.��-� : Name of Person Sealing Well or Boring �. HE-01434-11 IC#140-0423 . 2'oeR S .rasax.m ... . .._ . . . - r r�X:.+.-..W � .. 6 e_.r...wu .., t...._,. c.......,.u,�n r.v.uu.n....�rv m«..�_ ...�:_ ..s�..,,x. . �x�..�_..,....,�..