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Home My WebLink Aboutwell info _ • �. WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. ': CountyName WELL AND BORING RECORD Minnesota Statutes, Chapter 1037 �� Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed �� 161 N i-ZS-05 GPS DRILLING METHOD LOCATION: Latitude degrees minutes seconds Longitude degrees minutes seconds ❑Cable Tool ❑Driven -Dug ��Auger �Rotary [�Jetted House Number,SUeet Name,Cily,and Zip Code of Well Location or Fire Number � DRILLING FLUID WELL HYDROFRACTURED? ��Yes No Show exacl loca�ion of well in section grid with"X". ,_ ketch map o�we!I location. �ter FROM R.TO fl. Showing prop@(ty lines, -- N roads a 'tTuildings USE — ; w J Domestic y ��En9ironl Bore Hole �'Heating/Cooling � Industry/Commercial i�� Noncommunit PWS Irri ation .Remedial �' ; ; ; ; ❑Community PWS ['Dewatering I . _ CASING HOLE DIAM. ___� � . ; � I I I f w ; ; ; ; e T Drive Shoe? �Yes �No - __;___ _;___ __�__ __,__ I �"'"'�''� � �, ❑Steel ' ,Threaded �Welded , , '/z Mile 18SIiC _ _ -,___ "„" ' "' ;__ � '. 1 ` CASING DIAMETER WEIGHT s � �,, 1',� �f p �/� �iMiie—� ��'�- `_��r' �in.to 253 ft. G��Z IbsJft. C�in.to�tsft. __ in.to__. __ft. _._.._ Ibs./h. .�in.toi V1 ft. �� PROPERTY OWNER'S NAME/COMPANY NAME in.to__ ft. Ibs./ft. in.to ft. SCREEN OPEN HOLE . fi Proper!y owner's mailing address if ditterent than well location address indicated above. Make FROM ft. TO ft. � � $W� Type �� n �.� g Diam.��/�� SIoUGauze_ _�OlV Length +'F T `'� Set between�.��_ft.and 162 ft FITTINGS��][�~ STATIC WATER LEVEL �-�- 'Q tt.� below �!above land surface Date measured �'G7�'l7S PUMPING LEVEL(below land surface) WELL OWNER'S NAME/COMPANY NAME 1�� ft.after _..�;�hrs.pumping � g.p.m. WELL HEAD COMPLETION - Well owner's mailing address if different than properry owners address indicated above. �pitless adapter manufacturer._��.��(�,,,j' Model _ ' Casing Protection �2 in.above grade ❑At-grade(Environmemal Wells and Boring ONLY) - GROUTING INFORMATION Well grouted �!Yes ��.,_]No Grout material _�Neat cement �j Bentonite ❑Concrete �High Solids Bentonite � from�to__�__,ft. � ' �yds �6ags from�to�__ft. j��i__�,�, ;]bags GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO from to ft. MATERIAL ❑yds. �bags NEAREST KNOWN SOURCE OF CONTAMINATION � ,_ ; ,/�_J feet �� direction �,,,,.�_1_-� �. t...��"'"'t" rype • �� Well disinfected upon completion Yes ❑No ,..� .,_, . �j—.,.,..�,� d` j-��,*��- ` PUMP l� ��Not installed Date installed Manufacturer's name �7CLZW��r Model number HP � Vclts �� Length of drop pipe �� ft. Capacity g.p.m. Type:�� ubmersible ❑LS.Turbine ❑Reciprocating �J Jet r`l O ABANDONED WELLS _ a 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? [�Yes � No 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. �t] JC�OIB Welt Dril��#. IACs 2!1�2 �Licensee Business Name Lic.or Reg.No. D�(3"lJ J � �e epresentative,S� a re Date (�uck Moare � � �� q� � Name of Driller C.E7CAL COPY L� HE-01205-08(Rev.S/02) -�- IC 140-0020 � rw� c�-y w�-� c � � � r�,� 617 13th Ave So � Hopkins, Minnesota 55343 � (612) 935 - 3556 04/29/2005 Stodola Well Drilling 3841 North Main St. Boni facius MN 55375 938-21 1 1 REPORT OF WATER ANALYSIS Lab #: 225BN Our Laboratory reports these analytical results, determined on a sample taken by CLIENT on 04/26/2005 from the following location: John Whitman 1570 6th Ave N Orono,Mn Weil#719846 Coliform Bacteria <1/100 ml Nitrates Nitrogen <1.0 mg/1 The results of these tests indicare that this well is producing water that meets the standards for F.H.A., V.A., or conventiona/loans. This report is an analysis for coliform and nirrate only and does nor include analysis of Lead and orher contaminants. (Unless as specified by clieni). T,win City Water Clinic, Inc. . �. . l;:°�'L�.'`. eill Vd�b`�3�sdale :; Lab Cert�cation#027-053-119 WE�L OR BO'RI�IG lOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring H ��4 0 2 4 � ��a�� WELLAND BORING SEALING RECORD SealingNo. Minnesota Unique Well No. �x��pi� Minnesota Statutes,Chapter 1031 or W-�seri es�No. f � �_� j �J �` Township Name Township No. Range No. Section No. Fraction(sm�Ig) Date Sealed Date Well or Boring Constructed Oron� 118 23 26 �,. �,. �,. � GPS LaMude degrees minutes seconds .,, � r � LOCATION: �eptli Before Sealing ��+-~ ft. Original Depth `�a ft. Longitude degrees minutes seconds pqUIFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location �Single Aqu'rfer ❑Mul�aqu'rfer �570 Vt[l A� � �� Sg356 WELUBORING �Measured ❑Estimated Show exad location of well or boring . of well or boring �Water Suppy Well ❑Montt.Well � in section grid with"X" location, howing properry ❑Env.Bore Hole ❑Other �4 ri. �below ❑above land surface N lines,r s,and buildings. CASING TYPE(S) -Y- -T- -i-- -i— f : ; ; ; ; 0�.��1. Steel �Plastic ❑Tile ❑Other —�- -�-- - -- --i-- � WELLHEADCOMPLE110N W E TT Outside: ❑Well House Insfde: ❑Basement Offset _Y_ ____ _l__ _�__ I �^� `�Pitless Adapter/Unit ❑Well Pit --�- -i-- -i-- -i-- I 1 ❑Well Pit ❑Buried S �—'""�'—�` _ - � � ❑Buried PRDP�RTY O�yN�R�'S�NA�E/COMPANY NAME CASING(S) � `1Ej�Zt1 am Diameter Depth . Set in oversize hole? Annular space initialiy grouted? Property owner's mailing address'rf differeot than well location address indicated above � r.'�.�`r � in.from � t0�ft. ❑Yes �No ❑Yes ❑No ❑Unknown in.ffOm t0 ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown E 1 � in.f�om t0 ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown 1 WELL OWNER'S NAME/COMPANY NAME SCREEWOPEN HOLE r � � Well owner's mailing address if different than property owner's address indicated above Screen from ��✓ t0 j� ft. Open Hole from t0 ft. � OBSTRUCTIONS �Rods/Drop Pipe ❑Check Valve(s) ❑ Debris ❑ Fill ❑ No Obstruction � '� j � i Type of Obstructions(Describe) - i N.tl�% I-Ii1+G p- �1� .{] GEOLOGICAL MA7ERIAL COLOR HARDNESS OR FROM TO Obstructions removed? Yes ❑ No Describe � FORMATION PUMP ` If not krwwn,indicate estimated formation log from nearby well or bonng � �r ' Type ">c�G' �c.��'r' .� '�J� � �"'' '�'Removed ❑ Not resent ❑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 MATERtAL(S) (One bag of cement=94 Ibs.,one bag of bentonite=50 Ibs.) 6 /"•iL' t /=r,� Grou[ing Material/��f - ��'��'�� from�to�ft. yards �.�L— bags from to ft. yards bags trom to ft. yards bags OTHER WELLS AND BORtNGS REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING Other unsealed and unused well or boring on property? ❑ Ves �No How many? LICENSED OR REGISTERED CONTHACTOR CERTIFICATION This well or boring was sealed in accordance with Minnesota Rules,Chapter 4725.The intormation contained in this report is true to Uie best of my knowledge. Ib� Scoc�ola W�11 �rillin� Co., Inc. 2'71.72 Contractor Busi N License oi Regishation No. .. r � +�,�1 ' �_ r.l.�..% o' res¢taWe nature ' Date LOCAL COPV H 2�4�2 4 � =-a.�,. � r �..L�,Y..., Name o/Person Sealing Well or Boring