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Home My WebLink Aboutwell info MINNESOTA UNIQUE WELL 1/�F�L OR BORING LOCATION� MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. WELL AND BORING RECORD County Name �-- � Minnesota Statutes,Chapter 103I � � �6 7 5 �'enne in - , Township Name Township No. Range No. Section No. Fraction WELUBORING DEPTH(completed) DATE WORK COMPLETED 118 3 27 �� " � 0-2 GPS DRILLING METHOD LOCATION: Latitude degrees minutes seconds � ❑Cable Tool ❑ nven �;Dug Longitude degrees minutes seconds ❑Auger �Rotary ❑Jetted House Number,Street Name,City,and Zip Code of Well Location or Fire Number � I S A� lr DRILLING FLUID WELL HYDROFRACTUAED? ❑Yes o Show exact location of well/boring in section grid with"X" \ Sketch map of well/boring location. ��1�� From ft.To ft. � (Y Showing property lines, - N � roads,buildings,and direction. SE �Domestic ❑Monitoring ❑Heating/Cooling �' __j__ ._!__ ___�__ ___;__ ❑Noncommunity PWS n Environ.Bore Hole ❑Industry/Commercial " ❑Community PWS ��Irrigation ❑Remedial `� --�-----=-----=-------- ❑Elevator ❑Dewatering �] ` ' w ; ; ; ; e T CASWG MATERIAL Drive Shoe? ❑Yes ,�No HOLE DIAM. i�n --'-"" ""'""""--�-- ---'-- I ❑Steel ❑Threaded ❑Welded ,� , , , , Mile i �� Plastic _� �� . , , , 1 . . --.--- --r-----�-----.-- CAS W G S � Diameter Weight Specifications ; 1 Mi�e� ,.._.. ��J . _.�..�,.,}.._�. �� "--in.to��ft. ��Tlbs./ft. �alm _�in.to�'�ft. �••' ' �.,.:�1� �y,_� PROPERTY OWNER'S NAME/COMPANY NAME in.to ft. Ibs./ft. _�in.toi�ft. in.to ft. Ibs./ft. in.to ft. Property owner's mailing address if different than well location address indicated above. SCREEN OPEN HOIE 1� T�L. L� Make From ft. To ft. reCst L'g� � TYPe_ r�t8 �Ss $t Diam. / / � 1XSlCe� MN 5535b SIoUGauze •�10 Length 4� + �F� Set between �s�n ft.and t 77 ft. FITTINGS ~ ~ STATIC WATER LEVEL Measured from �7 ft.�Below ❑Above land surface Date measured WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) �n ft.after 2 hrs.pumping �2 g.p.m. Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION ,-.� • �3-� � �Pitless/adapter manufacturer � ��..�a�-.�.-,r"`��'R�odCh-� ❑Casing Protection �12 in.above grade ❑At-grade(Environmental Well and Boring ONLY) - GROUTING INFORMA,�T{ION ' Well grouted ,�I Yes ❑No Grout materials ❑Neat cement;[�Bentonite ❑Concrete ❑Other From_�_To��ft. �_ ❑Yds. C Bags GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO From__�Q_To�,.�'�ft. �s. ❑Bags MATERIAL From_�j�_To�$� r,a �Yds. �Bags NEAREST KNOWN SOURCE OF CONTAMINATION � (�'j$ e � �-J feet ��J-�-�'' direction ��-°--c. type � Well disinfected upon completion? �Yes ❑No PUMP ..� �/� ':..�'..� [i Not installed Date installed " �i ' +� t �� [A1 Manufacturer's name ,'�.`.� - _��v��".`'� �,� Model Number HP�Volts d �� r. Length of drop pipe � tf t ft. Capacity g.p.m. Type: Submersible ❑L.S.Turbine ❑Reciprocating ❑Jet ❑ ABANDONED WE�LS Does properry 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,il needed. REMARKS,ELEVATION,SOURCE OF DATA,etc. Hvn Stodola Weli illi Co,. Inc. 1691 Licensee Business N e Lic.or Reg.No. �' �� . `� �� , � rt epresentative'.Si nature Certified Rep.No. Date LOCALCOPY 750675 �� Name of Driller IC 140-0020 HE-01205-10(Rev.6/O6) . .� � + rw�. c�-y w�� c � � , r�. 617 13th Ave So � Hopkins, Minnesota 55343 • (612) 935 - 3556 , 10/04/2007 Stodola Well Drilling 3841 North Main St. Boni facius MN 55375 938-21 1 1 REPORT OF WATER ANALYSIS Lab #: 4766N Our Laboratory reporrs these analytical resulrs, determined on a sample taken by CLIENT on 10/02/2007 from the following locaiion: James Pierpont 1940 6th Ave N Orono,Mn Well 750675 Coliform Bacteria Absenr Nirrares Nirrogen <1.0 mg/1 The results of these tesi-s indicate that this well is producing water that meets the standards for F.H.A., V.A., or conventional loans. This report is an analysis for coliform and nitrate only and does not include analysis of Lead and other contaminanis. (Unless as speci�ed by client). Twin Ci� ater Clinic, �Inc. . ; f i` ;' Bill V¢�n dale Lab CeR�cation#027-053-119 . ��►�- �b'JELL O�BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring I„' ��"��H ' WELL AND BORING SEALING RECORD Menneso a�Unique Well No. ;, Counry Name Minnesota Statutes,Chapter 1031 or W-series No. (Leave blankilnolknown) Township Na Township No. Range No. Section No. Fraction(sm.�Ig.) Date Sealed Date Well or Boring Constructed '' '' !2 G T` G� , GPS Latitude degrees___ minutes_.__ seconds Depth Before Sealing / �` ft. Original Depih ft. LOCATION: Longitude degrees minutes _ seconds IFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring�Ltocation �ingle Aqui(er �]Multiaquifer �^/y�F, w tj V 1940 Sisth Ave N, � SS�JS7 WELUBORING �Measured [J Estimated Date Measured�.�� r !��7 l �Water-Supply Well ❑Monit.Well r� � Show exact location of well or boring Sketch map of well or boring '[ in sec[ion grid with"X" location,showing properry ❑Env.Bore Hole ❑Other �✓U ft. ,�below ❑above land surface ". N � es,ro�s,and buildings. CASING TYPE(S) '� --'---—'-- --`----'- � '�� Steel �,Plastic ❑Tile ❑Other - __ ---- --'_ _- _ + � WELLHEAD COMPLETION - W ET �. --•- -�--- ---� -� Outside: ❑Well House ❑At Grade Inside: ❑Basement Offset ' � � � � M'�e itless A p r/Und ❑Buried ❑Well Pit , � � '� �P" da te � , --:--- --r-- ---�-----:- 1 ❑Well Pit ❑Buried S ❑Other__ �-1 Mile� . � ❑Other_ L � J�.r' PROPERTY OWNER'S NAME/COMPANY NAME CASING(S) ,� Diam tek�, � Depth � Set in oversize hole? Annular space initially grouted? Proper owner mai ing dress i i er t an well location address indicated above �in.from_� to�ft. ❑Yes �No ❑Yes ❑No ❑Unknown 1�1 �C$t r�� l�d in.from to ft. ❑Yes ❑No � Yes � ] ❑No ❑Unknown 1,I� �� 3� in.from to R. []Yes ❑No ❑Yes �]No ❑Unknown WELL OWNER'S NAME/COMPANY NAME SCREEWOPEN HOLE t— • I Well owner's mailing address if different than properry owner's address indicated above SCreen from ��FJ to�ft. Open Hole from _,to_ ft. .t OBSTRUCTIONS ❑Rods/Drop Pipe ��Check Valve(s) [�Debris ❑Fill �No Obstruction � Type of Obstructions(Describe) __.______ GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? ❑Yes ❑No Describe FORMATION PUMP If not known,indicate estimated formation log from nearby well or boring. d �„ {/: TYPe �'� 'r��`i' � /'"�❑Removed (`�ot PreseM L]Other ____ A\ 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 R ❑Perforated ❑Removed Type of Perforator [j Other GROUTING MATEFIAL(S) (One bag of cement=94 Ibs.,one bag of bentonite=50 Ibs.) GroutingMateria��rE�/�'�`�Tom Qr to��ft` yards� bags from to ft. yards bags from to ft. yards bags OTHER WELLS AND BORINGS REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING Othei unsealed and unused well or boring on properry? �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. Don Stodola Well Dcf,111ng Co., Inc. 1693 Licensee Business Name � License or Registration No. _,= ,� � /%.;J /� �� er ed Representative SignaturE " � Certilied Rep.No. Date 4 265328 �`'. �� '°-'''�'-' LUGALCOPY H Name ol Person Sealing Well or Boring HE-01434-10 IC#140-0423 � sio7a �`•