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Home My WebLink Aboutwell info f ' ' ��` '�, �'�'� I`?"'� � � R _�<' � . �F, WELL IOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. County Name WELL AND BORING RECORD �. � 6 7 3 H 9 2 � Rennepin Minnesota Statutes Chapter f03! Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed n. drono 118 2? 27 ,. ,. ,. 200' 4-I8-02 House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD 2�C)S Ci� Rd b 0�."Q110 � 55 �6 �7 CableTool `❑�riven ❑ Dug 17 Auger �Rotary ❑ Jetted Show exact location of well in section grid with"X". Sketch map of.well location. ❑ _____ ____ "�v� {�}-v' �Showing property lines, � �� roads and buildings. DRILLING FLUID WELL HYDROFFACTURED? L YES O N water i i � i " FROM R.to.__. ft. _i _i_ ___ _i_ ,._. USE ❑ Monitoring ❑ Heating/Cooling i i i i _.._,_,,,� � Domestic _i_ _�_ _�_ _i_ �� . ❑ Irrigation ❑ Community PWS ❑ Industry/Commercial i i i i �-�` hh ❑ Noncommunity PWS ❑ Remedial . w e T � � ❑ Environ.Bore Nole — i i i i 4.�,�� ❑ Dewatering ❑ i i i i ,/zlMie ? CASING Drive Shoe? ❑ Yes �No HOLE DIAM. i i i � '� ❑ Steel ❑ Threaded ❑ Welded -i- -i- -i - -i "{ „� �'Plastic ❑ S �-t Mile-� �•.� -� �3 CASING C�AMETERZ�� WEIGH�� /o �� PRTOPERT OWNER'S NAME �� in.to ft. Ibs./tt. ��i�.�a .. - J�hn�Diane Macesh in.to ft. ___ Ibs./ft. "�li�.�p o0 Property owner's mailing address it different than well location address indicated above. — .— in.to ft. __ Ibs./ft. in.to ft. � �a�� ebove SCREEN OPEN HOLE Make J2hnson from ,__ ft.to fl. Type�_t$_�-��_...�*1 Diam. _ SIoVGauze_.____,_.�ViA Length t. t } t��__. r� Set between ft.and ft. FITTINGS: STATIC WATER LEVEL �� p WELL OWNER'S NAME �___ _tt.�below ❑ above land surface Date measured__�=j Q� 2 . i s_ ' PUMPINGtEVEL(below land surface) �t _ Well owner's mailing address if different than property owner's address indicated above. 1�Q k. after.___�___ _hrs.pumping G S g.p.m. WjLL HEAD COMPLETION W L CN�C e C ----- �"t Pitless adapter manufacturer_ Model �". ❑ Casing Protection__ _.�12 in.above grade ❑ At-grade(Environmental Wells and Borings ONLY) GROUTING INFORMATION Well grouted? �Yes ❑ No HARDNESS OF Grout Material ❑ Neat cement ❑ Bentonite ❑ Concrete Hi h Solids Bentonite GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO � 9 from__�_to___�Q._ft. � ❑ yds.�bags p from__2�__to �Q7 ft. �a��.�.�_� 1��] bags ��P`g�� C� S��`� Q � from to ft. ❑ yds. ❑ bags r9 e NEA/R��,i�T,�K�t�1pWN SOURCE OF C01�f�l=CCG�A�QAL t7 �"� �. ` .ry C�gy �r8y .g�lt .7 Zv � _feet _�_ �� direction��j��G �L type Well disinfected upon completion? j�Wes ❑ No �t�'"� �--� r� clay brown soft 1$ 14� � PUMP sand brown SO�t ��0 1 GO � Notinstalled Dateinstalled ��G _ 1V Manufacturer'sname BLC�fJt�C �� v�$V �ort ��^ �S� Modelnumber____._ �� HP_� _ Volts "�" a .7 i V Lengih of drop pipe.____ ft. Capacity ____ _g.p.m. BBAd gr8v $��t !$� 200 Type: �Submersible ❑ LS.Turbine ❑ Reciproca[ing ❑ Jet ❑ _ J ABANDONED 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? ❑ Yes �.No TNri WELL CONTRACTOR CERTIFICATION Use a second sheet,il needed This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. REMARKS,ELEVATION,SOURCE OF DATA,eta The information contained in this report is true to the best of my knowledge. - -- Do� Stadole �Ie12 D�illing Co. , Inc. 2 272 , ,:._._.._:. :,.�� - --- ---- - � Licensee Business ame - -. .-�Lic.orJ7eg.No. �`"i^ � ; ` ' � 7-16-OZ �°.� �� ` � uthorizedRepresentativeSignature ' ' Date ��r�r C�r�Nn;1�U Chuck Moore 4-18-4 Name ol Driller Date LOCA�COPY 6 7 3 8 9 2 HE-01205-07(Rev.2/99) IC#1ao-oo20 . - • r' . � � rw� c�-y w�� c � � � r�,� 617 13th Ave So � Hopkins, Minnesota 55343 • (612) 935 - 3556 04/22/2002 Stodola Well Drilling 3841 North Main St. Bonifacius MN 55375 938-21 1 l REPORT OF WATER ANALYSIS Lab#: 359 Our Laboraiory reports rhese analytical results, determined on a sample iaken by CLIENT on 04/18/2002 from the following�location: John Maresh 2085 County Rd. 6 Orono,Mn Unique Well#673892 Coliform Bacteria <1/100 ml Nitrates Nitrogen <1.0 mg/I The resulrs of these rests indicate ihat ihis well is producing water thai meets the siandards 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 concaminants. (Unless as speci�ed by client). �` ' Ciry Water Clinic, Inc. � Bill sdale � Iab Cettification#027-053-I 19 . ;� WELL OR 80RING LOCATION MINNESOTA DEPARTMENT OF HF_ALTH Minnesota Well and Boring j �� i +! �Q � ` Counry Name WELL AND BORING SEALING RECORD Sealing No. �H i}1 t� Minnesota Unique Well Na r-- — � "�nn��in Mrnnesota Stalutes.Chapter)031 or W-series No. I tiwve dan�n na k�own� L_ Township Name Township No. Range No. Section No. Fraction�sm.i Ig.) Date Sealed Date Well or Bonng Constructed OCOQO �.�.c� �3 Z� . ,. • ,.,%�:..�� } Numerical Street Adtlress or Fve Number and Gry of Well or Boring�ocauon /,�/ ' f�tl:�5 �t� �i.t1 �?� t)r,n�c�, :-11.? S�.?�U Depth Before Sealmg_f__��___Ft Original Depth / T � fl Show exact bcation of v,•ell or bormg Sketch map of well or bonng A�UIFER�S) STATIC WATER LEVEL in section gnd wdh"X'. location, showing property Single Aqwfer � Muthaqwfer � lines,rpads,and butldings. ry . y_ � . �UBORING Measured ❑ Estimated � � � � ; Water Supply Well ❑MONt.Well � ___ _ __ _ __ __ __ . .. ��,��' .._.. � ❑ Em Bore Hole ❑Other __ � -�-�- R. �below ❑ above land surface ,� — W -- - - -- -''- -' -- E � CASING TYPE�S) S O ' I I I . —�- -�— --i-- --i— � �` . ;,� � . �teel ❑ Plastic �Tile �Other .. I � � }lmile�4 � � � 1 —�- �— -� --i-- � i I CASING(S) . � � � � l ,� : i � - , Diam ter Depth f�` � Set in oversize hole� Annular space initially grouted? S J" i � � f� " I�7 J �i miie—qw ��--"""'^"--�� - m.from� to - ft. ❑ Yes �o ❑ Yes ❑No ❑ Unknown I PROPERTY WNER'S NAME m.from to ft. ❑ Yes ❑No ❑ Yes ❑No ❑ Unknown Jo��n�?3iRne �aresh Property ownei s mailing address if ditFerent than well locafion address indicated above. in.from to ft. ❑ �es ❑No ❑ �es ❑No ❑ Unknown SCREEWOPEN HOLE f ;..-� Screen trom! �/ '': to�L fl. Open Hole from to ft. ' +} -` OBSTRUCTIONS WELL OWNER'S NAME Ial Rods/Drop Pipe ❑ Check Valve(s) ❑ Debris ❑ Fill ❑ No Obstruction T j ,y�I Well owner's mailing aAOress if diflerent than property owner's atldress Indicated above. Type ot Obstruclions(Describe) ��l,j{-�/%�� f��'� �/ ��/��-�I' Obstructions removed? es ❑ No Describe PUMP 7ype l~'�.if�` � t.f}��l✓ GEOLOGICAL MATERIAL COLOR HARDNESS OF FROM TO �Removed ❑ Not Present ❑ Other FORMATION It not known,irWicete estimated formation log from nearby well w bonng. METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: '�7�IGo Annular Space F�cists � :?f l` , ❑Annular space grouted with tremie pipe � ❑Casing Perforation/Removal in,from to fl. ❑ Pertorated ❑ Removed in.irom to ft. ❑ Pertorated ❑ Removed Type of peAoretor ❑ Omer GROUTING MATERIAL(S) (One bag of cement=941bs.,one bag of bentonite=50 Ibs.) ?"� �t �"' ' —L':.�� Grouting Material �t�'`�}T`� - ;"14oi�'S r� to r R. yaras bags '�� from to ft. yards bags from to R. yards bags from to__ tt. yards bags REMARKS,SOURCE OF DATA,OIFflCULT1ES IN SEALING OTHER WELLS AND BORINGS Other unsealed and unused well or boring on property? ❑Yes o How many? LICENSED OR REGISTERED CONTRACTOR CERTIFICATION This well or boring was sealed in accorda�ce with Minnesota Rules,Chapter 4725. The information contained in this repoA is true to the best of my knowledge. - ��ar+ ��ac�o1�� t�ell F3rf12in� Ca. , inc. Z7T.�2 Contracror Busingss yeme License a Registretion Yio. ;�. f: A� ..• _, . _. r j .�: 1„ - -y� y'` � d RWhonred Repre3entative Signeture �� Dete � . . . . j� . . -_J LOCALCOPY H 19 413 8 Name ol Person Seeling Well or Bonng � . - - MINNESOTA OEPARTMENT OF NFALTH Minnesota Well and Boring �g 7�2 4 � WELL OR BORING LOCATION �yELL AND BORING SEALING RECORD sea��9 No. �i H_ co�r,ry Name Minnesota Unique Well No. � — � ��(j(�p��(} Mmnesota Statules,Chapter 7031 or W-series No. (Laeve deMc 11 not kmwn) Township Name Township No. Range No. Sechon No Frachon(sm.-i Ig.) Date Sealed Date Well or Bonng Consiructetl Ora�o 11� � �7 ,. � �=�i` �� e,. ��-� Numencal Sir�et Address o�Flre Number and Gty ot Well or Bonng Loca6on T ` � j f�7 � �{�� f�`��¢ �t� �j s (�� .��(�' S 5 34► epih Bebre Seal�ng /j 2 _.N Onginal Depth _ / �`^ ft Show exact locahon of well or bonng Sketch map of well or bonng ApU1FER(S) STATIC WATER LEVEL in section grid wdh"X". location, showmg property �Single Aywfer � Mulaaquder . lines,roads,a�hd buildings. N - WELVBORING �Measured ❑ Estimated i - � � � � � "' ` r ater Supply Well ❑Monit.Well � . _�_ 'i__ '_�' __� " f1 � I �-.�' —+,..--�`"- ;� � ]�Env.Bore Hole ❑Other _ 1��`�� `�- fl [�below ❑ above land surtace W --�- - -- - -- -- -- E � �� CASING TYPE(S) � � , � � � � � ` e S� ---- -- -r - �-- � �. � I XSteel ❑ Plasfic �Tile �Other � ' ' '- ' y,.. � � � Yemi1B �, j ' f � -�- �- --�-- --�— � �_ E E _. � CASING(S) _ - i t Diameter � Depth ` Set in oversize hole� Annular space initially grouted� l� S � f(a� �11�i miie� � _ in.from to tt. ❑ Ves �No ❑ Yes ❑No ❑ Unknown I PROPERTV OWNER'S NAME in.irom �o ft. ❑ Yes ❑ No ❑ Yes ❑ No ❑ Unknown �Q�7R �].�1RE' ''R3 @5�1 Property owner's mailing address if diRerent than well location address indicated above. in.irom to ft. ❑ Yes ❑ No ❑ �e5 ❑ No ❑ Unknown � �f � SCREEWOPEN HOLE � / /f'i,'!' '//�� Screen�rom j �- to� ft. Open Hole from to R. OBSTRUCTIONS WELL OWNER'S NAME Rods/Dro Pi e ❑ p p ❑ Check Valve(s) ❑ Debris ❑ Fill No Obstruction Well ownets mailing address if diflerent than property owner's address mdicatad above. Type ot ObstruCtiOns(D85Cribe) Obstructions removed7 ❑ Yes ❑ No Describe PUMP Type GEOLOGICAL MATERIAL COIOR HARDNESS OF FROM Tp � Removed Not Present ❑ Other FORMATION II not krrown,indicate estimeted formatbn log from nearby well or bonng. METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: '} No Annular Space 6cists :3 r i f t � +� ❑Annular space grouted with tremie pipe ❑Casing Perforation/Removal in.from to ft. ❑ PeAorated ❑ Removed in.from �o n, ❑ Perforated ❑ Removed Type of perforator ❑ Other GROUTING MATERIAL(S) (One bag of cement=94 Ibs.,one bag of bentonite=50 Ibs.) Grouting Matenal ��!%� ;�� '"`�flbrtf�`� �% to ��f ftr yartls �{ bags from ro R. yards bags from to ft. yards bags from to__ R. yards bags REMARKS,SOURCE OF DATA,DIFflCULT1ES IN SEALING OTHER WELLS AND BORINGS Other unsealed and unused well or boring on property? ❑Yes o 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 repoA is true to the best of my knowledge. �an ��ot.�a�a I��e11 €)�iTlir��; Go, . Ir�c. 27�I?� Contractor Bus�ness ame _ . , License a Regisfra6on I'ro. � `,� �� ,' /�- f�" �`--� � �"3 C�-i�7 - ,;�. .� 'r ._� f � pn F�epresentative Signature Date ..T�.tE1 �fitOt!!�� H 1 g.7,?2 4 Name ol Person Sealing Well or Bonng LOCALCOPY