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Home My WebLink Aboutwell info , MINNESOTA DEPARTMENT OF HEALTH M�N AEND BORIN�G NO. ELL �LI.O^BbRING LOCATION �o��,Y Name WELL AND BORING RECORD �TIt2e in Minnesota Statutes,Chapter 103I � 5��, �8 Township Name Township No. Range No. Section No. Fraction WELUBORING DEPTH(completed) DATE WORK COMPLETED Ororx� i 17 �, ,, �, ` K. GPS DRILLING METHOD LOCATION: Latitude ___ degrees minutes seconds Longitude degrees minutes seconds U Cable Tool ❑Driven ❑Dug ❑Auger �Rotary ❑Jetted House Number,Street Name,City,and Zip Code of Well Location or Fire Number �� 145 �ith Ave � DRILLING FLUID WELL HYDROFRACTURED? ❑Yes No Show exact location of well/boring in se tion grid with"X" Sketch map of ell/boring location. �ter From ft.To_ ft. � Sho ing property lines, � N roads,buildi.gs,.and direction. USE �li Domestic ❑Monitoring ❑Heating/Cooling � � �en� � .J__ __�__ ___�_____:__ '"._ - ❑Noncommunity PWS ❑Erniron.Bore Hole ❑IndustryiCommercial � � ❑Community PWS ❑Irrigation ❑Remedial - - - - -- - - - � .r ❑Elevator ❑Dewatering ❑ � _�-- - i- - -`- - -' - � W � � � � E � � �,� ` ASIN RIA OLE DIAM �, ; ; ; ; T � �� ., C G MATE L Drive Shoe? ❑Yes ❑No H � ` --;-- --�-- --F----.-- I '� ❑Steel ❑Threaded ❑Welded , , , , Mne � • ,�,/ L . � , , , � � � � -- ,yy Plastic ` --�--- --�-----�-- --�— , .:,� ;. 1 � CASING � � S � � `ti, � Diameter Weight Specifications ✓ ✓ L �n �—i nniie� �� `� in.to �52 n. I'�s./ft. �� in.to�ft. PROPERTY OWNER'S NAME/COMPANY NAME,'. in.to _ft. ____Ibs./ft. __ �in.�"O ft. Phili �D�Ci V in to ft. Ibs./ft. in.to ft. ,, , Property owner's mailing address if difterent than well loc ion address indicated above. SCREE OPEN HOLE Make�� From To ft. � � a� Type ��[i e�A�t Diam. SIoVGauze .�ZC7 Length �� ♦ �}� Set between ft.and R. FITTINGS » � STATIC WATER LEVEL � Measured from — ft.�Below ❑Above land surface Date measured WELL OWNER'S NAME/COMPANY NAME PUM*PING LEVEL(below land surface) i� ft.after � hrs.pumping 35 g.p.m. Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION ' , Pitless/adapter manufacturer 1 }..��'-'�—�Model a ❑Casing Protection �12 in.above grade ❑At-grade(Environmental Well and Boring ONLY) GROUTING INFORMATION Well grouted �Yes ❑No Grout materials ❑Neat cement�Bentonite ❑Concrete ❑Other From�To�_ft. _�_ �]Yds. �'Bags GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO From�_To�s�_ft.��'�is. �]Bags MATERIAL From To ft. ❑Yds. ❑Bags NEAREST KNOWN SOURCE OF CONTAMINATION �-'18 �Z�O�T '"�� feet �'^' direction `�—+—�" �_'x t_ � Well disinfected upon completion? �Yes ❑No ._.,eS... �� C ra PUMP ? ❑Not installed Date installed C.P � ;� .'r � L � . r8�j � ManufacturePs name � ��r-� Model Number HP�Volts � �.� ti�.! C� Length of drop pipe �('J v ft. Capacity_ g.p.m. �� T � � Type: Submersible ❑L.S.Turbine ❑Reciprocating ❑Jet ❑ 1 ABANDONED WELLS Does property have any not in use and not sealed well(s)? [�Yes,,_ry 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. �'j Stt�dvla t�kll Drilling Co�� 1�• 1�1 Licensee Business Na Lic.or Reg.No. , �� r �,i<;�� -G 7 rfi ,epresentative Signa [e- Certified Rep.No. Date 7 5 0 6 3 8 Name of Driller � �� LOCAL COPY -— -- IC 140-0020 HE-01205-10(Rev.6/O6) * - . �,_ Tw i�vv C i,�y 1Na•t��' C ' ' , I v�i,c� 617 13th Ave So � Hopkins, Minnesota 55343 � (612) 935 - 3556 06/29/2007 Stodola Well Drilling 3841 North Main �� St. Bonifacius MN 55375 938-21 1 1 REPORT OF WATER ANALYSIS Lab #: 254BN Our Laboratory reporis ihese analyrica/results, determined on a sample taken by CLIENT on 06/27/2007 from rhe following location: Phillip Remenski 145 Smith Ave. Orono,Mn Well 750638 Coli form Bacreria Absenr Nirrares Nitrogen <1.0 mg/1 The results of these tests indicate thar this well is producing water that meets the standards for F.H.A., V.A., or ccnventional!oans. This report is an analysis for coliform and nitrate only and does nor include analysis of Lead and other contaminants. (Unless as specified by clieni). Twin City Waier linic, Inc. ,. f�, 8" V Arsdale Lab Certification#027-053-I 19 .. T ;_ �. . .. s ..� . . . . .. . . .. . . . . y�lE�!pR�80RING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring H 2 6 Q 2 3 9 ` WELL AND BORING SEALING RECORD Minnleso a�Unique Well No. County Name f�rmepin Minnesota Statutes,Chapter 1031 or W-series No. (Leava Dlank if no�knov�n) Township Name Township No. Range No. Section No. Fraction(sm.�Ig.) Date Sealed Date Well or Boring Constructed � Orono I17 23 02 2l1-0019 �j GPS Latitude degrees minutes seconds Depth Before Sealing ��'� < ft. Original Depth ft. LOCATION: Longitude degrees minutes seconds IFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location Single Aquifer ❑Multiaquifer ��[ ��,/ WE�UBORING _ Measured ❑Estimated Date Measured � ��Water-Supply Well [Monit.Well � Show exact location of well or boring Sketch map of well or oring �Env.Bore Hole r,��Other �� ft. �below L]above land surface in section grid with"X' location,showing prop rty lines,roads,and buildi s. N �� CASING TVPE(S) ��- � � � � . � , , , ,y --•-- ---�-----�---�- ��,j �Steel ❑Plastic ❑Tile ❑Other _ - • ` "'--' —�------`-----`-- WELLHEAD COMPLETION W : ; ; ; ET � � � � Y Outside: ❑Well House �At Grade Inside: [�Basement Offset � --�--- --�-- --�—--%-- � 'k nniie �� ,Pitless AdapledUnit ��Buried ❑Well Pit ' --;-- --;----%-----;- I Y _ Buried - L / � ❑Well Pit �Other � S � � �1 Mile� ;�`..;��' ❑Other _ PR R NE NAMEICO P NY NAME CASING(S) °�.�t�l" `�e�s�cf P Di rr�tyr� � Depth t � Set in oversize hole? Annular space initially grouted? Property owner's mailing address if diflerent than well location address indicated above �/ /� �� F in.from 'V to�ft. L;Yes �No ❑Yes ❑No ❑Unknown � �. ai)l)Yc in.from to _ft. ❑Yes �`i No ❑Yes ❑No i_]Unknown in.from_ to_ ft. ❑Yes ��i No ❑Yes ❑No U Unknown �� WELL OWNER'S NAME/COMPANY NAME SCREEN/OPEN HOLE/ � 1 i Screen from /t• � to �C�� ft. Open Hole from to ft. Well owner's mailing address if different than property owner's address indicated above — � 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. Type � ,�� <J ��` ---- �^!Removed �Not Present (�Other__ .____ � M�E/THOD USEDTO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOIE: �No Annular Space Exists ❑Annular Space Grouted with lYemie 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.) �+y/y� �'" I Grouting Materiai!"�I�+T£_';///��from � 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 Other unsealed and unused well or boring on property? �Yes � No How many? LICENSED OR REGISTERED CONTRACTOR CERTIFICATION This well or boring was sealed in accordance with Minnesota Rules,Chapter 4725.The information conlained in this report is true to the best of my knowledge. Don Stodola Well bcilling c�,,_7�,___1�4L Contracror Busin s me License or Registration No. �' -�-. /.� %/- �:� 'l rtifi� epresentative Sig ature Certified Rep.No. Date � --- ?''��.i.��'�:.L��„a..'-"�.�,/ LOCALCOPY H 2 6 O Z�w/ Name ol Person Sealing Well or Boring HE-01434-09 IC#140-0423 siosa