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HomeMy WebLinkAboutwell info i � wELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring H 2 0 3 3 3 7 �'. County Name WELL AND BORING SEALING RECORD Menn'esoNa Unique Well No. Minnesota Statutes,Chapter 1031 or W-series No. He nn e p i n «aa.�e�e�k��,,,o,k�ow�, ��Township Name Township No. Range No. Section No. Fraction(sm�Ig) Date Sealed Date Well or Boring Constructed { Orono 118 23 26 4f—tt00 Z2, ��� 03 5 , s � GPS Latitude degrees minutes seconds - LOCATION: Depth Before Sealing ��� ft. Original Depth ��� ft. Longitude degrees minutes seconds p �FER(S) STATIC WATER LEVEL �- Numerical Street Address or Fire Number and City of Well or Boring Location Single Aquifer ❑Multiaquifer y I125 SpringHill Rd Orono EWBORING I�Wleasured ❑Estimated � [�q�ater Supply Well ❑Monit.Weil � ��� Show exact location of well or boring Sketch map of well or boring = in section grid with"X" c"'� location,showing property ❑ Env.Bore Hole ❑Other _�� ft. �below ❑above land surface N lines,roa ,and buildir}gq� CASING TYPE(S) K Steel ❑Piastic ❑Tile ❑Other i W -- - - — - -- -- — E WELLHEAD COMPLETION �� � � � � � � Outside: ❑Well House Inside: ❑Basement Offset �' � -�-- -�-- -i— -'�-- ;. Y�m�� ❑ PitessAdapter/Unit �Well Pit --- -�-- -i-- --�— I ►1 S ' � - _l� ���� ❑Well Pit ❑Buried �� o �rmne� ' � ;: �U� ❑Buried � PROPERTY OWNER'S NAME/COMPANY NAME CASING(S) Diameter �� Depth � � Set in oversize hole? Annular space initiall;�grouted? ��� Property owner s mailing address it di er t an well location address indicated above Z�� � in.from � to ft. ❑Yes �lo ❑Yes ❑ No ❑ Unknown I8340 Minnetot�ka B1�/� in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown �' Wayzata, MN 55391 in.fram to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown ,�� WELLOWNER'S NAME/COMPANY NAME SCREEN/OPEN HOLE � f �r. Well owner�s mailing address if diNereM than property owner's address indicated above Screen from .to ft. Open Hole from�t0 2 �ft. OBSTRUCTIONS �Rods/Drop Pipe ❑ Check Valve(s) ❑ Debris ❑ Fill ❑ No Obstruction Type of Obstructions(Describe) �NN�� �T/�L ¢- f�U�y7�-� GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? 0S ❑ NO D2sCfibO FORMATION PUMP = If not known,indicate estimated forma�ion log from nearby well or boring � � Type ��� �/el�� � f`''' � � [�?emoved ❑ Not Present ❑Other �. r:r . �� ) -�r�1-- .r:+J . �:r J(�i� 7 METHOD USED TO SEAL ANNULAR SPACE BETWEISN 2 CASINGS,OR CASING AND BORE HOLE: �Ivo Annular Space Exisis ❑ Annular space grouted with tremie pipe ❑ Casing Pertoration/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 ben�nite=50 Ibs.) Grouting Material NLlY r �'L���r�L�'"{�pm�to�J�t. yards � v ags from to ft. yards bags irom 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 �lo 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 Drilling Ca. , inc. 27172 Contractor Business Name License or Registration No. � ��/////� '_�...rf _J � �'" ����� h �e sentative Signa�i Date LOCAL COPY H �` "_ }.���.�..4�1^� 2 O 3 3 3� Name of Person Sealing Well or Boring � �.- WELL�OCA110� MINNESOTA DEPARTMENT OF HEALTH M/NNESOTA UNIQUE WELL NO. coU�tY Name WELL AND BORING RECORD�-�• • � �g O O O Hennepin Minqesota Statutes Chapter 1031 Township Name Township No. Range No. Section No. Fraction � -�.�WELL DEPTH(completed) Date Work Completed Orono 118 23 Zb ,, ,, ,, , 275 " 7-18-03 GPS �� DRILLING METHOD LOCATION: Latitude degrees minutes seconds _ - .. CaCleTool �.•� �,s ,{ Qnven � � I,J���Dug� Longitude degrees minutes __ seconds __ - T+�- �� .,-;- � - ��Auger � �iota�y ]Jettetl House Number,Street Name,City,and Zip Code of Well Location or Fire Number 3w,�r-" . , � 1 1 G) Sp r i ng Hi I l RU� �O�Ci n ��3�:} �FLUID )NELL HYDROFRACTURED? ,��Yes No Shop exact location of well in section grid with"X". � � � .Sketch map�of well IOca�ion �. �''�`'..^r � � � � � � r . FROM � ft.�TO_ ft. � �� Showing properry lines. � " -- �� --- � . . N . - � . . ,..� roads.and bu�ldings U r >�. � � .- � � r � .� � � � �'� � � Monrtonng ... �Heatina�Cooling��� � �. -'-- --.---t `--. ' �'.. ::`' ., ; � '� r�[3omestic:. . ':� i�Environ Bare Hole I��4ndustry>Cofimercwi- .�� ' � �?Nonc.ommunRy,F�S' � i[�igation � �Femedi� � � - -- -- �`�� � � , ' �'Comrrlunity PWS _,DeHateri g•-,�: " i -_„ _�_- — ,. ,. ' - . - .. . � .CA�{IVG. _ . � . � -HOL��IAM W . .E T . .. . - � bnve Shoe� �Yes ' ..,.,ge �; � ,_ _-- -- -�-� � t � � tiued e - �' i "siio- >�J. , , .. i � `� r y, i l ,,,_ Ste Threatled : . �_ � '/fzMiYe � ._ S \i : . ...---'- - - --��_. 1 . - -�:i3�{,j. � "`.CASING-DIAMETER.,.� � �-� -�W�IGHT .�.. . � =.- .. . � � � � - `"�' �� ��'* ft. 11 IbsJft. in.to .7lJft. S` ', : '" � . �-----�in.to , � ,. . f _ .--.�-1 Mite�—�-{ . . . . / �� . .. �-- ey )- ; ' -. ��I '�. .�� in.to ft. ------.-----Ibs./ft. _4_. in.toG 3Yft. _ _-" �:PRO�ER7YOWNER'$.NAMElCDMPANYNAME in.to ft. Ibs./ft. __/1.4T.toL�7�ft. �� ::.�.�elman SCREEN OPEN HOLE �.�-roperty owners mailing address if different than well locatior addre;s indicated above. Make FROM �+�'* ft. TO Z 7 5 ft. '�._..��-J'tn �S'"{��1netOnka �lnd Type —_.__Diam.— __ _.. - ? , '��Rnetonka, �N 55391 SIoUGauze _____ Length __ Set between_ ft.and it. FITTINGS �.�„''; . STATIC WATER LEVEL - - � 10� _ft�_i below ��above land surface Date measured__.7�8-03 * . �W�LL�OV��` RS N7�ME;COMPANY NAME PUMPING LEVEL(below land surface) �` � ' 2 3`} ft.after _3 .hrs.pumping__�_Q_ g.p.m. " ��- �"` �.��,,, � ' � �WELL HEAD COMPLETION � � 1 �' �.��Well.pvineT's maiUhg,addrESs if dilfAtent,�han>property ov�ners addcgs§indicated above. -. � '�pitless adapter manufacturer�..�-1` �.�t�'_''��.�T rl.�'Model . � �,� � � 'Casing Protection_ �12 in.above grade ,;� - ! 'At-grade(Environmental Wells and Boring ONLY) - i: � , - .�;;` �� � GROUTING INFORMATION � � - � - � "� ` Well grouted -�-�Yes ��"No . _.,��.,, '� �.�� �y ,` ,��_i '��. . .;'�. � � Grout matenal __. eat ce nt ��;Bentonite ,�Concrete iJ High Solids Bentonite ,-::_�- . .:N me � -:. .� ' �' � .�=, ..' - q �, . .. .: . ;� ,. .-.''. . `:. from- }Q to _.70 ft. --3— r-�Yds. =��bags c+� , .�,_ . ., ... ,.. w ;. . _:' ,. ���� .. , _., Y t: _- . . ; � " .._, . from 3L_ to Z 3�f__..ft. n8 ur8l�_��1��ags z �, .. ... _ -�. :, . .. ,, . " HARDNEgS dF ; ... � .�. QEO�OGICA��MAFERIALS�-� = �.�COLOR ���; .:� F.RQM--. Tp . .���� from to_. __.ft. i I yds �=_j bags . ;. �. . . ..,...�. . _.- . ..MA7ER(AL ��.. . a, . . „ � , . '� �NEAR.�SY KNOWN SOURCE OF CONTAMINATION _. . r :. . . „__ _., � , . . . -_ ;, . ` : � �. :' ,. '"' teet � ti..- direct' J_ . f� �; :. �� � C�3� ``'�" tsi�� ��' —, . ` r- ) wn _ _ e ����. Well dismfected upon campletion,- ,'-_,'��Yes .=�,No } t PUMP C18�:�, � '^�"'.j ���0. ' ;�� .. 4 �in.:� .�� -:� � .. �I � i\� .. 1. � Not installgd Date in3t2lled �' � CLA���'��'�� ' ;l#"':'ttj a'��.L�:.T! ;�. 1�� " '��'�� Manutactuier'snema t �� . .�,.a..� ; �... ., . ... . : ,Modaln - ,��. ., . .., : . , . _ 1.-L , ,.-- -�. [ :. . :;.� �. � umber__ ;.� •.' ..-� �^ ��� HP ' ���--.. Volts_. ..� ^.- �J �. � limeste�ne �"ziT�. i,�7��- : `��� �7� Eengthofdroppipe� '� .� _fit; Capaciry g.p.m. � '.: .... . � �-.�. �,. � . :'. . '.. ;ype y'1 Submersibfe��.`�l LS_Yurbine ��Reciprocating � ,Jef-�^ �. ��. . � . ,. .._ . �.. , �,. -. .,�. :.. '. `�:.�ABANDONEd'WELLS �� .� ..- ��� .. � �. �. � �_ ,� ' ".Dpes.property.have any not In use artd nOt sealgd WeA(s)._ ' Yes'.<�No . � � � � ����,�.VARtANCE, . . , .. . .., ,: . , , .,..� ,_�: - � � ` � � �� � �� ���� �� Was a varl2nce grante�i from the.MDH for ttiis v�ll? � Yes No TN#_.? � �^� ��. . ^- :;,, . ��� . �:`�:. `� . ..- �-- � . ,� . ��.�'WELL CONTRACTOR CF.RTIFICAT.ION ���� � `�-..:. � -- i•.:. "� � � � � � � -� ��This weJl.was dnNed under my:supeiv�,sion�and in accordance with Minnesota Rulss,Chapfer 4725. -' � "'" ' . � � �, � - - � �"-Fhe mformation contained m lhis report is lrue to the kest o(my knowledge. ��� - -- .�a.� - . � ... . . . . . � . . . . ;„;� '� � � Use a second sheet,if needed � � � �� � � . � ,, ���� REMARKS,ELEVATION,SOURCEOFDATA,eta ��j'1 �tQdOi�j Well Dri11.i�Co�. .�.si�_�___2_Z 72 �' --- �.,. � Licensee Business Name _ Lic. r Reg.No. �' _/ ,, -,- . . - � � --- ------..__ ._. ._____�_ _ .. _ .- -- -. ut ¢e epresentative Signature` Date Chuck Moeoee 7-18-03 - — --- --__ - -- - - --- -__ -- - � LOCAL COPY ? � Name olDriller oate , �� `'< °� � �0 HE-01205-OB(Rev.5/02) -A IC 140-0020 � � � - � �rw�,�. c�-y w�-� c � � , r�,� 617 13th Ave So • Hopkins, Minnesota 55343 • (612) 935 - 3556 07/23/2003 Stodola Well Drilling 3841 North Main St. Bonifacius MN 55375 938-21 1 1 REPORT OF WATER ANALYSIS Lab #: 649 Our Laboraiory reports these analytical results, determined on a sample taken by CLIENT on 07/21/2003 from ihe following location: 1125 Spring Hill Rd. Orono,Mn Unique Well#689000 Coliform Bacceria <1/100 ml Nitrates Nitrogen <1.0 mg/I The results of rhese tests indicare rhat this well is producing water ihat meets the standards for F.H.A., V.A., or conventional loans. This report is an analysis for coliform and nicrate only and does noc include analysis of Lead and other coniaminanrs. (Unless as speci�ed by clienc). � T " City Water Clinic, Inc. Bil �A ale Lab Certification#027-053-I 19