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Home My WebLink Aboutwell info � i �� MINNESOTA UNIQUE WELL WELUBORING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. - :: CountyName WELL AND BORING RECORD 7 3 ��5� Hi.yMA@}�3A Minnesota Statutes,Chapter 1031 Township Name Township No. Range No. Section No. Fraction WELL/BORING DEPTH(completed) DATE WORK COMPLETED 4r.ono 117 23 7 �,, �,, �,, 262 � 6_23-U6 GPS � DRILLING METHOD LOCATION: Latitude degrees minutes___ seconds Longitude degrees_, minutes seconds � !Cable Tool f �Driven I I Dug - '�. !Auger �otary I I Jetted House Number,Street Name,City,and Zip Code of Well Location or Fire Number � 1305 S'�r�Qe Place Orono DRILLING � � � � � � FLUID �WELL HVDROFRACTURED? �..I Yes o Show exact location of well/boring in section grid with"X." Sketch map of well location. l✓BntOA�t.e From ft.To ft. 55364 Showing property lines, N � "� roads,buildings, USE � omestic �.i Monitoring I�!Heating/Cooling e and direction. � �.Noncommunity PWS I�I Environ.Bore Hole I.'�.Industry/Commercial �' -� ' �--`�� ---�-- j 'i Community PWS ❑Irrigation I.1 Remedial ❑Elevator I 1 Dewatering ❑ - -' � �' � � CASING MATERIAL Drive Shoe? ❑Yes o HOLE DIAM. I ; I W ; ; ; , E T __ � Threaded I.l Welded --�--- --'-----�----'-- � t. �lastlic � �:. , � ; � ,/z Mile � ' � ' r � CASWG � --:--- --�--- ----- ------ 1 �., ._._ Diameter Weight Specifications � , S � , �1 Mile� '7 in.to 455 ft.��01 Ibs./ft. V in.to.av ft. e ♦ _in.to ft. IbsJft. _ �in.ta��ft. PROPERTY OWNER'S NAME/COMPANY NAME in.to ft. Ibs./ft. in.to ft. Cla tonnFuch� � SCREEN 1/@$ OPEN HOLE Property owner's mailing address if different than well location address indicated abo e. Make�Q��Q� From _ ff. o�___ ft. NOType �_�.6�� Diam.____ p` -__ Sa�� a8 A��e � � � 2006 Slot/Gauze 'QI Q____ Length _V� _ ��v Set between�ft.and� fl. FITTINGS�_ ° OF O�O�O STATI��ATERLEVEL ________f�elow . .Above land surface Date measured �$�.m@ { � PUMPING LEVEL(below land sur(ace) - �� : -� WEWBORING OWNER'S NAME/COMPANY NAME ZS3 ft,after Z hrs.pumping 5� a,ir , � � '�^.� �� .::__„. .. ..o-:.,,. _�- .;"'. - _ .. -. WELL HEAD COMPLETION � ��{y� '��-^_ �— �--� . 9Pm a Well/boring owner's mamng aaa�ess i �inerent[han�NwN.,,�y.,.. _.�audress indicated above. �Pitless Adapter Manufacturer v-�h-+�J"i-i-+�-3'"� . -- � ---- - I �.Casing Protection r'�42 in.above grade I �.At-grade(Environmental Well and Boring ONLY) GROUTING INFORMATION - - � Well grouted? �Yes . No Grout materials �_�.Neat cement.�,�entonite Concrete `.�ther__, �` From� To��('[��R �f�,�._�1�Yda �[�Bags From__t T�:7J ft. ��r�rl'11 �..1'�s��i�Bags GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO From To__ ft. _�.Yds. . '�.Bags MATERIAL NEAREST KNOWN SOURCE OF CONTAMINATION . ^ "�r„� s" .. .} G"2.d� yelZov �rt~ � �� `�;..''C�' feet � direction' -,:✓'..' ,,�,'�s�..-�a`a"-'[ype . Well disinfected upon completion?�Yes C No "`� ` C�.i�� graY S � 22 70 PUMP J � �Not installed Date installed� tJ ["�`•} � �`� saad yray S 70 $� Manufacturer'sname_ '�J��.�v� ��"'_. C13y gray S $3 �� ModelNumber HP ��vons ::- � ` Length of drop pipe �� ft. Capaciry g.p.m. ��11�' Si�Yld brown �,5, 'ZO �O Type:l ubmersible I 1LS.Turbine �..1Reciprocating L.'Jet I�7 ABANDONED WELLS r' G Does property have any not in use and not sealed well(s)?�Yes f I No � C�$r�e $a11d yray .S �0 VZ VARIANCE �� Was a variance granted from the MDH for this well? �.J Yes�No TN#__._,_ •'' _,___ ,� WELL CONTRACTOR CERTIFICATION . This well was drilled under my supervision and in accordance with Minnesota Rules,Ghapter 4725. The information contained in this report is true to the best of my knowledge. j��, / .�� Use a second sheet,il needed. � =. REMARKS,ELEVATION,SOURCE OF DATA,etc. arv21 Sta►uOia, �Qll Dri iI f_Q�. CO�� , � ---. —_._ —._— . ._. . Licensee Business Name � Lic.or Reg.No. ` ;��;1� �G� o d epresentative Signa e Date a Chuck M r_ LOGAL Ct.�NY 7 3 915 4 Name of Driller �grG — HE-01205-09(Rev.9/O5) � IC 140-0020 � � / ' �VI � / / � i �' v�/• rw� c�-y w 617 13th Ave So Hopkins, Minnesota 55343 � (612) 935 - 3556 06/28/2006 Stodola Well Drifling 3841 North Main St. Bonifacius MN 55375 938-21 1 1 REPORT OF WATER ANALYSIS Lab #: 3906N Our Laboratory reporis rhese analytical resulrs, determined on a sample taken by CLIENT on 06/26/2006 from rhe following location: Clayton Fuchs 1305 Spring Place Orono,Mn Well#739154 Coliform Bacteria <1/1 DO m! Nitrares Nitrogen <1.0 mg/1 The resulis of these tesrs indicare that this wel! is producing warer that meets the standards for F.H.A., V.A., or conventiona! loans. This report is an analysis for coli form and nitraie only and does not include analysis of Lead and other conraminants. (Unless as specified by client). ,T ," City Water Clinic, fnc. �..��,� . �\\ \ � BiN.; � sdale � �.nn r.en;r�oari�n u oz�-os3-�t� WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring I„I County Name WELL AND BORING SEALING RECORD MinnlesoNa Unique Well No. Minnesota Stafutes,Chapter1031 or W-series No. c�� Township Na•e Township No. Range No. Section No. Fraction(sm->Ig) Date Sealed Date Well or Boring Constructed OCt�lO 117 2� "7 �,. ��. � ��/ GPS Latdude degrees minutes seconds � ,,. LOCATION: �epih Before Sealing �� ft. Original Depth ft. Longitude degrees minutes seconds p UIFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Locatlon ingle Aqu'rfer ❑Mutbaqu'rfer 13ET5 Spruce Place, (lco�o 55364 �� ORING Measured ❑Estimated �� Water Supply Well ❑MonR.Well � Show exact location ot well or boring Sketch map of well nng in section grid with"X" location,showing perty ❑Ern.Bore Hole ❑Other �ft. �below ❑above land suAace N � lines, CASING TYPE(S) - - - - - -- -- �S[eel ❑Plastic ❑Tile ❑Other W -�- -i-- -i-- --i-- E � � WELLHEADCOMPLEf10N Ou[side: ❑Well House inside: ❑Basement Offset --�- ---- -;-- --i- � 1�� Pitless AdapterNnit ❑Well Pit -`- -�-- -�-- --�-- I 1 ❑Well Pit ❑Buried S �'--�'"+°-� . . ❑Buried ,.. : .�.a..h'.� :?,K_9`. PROPERN OWNER'S NAME/COMPANY NA E CASING(S) _ � �� Diameter � Depth 1 Set in oversize hole? Annular space initially grouted? Property ner s mailing address it different than well location address indicated above Z �� /� / in.fromS.` to ��O ft. ❑Yes, �Jo �11YAf ❑No ❑Unknown �UUV in.f�om to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown in.from to ft. s �� '�� ❑f�' ' ❑No ❑Yes ❑No ❑Unknown WELL OWNER'S NAME/COMPANY NAME SCREEN/OPEN HOLE/ � ( Well owner's mailing address if different than property owners adtlress indicated above $CfCCfI ffORl �"� t0 ��ft. Open Hole from t0 ft. 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 If not knqwn,indicate estimated formation log from nearby well or boring PUMP • � Type "� O Removed �Not Present ❑Other Y METHOD USED TO SEAL ANNUWR 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 RE�i fv�� ❑ Other GROUTING MATERIAL(S) (One bag of cement=94 Ibs.,one bag of bentonite=50 Ibs.) ,/ ) / � /[.,,Y"!Y� ,�'-.�`?'";,t%� U ' ' 9 Grouting Material - rom to ft. yards ba s C i TY O U f�'�I V � from to ft. yards bags from to ft. yards bags OTHER WELLS AND BORINGS REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING p�ryer 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 knowleck�e. lkm Stod�nl� �Iel I Dril lin�;, Co,. Tnc. 27172 Contractor Business a�� - �� License or Registration No. _ .,-�'" .� ._./ �'' �� A 'ed ta6x4 i ature / Date LC3CAL COPV H �� .�,3 �b'- r� Q� _,,, �"� ��}._�,,,� .JL Name ol Person Sealing Well or Boring !