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Home My WebLink Aboutwell info * � � MINNESOTA UNIQUE WELL WELUBORING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. County Name WELL AND BORING RECORD 7 4 3 4 2 5 � �� n Minnesota Statutes,Chapter f031 Township Name Township No. Range No. Section No. Fraction WELUBORING DEPTH(completed) DATE WORK COMPLETED Orano I� I18 23 32 �� < ��. 20Q � I1-2-06 GPS DRILLING METHOD LOCATION: Latitude degrees minutes seconds . � '.Cable Tool � 'Driven I I Dug Longitude degrees minutes seconds �:Auger �otary I ��.Jetted House Number,Street Name,City,and Zip Code of Well Location or Fire Number � -------- ----- 355 Stubbs Bs d N Ora�o 55356 DRILLI1NG,.F,�LUID.�j WELL HYDROFRACTURED? I I Yes o Show exact location of well/boring in section grid with"X." Sket map of well location. �;l�Di�t� __ � owing property lines, From ft.To ft. N roads,buildings, USE .Domes�ic �..,Monitoring I I Heating/Cooling and direction. � :Noncommunity PWS _;Environ.Bore Hole I I Industry/Commercial -"'""" ""`- --`-- ---`- --.Community PWS �.�_Irrigation ❑Remedial � .Elevator ':Dewatering ❑ '� --'----"--� -"�-"--""'"- CASING MATERIAL Drive Shoe? I_I Yes No HOLE DIAM. � ' W � ; ; � E T � "Threaded '�. I Welded ,, , , �teel '� � � � � I � --�--'-"'-- --�----'- lastic ;. : , � � '/z Mile ; I i I i I CASING : --�-----'-- --^-- '--r- � 1 Diameter Weight Specifications S R [� t/�q p �}/�} F�—t Mile� �Y� �"^ ,� _ ,., t��'� �) � � 'T in.to l7G ft. �� Ibs./ft. �u�� C� in.to _7Vft. �{yV-��-� �`' _in.to ft. IbsJft. ___ �in.to��ft. - PROPERTY OWNER'S NAME/COMPANY NAME - in.to____ ft. Ibs./ft. _ in.to ft. �'�"� �� SCREEN�j�$� OPEN HOLE Property owner's mailing address if�,,,erent�..,..�aei�,.,�ation address indicated above. Make��Qt�i_ From___ _ft.To ft. Type .__.. _ Diam. ___ )t .. ^ � Slot/Gauze •� 0 Length � �"� Set between��ft.and ft. FITTINGS��_ � STATIC WATER LEVEL �f�� .. 1�3__ ft.�Below Above land surface Date measu��1V PUMPING LEVEL(below land surface) q WELL/BORING OWNER'S NAME/COMPANY NAME __��1_ ,ft.after Z hrs.pumping„____„L� g.p.m. � WELL HEAD COMPLETION ��aCeC � Well/boring owner's mailing address if different than property owner's address indicated above. pitless Adapter Manufadurer _ �M del____ _ , I�.Casing Protection _____________ yY12 in.above grade I.I qt-grade(Environmental Well and Boring ONLY) GROUTING INFORMATION�( Well grouted? /`Yes �. .No Grou�materials . Neat cemenj/A�Bentonite ' I Concrete I '��+�Other � From �1 To� ft. J � :Yds. ..Y�'Bags � From_�To_��ft. ��s� C:Bags ` GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO From To ft. ❑Yds. ❑Bags MATERIAL NEAREST KNOWN SOURCE OF CONTAMINATION � 7� �.s _.y , Y�, �� . �� feet . directian ��i"��type Well disinfected upon completion? J Yes f�..l No y� PUMP * `�t� �' �� .J Not installed Date installed i�l� �� t �e � Manufacturer's name ��t�r y CJ Model Number HP Volts �� I br�4�'i �f t 'i Length of drop pipe �`t� ft. Capacity__ g.p.m. Type;�Submersible =]LS.Turbine �l Reciprocating I i Je[ L; ABANDONED WELLS � � Does property have any not in use and not sealed well(s)? I J 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,i/needed. aN(i Stodala We12 Drilling co�� 1�a ib� REMARKS,ELEVATION,SOURCE OF DATA,eta ' -t� _.-__... - — �� - --.._. . _----- .. Licensee Business Nam Lic.or Reg.No. I L"C7"llC7 Au iz resentative Signa ure Date �k M�ore LOCAL COPY �� /� � � Name of Driller `'� � HE-01205-09(Rev.9/O5) IC 140-0020 i � �_ 'r � Tw i�vv C%t� litl a�"�' C ' ' , I v��,c� y 617 13th Ave So � Hopkins, Minnesota 55343 � (612) 935 - 3556 11/06/2006 Stodola Well Drilling 3841 North Main Sr. Bonifacius MN 55375 938-21 1 1 REPORT OF WATER ANALYSIS Lab #: 727BN Our Laboratory reports these analytica/results, derermined on a sample taken by CLIENT on 1 1/02/2006 from the following location: S•iv,,bb:; 355 S�ebd�s Bay Rd. N Orono,Mn Well#743425 Coli form Bacteria <1/100 ml Nitrates Nitrogen <1.0 mg/1 The results of these tests indicate t��at this we/l is producing water that meers the standards for F.H.A., V.A., or conventional loans. This report is an analysis for coliform and nirrare only and does nor include analysis of Lead and other contaminants. (Unless as specified by client). �t!kn Ci Water Clinic, Inc. 1��,��;ti\,.` .�\ B%�l 1�G�1� L7�2 .; Lab Cert�cation#027-053-119 MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring �C�Q O /t WELL OR BORING LOCATION WELL AND BORING SEALING RECORD Mennleso a�Unique Well No. H `� "� �� County N e � Minnesota Statutes, Chapter 103L or W-series No. in ,�ea�a b�a�k�,�o,k„aw�, Township Name Township No. Range No. Section No. Fraction(sm.�Ig.) Date Sealed Date Well or Boring Constructed corio I18 23 32 '' '' '' Latitude degrees minutes seconds De th Before Sealin � ' '� GPS P g—/ / ft. Originai Depth ft. LOCATION: Longitude degrees minutes ._ seconds �UIFER(S) STATIC WATER LEVEL - Numerical Street Address or Fire Number and City of Well or Boring Location Single Aquifer �._,'�Multiaquifer - ."',� WELUBORING Measured ❑Estimated Date Measured � �� Water-Supply Well �]Monit Well r Show exact location ot wel boring map o well or oring �� in section grid with"X" loca on,showing prop rty �J Env.Bore Hole � 'Other I_S�ft.�below ❑above land surface N line r and buildi gs� �ASINGTYPE(S) � --'-----'-----`----'— ��`.=� '�,� Steel ❑Plastic ❑Tile ❑Other ��: --'--- --�------`----'-- WELLHEAD COMPLETION � : W _ �_ _; __ � _ _r E T •� utside __ ell House ,_ t Grade Inside. asement Offset I O : [�W ir�A ❑B :' , , , , Miie dless A p dUnd ��guried ❑Well Pit - 'h ;, , . , , � � �P' da te ' , •. --�--- --�----�----�- - ❑Buried ' S ' ❑Well Pit ❑Other r 1 Mile� �� U Other i p�•nPERTY O�NNFr,,•nin••—,• - •,• .,•..••_ CASING(S) Y'��.,,'��,'�e - � � _ � Dia �� Depth � Set in oversize hole? Annular space initially grouted? Y'. �q /� j Pro�e�[y dwnei.,�A2i �� ss if different than well location address indicated above �in.from (/ to /2/_ft ❑Yes �o ❑Yes �]No U Unknown i ' in.from to ft. �_]Yes ❑No ��]Yes ❑No ❑Unknown in.from__ ro ft. U Yes ❑No ❑Yes ❑No ❑Unknown WELL OWNER'S NAME/COMPANY NAME SCREEN/OPEN HOLE t � Well owner's mailing address if different than properry owrzr's address indicated above SCreen from��,_to��• ft. Open Hole from to 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 ❑fvo Describe FORMATION PUMP If not known,indicate estimated formation log from nearby well or boring. � Type �—ti-' � �_1 Removed �Not Present ❑Other_ ____ ___ s � � � METHOD USEDTO 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 ft. ❑Perforated ❑Removed Type of Perforator ❑Other GROUTING MATERIAL(S) (One bag of cement=94�bs.,one bag of bjntonite=50 Ibs.) Grouting MaterialN!G/�f��//�/�// 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? r'��Yes �� No How many? LICENSED OR REGISTERED CONTRACTOR CERTIFICATION This well or boring was sealed in accordance with Minnesota Rules,Chapter 4725.The iniormation contained in this report is true to the best of my knowledge. ��toclola t�Z1�ri11in�Co.� In�.--�.b�l -- Contractor Bus ss ame License or Registration No. ��..�__ J- /:>=� r:�:�? -:��:r � Certified Representative Signature Certified Re�o. Date : ' \` j � �,�. , K Y"�,—?r„�,, i LOCAL COPY � 2 5 4 9 0� Name of Person Sealing Well or Boring HE-01434-09 IC#140-0423 � 6/osa