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Home My WebLink Aboutwell info . 4 . ., , WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIOUE WELL NO. � : County Name — WELL AND BORING RECORD 6 7 3 8 6 0 - Aen[lepil2 Minnesota Statutes Chapter 103! Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed � n Orono 117 23 04 ,. ,. ,. 140 I-8-OZ House Number,Stree[Name,City,and Zip Code ot Well Location or Fire Number DRILLING METHOD C Cable Tool 17 riven ❑ Dug 395 Sussea Lane, ��n� 55356 ❑ Auger , Rotary ❑ Jetted Show exact location of well in section grid with"X"�� Sketch map of well location. ❑ _.._____ .__._______._..____.—.. _— Showing property lines, ,_._ rpa s and 6uildings. DRILLWG FLUID WELL HYDROFRACTURED? !,YES O N water i 1 _i i i i_ �. � � FROM r R.to ft. i _i_ _i_ _i ,�e, USE ❑ Monitoring ❑ Heating/Cooling i i i i _�l" �Domestic ❑ Communi PWS _i_ _�_ _�_ _i_ ❑ Irrigation h' ❑ Industry/Commercial i i i i e ❑ Noncommunity PWS ❑ Remedial w e ❑ Environ.Bore Hole i � i i ❑ Dewatering � i � T r '/2Mie � �� a � X F -�{�Q CASING Drive Shoe? ❑ Yes No HOLE DIAM. - - i �,. --- - , i i i ❑ Steel ❑ Th�eaded ❑ Welded i- - �- -i - -, �/ ,t+5 Plastic ❑ s �1 Mile� CASINC�DIAMETER�� VEIC�II � �� PROPERTY OWNER'S NAME �; in.to ft. L��t'� Ibs./ft. in. o/��('�fl. T�� Siden liQ� a� ------in.to----ft. _ _IbsJR �in.�'.`_ft. Property owner's mailing address if different Ihan well location address indicated above. _. __in.[o___ ft. _ _Ibs./ft. in.to ft. 410� Berkst►ire Laae SCREEN`�..L,��e;,� OPENHOLE 7f1 1� IIii T1�7�QutII� MN 5544b Make S«�e� from �_fLto _ft. Type _ � _ .__Diam. SIoVGauze •� Length�-� ♦ � Set between��, tt.and_ 14� tt. FITTINGS:_ 7~X�n~ V�� STATIC�W/A�TER LEVEL `� WELLOWNER'SNAME . ___TSl______—_—ft.�6 below ❑ abovelandsurtace Datemeasured i!$�� PUMPINC�.��(below land surface) •f y C 4 6) Well owner's mailing address if different than property owner's address indicated above. _ ft. after hrs.pumping g.p.m. WELL HEAD COMPLETION }�j �{Pitless adapter manufacturer�±�1 C��a t e� Model _ _ ❑ Casing Protection__ ,___ ______� 12 in.above grade ❑ At-grade(Environmental Wells and Borings ONLY) " GROUTING INFORMATION Well grouted? �Yes ❑ No GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO Grout�vtateria� C7 Neat cement �� eernonite ❑ Concrete �High Solids Bentonite MATERIAL �to _�. _ 2.5❑ yds.j�bags from_ fill ro�n $Q�t Q f� from__�__to_�_�[ ��}t+� �'fd�i] bags from__._____to._____ft. ❑ yds. ❑ bags £18y r�NII H!@t�itltt! (� 60 Nenr�sr��ewwsouace oF co/prn/nyNgy� � f�--("' �� feet �f/�/� direction f type Well disinfected upon completion? Rf^Yes ❑ No �� f�) G.. � sand rown soft 60 90 pUMP C�ay rev 9drt 40 �20 ❑ Notinstalled Dateinstalled ��'6!'�oG � �' Manutacturer's name A�� i -- �—�----1 @ -----—- '2 Model number_.__ __ HP +a l Volts �+0 sand ray soft i20 140 ��--" - Length of drop pipe.______.____ __ tt. Capaciry ..__ __g.p.m. Type: A� Submersible ❑ LS.Turbine ❑ Reciprocating ❑ Jet ❑ _______ 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 p No TN#_ 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,etc. The information contained in this report is true to the best of my knowledge. Don Stodol8 Well Drilling Co. , Inc. 27 72 Lice e Busines ame � „'� �6.or Reg.No. -`" 3-2b�-�2 - Authorized Represe ive Signature Date Chuck Moore 1-8-02 ----__-- __ Name ol Driller � Date LOCAL C(7PY 6 7 3�6 0 HE-01205-07(Rev.2/99) IC#140-0020 L • - h rw� c�y w�� c � � , r�,�. 617 13th Ave So • Hopkins, Minnesota 55343 • (612) 935 - 3556 01/ll/2002 Stodola Well Drilling 3841 Nor[h Main St. Boni facius MN 55375 938-21 1 1 REPORT OF WATER ANALYSIS Lab#: 27 Our Laboratory reporrs these analytical results, determined on a sample taken by CLIENT on 01/09/2002 from ihe following locaiion: Tony Eiden 395 Sussex Lane Orono,Mn Unique Well#673860 Coliform Bacreria <1/100 ml Nirrates Nitrogen <1.0 mg/I The results of these tesis indicate t-hat this well is producing water thar meers the standards for F.H.A., V.A., or conventional loans. This repori is an analysis for coliform and nitrate only and does not include analysis of Lead and other coniaminants. (Unless as specified by clieni). T ' �ity Water Clinic, Inc. , � Bill dale Lab Certification N 027-053-119