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Home My WebLink Aboutwell info WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring ■ Sealing No. 2181 County Name WELL AND BORING SEALING RECORD Minnesota Unique Well No. Hermepin Minnesota Statutes,Chapter 1031 or W-series No. (Leave blank if not known) Township Name Township No, Range No. Section No. Fraction(sm->Ig) Date Sealed Date Well or Boring Const ru ed Orono 117 23 6 /& ) , 0 GPS Latitude degrees minutes seconds f Q Oil LOCATION: Depth Before Sealing ` ft. Original Depth ft. Longitude degrees minutes seconds UIFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location L.Kingle Aquifer ❑Multiaquifer ]( 473 Tonkawa Rd, Orow 55356 EL BORING Xleasumd ❑ Estimated ater Supply Well E]Monit.Well / Show exact location of well or boring Sketch map of well orb ring in section grid with"X" location,showing prope ty ❑ Env.Bore Hole ❑Other ft. below ❑above land surface N lines,roads,and buildin s. CASING TYPE(S) i ' 4 r Steel E]Plastic ❑Tile ❑Other W E ,� n WELLHEAD COMPLETION I Outside: ❑Well House Inside: E] Basement Offset �Pitless Adapter/Unit ❑Well Pit ` ❑Well Pit ❑Buried S /1 -rmde ' ❑ Buried PROPERTY OWNER'S NAME/COMPANY NAME CASING(S) Dia t r Depth j Set in oversize hole? Annular space initially grouted? Property owner's mailing address if different than well location address indicated above ! //�'� t in.from to /�2 ft. E]Yes o L]Yes ❑No E]Unknown in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown in.from t0 ft. ❑Yes ❑ No ❑Yes ❑No ❑Unknown WELL OWNER'S NAME/COMPANY NAME SCREEN/OPEN HOLE / l Well owner's mailing address if different than property owner's address indicated above Screen from/42 toft. 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? E]Yes E] No Describe FORMATION If not known,indicate estimated formation log from nearby well or boring PUMP Type ❑ Removed )<Not Present El Other HOD USED TO 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) (Onn}e'bag goofcement=94 lbs.,one //bag �ooff berr jonite=50 Ibs.) Grouting Material L`�� r+z�� ^">,frnm to . yards bags from to ftyards 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 Vo 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 Co., Inc. 27172 Contractor Busines,Name License or Registration No. uth r e Representative Signature Date LOCAL COPY h 218151 Name of Person Sealing Well or 6 frig WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. County Name WELL AND BORING RECORDRefaidAn Minnesota Statutes,Chapter 1031 705902 Township Name 7`117 hip No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed Orono 2 06 � 170 12-18-03 GPS DRILLING METHOD LOCATION: Latitude degrees minutes seconds Longitude degrees minutes seconds ❑Cable Tool F]Auger Jetted oX rtary iven ❑Dug ❑ House Number,Street Name,City,and Zip Code of Well Location or Fire Number 1:1 473 Tonkm a Rd 553% DRILLING FLUID WELL HYDROFRACTURED? ❑Yes o Show exact location of well in section grid with"X". �}, Sketch map of we location. sled' FROM ft.TO ft. 0 Showing pro rty lines, N roads an bulbs USE ❑Monitoring ❑Heating/Cooling Domestic ❑Environ.Bore Hole ❑Industry/Commercial Noncommunity PWS ❑Irrigation ❑Remedial ❑Community PWS ❑Dewatering ❑ --i-----r----`-----`-- OLE CASING DIAM W e T Drive Shoe? ❑Yes o I ❑Steel ❑Threaded ❑ Ided _ 'h Mlle 1 Plastic ❑ ` CASIN DIAMETER WEIGHT '�(� F--t Mile--i J\ 4 in.to 163 ft. 2.M lbs./ft. 8 in.to Oft. _ fff n.to ft. lbs./ft. in.to 1•0 PROPERTY OWNER'S NAME/COMPANY NAME in.to ft. lbs./ft. in.to ft. Dmm Fritz SCREEN OPEN HOLE Property owner's mailing address if different than well location address indicated above. Make B1~ FROM ft. TO _ft. Type PC Diam. Slot/Gauze 0w Length 71 Set between ft.and ft. FITTINGS _ STATICWATE L EL i � imft. elow ❑above land surface Date measured 12-18-03 WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(bel6w land surface) Is 160 ft.after Z hrs.pumping 1S g.p.m. WELL HEAD COMPLETION �,y, Well owner's mailing address if different than property owners address indicated above. itless adapter manufacturer lfttMtef Model Casing Protection [K2 in.above grade ❑At-grade(Environmental Wells and Boring ONLY) GROUTING INFORMATION��rrrr Well grouted s F1No Grout material Neat cement [-]Bentonite LlConcrete Fligh Solids Bentonite c from 0 to 30 ft. 3 ❑ +� ,�1 yds. bags from to ft. 10tUC�1 ❑bags GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO from to ft. MATERIAL ❑yds. ❑bags soft KNOWN SOURCE OF CONTAMINATION clay yellow soft 0 16 feet --- direction type' Well disinfected upon completiones ❑No clay gray soft 16 W PUMP ❑Not installed Date installed 12-19-03 sand/gravel bram soft 60 120 Manufacturer's name Aermater sandgrAj► 1 sol t '120 17 IP Model number �t HVolts 230 Length of drop pipe 166 ft. Capacity g.p.m. Type: Submersible ❑L.S.Turbine ❑Reciprocating ❑Jet ❑ ABA14DONED WELLS Does property have any not in use and not sealed well(s) ❑Yeso VARIANCE Was a variance granted from the MDH for this well? ❑Yes X0 TN# WELL CONTRACTOR CERTIFICATION This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. The information contained inthisreport is true to the best of my knowledge. Use a second sheet,if needed REMARKS,ELEVATION,SOURCE OF DATA,etc. DontDrilling3todola elDrillingclos,, Itm. 27172 Licensee Business Na Lic.or Re .No. C-51w, r Z", _;_4 — 12-30-03 /Z/Xi A ri r sentative Sig atur Date ClyaWbore SINX9111151M 12-18-03 Name o/Driller LOCAL COPY � 705902 HE-01205-08(Rev.5/02) IC 140-0020 lrw o' C4 wl wat-eor cU*v,6c1 , InAcl. 617 13th Ave So Hopkins, Minnesota 55343 (612) 935 - 3556 12/22/2003 Stodola Well Drilling 3841 North Main St. Bonifacius MN 55375 938-2111 I REPORT OF WATER ANALYSIS Lab #: 1138 Our Laboratory reports these analytical results, determined on a sample taken by CLIENT on 12/18/2003 from the following location: Dave Fritz 473 Tonkawa Rd Long Lake,Mn Unique Well#705902 Coliform Bacteria <1/100 ml Nitrates Nitrogen <1.0 mg/1 The results of these tests indicate that this well is producing water that meets the standards for F.H.A., V.A., or conventional loans. This report is an analysis for .coliform and nitrate or;ly and does not include analysis of Lead and other contaminants. (Unless as specified by client). City Water Clinic, Inc. Bil sdale Lab Certification#027-053-119