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HomeMy WebLinkAboutwell info WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. County Name WELL AND BORING RECORD Minnesota Statutes, Chapter 1037 726426 Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed Ormo 1127 23 S 14 ,/ 215 l 12-14-0 GPSILLING METHOD LOCATION: Latitude degrees minutes seconds Longitude degrees minutes seconds P ❑Cable Tool y ❑Dug Auger k'Drivern otaJetted ❑ House Number,Street Name,City,and Zip Code of Well Location �or Fire Number '. ❑ 825 Rd © ! DRILLING FLUID WELL HYDROFRACTURED? ❑Yes No Tordcm Show exact location of well in section grid with"X'. J Sketch ap of well location. Sh in roperty lines, bmto 1ite FROM ft.TO ft. N r nd buildings USE ❑Monitoring ❑Heating/Cooling �. omestic ❑Environ.Bore Hole ________ /? yam✓ ❑Industry/Commercial K T:Noncommunity PWS ❑Irrigation ❑Remedial ❑Community PWS ❑Dewatering ❑ _ , f CASING HOLE DIAM. W I T Drive Shoe? ❑Yes 00 ------ ------- }__ ;__ I ❑Steel ❑Threaded ❑Welded , 'h Mile 1 � Plastic / ASING DIAMETER WEIGHT s in.to_.207__ft. lbs./ft. 8 in.to-30 ft. 1 Mile It n.to lbs./ft. I in.1 15 ft. ft. PROPERTY OWNER'S NAME/COMPANY NAMEd,? in.to ft. lbs./ft. in.to ft. SCREENOPEN HOLE Property owner's mailing address if different than well location address indicated above. MakeJ hnsw - FROM ft. TO ft. Dr 4420 Shoreline SfL Type aboin eas 90 Diam. 2n ng Pack, MN 5533'. Slot Gauze Length rK1 J ��'t Set between a t.and ft. FITTINGS _ STATIC WATE L 4A.7 4116 all ft. below ❑above land surface Date measured WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) ' 210 ft.after hrs.pumping so — 9-p.m-WELL HEAD COMPLETION (� Well owner's mailing address if different than property owners address indicated above. )(Pitless adapter manufacturer'k Y'C—, odel ❑Casing Protection X12 in.above grade ❑At-grade(Environmental Wells and Boring ONLY) GROUTING INFORMATION Well grouted ,Yes ❑No Grout material ❑Neat cement ❑Bentonite ❑Concrete XHigh Solids Bentonite from___to 30 ft. 3 [:1 yds. Xbags from IN ft.njjtAjL-4Lj—fn2. E]bags GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO from o . MATERIAL tft ❑yds. E]bags NEAREST KNOWN SOURCE OF CONTAMINATION -4 .r% I feet Lj direction t C. rq .+—tYPe Well disinfected upon completion XYes ❑No PUMP ❑Not installed Date installed I,-:) CJ.S Manufacturer's name jZray Model number `` HP J Volts ' } } Length of drop pipe /l;�Ca ft. Capacity g.p.m. Type: ubmersible ❑L.S.Turbine ❑Reciprocating ❑Jet ❑ ABANDONED WELLS Does property have any not in use and not sealed well(s) [-]Yes o 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 econd sheet,it needed - REMARKS,ELEVATION,SOURCE OF DATA,etc. Licensee Busine s ame L C.or Reg.No. tho e Rep r sentative Sign re f Date James Kohls 1726426 � Name of DrillerLOCAL COPYHE-01205-08(Rev.5/02) IC 140-0020 rw i vv C xy W ao'' . 617 kins, Minnesota 55343 612 935 - 3556 12/20/2005 Stodola Well Drilling 3841 North Main St. Boni facius MN 55375 938-2111 REPORT OF WATER ANALYSIS Lab #: 765BN Our Laboratory reports these analytical results, determined on a sample taken by CLIENT on 12/14/2005 from the following location: 825 Tonkawa Rd. Orono,Mn Well #726426 Coliform Bacteria <1/100 ml Nitrates Nitrogen <l.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 only and does not include analysis of Lead and other contaminants. (Unless as specified by client). TvXin City Water Clinic, Inc. B1N dale Lah Certification 4 027-053-119 WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring H 249106 County Name WELL AND BORING SEALING RECORD Minnesota Unique Well No. HennepinMinnesota Statutes,Chapter 1031 or W-series No. (Leave meek if rat k—) Township Name Township No. Range No. Section No. Fraction Ism i Ig) Date Sealed Date Well or Boring Constructed Oroeo 117 3 OP 21 2 f GPS Latitude degrees minutes seconds LOCATION: Depth Before Sealing ft. Original Depth ft. Longitude degrees minutes secondsO FER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location Single Aquifer ❑Multiaquifer I .Te t� WELL/BORING Measured ❑Estimated X325 �• w'a A OroI 7 Show exact location of well or boring Sketch map of well or poring (Nater Supply Well E]Monit.Well in section grid with'X" location,showing pro rty ❑ Env.Bore Hole ❑Other ft. [ frelow E]above land surface N lines,roads,and buil ngs. CASING TYPE(S) T Y teel ❑Plastic ❑Tile ❑Other W -�- - -- - -- --�-- E WELLHEAD COMPLETION Outside: ❑Well House Inside: ❑Basement Offset Xitless Adapter/Unit E]Well Pit -�-- -i-- -�-- --i-- � t` TTTTTT```"` ❑Well Pit ❑Buried S \\ ❑Buried PROPERTY OWNER'S NAME/COMPANY NAME CASING(S) Diameter r Depth t Set in oversize hole? Annular space initially grouted? Prole i ad a t o do ess indicated above r ��,y � in.from� to�ft. E]Yes f�Mo E]Yes ❑No E]Unknown 7407 wagzat'a Blvd ❑Yes ]]No Yes No in.from to ft. ❑ ❑ ❑ E]Unknown Mirmeaolis, T1 55426 in.from t0 ft. ❑Yes ❑No ❑Yes ❑ No ❑Unknown WELL OWNER'S NAME/COMPANY NAME SCREEN/OPEN HOLE r Well owner's mailing address if different than property owner's address indicated above Screen from if to ft. Open Hole from t0 ft. OBSTRUCTIONS Rods/Drop Pipe ❑ Check Valve(s) ❑ Debris ❑ Fill ❑ No Obstruction Type of Obstructions(Describe) -J41 o0q 49 GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? Xes ❑ No Describe FORMATION If not known,indicate estimated formation log from nearby well or boring PUMP Type ^ Removed ❑ Not Pres nt E]Other METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: ly No Annular Space Exists El Annular space grouted with tremie pipe El 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 lbs.,one bag of bentonite=50 lbs.) Grouting Material/0.-�''�/�l�rh'r/�Zfrom�' to "n 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? ❑ Yes XNo 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 Drillim, Co,. Inc. 2ilW 16" Contractor Bus' sS-Name License or Registration No. AtffhorlYed Representative Signature Date H 2491.0E ->�- LOCAL COPY Name of Person Sealing Well or Boring