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HomeMy WebLinkAboutwell info WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. County Name WELL AND BORING RECORD Towns696476 „_____in Minnesota Statutes Chapter 1031 Township Name hip No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed Orono 117 23 8 y. 'k 204 h. 9-22-03 GPS Latitude degrees minutes seconds DRILLING METHOD LOCATION: ❑Cable Tool ❑ riven ❑Dug Longitude degrees minutes seconds ;❑Auger otary ❑Jetted House Number,Street Name,City,and Zip Code of Well Location �or Fire Number ❑ 847 Tor"m Rds Orow 553% DRILLING FLUID WELL HYDROFRACTURED? ❑Yes o Shop exact location of well in section grid with"X". ketch map of well location. pater FROM ft.TO ft. Showing property lines, roads and buildings USE N � E]Monitoring ❑Heating/Cooling Domestic ❑Environ.Bore Hole ❑Industry/Commercial Noncommunity PWS ❑irrigation L]Remedial --'-----'-----`-----`-- ASING ❑Dewatering _❑ OLE DIAM. ❑Community PWS ng I I I �. C Drive Shoe? [ Yes No W ET 4 u ------ - - -- ❑Seel ❑Threaded ❑Welded Ste Mile 1 CASING DIAMETER WEIGHT "y�.j1 S t;y �* in.to 1% ft 2.01 lbs./ft. 8 in.to--Wft. —1 Mile in.to ft. lbs./ft. in.to2�tt. PROPERTY OWNER'S NAME/COMPANY NAME in. in.to ft. lbs./ft. in.to ft. StonewaW Bni1d SCREEN _ OPEN HOLE Property owner's mailing address if different than well location address indicated above. Make_ FROM ft. TO ft. 90 Shoreline Dr Type amhqe" Diam. Spring Park 553M Slot/Gauze • Length Set between--2;04—ft.and_1% ft. FITTINGS STATIC WATER LEVEL 75 ft. below ❑above land surface Date measured 9 .22-03 PUMPING LEVEL(below land surface) WELL OWNER'S NAME/COMPANY NAME 1-9A 3 ft.after 3 hrs.pumping 30 71! g p.m. WELL HEAD COMPLETION Well owner's mailing address if different than property owners address indicated above. ❑Pitless adapter manufacturer i*i temater Model ❑Casing Protection ❑12 in.above grade ❑At-grade(Environmental Wells and Boring ONLY) GROUTING INFORMATION���/// Well grouted Yes F_No Grout material ?Neat cement ❑Bentonite El Concrete High Solids Bentonite from to ft. 3 _ ❑yds. �Xags from 0 to._J%ft. nQtjr&L fUl ❑bags GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO from to ft. ❑yds. ❑bags MATERIAL NEAREST-KNOWN SOURCE OF'CONTAMINATION t r -....� feet direction e1 11ow soft _ _21Well disinfected upon completion es ❑No PUMP dR la :_ soft 2$ ❑Not installed 7V Date insttalled ___1—_22a_-04___ fir mid . .. _.-. sof t - ... .._.1 anufacturer's name Aermtnr w /� 90 Model number HP 1 e 5 Volts_ 230 1a soft 150 .- -1 engthof-dreppipe .1.91. ft. Capacity g.p.m. / / p �y0 Type:❑.Submersible '�❑L.S.Turbine E]Reciprocating ❑Jet E]ravel - - - bro�nre . .croft _.. :..:143BANDONED WELLS Does property have any not in use and not sealed well(s) ❑Yes X. VARIANCE, - - - Was a variance granted from the MDH for this well? ❑Yes 46o TNri 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,it needed 'f REMARKS,ELEVATION,SOURCE OF DATA,etc. Don Stcdola Well AriilU&Co-,-. Itic._ 2nn _ Licensee Business Name �'O ic.or Reo.No. 3-31-04 o d re entative Signatu Date � 6964761 hick Moore _S�-22-03 LOCAL COPY Name of Driller Date HE-0120508(Rev.5/02) IC 140-0020 rivCUnI y W at-or cU41� ', I� 617 13th Ave So Hopkins, Minnesota 55343 (612) 935 - 3556 04/07/2004 Stodola Well Drilling 3841 North Main St. Bonifacius MN 55375 938-2111 REPORT OF WATER ANALYSIS Lab #: 222 Our Laboratory reports these analytical results, determined on a sample taken by CLIENT on 04/05/2004 from the following location: 847 Tonkawa Rd. Orono,Mn Unique Well #6964767 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 only and does .not include analysis of Lead and other contaminants. (Unless as specified by client). n City Water Clinic, Inc. Bi� sdale Lab Certification#027-053-119 WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring o. H County Name WELL AND BORING SEALING RECORD Sea211995 Minnesota Unique Well No. HIMM Hennepin Minnesota Statutes,Chapter 1031 or W-series No. (Leave blank it nal known) Township Name Township No. Range No. Section No. Fraction Ism->Ig) Date Sealed Date Well or Boring Constructed Orono 117 23 S GPS Latitude degrees minutes seconds LOCATION: Depth Before Sealing //v/'} ft. Original Depth—/// ft. Longitude degrees minutes seconds AQUIFER(S) STATIC WATER LEVEL Wl. Nu eat Address or Fire Number and City of Well or Boring Location Single Aquifer [_1Multiaquifer L/BORINGeasured E] Estimated 8V Tonkawa Rd Oro[!© Water Supply Well ❑Monit.Well ` Show exact location of well or boring Sketch map of well orri in section grid with"X' location,showing prop ❑Env.Bore Hole ❑Other ft. below ❑above land surface N lines,roads,and buildii g CASING TYPE(S) Steel ❑Plastic ❑Tile ❑Other W -- - - -- - -- --�-- E WELLHEAD COMPLETION Outside: ❑Well House Inside: ❑Basement Offset kmas LJ�Yitless Adapter/Unit E]Well Pit i --i - 1 / ❑Well Pit ❑Buried S r mae F-1Buried P ERTY OWNER'S NAME/COMPANY NAME CASING(S) d ld Diame r/ Depth Set in oversize hole? Annular space initially grouted? Property owner's mailing address if different than well location address indicated above 4420 Shoreline Dc /� ,.y �/ E] ❑ in.from C./ to_/_06t. E] TT�� Yes I 0 ❑Yes No Unknown springy; Park, lit 55384 in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown in.from to ft. ❑Yes ❑ No ❑Yes ❑ No ❑Unknown WELL OWNER'S NAME/COMPANY NAME SCREEN/OPEN HOLE If / )//��, j Well owner's mailing address if different than property owner's address indicated above Screen from�to _ft. Open Hole from t0 ft. OBSTRUCTIONS Rods/Drop Pipe ❑ Check Valve(s) ❑ Debris f❑ Fill ❑ No Obstruction Type of Obstructions(Describe) /2r,—,l GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? YeS ❑ No Describe FORMATION If not known,indicate estimated formation log from nearby well or boring PUMP n Typedri ft n Ili / /� IX"Removed ❑ Not Present ❑ Other METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: Diel"To 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 celment=94 Il one bag of bentonite=50 lbs.) Grouting Material /�� f r~ 1` 0 to `— ft./ yards _4� 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 4NO 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. Ion Stodola Well Drilling Co, Inc. 27172 Contractor Busines ame License or Registration No. Oth6eec(ReFp—resenlalive Signature Date LOCAL COPY H 2119 9 5Jim Antonson - Name of Person Sealing Well or Boring