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Home My WebLink Aboutwell info MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring 266470 WELL Na BORING LOCATION WELL AND BORING SEALING RECORD Menne o a Unique well No. " County Name iR Minnesota Statutes,Chapter 1031 or W-series NoHermp . (Leave blank it not known) Township Name Township No. Range No. Section No. Fraction(sm. Ig.) Date Sealed Date Well or Boring Constructed orono 117 23 08 2-110M '� t--,c7 Q GPS Latitude degrees minutes seconds Depth Before Sealing ,y� ft. Original Depth ft. LOCATION: Longitude degrees minutes_ seconds IFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location Single Aquifer F]Multiaquifer 1220 iodkmm Rd. Omm W LUBORING Measured ❑Estimated Date MeasuredsOOX- 6A K Water-Supply Well ❑Monit.Well f Show exact location of well or boring map of well or boring in section grid with"X" locat n,showing property ❑Env.Bore Hole ❑Other ft. �]below ❑above land surface lines roads,and buildings. N CASING TYPE(S) Steel [-]Plastic F]Tile ❑Other d s ----'-'--'-- -----`-- WELLHEAD COMPLETION W ET ------, ____ _____ II Outside: ❑Well House ❑At Grade Inside: ❑Basement Offset 'h Mile ltless Adapter/Unit ❑Buried ❑Well Pit �P' ---- ❑Well Pit ❑Buried s ❑Other 1 Mile N ❑Other PROPERTY OWNER'S NAMMEE//COMPANY NAME CASING(S) Steiner al Ko 1mw Inc Di"am�eter f Depth f Set in oversize hole? Annular space initially grouted? Prop�rot•340 m r�( ni.tha tion address indicated above �/1,in.from to ft. Yes No Yes ❑No ❑Unknown Wayzata, MAT 550391 —t 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 HOLL��E�� r / Well owners mailing address if different than property owner's address indicated above Screen from q a to /0/ ft. Open Hole from to ft. OBSTRUCTIONS Rods/Drop Pipe ❑Check/Valve(s) ❑Debris ❑Fill ❑No/O/b/s�truction Type of Obstructions(Describe) ToyA tex �P05 g ! (JM19 GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? es E]No Describe FORMATION PUMP If not nown,indicate estimated formation log from nearby well or boring. �j- Type Removed ❑Not Prelent ❑Other METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: )Jo Annular Space Exists ❑Annular Space Grouted with Tremie Pipe L]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.) .�. i 41 Uy� Grouting Materia4%•&�&/fr.om_40 tom 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 Xo 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 Stole Well Drilling CA., Im. 16% Licensee Business Name License or Registration No. epresentative Signat&M Certified Rep.No. Date LOCAL COPYH ` 26`+S��+''/�I Name of Person Sealing Well or Boring HE-01434-10 IC#140-0423 5/07R MINNESOTA UNIQUE WELL WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. County Name WELL AND BORING RECORDftmpft 760620 " " Minnesota Statutes,Chapter 1037 Township Namehip No. Range No. Section No. Fraction WELUBORING DEPTH(completed) DATE WORK COMPLETED 0900 117 23 :moi,08 in W 108 h. Towns4-"-m GPS DRILLING METHOD LOCATION: Latitude degrees minutes seconds Longitude degrees minutes seconds E]Cable Tool [_1 Driven [j Dug ❑Auger ❑Jetted House Number,Street Name,City,and Zip Code of Well Location �or Fire Number �❑ - W Orem 553% DRILLING FLUID WELL HYDROFRACTURED? ❑Yes o Show exact location of well/boring in section grid th^X' Sketch map of well/boring location. MOW From ft.To ft. Showing property lines, ''. roads,buildings,and direction. USE g ❑Heating/Cooling n i N omestic ❑monitoring ' __L_____t__ ❑Noncommunity PWS ❑Environ.Bore Hole ❑Industry/Commercial ❑Community PWS ❑Irrigation ❑Remedial --'------------�-----`-- F]Elevator ❑Dewatering ❑ �`"' w f E T CASING MATERIAL Drive Shoe? ❑Yes j�o HOLE DIAM ' I ❑Steel ❑Threaded ❑Welded y h Mae �astic E J ; 1 - -T-- ---�-- ---'-- CASING s DiametQr 100 Weight 4j nJ Specification 8 30 —1 Miie in.to ft. IbS�./R. i+yL� n.toft. PROPERTY OWNER'S NAME/COMPANY NAME in.to ft. lbs./ft. in.to ft. n.to ft. lbs./ft. in.to ft. Property-owner's mailing address it different than well location address indicated above. SCREEN OPEN HOLE IBM �yy� Make From ft. To ft. 18340 371umC dU Blvd Type Diam. metas M 553% SIoUGauze Length Set between_ _ft.and1, Q ft. FITTINGS STATIC WATER LEVEL Measured from _gyp 45 ft.LYIfelow ❑Above land surface Date measured��R)O WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) 1+5 30 A7�J ft.after hrs.pumping g.p.m. Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION LAtless/adapter manufacturerthitmater Model ❑Casing Protection [>w in.above grade ❑At-grade(Environmental Well and Boring ONLY) GROUTING INFORMATION Well grouted ( "Fes ❑No Grout materials ❑Neat cement L_�dentonite ❑Concrete 7 Other 0y From__To ft. 3 ❑Yds. �ags GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO 30 From IM To �, _ tjL [_]Yds. [:]Bags MATERIAL From To ft. ❑Yds. ❑'Bags NEAREST KNOWN SOURCE OF CONTAMINATION 0 911 7.5 C". feet ..1 direction Well disinfected upon completion? LVes ❑Nosaw 90 UMP 6-1 E]Not installed Date installed Manufacturer's name t, 2W Model Number HP 1.5 Volts Length of drop pipe 63 ft. Capacity g.p.m. Type:submersible ❑L.S.Turbine ❑Reciprocating ❑Jet ❑ ABANDONED WELLS Does property have any not in use and not sealed well(s)? ❑Yes L Qo VARIANCE Was a variance granted from the MDH for this well? ❑Yes TN# WELL CONTRACTOR CERTIFICATION This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. Use a second sheet,if needed. The information contained in this report is true to the best of my knowledge. REMARKS,ELEVATION,SOURCE OF DATA,etc. . DM at a j,a j Wel• DrUlIng 0D*' Toe. 16" Licensee Business Name „* Lic.or Reg..No. 1?rli Ce d esen a igna r Certified Rep.No. Date CIMA LOCAL COPY � 760620 Name of Driller MOM IC 140-0020 HE-01205-11(Rev.3/07) C Xy W cxt"�' C , I vlcr. 617 13th Ave So Hopkins, Minnesota 55343 (612) 935 - 3556 05/01/2008 Stodola Well Drilling 3841 North Main St. Boni facius MN 55375 938-2111 REPORT OF WATER ANALYSIS Lab#: 154BN Our Laboratory reports these analytical results, determined on a sample taken by CLIENT on 04/29/2008 from the following location: 1220 Tonkawa Rd. Orono,Mn Well 760620 Coliform Bacteria Absent 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). Twin City Water Clinic, Inc. ,BOan Arsdale Lab Certification#027-053-119