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HomeMy WebLinkAboutwell info t WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. County Name WELL AND BORING RECORD 696471 B� Minnesota Statutes Chapter 1031 Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed ©rem 118 23 33 ,� ,/ ,, 253 h 8-27-83 GPS DRILLING METHOD LOCATION: Latitude degrees minutes seconds Longitude degrees minutes seconds ❑Cable Tool ❑ riven ❑Dug ❑Auger !Jf�Rotary ❑Jetted House Number,Street Name,City,and Zip Code of Well Location CL or Fire Number ❑ T 2W atertmn Rd. 5531V DRILLIINNGG FLUID WELL HYDROFRACTURED? ❑Yes No Shop exact location of well in section grid w X". Sketch map of well location. "ento4te FROM ft.TO ft. mowing property lines, N 0,A roads and buildings USE ,,,/// ❑Monitoring [Heating/Cooling 1 Domestic ❑Environ.Bore Hole ❑Industry/Commercial Noncommunity PWS L1 irrigation ❑Remedial ❑Community PWS ❑Dewatering ❑ --i------------------------ CASING HOLE DIAM. yy E� Drive Shoe? EJ Yes Eo IEsteel ❑Threaded ❑WeRed l,M [)(Plastic ❑ --- ----'-'-- -- CASING DIAMETER s�`* WEIGHT /� 41 S ; 77 in.to 241 ft 2.A1 lbs./ft. in.to 1 Mile--{ in.to ft. lbs./ft. in.to PROPERTY OWNER'S NAME/COMPANY NAME in.to ft. Ibs./ft. in.to ft. Sharon Ehlen SCREEN OPEN HOLE Property owner's mailing address if different than well location address indicated above. Make FROM ft. TO ft. Type stainlom St Diam. t Slot/Gauze .�� Length of + W # 4" Set between ft.and ft. FITTINGS STATIC WATER LEVEL 8-2 �q 133 ft. elow ❑above land surface Date measured 8-27 —03 PUMPING LEVEL(below land surface) WELL OWNER'S NAME/COMPANY NAME30 250 ft.after 3 hrs.pumping g.p.m. �Gasing L HEAD COMPLETION vhitemter Well owner's mailing address if different than property owners address indicated above. itless adapter manufacturer Model Protection _ �2 in.above grade ❑At-grade(Environmental Wells and Boring ONLY) GROUTING INFORMATION Well grouted Yes ❑No Grout material Neat cement E]Bentonite ❑Concretetiigh Solids Bentonite fromQ_to 30 ft. 2_5 ❑yds. ) 6ags from 30 to2fil ft. TjotljCjd fft.1❑bags GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO from to ft. ❑yds. ❑bags MATERIAL t NEAREST KNOWN SOURCE OF CONTAMINATION Clay yellow Soft © 26 X00 feet J direction "- type p��p Well disinfected upon completion ss [3 No Clay 9r � 26 60 PUMP 8-2013 �p L-]Notinstalled Date installed Cra�V l colored �un 6© 120 Manufacturer's name Aermotor t q Model number HP ^Volts 230 clay brown medico 120 210 Length of drop pipe 168 ft. Capacity _g.p.m. //�� Type: ubmersible ❑L.S.Turbine ❑Reciprocating Jet fine Sand brown medium 210 238 ABAI,11DONEDWELLS w! soft �.�p Does property have any not in use and not sealed well(s) i�Yes o coarse Sand brooft 238 233 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 second sheet,if needed REMARKS,ELEVATION.SOURCE OF DATA,etc. ilea-Stodolst ,Ian- 27172 Licensee Business me Lic.or Reg.No. thorize epre Live Signage Date Chuck Moore Z LOCAL COPY 696471 Name of Driller Date HE-01205-08(Rev.5/02) IC 140-0020 s rivLN11 cry w � c , I n�. 617 13th Ave So Hopkins, Minnesota 55343 (612) 935 - 3556 11/06/2003 Stodola Well Drilling 3841 North Main St. Bonifacius MN 55375 938-2111 REPORT OF WATER ANALYSIS Lab #: 1027 Our Laboratory reports these analytical results, determined on a sample taken by CLIENT on 1110412003 from the following location: Sharon Ehlen 2640 Watertown Rd Orono,Mn Unique Well#696471 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). in City Water Clinic, Inc. Bil, rsdale X :,. Lab Certification H 027-053-119 WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring '„I o. Count Name WELL AND BORING SEALING RECORD Minnlesotta Unique Well No. 13 796 Hennepin 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 Constructed Orono 11 ON 23W 33 /I j v`/ U GPS Latitude degrees minutes seconds f 00 LOCATION: Depth Before Sealing. ft. Original Depth 1ft. Longitude degrees minutes seconds C UIFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location 7 Single Aquifer ❑Multiaquifer WELL/BORING [Measured fl Estimated ater Supply Well ❑Monit.Well Show exact location of well or boring 7640 Watertown R.d- T Sketc m"" well or boring in section grid with"X" 55356 location,showiM property El Env.Bore Hole ❑Other / ft. )6elow ❑above land surface lines,roads)dnd buildings. CASING TYPE(S) r7CSteel ❑Plastic ❑Tile ❑Other W -- - - -- - -- -- -- E WELLHEAD COMPLETION — Outside: ❑Well House Inside: ❑Basement Offset &mit _ xPitless Adapter/Unit ❑Well Pit ❑Well Pit ❑Buried r mrle } h /- �'''_ _. ❑Buried t - r PROPERTY OWNER'S NAME/COMPANY NAME CASING(S) n1enDiam e� Depth jr Set in oversize hole? Annular space initially grouted? Property owner's mailing address di event than well location address indicated above //..�� }}� in.from V t0/ ft. ❑Yes [ Jo ❑Yes ❑No ❑Unknown 952-473-2397 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 Well owner's mailing address if different than property owner's address indicated above Screen from Z`---to ft. Open Hole from to ft. OBSTRUCTIONS ❑ Rods/Drop Pipe ❑ Check Valve(s) ❑ Debris ❑ Fill EXo Obstruction Type of Obstructions(Describe) GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? E]Yes ❑ No Describe FORMATION If not known,indicate estimated formation log from nearby well or boring PUMP t Type ❑ Removed Not Present ❑Other _ METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: L]�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 MATE,RIA/L(S�)+} /^ (One bag of cement=94 lbs.,one bag of bentonite=50 lbs.) Grouting Material 1�+�ii T( � m � to�ft. yards —Z-,?,— 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 A. 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. DOM STODOLA WELL DRILLING CO., INC. 27172 Contractor Bus es Name - License or Registration No. ho d epre entative toe ' Date t LOCAL COPY H 1 Name of Person Sealing Well or B-ring