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Home My WebLink Aboutwell info WELL'OCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. County Name WELL AND BORING RECORD Hennepin i Minnesota Statutes Chapter 1031 �[- 8 0 5 5 5 Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed Orc>n0 l 1 b _ 1 1. 1 1-5-96 House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD / t: 6'?r�tt33 t t_;k;11 C?ctCl �,� ?ll(3 I1. �`5 3-�t5 El Cable Tool El Driven ❑ Dug ❑ Auger 19 Rotary ❑ Jetted Show exact location of well in section grid with"X". Sketch map of well location. ❑ _ _ Showing property lines, roads and buildings. DRILLING FLUID BentoniteN I 1 I I USE El Monitoring ❑ Heating/Cooling I Domestic ❑ Community PWS EI Irrigation ty ❑ Industry/Commercial I ❑ Noncommunity PWS ❑ Remedial W, E El Test Well ❑ Dewatering ❑ CASING Drive Shoe? ❑ Yes ❑'No HOLE DIAM. ❑ Steel ❑ Threaded ❑ Welded 1 ❑'Plastic ❑ S —1 Mile _ JQ 7,5— f i tJ+�..� ,ice rCASING DIAMETER WEIGHT / PROPERTY OWNER'S NAME ) in.to ft. lbs./ft.1 . 9 7n.to- ; h. F,to ew'and Develt^oment in.to ft. tbs./ft. Property owner's mailing address if different than well location address indicated above. in.to ft. - _ lbs./ft. _in.to ft. t� Corporation SCREEN OPEN HOLE 106?9 Brunswick Circle Make JGtiiiscin from ft.to ft. BioC)Ti i IQ_ t:on, Mn.-55438 Type c .. 3 Aq Diam. SIoUGauze T t 1 t f Length K. P.Set between t ft.and (�ft. FITTINGS: X r �` STATI WATER LEVEL _ WELL OWNER'S NAME wi 0 ft. E3''below El above land surface Date measured 1 G- 0- 6 PUMPING LEVEL(below land surface) [- Well owner's mailing address if different than property owner's address indicated above. ft. after hrs.pumping 3 u a i g.p.m. WELL HEAD COMPLETION EXPitless adapter manufacturer Whi to w>I4. .IF%b lel ❑ Casing Protection 112 in.above grade ❑ At-grade(Environmental Wells and Borings ONLY) GROUTING INFORMATION Well grouted? 01 Yes ❑ No HARDNESS OF Grout Material ❑ Neat cement ❑ Bentonite ❑ Concrete ❑ H' h Solids Bentonite GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO f. _, from to ft. ❑ yds. 1!' bags Clz--i J Brown � t � 1 L, , from to ft. ❑ yds. ❑ bags from to ft. ❑ yds. ❑ bags NEAREST WQW .SOURCE OF CONTAMINATION _ c F` Sand Tan S 1 1 ` 1`_?u t rte', feet 4. .�Z - % direction -.-G-f type Well disinfected upon completion? Wes ❑ No Clay/Gravel Reddish Brown 15C ' 1 f o PUMP ❑ Not installed Date installed 3- 1-97 Water :7:.nO 1 ",1` 1 7L 1 19 1 'Manufacturers name to J aCkQ-t C Model number 1-d l+ ='!--CN L'1 C_1;1 Volts Length of drop pipeff. Capacity 22 g.p.m. Pressure Tank Cap aci ' '1 - rialupi on Type: ❑'Submersible ❑ L.S.Turbine ❑ Reciprocating ❑ Jet ❑ ABANDONED WELLS Does property have any not in use and not sealed well(s)? ❑ Yes E u No VARIANCE Was a variance granted from the MDH for this well? ❑ Yes Ei'qo WELL CONTRACTOR CERTIFICATION Use a second sheet,if needed This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. REMARKS,ELEVATION,SOURCE OF DATA,etc. The information contained in this report is true to the best of my knowledge. DON Eiii0l)OLA WELL DRILIJING CO. , iNC 27 1' Licensee Business Narne ,.,. Lic.or.Reg.No. Authorized Representative Signature Date (Aluck Moore 12-- -9t' /� i Name of Driller Date I.-OCAL COPY 58 05 5 AJ HE-01 205-05(Rev.1/95) Jahn City W.t., clinic, Jn'. 617 13th Ave So • Hopkins, Minnesota 55343 • (612) 935 - 3556 12/10/1996 Stodola Well Drilling 15306 Hwy 7 Minnetonka MN 55345 938-2111 REPORT OF WATER ANALYSIS Lab#: 31684 Our Laboratory reports these analytical results, determined on a sample taken by CLIENT on 12/05/1996 from the following location: 2760 Watertown Rd Orono,Mn Unique Wall#580556 Coliform Bacteria <1/100 ml Nitrates Nitrogen <1.0 mg/I 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). Xy Water Clinic, Inc. ` Bill ale AnrW W-ntmy co-UNME 6in— W&W Andras Reagedb BoiW WAw C6mosiw6 Lob Cerffimfi n/027-053-119 MINNESOTA UNIQUE WELL CLL OR ITORING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. County Name WELL AND BORING RECORDHemep7 7 O O®,. in Minnesota Statutes,Chapter 1031 Township Name Township No. Range No. Section No. Fraction WELUBORING DEPTH(completed) DATE WORK COMPLETED Oruro 118 23 33 8W Sid SE,, 140 n 2_A) Y GPS DRILLING METHOD LOCATION: Latitude degrees minutes seconds Longitude degrees minutes seconds ❑Cable Tool ❑Driven ❑Dug Auger [ otary [_1 Jetted House Number,Street Name,City,and Zip Code of Well Location �or Fire Number 0 2760 Waterton Rd Ottxio 55356 DRILLING FLUID WELL HYDROFRACTURED? ❑Yes 5k4Qo Show exact location of well/boring in section grid w Sketch map of well/boring location. becitOnite From ft.To ft. 4 Showing property lines, N ) roads,buildings,and direction. USE 'Domestic ❑Monitoring ❑Heating/Cooling ---------- __ --------- ❑Noncommunity PWS ❑Environ.Bore Hole ❑Industry/Commercial ❑Community PWS ❑Irrigation ❑Remedial Elevator Dewatering ❑ w E t_, CASING MATERIAL Drive Shoe? ❑Yes [eo HOLE DIAM. C G 'h Mile Threaded Welded 1 J Steel ❑T ❑ I J�'qe------ ,*Plastic ❑ --- - CASING S Diameter Weight Specifications —1 Mile _5.. '.i.. -*_ _:�-'--s�;`•.- .A. _4 in.to�2 ft. 1 A lbs./ft. 128M _�in.ta490—ft. ��(+�� ft. PROPERTY OWNER'S NAME/COMPANY NAME in.to ft. lbs./ft. in.hilt/ ft. Fred, s�,�„_ in.to ft. lbs./ft. in.to ft. ['[!�l ski' SCREEN OPEN HOLE Property owner's mailing address if different than well location address indicated above. Make Johnow From ft. To ft. Type staroles- at? Dia . Slot/Gauze_ .010 Length 41 i V Setbetween ft.and ft. FITTING STATIC WATER AW M Measured from q 100 ft.[Kelow ❑Above land surface Date measured 2-''9-09 WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) 180 ft.after I.5 hrs.pumping 20 —9 p.m. Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION i- f(Pitless/adapter manufacturer i _1; _ :_ Model ❑Casing Protection A 12 in.above grade ❑At-grade(Environmental Well and Baring ONLY) F� GROUTING INFORMATION Well grouted les ❑No Grout materials ❑Neat cement [Aentonite ❑Concrete ❑Other From T.--M—ft. 4 E]Yds. [; ags GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO From To182 ft.nain. ❑Bags MATERIAL From To ft. ❑Yds. ❑Bags NEAREST KNOWN SOURCE OF CONTAMINATI(�1 clay 0 16 %-� feet direction type Well disinfected upon completion? ,ees ❑No elav arw soft 16 PUMP ❑Not installed Date installed -� Manufacturer's name i Model Number HP Volts 178 Length of drop pipe L� ' 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 o 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. Don Stodala We11 DiftlUng Co,. Inc. 1691 Licensee Business Name Lic.or Reg.No. rtified Representative Signatur Certified Rep.No. Date Cho* Noom LOCAL COPY 770001 Name of Driller IC 140-0020 HE-01205-11(Rev.3/07) ' riv Cvv C Xy W at-e4l' C , I YW 617 13th Ave So Hopkins, Minnesota 55343 (612) 935 - 3556 02/11/2009 Stodola Well Drilling 3841 North Main St. Boni facius MN 55375 938-2111 REPORT OF WATER ANALYSIS Lab #: 34BN Our Laboratory reports these analytical results, determined on a sample taken by CLIENT on 02/09/2009 from the following location: Fred Zeman 2760 Watertown Rd. Orono,Mn We&770001 Coll form Bacteria Absent Nitrates Nitrogen <1.0 mg/1 Arsenic 5.41 ppb Twin CitK'VV�ter Clinic, Inc. r Bill VcrnA�ddale Analyical laboratory Consulting Engineer Water Analysis Reagents Boiler Water Chemicals Lab Certification#027-053-119 WELL OFt BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring H275521 County Name WELL AND BORING SEALING RECORD MinneSealinsota oaUnique Well No. Minnesota Statutes,Chapter 103! or W-series No. Hennepin (leave blank if-known) Township Name Township No. Range No. Section No. Fraction(sm.�Ig.) Date Sealed Date Well or Boring Constructed Orono 118 23 33 SW SW SC f F,</� j � GPS Latitude degrees__ _ minutes _ seconds Depth Before Sealing /90 ' ft. Original Depth _ ft. LOCATION: — Longitude degrees_-___ minutes seconds - A IFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location Ingle Aquifer ❑Multiaquifer rn WELL/BORING Measured ❑Estimated Date Measured �;,n ,4- 2760 Watertown Rd, Or+�no SS3S6 � - [XNater-Supply Well ❑Mont.Well 8 Show exact location of well or boring Sketch map of well or boring Env.Bore Hole in section grid with"X." location,showing property ❑ ❑Other ft. )Kelow ❑above land surface lines,roads,and buildings. N CASING TYPES) - --t-- I ❑SteelPlastic ❑Tile ❑Other ----- ---- -- -- ----- WELLHEAD COMPLETION W ET House E [_]r r 'h Mile Outside: Well Adapter/Unit At Grade Inside: ❑Basement Offset tPtleLl❑Buried Well Pit T . 1F 1 F]Well Pit ❑Buried s ❑Other _ 1 Mile —( 1 J /) p ❑Other PRQ,eE_RTY.OWER'SNAME/COMPANY NAME CASING(S) FMZAM Diam e;* t Depth t Set in oversize hole? Annular space initially grouted? Property owner's mailing address if different than well location address indicated above In.from 10 Yes o Y@S �ft t. ❑ Ao ❑ ❑No ❑Unknown SaA1e as above 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 r Well owner's mailing address if different than property owner's address indicated above Screen from / & to�ft. Open Hole from to ft. OBSTRUCTIONS ❑Rods/Drop Pipe ❑Check Valve(s) ❑Debris ❑Fill *0 Obstruction Type of Obstructions(Describe) GEOLOGICAL MATERIAL I COLOR HARDNESS OR FROM TO Obstructions removed? FORMATION ❑Yes ❑No Describe If not known,indicate estimated formation log from nearby well or boring. PUMP Type ❑Removed FVFlot Present ❑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 ❑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.) n r t Grouting Material Q to_ 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 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. Dai Sto&la Well Drilling Co., Inc. 1691 Licensee Business Name License or Registration No. erti ed Pepresentative Signa Certified Rep.No. Date ,I H 275521 } / y' y`Ij LOCAL COPY Name of Person Sealing Well or Boring HE-01434-11 IC#140-0423 .! 2,08R