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Home My WebLink AboutWell and Boring Records 4 _ WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. County Name WELL AND BORING RECORD Hmmon Minnesota Statutes, Chapter 1031 705924 Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed n. Aram 23 32 lit. '/ GPS DRILLING METHOD LOCATION: Latitude degrees minutes seconds Longitude degrees minutes seconds ❑Cable Tool ❑Driven ❑Dug ❑Auger Rotary ❑Jetted House Number,Street Name,City,and Zip Code of Well Location �or Fire Number ❑ Watiortam Rel- Ornm 553M DRILLING FLUID WELL HYDROpRACTURED? YesFlo Show exact location of well in section grid with"X". Sketch map of well location. FROM ft.TO // tt. Showing property lines, N roads and buildings USE _ i� Monitoring ❑Heating/Cooling `p Domestic ____________�_____,_ Environ.Bore Hole ❑Industry/Commercial Noncommunity PWS ❑Irrigation ❑Remedial Community PWS ❑Dewatering ❑ CASING❑ HOLE DIAM. W E # Drive Shoe? ❑Yeso 1 El steel El Threaded Elelded Mile (t r ,h lastic ❑ 1 CASING DIAMETER WEIGHT 1 Mlle 1' in.to 184 ft. 2.01 lbs./ft. a in.to -40 ft. --i � p ��'j� n.to ft. lbs./ft. W in.tit. PROPERTY OWNER'S NAME/COMPANY NAME in.to ft. lbs./ft. in.toff. SCREEN OPEN HOLE Property owner's mailing ddress if different than well location address indicated above. MakeJbfil� FROM ft. TO ft. Type stainless stl Dm. ia Slot/Gauze -010 Length 4! + 4! Set between ft.and ft. FITTING M STATIC WATER LEVEL 100 tt. elow ❑above land surface Date measured 4-29"M PUMPING LEVEL WELL OWNER'S NAME/COMPANY NAME (b,eIA land surface) - ft.after 2 40 hrs.pumping _g.p.m. WELL HEAD COMPLETION Well owner's mailing address if different than property owners address indicated above. 0itless adapter manufacturer Adtewter Model Casing Protection X12 in.above grade ❑At-grade(Environmental Wells and Boring ONLY) GROUTING INFORMATION Well grouted OIYs [—]No Grout material Neat cement ❑Bentonite ❑Concrete [�iigh Solids Bentonite from to 30 ft. 3 ❑yds. gs from--"30�. to ft. jj�jj bags HARDNESS OF +•^ � � GEOLOGICAL MATERIALS COLOR FROM TO from o ft. MATERIAL t ❑yds. ❑bags NEAREST/KNOWN SOURCE OF CONTAMINATION ft_7 feet direction A. Well disinfected upon completion es ❑No PUMP cuy VAI I nu soft ❑Not installed Date installed 5-3-04 II-1 av sof t 38 140 Manufacturer's name Aecwto gray Model number HP 1 Volts 230 sand rave I . 1h boamt— soft j4j0__ 192 Length of drop pipe 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 Wo 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. 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. r a Licensee Business 27172 N e fc.or eg. o d res n ti Si ` Date Chuck Moore 4-29-04 IC 140-0020 LOCAL COPY 1705924 Name of Driller _ HE-01205-08(Rev.S/02) f � rw� cry water CUtio�cl , InACI. 617 13th Ave So Hopkins, Minnesota 55343 (612) 935 - 3556 05/04/2004 Stodola Well Drilling 3841 North Main St. Bonifacius MN 55375 938-2111 REPORT OF WATER ANALYSIS Lab #: 314 Our Laboratory reports these analytical results, determined on a sample taken by CLIENT on 05/03/2004 from the following location: Stephen Gagne 3505 Watertown Rd. Orono,Mn Unique Well#705924 Coliform Bacteria <1/100 ml Nitrates Nitrogen <1.0 mg/l 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). Nirk City Water Clinic, Inc. Bi n Arsdale Lab Certification N 027-053-119 WEl<OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring '„I WELL AND BORING SEALING RECORD Sealin No. 9 County Name 2118195 Minnesota Unique Well No. Hennepin Minnesota Statutes,Chapter 1031 or W-series No. (Leave blank if not known( Township Name Township No. Range No. Section No. Fraction ism- Ig) Date Sealed Date Well or Boring Constructed Orono 118 23 32 43,-0007 GPS Latitude degrees minutes seconds LOCATION: Depth Before Sealing ft. Original Depth It, Longitude degrees minutes seconds ApUIFER(S) STATIC WATER LEVEL Numerical StreettAdddress or Fire Number and City of Well or Boring Location ^Single Aquifer E]Multiaquifer ��..,,// 3505 > atertom Rd, Orono 55356 WELL/BORING )(Measured ❑ Estimated )J.7 Water Supply Well [_]Monit.Well f Show exact location of well or boring Sketch map of well or boring in section grid with"X" location,showing property ❑ Env.Bore Hole ❑Other ft. [below ❑above land surface link,roads,end buiJ�r N �'..,,i---} �:.J.i_}.�l"-�.c r^- (`._�.." CASING TYPE(S) )(feel ❑ Plastic ❑Tile ❑Other �- -�-- -�-- --- WELLHEAD COMPLETION W E Outside: ❑Well House Inside: ❑ Basement Offset -i-- - -- -i-- --i-- ^"�' XPitless Adapter/Unit ❑Well Pit ❑Well Pit ❑ Buried S r mVe ❑ Buried PROPERTY OWNER'S NAME/COMPANY NAME CASING(S) st4illen GA9W Dia m tet/ Depth Set in oversize hole? Annular space initially grouted? Property owner's mailing address if different than well location address indicated above / in.from�„)- tOfft. E]Yes XNo C]Yes ❑No ❑ Unknown 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_45]iLL to_f ft. Open Hole from to ft. OBSTRUCTIONS Rods/Drop Pipe ❑ Check Valve(s) ❑ Debris El Fill ElNo Obstruction Type of Obstructions(Describe) I NA.1j 0e2 GEOLOGICAL MATERIAL 7 COLOR HARDNESS OR FROM TO Obstructions removed? Yes ElNo Describe ! FORMATION If not known.indicate estimated formation log from nearby well or boring PUMP Type r Removed ❑ Not Presen Ll Other _ MET/HOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: I XfVo Annular Space Exists ❑ Annular space grouted with tremie pipe El Casing Perforation/Removal 7` 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/r+_ - ,i �,f{,(m to-Z Z26t. 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 No How many? LICENSED OR REGISTERED CONTRACTOR CERTIFICATION This well or boring was sealed m accordance with Minnesota Rules,Chapter 4725.The information contained in this report is true to the best of my knowledge. Don Stodola Well Drilling Co. Inc. 27172 Contract u ame License or Registration No. onz d epresentative Signah Date 218125 LOCAL COPY H f},�_� Name of Person Sealing Well or Bdiing