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Home My WebLink AboutWell and Boring Record MINNESOTA UNIQUE WELL WL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. County Name WELL AND BORING RECORD 760618 �� Minnesota Statutes,Chapter 1031 Township Name Township No. Range No. Section No. Fraction WELUBORING DEPTH(completed) DATE WORK COMPLETED MIMI, 118 23 32 216 tt' GPS DRILLING METHOD LOCATION: Latitude degrees minutes seconds Longitude degrees minutes seconds Auger Cable Tool L]Driven Dug ❑Auger ❑Jetted House Number,Street Name,City,and Zip Code of Well Location �or Fire Number n . . " .3%0Watutom Ris Omw U359 DRILLING FLUID - HYDROFRACTURED? [-]Yes o Show exact location of well/boring in ction grid with"X" Sketch map of well/boring location. t�t�= From ft.To ft. Showing property lines, N (J roads,buildings,and direction. USE omestic ❑monitoring y� g ❑Heating/Cooling �� Noncommunity PWS ❑Environ.Bore Hole L]Industry/Commercial �� ❑Community PWS ❑Irrigation ❑Remedial ---- -----F-- -- -- ❑Elevator ❑Dewatering ❑ W E ` CASING MATERIAL Drive Shoe? ` Yes I�l HOLE DIAM. -�--- - --�-----%-- y ��o -.. T ❑Steel ❑Threaded ❑Welded 'h Mile lastic ❑ 1 CASING S Diameter Weight Specifications 1 Mile 4 in.to 21% ft. 1.9Ibs./ft _B_in.to — fit. PROPERTY OWNER'S NAME/COMPANY NAME in.to ft. lbs./ft in.to-M. Boyec DEl3 a.2 4.i.dlft in.to ft. lbs./ft. in.to ft.Property owner's mailing address if different than well location address indicated above. SCREEN OPEN HOLE 3435 ety Rd 101 MakeJbbFrom ft. To ft. �onlm, iV 5�5 Type e w Length , Slot/Gauze •�viA Length 411 4 4* Set betweenft.and ft. FITTINGS *21 pip STATIC WATER L Measured from 112 ft. elow ❑Above land surface Date measured WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) ft.after I jS hrs.pumping 30 9.p-m. Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION ,} ❑Pitless/adapter manufacturer ❑Casing Protection EX in.above grade ❑At-grade(Environmental Well and Boring ONLY) GROUTING INFORMATION Well grouted FXes ❑No Grout materials ❑Neat cement [Centonite [_1 Concrete ❑Other From 0 To 30ft. 3 '❑Yds. L_�Cags GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO From Toft. [:]Bags MATERIAL From To R ❑Yds. ❑Bags y. NEAREST KNOWN .s WN SOURCE OF CONTAiMINATIION C � 1e& /16 :7c feet ! direction _N type Well disinfected upon completion? es ❑No el" 9M ft 16 12D PUMP ��p F]Not installed Date installed �1 soft 1120 140 Manufacturer's name /.� -�"4'>--•-�Y^�—'11 CIAY be. soft 3E�l ft �y Model Number f HP .;� Volts Length of drop pipe ! �+� I ft. Capacity g.p.m. �..�) bvow i7ii7� 2W 216 Type: ubmersible [_]L.S.Turbine L]Reciprocating ❑Jet ❑ !+i 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. The information contained in this report is true to the best of my knowledge. Use a second sheet,h needed - - REMARKS,ELEVATION,SOURCE OF DATA,etc. Dw 3todols WeU DrUUng co., rw. 16% Licensee Business Name Lic.or Reg.No. `7` ld j Ce r entative Slg atureCer4 ied Rep.No. Date momLOCAL COPY 760618 Name of Driller —_ IC 140-0020 HE-01205-11(Rev.3/07) 1 rwL"4/1/ cry Wat-er CUNv6c/, I nAcl. 617 13th Ave So Hopkins, Minnesota 55343 (612) 935 - 3556 05/08/2008 Stodola Well Drilling 3841 North Main St. Bonifacius Mn 55375 REPORT OF WATER ANALYSIS Lab #: 167BN Our Laboratory reports these analytical results, determined on a sample taken by CLIENT on 05/06/2008 from the following-location: 3940 Watertown Rd. Orono,MN Well 760618 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). Twin Ci W to Clinic, Inc. Bill ri" "rsdale Lab Certification#027-053-119 WELL MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring 266476 WELL AND BORING SEALING RECORD Minnlesso ao Na County Name BORING LOCATION Unique Well No. H Minnesota Statutes,Chapter 1031 or W-series No. Here in (Leave Wank 0-known) Township Name Township NrRangeNo. Section No. Fraction(sm. Ig.) Date Sealed Date Well or Boring Constructed Orono 1182 32 " '' 3 IL% ' GPS Latitude degrees minutes seconds Depth Before Sealing /,✓o ft. Original Depth ft. LOCATION: Longitude degrees minutes seconds UIFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location single Aquifer ❑Multiaquifer 5A/Al– Water-Supply �� 3940 t� W UBORING Measured ❑Estimated Date Measured J 3940 Watertown Rd Water-Su I Well t pp y ❑Monit.Well Show exact location of well or boring Sketch map of well or boring U in section grid with"X.' location,showing property ❑Env.Bore Hole ❑Other �ft. below above land surface N lines,roads,and buildings. CASINGTYPE(S) �V Steel ❑Plastic ❑Tile ❑Other jj -- ---`----------------- WELLHEAD COMPLETION , T W EI Outside: L]Well House ❑At Grade Inside: Basement Offset %Mile ❑Pitless Adapter/Unit ❑Buried ❑Well Pit -----T---- I Buried 1 ❑Well Pit ❑ 1 Mile ❑Other ❑Other PROPERTY OWNER'S NAME/COMPANY NAME CASING(S) Ber NAlding Diarrt�tprr r Depth r Set in oversize hole? Annular space initially grouted? Property owner's mailing address if different than well location address indicated above t�r //__� �/ C in.from � to //2m ft. L]Yes No Ll Yes L]No Ll Unknown 3435 Cty Rd 101 in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown linetonka, IST 55345 in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown WELL OWNER'S NAME/COMPANY NAME SCREEN/OPEN HOLE f s / Well owner's mailing address if different than property owner's address indicated above Screen from to /3 o ft. Open Hole from to ft. OBSTRUCTIONS Rods/Drop Pipe ❑Check Valve(s) ❑Debris [j Fill ❑No Obstruction Type of Obstructions(Describe)— OF GEOLOGICAL MATERIAL I COLOR HARDNESS OR FROM TO Obstructions removed? As ❑No Describe FORMATION If not known,indicate estimated formation log from nearby well or boring. PUMP P !� Type � f"� `0 136 VRem ed ❑Not Present ❑Other U METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: 500 Annular Space Exists E]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) AA (One bag of cement=94 lbs.,one bag of bentonite=50 lbs.) Grouting Material�sA etc"t 1hrom 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 &No 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 Stodola Well Drilling Co., Inc. 1691 Licensee Business Name i License or Registration No. e Representative.&) at Certified Rep.No. Date 266476 LOCAL COPY " Name o/Person Sealing Well or Boring HE-01434-10 IC#140-0423 r 5/07R Name MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring H 255784 7 A County Na WELL BORING LOCATION WELL AND BORING SEALING RECORD Minnesota No.oUnique Well No. �.? 1 i} Minnesota Statutes,Chapter 1031 or W-series No. Hennepin (Leave tolank II not known) Township Name Township No. Range No. Section No. Fraction(sm.—Ig.) Date Sealed Date Well or Boring Constructed Orono 118N 23V 32 '/ '/SH/, January 26, 2007 GPS Latitude degrees minutes seconds Depth Before Sealing 136 ft. Original Depth ft. LOCATION: Longitude degrees minutes seconds AQUIFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location Single Aquifer ❑Multiaquifer 3940 Nat@moan Rd, E)rt 0 WELLBORING !k Measured ❑Estimated Date Measured 1/26/07 / Water-Supply Well ❑Monit.Well 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 97ft. fl below ❑above land surface N lines,roa�,apf buildings. CASINGTYPE(S) C l 1 I Steel ❑Plastic ❑Tile ❑Other --i----- ------------- WELLHEAD COMPLETION , T W E1 ❑ ____'__ ____'__ Outside: ❑Well House ❑At Grade Inside: Basement Offset 'k Mile ❑Pitless Adapter/Unit ❑Buried Well Pit ---- - -- ------- ❑Buried S ❑Well Pit ❑Other )- 1 Mile ❑Other PROPERTY OWNER'S NAME/COMPANY NAME CASING(S) Br IAM Mcconnell Diameter Depth Set in oversize hole? Annular space initially grouted? Property owner's mailing address if different than well location address indicated above 4 in.from is 0 t0 132 ft. ❑Yes g]No ❑Yes ❑No X Unknown 6249 Cavendish Place Eden Prairie, MN 55346 in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown WELL OWNER'S NAME/COMPANY NAME SCREEWOPEN HOLE Brian McConnell Well owner's mailing address if different than property owner's address indicated above Screen from 132 to 136 ft. Open Hole from t0 ft. OBSTRUCTIONS ❑Rods/Drop Pipe ❑Check Valve(s) ❑Debris ❑Fill :J No Obstruction Type of Obstructions(Describe) GEOLOGICAL MATERIAL I COLOR HARDNESS OR FROM TO Obstructions removed? L]Yes E]No Describe FORMATION PUMP If not known,indicate estimated formation log from nearby well or boring. Type ❑Removed ]Not Present ❑Other METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: No 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 MATERIALS) (One bag of cement=94 Ibs.,one ♦bag �of bentonite=50 lbs.) Grouting Material Neat `t.�! from 0 to 136 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 I No 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. Stevens Drilling 6 Environeental Svc 2255 Contractor Business Name License or Registration No. 1/26/07 Certified Representative Signature Certified Rep.No. Date LOCAL COPY " 25578 ` �""' Name of Person Sealing Well or Boring HE-01434-09 ICN 140-0423 6/06R