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HomeMy WebLinkAboutWell and Boring Record ESOTA UNIQUE WILLR E&gING LOCATION MINNESOTA DEPARTMENT OF HEALTH MIN AND BORING NO.WELL County Name WELL AND BORING RECORD 06 21 Hennepin Minnesota Statutes,Chapter 1037 Township Name Township No. Range No. Section No. Fraction WELL/QORING DEPTH(completed) JDATI WORK COMPLETED Orono 117 23 04 123 5-3-07 GPS DRILLING METHOD LOCATION: Latitude degrees minutes seconds Longitude degrees minutes seconds ❑Cable Tool E]Driven Dug ❑Auger Rotary ❑Jetted House Number,Street Name,Ciry,and Zip Code of Well Location �or Fire Number r-1305 Willow Dr S. Orono 55356 DRILLING FLUID WELL HYDROFRACTURED? ❑Yes o Show exact location of well/boring in section grid with"X.' Sketch map of well/boring ication. Inter From ft.To ft. Showing prope lines, N roads,buildings,and d 9 Qn. USE Domestic El Monitoring [IHeating/Cooling �r� Y ❑Noncommunity PWS ❑Environ.Bore Hole ❑Industry/Commercial ❑Community PWS ❑Irrigation ❑Remedial --'-----�------F-----1-- \� ❑Elevator ❑Dewatering ❑ w E N.__.,_ CASING MATERIAL Drive Shoe? ❑Yes No OLE DIAM. T C GMAT L H �• ❑Steel ❑Threaded ❑Welded h Mile Plastic ❑ 1 � CASING s t `.`} Diameter Weight Specifications 1 Mile 1 in.to 115 ft. 2-M lbs./R 8Stm 8 in.to 30 ft. PROPERTY OWNER'S NAME/COMPANY NAME in.to ft. —lbs./ft. 6k in.tol23 ft. ChriS/(Ann .Stariiah in.to ft. lbs./ft. in.to ft. Property owner's mailing address if different than well location address indicated above. SCREEN OPEN HOLE same as above Make JobrMM t From ft. To ft. Type stainless stl ----Diann. Slot/Gauze .010 Length 41 f 49 Set between ft.and=1.1 r FITTINGS N w STATIC WATER LEVEL Measured from c j ft.?(Below F]Above land surface Date measured�� WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface)) 114 ft.after 1.4 hrs.pumping 30 9-p m. Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION t, } Pitless/adapter manufacturerh-� ❑Casing Protection 12 in.above grade ❑At-grade(Environmental Well and Boring ONLY) GROUTING INFORMATI N Well grouted Yes ❑No Grout materials ❑Neat cement Bentonite ❑Concrete ❑Other From_To--30—ft- 3 ❑Yds. Bags GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO From30To 1'!! ft.jW '�s. ❑Bags MATERIAL STT From To ft. ❑Yds. ❑Bags NEAREST KNOWN SOURCE OF CONTAMINATION topsoil black soft 0 3 /yJ feet E� direction —type:_-�! S Well disinfected upon completion? Yes ❑No ti Clay gray ft 3 30 PUMP r,t w_�,,� V �[�} ❑Not installed Date installed - y " line Ali[ 9EMJ soft 60 Manufacturer's name clay/sand gray pit, > i 11 Model Number ` HP�Volts Length of drop pipe �✓ ' ft. Capacity g.p.m. sand brmn 12 Soft ! 123 Type: Submersible ❑L.S.Turbine ❑Reciprocating []jet ❑ 1 11 GJ ABANDONED WELLS Does property have any not in use and not sealed well(s)? ❑Yes 5jeNo VARIANCE Was a variance granted from the MDH for this well? ❑Yes XNo 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. � �/ om, REMARKS,ELEVATION,SOURCE OF DATA,etc. Don Stodola Well �1�.iE� Co..WIm. 1691 Licensee Business Name Lic.or Reg.No. 2550�e ent a Signatu Certified Rep.No. Date LOCAL COPY F750621 �k Mooce Name of Driller IC 140-0020 HE-01205-10(Rev.6/06) t , riv L4n/ C XV 0 ate-or c UI nc/. 617 13th Ave So Hopkins_Minnesota 55343 (612) 935 - 3556 05/07/2007 Stodola Well Drilling 3841 North Main St. Boni facies MN 55375 938-2111 REPOP VCIF WATER ANALYSIS Lab M 151BN Our Laboratory reports these analytical results, determined on a sample taken by CLIENT on 05/03/2007 from the following location: Chris Standish 305 Willow Dr. S Orono,Mn Well 750621 Coliform Bacteria < 1/1 CIO 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 iot include analysis of Lead and oth.or contaminants. (Unless as specified by client). Twin City Water Clinic, Inc. Bill" L�i dale L ib(citlication t 027-053.110 MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and BoringLL,GiI I C O A County Na BORING LOCATION WELL AND BORING SEALING RECORD Minnesota loUnique Well No. J Q�l• 60 County Name Minnesota Statutes,Chapter 1031 or W-series No. (Leave blank R not known) Township Narne Township No. Range No. Section No. Fraction(sm.—Ig.) Date Sealed Date Well or Boring Constructed U i GPS Latitude degrees minutes seconds Depth Before Sealing 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 li A�1 305 Willow DC S, Olono, M 55356 WELL/BORING x1Measu/ed E]EstimatedDate Measured-... o Water-Supply Well F1 Monit.Well Show exact location of well or boring Sketch map of well o boring j in section grid with"X" location,showing pro erty�C ❑ ❑ Env.Bore Hole Otherft. below E]above land surface N ds,and buil n^�` CASING TYPE(S) --- - C O Steel ❑Plastic ❑Tile ❑Other ---f---- l WELLHEAD COMPLETION W E «33TT --- ---r Outside: ❑Well House ❑At Grade Inside: ❑Basement Offset � "`..,� X Pitless Adapter/Unit ❑Buried ❑ Well Pit --T-- ❑Well Pit E]Buried S ❑Other )--1 Miley ,.f ❑Other _ PROPERTY OWNER'S NAME/COMPANY NAME CASING(S) Diameyerf,f / Depth r Set in oversize hole? Annular space initially grouted? Prope own is mai mg a dress 40,even an well location address indicated above 4L in.from to //&ft. E]Yes to ❑Yes ❑No E]Unknown n.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown n.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 1167 to , U ft. Open Hole from l0 ft. OBSTRUCTIONS ❑Rods/Drop Pipe ❑Check Valve(s) ❑Debris ❑Fill X No Obstruction Type of Obstructions(Describe) GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? ❑Yes ❑No Describe FORMATION -- PUMP It�not 7fknown,indicate estimated formation log from nearby well or boring. �J © Type E]Removed Klot 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 MATERIAL(S) (One bag of cement=94 lbs.,one bag of bentonite=50 lbs.) _ / Grouting Material!"jillio _ "'Mom 0 to/20 ft. yards 0 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 •to&la well Drilling Co., Inc. 1691 Contractor Business Name License or Registration No. presentative Signatufel Certified Rep.No. Date LOCAL COPY " 2 5 8 4 6 4 Name of Person Sealing Well or Boring f, HE-01434-09 IC#140-0423 6/06R