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Home My WebLink AboutWell and Boring Record } MINNESOTA UNIQUE WELL WELL/BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. County Name WELL AND BORING RECORD Hennepin Minnesota Statutes,Chapter 1031 743401 Township Name Township No. Range No. Section No. Fraction WELUBORING DEPTH(completed) DATE WORK COMPLETED Orono 117 23 I 03 ft. GPS DRILLING METHOD L1 Cable Tool Ll Driven El Dug LOCATION: Latitude degrees minutes seconds Longitude degrees_ minutes seconds_ ❑Auger XAotary ❑Jetted House Number,Street Name,City,and Zip Code of Well Location or Fire Number LI 450 Willow Dr $ Orcxw 55356 DRILLING FLUID WELL HYDROFRACTURED? ❑Yes o Show exact location of well/boring in section grid wit "X." Sketch map of well location. Nater From ft.To ft. Showing property lines, N roads,buildings, USE omestic 1-1Monitoring 11Heating/Cooling Iand direction. ❑Noncommunity PWS EJ Environ.Bore Hole 11Industry/Commercial " ?------'------- t 1 a ❑Community PWS ❑Irrigation ❑Remedial ❑Elevator ❑Dewatering ❑ CASING MATERIAL Drive Shoe? ❑Yes ❑No HOLE DIAM. W E ❑St eel ❑Threaded 11Welded , lactic 11 /z Mile CASING I t Diater 116 Weight_ _ Specifications's S '2 aster �1 Mile� \ f in.to ft. Ibs.ttt. in.t 30 ft. in.to ft. lbs./ft. in.t ft. PROPERTY OWNER'S NAME/COMPANY NAME in.to ft. lbs./ft. in.to ft. Smn Valentine SCREEN OPEN HOLE Property owner's mailing address if different than well location address indicated above. Make From sl"ft.To ft. 12600 OrchardRd Type stainless stl Diam. 2 _ Nim*tomka� � 55305 Slot/Gauze _020 Length 60 ;fit rLL VIiR�II .rill Set between ft.and ft. FITTINGS - STATIC WATER LEVELL�/ ft.Xelow ❑Above land surface Date measured 9-7 PUMPING LEVEL(below land surface) WELL/BORING OWNER'S NAME/COMPANY NAME 114ft.after 2 hrs.pumping 30 g.p.m. W LL HEAD COMPLETION Well/boring owner's mailing address if different than property owner's address indicated above. OrVitless Adapter Manufacturerel El Casing Protection 2 in.above grade ❑At-grade(Environmental Well and Boring ONLY) GROUTING INFORMATION Well grouted? P(Yes ❑No Grout materials ;--1 Neat cement Bentonite El Concrete ❑Other From -0 To30� ft. 3 ❑Yds. ❑Bads -From_�__To i�46 ft.�—fjlli ElBags GEOLOGICAL MATERIALS COLOR HARDNESS OF MATERIAL FROM TO - From To ft. LlYds. 17 Bags NEAREST KNOWN SOURCE OF CONTAMINATION �,ry feet direction m,». '!*" —tyl- topwil black Well disinfected upon completion? es ❑No PUMP cls ❑Not installed Date installed {� said gmy soft 93 12A Manufacturer's name Model Number HP + Volts Length of drop pipe ft. Capacity 9.p-m. Type: Submersible ❑L.S.Turbine ❑Reciprocating ❑Jet ❑ ABANDONED WELLS Does property have any not in use and not sealed well(s)? ❑YesJo 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,i/needed. � � REMARKS,ELEVATION,SOURCE OF DATA,etc. r 7f�`.a&1s � 11Dri1ling Co.. Im. Licensee Business Name ,.� "O Lic..or Reg.No. Iv2- G 0(0 A horized Representative ;gnature Date Chwk Mom LOCAL COPY 743401 A 3 4 n Name of Driller '+ t,.! HE-01205-09(Rev.9/05) IC 140-0020 TwwvCXy W at� C ' ' , I'nocr. 617 13th Ave So Hopkins, Minnesota 55343 (612) 935 - 3556 09/11/2006 Stodola Well Drilling 3841 North Main St. Boni facius MN 55375 938-2111 REPORT OF WATER ANALYSIS Lab #: 593BN Our Laboratory reports these analytical results, determined on a sample taken by CLIENT on 09/07/2006 from the following location: Susan Valentine 450 Willow Dr. S Orono,Mn Well#743401 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). Nin'City Water Clinic, Inc. Bill rsdale Lab Certification#027-053-119 i WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring H County Name WELL AND BORING SEALING RECORD Minnesota No. Sealing Minnesota Unique Well No. -251769 Minnesota Statutes,Chapter 1031 or W-series No. !�. - (Leave Blank n-known) Township Name Township No. Range No. Section No. Fraction(sm i Ig) Date Sealed Date Well or Boring Constructed Orono 1.17 23 03 32-M12"_ // �t ✓(� GPS Latitude degrees minutes seconds , LOCATION: Depth Before Sealing �-�`4/ ft. Original Depth ft. Longitude degrees minutes seconds QUIFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location Single Aquifer ❑Multiaquifer = WELUBORING Measured E] Estimated 14 50 {y Water Supply Well ❑Monit.Well f Show exact location of well or boring Sketch map of well or boring , t7 t in section grid with"X" �' location,showing property E]Env.Bore Hole E]Other 7 ft. pelow ❑above land surface N lines,roads,and buildings. CASING TYPE(S) ----- (71 74 Steel ❑Plastic ❑Tile ❑Other W -�- -i-- -i-- --i-- E } WELLHEAD COMPLETION Outside: ❑Well House Inside: Basement Offset ❑Pitless Adapter/Unit ❑Well Pit -- - -i-- -i-- --�-- 't ❑Well Pit ❑Buried ❑Buried PROPERTY OWNER'SSrNAME/COMPANY NAME CASING(S) Susan ValAnt ine Diame e�i r Depth i Set in oversize hole? Annular space initially grouted? Property owner's mailing address if different than well location address indicated above ,[ in.from to ft ft. ❑YesFlo ❑Yes E]No E] Unknown 12W Orchard Rd n ,\ 14innetonT a, � 55305 in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown in.from t0 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�t0- L. ft. Open Hole from t0 ft. OBSTRUCTIONS ❑ Rods/Drop Pipe ❑ Check Valve(s) ❑ Debris ❑ Fill ;KNo 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 Type ❑ Removed X,of Present ❑Other J 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 Ibs.) Grouting Material A241'7 from to `-L' 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 KNO 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. F1on Stodola Well Drilling Co,. Inc. 1691 Contractor Busine Name License or Registration No. J, / t ri j epresentative Sig ature' Date LOCAL COPY � H251769 , Name of Person Sealing Well or Boring