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Home My WebLink AboutWell info WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. � CountyName WELL AND BORING RECORD 6 5 5 0 5 5 Minnesota Statutes Chapter 103! Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed i. . �T� n Z2�28��0 House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD ❑ Cable Tool �iven C7 Dug ❑ Auger Rotary ❑ Jened Show exact location of well in section grid with"X". Sketch map of well location. i.�l � �� Showing property lines, -----.._--------------�—�----------- �� roads and buildings. DRILLING FLUID WELL HYDROFRACTURED? ❑YES �fJO " �� vater , , � , FROM n.�o n. ,- -;- -;- -, � USE J ❑ Monitoring ❑ Heating/Cooling , i i i �,ySi Domestic ❑ Communi PWS f7 Irrigation Ty ❑ Indusiry/Commercial i i i i � [,.� ❑ Noncommunity PWS ❑ Remedial w I ' I I E r � C� Environ.Bore Hole ❑ Dewatering ❑ -r --�- -r- -r i i i i � CASING Drive Shoe? ❑ Yes o HOLE DIAM. /2Mne _i _i_ _L_ _i_ I ^ ��L �Steel ❑ Threaded ❑ Welded � � � � 1 U ,r, Plastic ❑ S �t Mile-� CASING DIAMETER WEIGHT PROPERTY OWNER'S NAME � in.to_��fl. Ibs./ft. �in.to�' tlj in.to fl. Ibs./ft. in.to Property owner's mailing address if di rent[han well location address indicated above. in,to ft. Ibs./ft �in.to� SS�C SS above SCRE�jJ�t.�_a�r�_ OPEN HOLE MakeJ T from ft.to ft. Type St81IZ�Q88 .��e�l__ Diam-•/ SIoUGauze f1 /� y� �t •V�St.---------------.--Length '� Setbetween ��'� ft.and_�.T_�__ft. FITTINGS:7��(3�~_.�,�� - STATIC WATER LEVEL WELL OWNER'S NAME �5 ft.�elow ❑ above land surtace Date measured�'��._� O - PUMPING LEVEL(below land surface) Well owner's mailing address if different than property owner's address indicated above. _ r� ft. after___ hrs.pumping_ g.p.m. --�-}H----- �--------- ---� �L HEAD COMPLETION - Pdless adapter manufacturer vh i t e�t e r Model ❑ Casing Protection___ _�2 in.above grade ❑ At-grade(Environmental Wells and Borings ONLY) GROUTING INFORMATIQN � Well grouted? ➢e�Yes G No GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO Grout Material ❑ Neat cement '�l Bentonite ❑ Concrete �High Solids Bentonite MATERIAL from to ❑ yds.�bags � ��t --�— from_._ to ft. s. ❑ bags cla ellow ffiediw� 1 � ��'� �S#��'i'21 from_ to ft. ❑ yds. ❑ bags NEAR/ES-T KNOWN SOURCE OF CONTAMINATION�J � C18 TS8 30f� �, 9 ---tC�� _feet �C'Jdt I�`'� direction �� j � type Well disinfected upon completion? j�Yes ❑ No ��.'+�(-�J j�/F(,.. saud (fine) bro�n sof t 9 22 PUMP ❑ Not installed Date installed�__4"'u,1 ' ��8 brown mediun� 42 25 ManufacturePsname v��_____. _ 10�Se/CQar$� Modelnumber ___ HP.7(�_____ VOIts23V sandstone Nhite ��ft Z6 L7 Lengthofdroppipe L9 ft. Capacity ___ _ ___g.p.m. �T Type:�Submersible ❑ LS.Turbine ❑ Reciprocating ❑ Jet ❑ _ ABANDONED WELLS Does property have any not in use and not sealed well(s)? ❑ Yes �No VARIANCE Was a variance granted from the MDH for this well? [, Yes �o TN#_. �� WELL CONTRACTOR CERTIFICATION Use a second sheet,il needed This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. � The information contained in this report is true to the best of my knowledge. REMARKS,ELEVATION,SOURCE OF DATA,etc. � ° Stodola �lell Dril2ing Co,� Inc.. _.27 72 �: � Licensee$usiness Name Lic.or Reg.No. �� -: � " '� 2-12-�OI : ; �"� ' - � � .�._ _ -� ,., . . --- _ — uthorize prese hv Signature Date Chuck Moore IZ-28-�1 Name o/Orillei Date LOCAL COPY 6� 5 0 5 5 HE-01205-07(Rev.4/99) . . rw� c�-y w�-� c � � , I �,�. 617 13th Ave So � Hopkins, Minnesota 55343 � (612) 935 - 3556 0l/02/2001 Stodola Well Drilling 3841 North Main St. Boni facius MN 55375 938-21 1 1 REPORT OF WATEK ANALYSIS Lab #: 748 Our Laboratory reports these analytical results, determined on a sample taken by CLIENT on 12/28/2000 from the following location: Mark Versteeg 1384 Baldur Park Rd Orono,Mn Unique Well #655055 Coliform Bacteria <1/100 ml Nitrates Niirogen <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. Thi.s report is an analysis for coliform and nitrare only and does not include analysis of Lead and othev contaminants. (Unless as specified by client). T�v� Cit Water Clinic, Inc. �� Bill Vb�Arsdale Lab Certification#027-053-119 � . - MINNESOTA DEPARTMENT OF HFALTH Minnesota Well and Boring ��n�� WELL OF BORING LOCATION Sealing No. ��H_ a �o��Y Name -- — WELL AND BORING SEALING RECORD M;�„esota u��q�e we��No. r -- � �e�A$p�A Minnesota Statutes.Chapter 1031 or W-series No. �— �Leaw denk rc na known� Township Name j Township No. �Range No Section No. Fracuon 1sm.-i Ig 1 Date Sealed Date Well or Boring Constructed Otono ; 217 Z 08 3�1-� � Numeprical Street Adtlress or Fire Number and Gry of Well or Bonng Locat�on ( / 1.7Q+F 881��. P�rA A�,� Or,Od� SS37 Depth Before Sea6ng��____fl Original Depth 9�1 h Show exact location of v.�ell or boring Sketch map of weil or boring A IFER(S) STATIC WATER LEVEL m section gnd with"X". �i locatwn, showmg property Single Aqurfer ❑ MWtiaquifer 1 lines,roads,and buildings N WELL/BORING Measured ❑ Eshmated � ' I I , � Env.BorePHole ❑OtheL Well t ; Water Su I Well ❑Mon �7,� I � � ❑ r _ _�L.�—ft. IRbelow ❑ above land surtace �� r- W --�- - -- - -- -- -- E CASING TYPE�S) � , , � � � i i� \, � —�- -;-- -;-- --�— � ; _� Steel ❑ Plastic �Tlle � Other LL i � /[mI�B --�- -i-- -�-- --i— � � CASING(S) Diameter Depth � Set m oversize hole? Annular space initially grouted? S �i �� Yes �No ❑ Yes ❑No ❑ Unknown ��m,��{, _�,�_ in.irom O to R. ❑ I PROPERTV OWNER'S NAME in.from to fl. ❑ Yes ❑No ❑ Yes ❑No ❑ Unknown Property ownei s mailing address d erent than well iocation address indicated above. in.from to fl. ❑ Yes ❑No ❑ Yes ❑No ❑ Unknown SBAe 8$ BbOY� SCREEWOPEN HOLE ' � Screen from_�_to� ft. Open Hole from to tt. 08STRUCTIONS WELL OWNEF'S NAME Rods/Drop Pipe ❑ Check Valve(s) ❑ Debris ❑ Fill ❑ No ObsVuction •�-�- Well owners mailing a0dress it diBerent than properry owner's address indicated above. Type of ObS�ructions(Describe) �� ,o.�E� �- P�n�P Obstruclions removed? Yes ❑ No Describe PUMP /� TYPe b'��Cl��L�1 6EOLOGICAL MATERIAL COLOR HARDNESS OF FROM TO Removed ❑ Not Present ❑ Other FORMATION If rat known,indicate estimated formatbn log from nearby well or boring. �METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: �o Annular Space Exists �� r ❑Annular space grouted with tremie pipe ❑Casing Perforation/Removal in.from to ft. ❑ PeAoreted ❑ Removed in.from �o ry. ❑ Perforated ❑ Removed Type of perforator ❑ otner GROUTING MATERIAL(S) (One bag of cement=94 Ibs.,one bag of bentonite=50 Ibs.} Grouting Matenal r6m _� to�_ h _ __ ya�ds _ � hags 5. --_ trom to R. yards bags from to ft. yerds begs from to__ fl. yards bags �., ._._r.:_., � REMARKS,SOURCE OF DATA,DIFFlCULTIES IN SEALING OTHER WELLS ANO BORINGS Other unsealed and unused well or boring on property? ❑Yes No How many? LICENSED OR REGISTERED CONTRACTOR CERTIFICATION This weli or boring was sealed in accord n„e svitF F n � �.o!=Floles,Ch�pr� -_: - ,,-nc,i�o�:;ntainin�i-�n inia�sport ie true ro the best of my knowledge. " �a Stodols �iel.l Drilling Co., Ioa. 27ITZ Contractor 6us;ness Namc License or Regisfrefion hip. � ,,,�- ,5- Q ! � - � e resentative Signa�uYe � pete � �iIM1IYY� �../`.."Y`/ '."'1I^h.,,I�!„�}�""y'�"'+...r 1` ___. . _.___ __— �d��!_��y H �w�^�� Name ol Person�ing Well or Boring i M �> ' WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring H � 2 3� 2 5 County Name WELL AND BORING SEALING RECORD Menn�esoNa Unique No. } � p�=,�,:; � r2 Minnesota Statutes,Chapter 1031 or W-series No. (Leave blank If not known) Township Name Township No. Range No. Section No. Fraction(sm.�Ig.) Date Sealed Date Well or Boring Constructed ��L� �.�.� _� � J iMi:� �i� 'b �f..a`'�. at'� t �.�c1`' '�t"�'�f}F `'. Numerical Street Address or Fire Number and Ciry of Well or Boring Location 1�F !k t •_3��#`� �;�°=7��t��'' f�ks�t� ��! DepthBeforeSealing � � �� tt. OriginalDepth �� ft. Show exact location of well or boring Sketch map of well or boring A UIFER(S) - STATIC WATER LEVEL in section grid with"X". � location, showing property Single Aquifer ❑ Multiaquifer lines,roads,and buildings. N WELUBORING [�Xvleasu�ed ❑ Estimated � � ��Water Supply Well ❑Monit.Well 4U _ _Y_ _ __ __l__ � ❑ Env.Bore Hole ❑Other ft. �below ❑ above land surface —�- -�-- -;-- --i-- W E t�'1 k^^"^'�] CASINGTYPE(S) � � � � � �nil � -;-- -;-- -�-- --�-- � �� Steel ❑ Plastic ❑Tile �Other Y.mile - -�-- -�-- --�-- � . CASING Diameter Depth � Set in oversiz�e7 Annualar space initially grouted? S �J� �lh—i m��e--q� in.from �} to � � ft. ❑ Yes No ❑Yes ❑No ❑ Unknown I PROPERTY OWNER'S NAME in.from to ft. ❑ Yes ❑No ❑Yes ❑No ❑ Unknown Ai�t� 4��3 ,�i}?.I:E V�R�'�°E�U Property owner's mailing address if ditterent than well location address indicated above. in.from to ft. ❑ Yes ❑ No ❑Yes ❑No ❑ Unknown �,.3�� E�ISIa�UN �Ak�C JZI) SCREEWOPENHOLE .��}� � �TJ�y� Screen trom �''� to � 7� ft. Open Hole from to ft. OBSTRUCTIO WDEBRIS/FILL WELL OWNER'S NAME ,�� ❑ Obstruction ❑ Debris ❑ Fill �NoObstruction Well owner's mailing address if diiferent than properry owners address indicated above. Type of Obstruction/Debris/Fill ObstructioNDebris/Fill removed? ❑ Yes ❑ No PUMP �,�!k3 Type GEOLOGICAL MATERIAL COLOR HARDNESS OF FROM TO � Removed ❑ Not Present ❑ Other FORMATION It not known,indicate eslimateG formation log from nearby well or boring. METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: �)�`�' (:t c�� (f�{��' � ��y r,p�No Annular Space Exits T'" ❑ Annular space grouted with tremie pipe F SNF. :iAN€) GRAY ":�i �C) ❑ Casing PeAoration/Removal F-.;..��'4. J��}!.� F��.�� 1.�.�,. in.from �o n. ❑ Perforated ❑ Removed ��T ��Y ��Y ��x�-� in.from to ft. ❑ PeAorated ❑ Removed Type of perforator ❑ Other GROUTING MATERIAL(S) i't?IK`�'I,ANl� � ";� :'s(,�[��` ,'� Grouting Material from to ft. yards bags from to ft. yards bags from to ft. yards bags from to__ ft. yards bags REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING UNSEALED WELLS AND BORINGS �.i�.U1..��.s� N��1�"�; ;F1?'%�% �'t){�`�'1"i ��R�". � �therunsealedwellorboringonproperty? ❑ Yes � No �fIA��'L',R LL'V�L 1.N �U.�UV� �L.LL: �O f UCENSED OR REGISTERED CONTRACTOR CERTIFICATION �..s�1�`��'. �:��'�� Le�'1V�J. TA��N: �.Q'-'��" f. This well or bonng was sealed in accordance with Minnesota Rules,Chapter 4725. The information contained in this report is t.,, � �,l true to the best of my knowledge. t�<.l�_ �ti�;t�tA1Lf? & 7C)t�iS, INC: . 7#.t�'� '� Conhactor Business Name License or RegistreNon No. . �:.as -. , . .�` �� ' ��f��fj'? .. � _ Authonzed Representative Signature 1 Date n.-�- ` �:�;� �' �� P��E �� R�' .. � . ��:�._ �� :�s,,��:��t;.�zL�:.sr�fx�:v�N �a�� LOCAL COPY H 12 3 3 2 5 Name ol Person Sealing Well or Bonng HE-01434-02 10/95R