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Home My WebLink AboutWell info WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIc?UEWELL NO. �� CountyName WELL AND BORING RECORD {� Minnesota Statutes, Chapter 1031 � � � L?� � � Towns ip a Township No. Range No. �fiection No. Fraction WELL DEPTH(completed) Date Work Completed n. '/. '/< '/. Z 8"'�"'� G DRILLING METHOD LOCATION: Latitude degrees minutes seconds Longitude degrees minutes seconds ❑Cable Tool j Driven Dug U Auger �Rotary Jetted House Number,Street Name,City,and Zip Code of Well Location or Fire Number � DRILLING FLUID WELL HYDROFRACTURED? [_I Yes .�Na Show exact loca i o we I i ection gri wit . �Sketch map of we!I location. "'�"•t�t� FROM R.TO ft. Showing property lines, N roads and buildings USE ' []Moniroring ❑Heating/Cooling �-� I I I 1 , Domestic Environ.Bore Hole ',Industry/Commercial --'--- --'--- ---`-- ---'— � l_� _..,. �. j j ' 1 � � i Noncommunity PWS [ �Irrigation ❑Remedial ; � CASING M1 - � � � , �Community PWS �Dewatering ❑ � --'--- --i--- ---`- OLE D M . w ; ; ; � e T � Drive Shae?�Yes ❑No �A H ; __;___ _;__ ._�__ ___;__ I �Steel �-� �Threade �]Welded i�� '/Mile ❑Plastic �.: --�--- --�-- ---�-----%-- 1 CASING DIAMETER WEIGHT g � � 4:, � "T� \,� _�__in.to �ft. ��Ibs./ft. �_in.to�_ft. �—�Mi�e� _ in.to_.___ ft. Ibs./ft. � in.t��ft. PROPERTY OWNER'S NAME/COMPANY NAME in.to ft. Ibs./ft. .t ft. �u�#� C SCREEN OPEN HOLE Property owner's mailing address if different than weil location address indicated above. Make FROM �� ft. TO �� ft. � �+ a� Type Diam. _,_ Slot/Gauze Length Set between ft.and it. FITTINGS STATIC WATER LEVEL ft. below ❑above land surface Date measured WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(b ow land surface) ft.after hrs.pumping g.p.m. WELL HEAD COMPIETION Well owner's mailing address if different than property owners address indicated above. �Pitless adapter manufacturer �?Y�+� � n �• lvtodel ❑Casing Protection �12 in.above grade '�;At-grade(Environmental Wells and Boring ONLY) , GROUTING INFORMATION Well grouted es U No - Grout material �eat cement [_J Bentonite n Concrete�`High Solids Bentonite from _�__to�ft _� _yds. �,'bags from_�to_�_ft.��tf[f�gs HARDNESS OF ��t�� GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO from to ft. ;�yds. bags NEAREST KNOWN SOURCE OF CONTAMINATION ��C b� �t V �L. :._!"''_� feet "�'`...� direction >._X_+. .,:..�S�a�.iat.yYPe Well disinfected upon completion ��es ��No ..:',�„A,,.,�, C� U�j L� lq 4Z PUMP J l 4 !"' � (_]Not installed Date installed �_�l " - � �+�$. f� �� Manufacturer's name - _ «--..� Model number HP�_��_Volts a`ii{Iiu $9 Lt � �1Q Length of drop pipe l�J� ft. Capaciry g.p.m. Type:� � ubmersible ❑L.S.Turbine ❑Reciprocating �;Jet ❑ �L�I 'ilO Z�AB DONED WELLS Does property have any not in use and not sealed well(s) 'L;Yes No Cl � b,� 'Ft 2W VARIANCE "'+"'�-`+ g`�� white/ Was a variance granted from the MDH for this well? ❑Yes - No TN# s� ""`+��t(�f t't �� A WELL CONTRACTOR CERTIFICATION �V This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. RThe information contained in this report is true to Ihe best of my knowledge. � T•imE+$�� fieet,ifneeded r� �,' ��` Use a sec REMARKS,ELEVATION,SOURCE OF DATA,etc. Licensee Business Name Lic.or Reg.No. i `�: /„�-G'/ or¢e presentative Signatur Date l+liLli�� LOCAL COPY � '`j �� ^ F,� Name olDiiller 1" �'} �3 HE-01205-08(Rev 5/02) IC 140-0020 r�� c�-y w�-� c � � , r� 617 13th Ave So � Hopkins, Minnesota 55343 � (612) 935 - 3556 08/OS/2004 Stodola Well Drilling 3841 North Main St. Bonifacius MN 55375 938-21 1 1 d REPORT OF WATER ANALYSIS Lab #: 603 Our Laboratory reporis these analytical results, derermined on a sample taken by CLIENT on OS/03/2004 from the following location: Ken Youngberg 1513 Bay Ridge Rd. , Orono,Mn Unique Well #711468 Coliform Bactevia <1/)00 ml Nitraies Nitrogen <1.0 mg/I The results of these tesrs indicate that this well is producing water that meets the standards for F.H.A., V.A., or conventional loans. This reporr is an analysis for colifarm and nitrate only and does not include analysis of Lead And other contaminants. (Unless as specified by client). in City Water Clinic, Inc. ,, Bill`y rsdale Lab Certification#027-053-119 WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring '„I ��1 �� County Name WELL AND BORING SEALING RECORD Minnle ota Unique Well No. J' Minnesota Statutes,Chapter 1031 or W-series No. . (Leeve Wenk H not bwvm) Tawnship Na e Township No. Range No. Section No. Fraction(sm�Ig) Date Sealed Date Well or Boring Constructed (?[Oi]ri 1�7 2 1� ��. �. � � � � , r GPS �� de9rees minutes seconds f LOCATION: Depth Before Sealing �J R. Original Depth�� fl. Longitude degrees minutes seconds AQUIFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Welt or Boring Location Single Aquifer ❑MuRiaquifer 1J13 � �i Rd� O�fl'I� �5391 WELUBORING Measured ❑Estimated Water Supply Well ❑Monit.Well � Show exact location of well or boring Sketch map of well or bonng in section grid wtth"X" Ixation,showing property ❑Env.Bore Hole ❑Other �_ft. �below ❑above land surface N lines,roads,and buildings. CASING TYPE(S) t Steel ❑Plastic ❑Tile ❑Other 1� W -- - -i-- -i-- --i— E `(1, WELLHEADCOMPLETION r � � � � � ,�� - Outside: ❑Well House Inside: ❑Basement Offset ' —�- -�-- -i-- --i— � `� 1�� y/�Pitless AdaptedUnit ❑Well Pd --�- -�-- -�-- -�-- � j� ❑Well Pit ❑Buried S �'—'"'�'—�' ❑Buried PROPERTY OWNER'S NAME/COMPANY NAME CASING(S) Diam �r� Depth � Set in oversize hole? Annular space initially grouted? Property owner s mailing a ress i erent n well location address indicated above /1 in.from5.� t0��ft. ❑Yes �No ❑Yes ❑No ❑Unknown in.from to ft. ❑ves ❑No ❑ves ❑No ❑Unknown in.f�ortl to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown WELL OWNER'S NAME/COMPANY NAME SCREEWOPEN HOLE �j�J/� � f Well owner's mailing address if ditterent than properry owner's address indicated above Screen from��t0�ft. Open Hole from t0 n. OBSTRUCTIONS Rods/Drop Pipe ❑Check Valve(s) ❑ Debris ❑ Fill ❑ No Obstruction Type of Obstructions(Describel�,G.�s�'��'��/.� @ �/�YY� � GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? YES ❑ NO Describe FORMATION If not known,indicate esfimated forma6on log from nearby well or boring PUMP Cj ; .,�, TYPe Removed ❑ Not P esent ❑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 MATERIA�(S) (One bag of cement=94 Ibs.,one bag of bentonite=50 Ibs.) / . Grouting Materia7lA�/f�,�,T�/?%tl?from�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 infortnation contained in this report is true to the best of my knowledge. ^r Contractor Busipess �ame �/ - �r��- License or Registration No. y�,; f ... ..-. ./ r.. ' � �-C �"` J�� .,�t. t n R� ��sentativeSignatu�e Date LOCALCOPY H �25139 ��JL��v� `,,_/"o�.�'�"� �-n-f�7�---- Name o/Person Sealing Well or Boring