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Home My WebLink AboutWell info y MINNESOTA DEPARTMENT OF HFALTH M�nnesota Wef and Bonng i WELL OR BORING LOCATION Sealmg No I�"� �� "��S � Counry Name WELL AND BORING SEALING RECORD M,��eso,a��,q�e No r � p Minnesota Statutes,Chapter 1031 or W-senes No. I Henne in l�eave biank�I not known� L Townshlp Name Township No. Range No. Section No. Fractwn(sm.-s Ig.) Date Sealed Date Well or Boring Constructed Qrono 127 23 - Numerical Sheel Adtlress or Fire Number and Ciry of Well or Bonng Location /']�/ t/]� � �8 5 .[7� �1 e R Depth Before Sealing ,""r R. Original Depth . f`�� h Show exact Ixation of�-ell or boring Sketch map of well or bor�ng A UIFER(S) STATIC WATER IEVEL m section giid with'X'. locauon, showing property Single Aywfer ❑ Multiaquiter lines,roads,and bwldings N W LUBOFiING Measured ❑ Estimated , �_ Water Supply Well ❑Monit Well / _ _ _T_ _ _ ❑ Env.Bore Hole ❑Other _ _ � H. �below ❑ above land surtace W —�- -i-- -i— -- -- E CASING TVPE(S) � � � � � � � � ' —�- -;-- -�-- --�-- � Steel ❑ Plastic ❑Tile � Other ti mrle ` I CASING -�-- --i-- --i-- � � � Diameter Depth � Set in oversrze hole7 Annualar space mitially grouted? � S �� m�� `�� _ in trom � to �� ft. ❑ Yes No ❑ �es ❑No ❑ Unknown PROPERTV OWNER'S NAME in.from to R. ❑ Ves ❑No ❑ Yes ❑No ❑ Unknown Property ownei s mailing aWress if diflerent than well locafion address indlcated above. in.from to tt. ❑ Yes ❑No ❑ �es ❑No ❑ Unknown 2II2 S FL�X S t SCHEEWOPEN MOLE r / w�y�i��i� t`il' 5 5 391 Screen from J�to /� ft. Open Hole from to R. �t 7 3!2 78 3 ossraucnoNs WELL OWNER'S NAME Rods/Drop Pipe ❑ Check Valve(s) ❑ Debris ❑ Fill �lo Obsiruction Well owner's mailing a4Aress if diflereN Man properry owner's adtlress indicated above. Type Of ObstruClions(DesCribe) Obstructions removed? ❑Yes ❑ No Describe PUMP Type 6EOLOOICAL MATERIAL COIOR HARDNESS OF FROM TO � Removed �Not Present ❑ Other FORMATION � If rat krawn,indicate esUmated formatan log from nearby well or boring. M�E,yT{HOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOIE: J4J No Annular Space Exists �� ❑Annular space grouted with tremie pipe � � ❑ Casing Perforation/Removal f in.from !o ft. ❑ PeAorated ❑ Removed in.from �o ry. ❑ PeAorated ❑ Removed Type of peAorator ❑ Other GROUTING MATERIAL(S) rr GroutingMatenal�"" ��-'�'''�'�" from Q to! � 'R. yards � bags from to R. yards bags from to fl. yards bags f�om to__ ft. yards bags REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING OTHER WELLS AND BORINGS Other unsealed and unused well or boring on propeAy7 ❑Yes o How many? LICENSED OR REGISTERED CONTRACTOR CERTIFICATION This well or boring was sealed in eccordance with Minnesota Rules,Chapter 4725. The information confeined in this report is true to the best ot my knowledge. Don Stodola We31 Dri.11i�g Co. , Inc. 27172 Conhedor Business Na r ,t License a Registrefbn I'.o. ._,_.��./'� f� �� <,, -� �:�r A nz epresenfative Sig Nre' Dete �� ; � y/I�.�.. .r"'./1. "J'✓-�1a��./'e...1_� 'Y �1.� Name ol Persan ling Well or Boring LOCAL COPY �"� HE-01434-04 8�98 R f Twin City Water Clinic , Inc . 617 13th Ave So � Hopkins, Minnesota 55343 � (612) 935 - 3556 06/26/1999 Siodola Well Drilling 3841 North Main St. Bonifacius MN 55375 938-21 1 1 REPORT OF WATER ANALYSIS ' Lab #: 37283 Our Laborarory reports these analyrical resulis, deiermined on a sample iaken by CLIENT on 06/23/1999 from the following location: Dave Peterson 3855 Bayside Rd. Orono,Mn Unique Well #624935 Coliform Bacteria <1/100 ml Nitrates Nitrogen <1 . 0 mg/1 The resulrs of these iests indicaie that this well is producing water rhat meets the standards for F.H.A., V.A., or conventional loans. This report is an analysis for coliform and ni[rate only and does not include analysis of Lead and other contaminqnis. (Unless as specified by client). i a er Clinic, Inc. Bil! � sdale Malyical laboratory Consulting�nguieer Water Analys�s Reagents Boilar Water Chemicals Lab Cert�caGon#027-053-119 • WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. CountyName . WELL AND BORING RECORD 6 2 4 9 3 5 Hennepi n Minnesota Statutes Chapter 1037 Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed �rano 117 23 45 ,,. ,, ,,, 1Ifl� � 6-23-99 House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRI�LING METHOD C ,a ❑ Cable Tool ❑ Driven ❑ Dug �JS ��.'�►f�� au Orono, �• ❑ Auger �1 Rotary ❑ Jetted Show exact location of well in section grid with"X". Sketch map of well location. ❑ Showing property lines, roads and buildings. DRtLLING FLUID WELL HYDROFRACTURED? ❑YESX[7 NO " Bentintbe , , , , } FROM n:co n. -,- -;- - - -,- ��t�,4 USE ❑ Monitoring ❑ Heating/Cooling i i � i �1 Domestic �_ _�_ _�_ _i_ ❑ Communiry PWS ❑ Industry/Commercial i � i i � ❑ Irrigation ❑ Noncommunit PWS w E T ❑ Environ.Bore Hole Y ❑ Remedial i i i � ❑ Dewatering ❑ i i r i �/ZIM;ia CASING Drive Shoe? ❑ Yes No HOLE DIAM. - _i_ _ i_ _i _ _i_ ❑ Steel ❑ Threaded ❑ Welded i l i i 1 x] Plastic ❑ C�7 s�n �1 Mile� h4 i f} '�"� { �t�-+� �O CASING DIAMETER WEIGHT PROPERTY OWNER'S NAME '4 in.to �02 ft. 2�05 Ibs./ft. � in.to 31 �ft. P��gy Peterson in.to ft. Ibs./ft. �in.t�j�ft. Property owner's mailing address if different than well location address indicated above. in.to ft. Ibs./ft. in.to R. SCREEN OPEN HOLE Make JD n�1 from ft.to ft. Type .�Stgirll��$ Steei Diam. �M SlotlGauze_ ��1� Length �� 9 � Set between 1�Z ft.and � �ff ft. FITTINGS: 2 x x J�~ fIT� STATIC WATER LEVEL WELL OWNER'S NAME 3� R.�[below ❑ above land surface Date measured�,=_�3�1�� pe��y Peterson PUMPING LEVEL(below land surface) Well owner's mailing address if different than property owner's address indicated above. �9 n. aeer 1 hrs.pumping �� T g.p.m. %Dave Peterson yWELLHEADCOMPLETION ' G�1 C tF7 Pitless adapter manufacturer Wh i t ewa t er Model 2V 6 J r'Qx s t ree t ❑ Casing Protection X7 12 in.above grade Q�C}T10� �• 55 391 ❑ At-grade(Environmental Wells and Borings ONLY) GROUTING INFORMATION _ Well grouted? C�(Yes ❑ No y GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO Grout Material ❑ Neat cement ❑ Bentonite ❑ Concrete LT High Solids Bentonite MATERIAL from � to�ft. 2.5 ❑ yds.�7 bags from to ft. ❑ yds. ❑ bags TO 80f 1 BiaCk fl� 5� from co n. ❑ ya5. ❑ bags ' NEA T OV�N SOURCE OF CON�7/q/N�JN,ATIIO�N -� 'V-(/V• direction ; Ciay Y@110W M 5� I$* feet � �� ryPe Well disinfected upon completion? ❑ Yes ❑ No �� Clay (Rocks) Grey M 18� 95' PUMP ❑ Not installed Date installed 7�$�� Water Sand Grey S 95• I 1 fl* Manufacturer's name Red Ja�cket Model number Q 1`S I S�7 HP 3 4 vons 2 30 Length of drop pipe V� R. Capacity �` g.p.m. Type:`d Submersible ❑ L.S.Turbine ❑ Reciprocating ❑ Jet ❑ ABANDONED WELLS �/ Does property have any not in use and not sealed well(s)? ❑ Yes *E] No VARIANCE ! � Was a variance granted from the MDH for this well? ❑ Yes 1J No 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. REMARKS,ELEVATION,SOURCE OF DATA,etc. The information contained in this report is true to the best of my knowledge. y D�N STODC?LA �tELL DRILLIWG C0. , INC. Licensee Busines a Lic.or Reg.No. Z'�1 T 2 .=-- 7-I2-99 Authorized ReprEsentative Signature Date Chuck Moor� 6-23-9g Name of Driller Date LOCAL COPY 6 �4 9 3 5 HE-01205-06(Rev.7/98) A � Twin City Water CI inic , Inc . 617 13th Ave So � Hopkins, Minnesota 55343 � (612) 935 - 3556 06/26/1999 Stodola Well Drilling 3841 North Main St. Bonifacius MN 55375 938-21 1 1 REPORT OF WATER ANALYSIS Lab #: 37283 Our Laboraiory reporrs ihese analytical results, determined on a sample taken by CLIENT on 06/23/1999 from the following location: Dave Peterson 3855 Bayside Rd. Orono,Mn Unique Well #624935 Coliform Bacteria <1/100 ml Nitrates Nitrogen <1 . 0 mg/1 The results af these tesis indicate that this well is producing water thar meets ihe standards for F.H.A., V.A., or conventional loans. This report is an analysis for coliform and niirate only and does not include analysis of Lead and other ccntaminc�nfs. (Un(ess as specified by clienrj. i a er Clinic, Inc. Bill � sda/e Anelyical laboratory Consulting Engineer Water Malysis Reagents Boiler Water Chemicals Lab Cert�ficauon#027-053-I 19 •