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Home My WebLink AboutWell info � --:�. .- �. �. �_ -�.�.� . -�. _. � _ , . _ ..�. . . r � _Y.. . _ _ r;��.'�': MINNESOTA UNIQUE WELL WEL�OR BORWG LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BOR/NG NO. � CountyName WELL AND BQRING RECORD p'� ''"� � ,'T,ip�,..� Minnesota St�tutes,Chapter 1037 E �l�� .: JL` , Township Nam Township No. Range No. Section No. Fraction .�-WEI;L/80RING DEPTH(cpmpleted) DATE WORK COMPLETED � �� " '/, IfiC� n 6-2'S"06 GPS - ��RILCiNG METHOD ' LOCATION: Latitude degrees minutes seconds � Longitude degrees minutes seconds � . ��Cable Toof�� 'Driven ��,Dug I �Auger .�ofary Jetted House Number,Sheet Name,City,and Zip Code of Well Location or Fire N�tber . � � �� (� �,� � S�� DRILLiNG FLUID WELL HYDROFRACTURED? ,�.1 Yes '�^' o Show exact location of well/boring in section grid with"X" Sketch map of well/boring location. -�� From ft.To ft. N roads, uildin s,an direotion� USE _ Noncosmmund py�/g � �'�Monitoring ]Heating/Cooling � �� Y 9 � _ __L____1_ __�__ ___:__ 'y �-]Environ.Bore Hole !�Industry/Commercial �,�.7 • �� `Community PWS ;_�Irrigation �Remedial �i --- �q � Elevator �Dewatering ] r�� w ' E y e. CAStNG MATERIAL Drive Shoe? � HOLE DIAM � , ; , ; T y �.J Yes �lo �r� - �--- � � : '_` . �.,. : � V� ��Steel '�__]Threaded ❑Welded , , , '/�Mile , , . , , I � tastic �J ,.: --,---—r----�-- ---:- 1 � CASING S � Diameter Weight Specifications F—�Miie—� �in.to��,.ft. 1+7 IbsJft. �� _$_in.to__�. PROPERTY OWNER'S NAME/COMPANY NAME in.to___ ft. Ibs./ft. �in.to�. � �'�,�{e'(♦� n lR��4� _ . in.to _ ft. IbsJft. in.to.__ft. s•.�s� aa�c a �7i lE: OPEN HOLE Property owner's mailing address if different than well location address indicated above. SCREEN 2�t�.�.�� y� Make From ft. To ft. ��` aW�ra �LA�i'j 3 Type �{'� Diam. � SlotlGauze "'� �yw� Length + Set between � ft.and�ft. FITTINGS � ~ � � STATIC WATER LEVEL /;� Measured irom q��,/�p L7V ft.'�. elow i__;Above land surface Date measured �4��R WELt OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) � 1C7V ft.after is� hrs.pumping 9lJ g.p.m. �.g Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION � �(� '{-_- �itless/adaptermanufacturer t.3--k��"�Al�del F � � I,J Casing Protection m.above grade . � �'�.At-grade(Environmental Well and Boring ONLY) � GROUTING INFORMATI N Well grouted es n No ,� Grout materials �..�Neat cement (_�entonite [.�Concrete 'j�'�,Other From Q To f�t � _ Yds. ags �s HARDNESS OF From � To_ .L��ft. �l��Bags -GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO From�To�t. � ]Yds. ags —*u NEAREST KNOWN SOURCE OF CONTAMINATION ---/ �� O feet � direction "»'+��.+C1 "�`�type �� PUIMPisinfected upon comple�ion? es ❑No � �� a , �` * � J Not installed Date installed � ��'`W�`� � ��i �� Manufacturer's name Model Number HP�Volts �� Length of drop pipe ��.� ft. Capacity g.p.m. Type: ubmersible ❑LS.Turbine ❑Reciprocating ' ��.Jet I ' ABAN ONED WELLS . Does property have any not in use and not sealed well(s)? '��Yes '�, o VARIANCE � Was a variance granted from the MDH for this well? [_]Yes [ o TN# WELL CONTRACTOR CERTIFICATION This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. The information contained in this report is hue to the best of my knowledge. Use a second sheet,il needed. `� REMARKS,ELEVATION,SOURCE OF DATA,etc. �� ,,��,$ �IY �I�� T�S� ��I 1 E` _ —_ ._____. — _ , Licensee Business Name Lic.or Reg.No. -�..._� ,..�,Gt+' .�_ � �,_ -�"��,�, Ce d presentative Signature-' Certified Rep.No. Date LOCAL COPY �5 0 6 �1 Name of Driller � �� IC 140-0020 HE-01205-11(Rev.3/07) i f. � �u�i�v C �,t� W�e�' C ' ' , I v�.c� y 617 13th Ave So � Hopkins Minnesota 55343 � (612) 935 - 3556 06/27/2008 STodola Well Drilling 3841 North Main St. Boni facius MN 55375 938-21 1 1 REPORT Oi�WATER ANALYS(S Lab #: 262BN Our Laboratory reports these ana(s%ticcal j esult.s, derer�r�ined on a sample taken by CLIENT on 06/25/2008 from the fol(o��ving lc�rtlon: Thad Steefe 4050 Baysii.ie Rd Orono,Mn Well 760631 Coli form Bacteria Absenr Nitrares Nitrogen <1.0 i�ng/1 The results of these tests indicate that this well rs producing water that meets the standards for F.H.A., V.A., or r.onventro��al loa��is. This report is an analysis for coliform and nitrate only and does nor include analysis of Lead and other contaminants. (Uniess as specijied by cl;ent). Twin Cit � rer Clinic, Inc. , Bill Va A ale Lnb l`cililic,iti��n d n`7-n�;-I I`� 4^�ELt OR�ORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring H �']��A WELL AND BORING SEALING RECORD Sealing No. � �•� Counry Name Minnesota Unique Well No. Henne�:i n Minnesota Statutes, Chapter 1031 or W-series No. (L2ave blank��I nol known) Township Name Township No. Range No. Section No. Fraction(sm.�Ig.) Date Sealed Date Well or Boring Constructed 1�7 23 06 �� ;U� p�j , GPS Latitude degrees minutes seconds Depth Before Sea�ing f S�ji ft. Original Depth ft. LOCATION: Longitude degrees minutes seconds IFER(S) STATIC WATER LEVEL - Numerical Street Address or Fire Number and City of Well or Boring Location Single Aquiter ❑Multiaquifer �� ^��/ 4�,J0 Bg B��e n� Or n0 . �[ LL/BORING �Measured ❑Estimated Date Measured � �� • ._��Water-Supply Well ❑Monit.Well Show exact location of well or boring � Sketch map�f well or boring in section grid with"X." location,sh ing property ��_�Env.Bore Hole ❑Other �ft.�below n above land surface N lins s,r#ads, nd buildings. CASING TYPE(S) I I I I /._ --�--- --�--- ---�---�-- s j j j � ,+ �Steel ❑Plastic [�Tile U Other ` �y4; � -.____--- ----- --------- ----- -- �__,. � WELLHEAD COMPLETION � � � , � W � ; ; ; ET � __�___ __,____�.___r__ �_ Outside: ❑Well House ❑At Grade Inside: ❑Basement Offset �� ' ' ' ' � M [� ell Pit , , , , h iie �Pitless Adapter/Unit Buried ❑W --:-- -r-----:- ---:-- 1 S U Well Pit ❑Buried �1 Mile� ' \ ❑Oth2� ❑Other ��J-..A �r`T'/ PROPERTY OWNER'S NAME/COMPANY NAME l� CASING(S) Diame �� Depth � Set in oversize hole? Annular space initially grouted? Property owner's mailing address if ditterent ihan well location address indicated above �in.from � to ��ft. ❑Yes �lo ❑Yes ❑No ❑Unknown in.from to ft. ❑Yes n No ❑Yes ❑No ❑Unknown in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown WELL OWNER'S NAME/COMPANY NAME SCREEWOPEN HOLE r E r lS(� Well owner's mailing address if different than property owner's address indicated above SCfeen from �J to ! `" ""' ft. Open Hole ffom to ft. OBSTRUCTIONS '�Rods/Drop Pipe ❑Check Valve(s) ❑Debris ❑Fill U No Obstruction Type of Obstructions(Describe) +t-�i��,J`� - �- ' "- ¢ / V i•IN _ GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? es ❑No Describe FORMATION PUMP If not known,indicale estimated formation log from nearby well or boring. ��/), �v M� ,/ � ,�y TYPe �"' �.. ^ T �`"'`Y `-`' ��"'�p Removed ❑Not Present ❑Other METHOD USEDTO 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 [J Removed in.from to ft. ❑Perforated ❑Removed Type of Perforator ❑Other GROUTING MATERIAL(S) (One bag of cement=94 Ibs.,one bag of bentonite=50 Ibs.) /' '�' �p � / P / Grouting Material �"'��j ��l�'�(rom_.1./ to��4�' ft. yards f � 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 STODOLA GIBLL DRILLING CO. ,. INC. 159I Licensee Business Name � License or Regist�afion No. _ f/� ; �,� �8 A �� -/ r,✓ y = i epresentative Sigrret Certified Rep.No. Date z72�sa ��' __ !CCAL COPY �"{ N'l.v-- L/""`" ��`�'�'��"' Name of Person Sealing Well or Boring � HE-01434-10 IC#740-0423 5/o7R 4