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Home My WebLink AboutWell info .� wELL OR BORING LOCA7ION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring H � 2�g 5 5 County Name WELL AND BORING SEALING REC RD Mennle90 aoUnique No. I3ennep j.A Minnesota Statutes,Chapter 1031 or W-series No. T' (Leave blank if not known) Township Name Township No. Range No. Section No. Fraction(sm.�Ig.) Date Sealed '��.. Date Well or Boring Constructed Orono 117 23 Ob 2Lr-OOd2� ` ` � Numerical Sheet Address or Fire Number and City of Well or Boring Location • 4'i J 5 �ays ide RD, Or�I�O S 5 3 59 Depth Before Sealing � r-' ft. Original Depth ��i� , R. Show exact location of well or boring Sketch map of well or boring Ap IFER(S) STATIC WATER LEVEL in section grid with"X". location, showing property Single Aquifer ❑ M Itiaqui r lines,roads,an.d.b dings. N �; �� WELUBORING � �Measured ❑ Estimated _ .'.� - ,'rti�;.,,,,, � Water Supply Well ❑Monit. ell ,� i - - - - - -- --;-- 1 � � � � � � � T T � , - I I I � `� r ❑ Env.Bore Hole ❑Other � � �' ft. �below ❑ above land surface � � � � � � W —�- -i-- -i-- --i-- E � .....�..._,.... CASING TYPE(S) � --�- -�-- -�-- --�-- �� Steel ❑ Plastic ❑Tile Other � ;Gmlle � � _.��. � --�- -�-- -�— --�-- ,_ ...._._. ._.., CASING � � �_.._ Diamet�r f De th � Set in oversize hole? qnnualar space initially grouted? pt�i m��e , , � � in.from '�� L �� R. ❑ Yes �No ❑ Yes ❑No ❑ Unknown I PROPERTY OWNER'S NAME in.from ry. ❑ Yes ❑No ❑ Yes ❑No ❑ Unknown Property owner's mailing address if diflerent than well location address indicated above. in.from fl. ❑Yes ❑ No ❑ Yes ❑No ❑ Unknown SCREEWOPEN HOLE � f, '� t „�, `�} �'°.�� Screen from �� / � to , it. Open Hole from to ft. 'p i`y,p i.✓ OBSTRUCTIOWDEBRI ILL WELL OWNER'S NAME �� P Obstruction ❑ De ris Fill �No Obstruction S �.� Well owner's mailing address if different th�r' ropeAy owners adqr@sai�qjcated above. Type of ObsiructioNDet�ris/Fill Obstruction/Debns�Fill r Imoved ❑ Yes ❑ No PUMP Type_� GEOLOGICAL MATERIAL COLOR HARDNESS OF FROM TO � Removed � No Prese ❑ Other FORMATION If not known,indicate estimated tortnation log from nearby well or boring. METHOD USED TO SE L ANN LAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: . ,� ,') ;.,� � No Annular Space 6cits ❑ Annular space grou�with emie pipe �� ❑ Casing Pertoration/ emova in.fr m to ft. ❑ PeAorated ❑ Removed in.fr�m ro R. ❑ PeAoreted ❑ Removed Type of perforator ❑ Other GROUTING MATERIAL�S) 9 f �c✓:%!. ',!!✓--{f {.� < /' Groutin Material from to ft. yards �� bags from to ft. yards bags � from to ft. yards bags from to ft. yards bags HEMARKS,SOURCE Of DATA,DIFFICULTIES IN SEALING UNSEALED WEL�S AND BOR NGS Other unsealed well or boring o property? ❑ Yes ,�No LICENSED OR REGISTERED ONTRACTOR CERTIFICATION This well or boring was sealed i accordance with Minnesota Rules,Chapter 4725. The information contained in this report is true to the best at my knowledg . Don �tadol 6�ell Driilin co. Ine. 27I22 Contractor Business Name - License or RegisheHon No. .....,..� . , .- - � , �, ..�_r ,.; v; �, �. Autho ed epresentaNve Sig fure Date e- \'� r w ,,,,...a� ,� t`./.tJl�V��.. LOCALCOPY H 12 7 9 5 5 Name ol PersoA Sealing Well Bonng HE-01434-02 "� 10/95R � _ _ WELL LOCATION MINNESOTA DEPART ENT OF HEALTH MINNESOTA UNIQUE WELL NO. CountyName ��,in WELL AND BOR NG RECORD � ��6 �2 Minnesota Statutes hapter 1031 Township Name Township No. Range No. Section No. Fraction WELL DEP H(completed) Date Work Completed t:�rc�n�� i 1 `,` 2� 3-;% i 81 " G-�-y"i �. �, �. House Number,Street Name,City,and Zip Code of Well Location or Fire Number DFILLING ETHOD ��+�� +�y�.l.�.'<� ��Ji�C1 Ctron�,MN. r F'J''y ❑ ableTool ❑ Driven ❑ Dug ` C7 uger O}{totary ❑ Jetted Show exact location of well in section grid with"X". Sketch map of well location. ' ❑ � ert lines, �� Q Y$;a� � oa s an D ILLING LUID WELL HYDROFRACTURED? ❑YES ❑NO " �n c7nite i i i i FROM ft.to ft. _i _i_ _i_ _i_ US ❑ Monitoring ❑ Heating/Cooling i i i i �] omestic _i_ _�_ _�_ _i_ ❑ Community PWS ❑ Industry/Commercial i i � i , ❑ rrigation ❑ Noncommunity PWS ❑ Remedial ❑ est Well W i � i i E T ❑ Dewatering ❑ -r -�- -r- -r -_- � i i i ��ZM11e CASING Drive Shoe? ❑ Yes ❑ No HOLE DIAM. _i_ _ i _i_ _i_ � � '�, ❑ teel ❑ Threaded ❑ Welded i i- i i � lastic ❑ S I--1 Mile-� CA ING D AMETER WEIGHT PROPERTY OWNER'S NAME ti. �I !c: SDR ! t � in7dj�' fts ' � in.to ft. Ibs./ft. r+;FRI:'.ii. a7U�IC1��G12 in.to R. Ibs./n. �7 in�o�� t�. `� Property owners mailing address if different than well location address indicated above. in.to ft. Ibs./ft. in.to ft. `�,, SCREEN . OPEN HOLE Ma e �� -, from ft.to ft. �' -"� �' , .it C:11 . �c� :J�f��l � 3.{,... -�.,'s.,.a ` TY Diam. � SIo�Gauze f%- �� Length �i � �j � ��y"'�; SeNbetwee � !L. ft.and �}k�t. FITTINGS: " a f;,11 � " � STATIC T��L€VEL X WELL OWNER'S NAME _�ay:� L"� ft.II below ❑ above land surface Date measured �—�"�_� � PUMPING EVEL(below land surface) Well owner's mailin address if different than ro ert owneYs address indicated above. � ^ �' g p p y � 4 ! ft. after hrs.pumping .0� g.p.m. V1(E�L HEA COMPLETION C3''�itlessa aptermanufacturer `�h�-��del ❑ asing rotection C}j12 in.above grade ❑ t-grade(Environmental Wells and Borings ONLY) GROUTIN INFORMATION i Well g uted? CJ��Yes ❑ No HARDNESS OF Grout aterial ❑ Neat cemen C�Bentonita ❑ Concrete ffiy�p�Solids Benbnite GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO � J � from_�_to �� ft. '�"� ❑ yds.� bags from to ft. ❑ yds. ❑ bags �l�;y ��j�� il �� , j� from to ft. ❑ yds. ❑ bags NE REST N N SQURCE OF CO MINAT C1��= Grey S : � '� .�'o�,�a",�/ s� T'tG ;�j �(_i teet direction type Well,disinfe ed upon completion? C]�'es ❑ No S['3jIC3 GY�c�VG'�� PUMP L, �7 � "`4`Yl � -��-' •� i❑ Not inst Iled Date inst�lJe� 7��U �` N ManUfactur 's n�m�^� _ 7 ModBlnum r_�_�d�7 ► HP_�t�olts Length of dr p pipe ft. Capacity g.p.m. Type: LT5 bmersible ❑ L.S.Turbine ❑ Reciprocating ❑ Jet ❑ � ABANDON D WELLS �t�� - Does prope have any not in use and not sealed well(s)? ❑ Yes L]'No VARI NCE � Was varia e granted from the MDH for this well? ❑ Yes C�No WE CON RACTOR CERTIFICATION Use a second sheet,if needed This well wa drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. REMARKS,ELEVATION,SOURCE OF DATA,eta The�forma n contained in this report is true to the best of my knowledge. C1C!N :i`iGBci�l� G�'E�,L i�RII3i:,I�� i.;C). , INC. Licensee Business me.�" Lic.or Reg.No. �(�1;> *� ,� ,..�i' `�.�- 9-5-9� Authorized Representative Signature Date � f'�x"c^C� I,�7�1:,�,r y...�_�7 Name of Driller HE 01205-D6(Rev.9/96) LOCAL CC2PY 5 � G b 5 2 • Jwin C,it �ater �inic, J�nc. � 617 13th Ave So • Ho kins, Minnesota 5343 • 612 935 - 3556 09h 0/1997 Stodola Well Drilling j 15306 Hwy 7 Minnetonka MN 55345 938-2111 REPORT OF WATER ALYSIS Lab#: 33405 Our Laboratory reports these analytical results, determin d on a sample taken by CLIENT on 09/08/1997 from the following location: Mark Johnson 4455 Bayside R . Orono,Mn Unique 1Mell#596 52 Coliform Bacteria <1/100 I Nitrates Nitrogen 1.0 mg/I The results of these tests indicate that this w�ell is produc ng water that meets the standards for F.H.A., V.A., or conventional loans. This report is an an lysis for coliform and nitrate only and does not include analysis of Lead and other contaminant . (Unless as specified by Gient). ` T � City Water Clinic, Inc. � � � Bill �ale I Ans�ro,�ubor,Wry i co�ultros� Water Aoalyaie Reagenta Boibr Water Chemio�L Lab Cortifiwtiou Y 02'I-033-1 9