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Home My WebLink AboutWell info WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUEWELL NO. CcuntyName WELL AND BORING RECORD � g� 4 � 7 ��p� Minnesota Statutes Chapter 1031 Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed Orono lI8 23 31 �,, ,, ,, 270 n 10-?.�►-03 GPS DRILLING METHOD Latitude degrees minutes seconds LOCATION: �-- �--]Cable Tool ❑D iven ��Dug Longitude __ degrees minutes seconds -r L�Auger � Rotary `.Jetted House Number,Street Name,City.and Zip Code of Well Location or Fire Number r� 4720 Bayside Rd, OrOC1O 55359 DRILLING FLUID WELL HYDROFRACTURED? [,',Yes �` _ o Shop exact location of well in section grid with"X". Sketch map of well iocation. �tVlute FROM ft.TO ft. Showing property lines, _ �: N roads and buildings USE . ❑Monitoring �,!Heating/Cooling ; ; ; ; ; �Domestic ❑Environ.8ore Hole ��_'Industry/Commercial - --'-----J--- '--`— --`-- — — [Noncommunity PWS '_ Irrigation J Remedial �. �Community PWS J��.Dewatering ❑ -- ---- - - --- -- CASING� HOLE DIAM. ' -�--- --�_ � s ;� W E� ,.,�(�� Shoe? .�Ves '�,;��No � ; ,__ ,1�?�Steel �Threade ❑Welded --� ----�— - � ; ; stic , , � � �hI nnua .�,1� — — �Pla �, "-'"-- --'--- --'- ; 1 CASING DIAMETER WEIGHT ,� S t;,.-�^ � � in.to �� ft �� Ibs/ft � in.to_ �—i na�ie---{ �� in.to ft. Ibs.�ft "• in.to � � PROPERTY OWNER'S NAME/COMPANY NAME in.to ft. ibs.;it. ��`fi.to �� te A�:1� SCREEN OPEN HOLE Property owner's mailing address if different than well location address indicated above. Make --- FROM �I' ft. TO ��O ft. - � �s $� Type Diam.___ SIoUGauze Length___ ___ __ Set between tt.and it. FITTINGS STATIC WATER LEVEL � �� ft�,� �� elow [J�above land surface Date measured___.. l��'T� � PUMPING LEVEL(below land surface) WELL OWNER'S NAME/COMPANY NAME '��(} "�"" ft.after_ � hrs.pumping � g.p.m. W LL HEAD COMPLETION �iteaater ,� Well owner's mailing address if different than property owners address indicated above. Pitless adapter manufacturer__.,_._ ___ .____ _ MoSJeI_ ��. �Casing Protection___,___ ._________��12 in.above grade ',�i Ab9rade(Environmental Wells and Boring ONLY) GROUTING INFORMATION � Well grouted �es �r '�.No ,�/ Grout material �_;Neat cemen I.-�Bentonite j Concrete I JKFii h Solids Bentonite r from____ ��to �ft. _ � r__yds. '�__rbags from__ �to��ft. ��ra� �!�� '�__I bags GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO from_ to ft. �yds. ��, I bags MATERIAL --- NEAREST KNOWN SOURCE OF CONTAMINATION ;� ; '� '`�,� � ' C�$� �� r= O �� _ ' .� .� feet ___, direction � �,�1�--�� _type � Well disinfected upon completion Yes �_�.No PUMP ��y r� � i� 1�0 t(��j� ' '�_,,�Not installed Date installed _ . .s" "�� t *� �� Manufacturer's name___ ��qtQ� y�{ � _... -- —�--�31/ �- 1 Model number __ _.__ �_ Volts ___. C� b�; i� i� �� Length of drop pipe_ /"?�_ _____ft. Capacity g.p.m �l�=gV `_� �� ^� Type:�_,Submersible �LS.Turbir�e __.Reciprocating ❑Jet ❑ ahale/s8ndsta� � `� � ABA DONED WELLS Does property have any not in use and nof sealed v.�ell(s) �JI Yes � �No VARIANCE Was a variance granted from ihe MDH for this well? [��;Yes No TN# WELL CONTRACTOR CERTIFICATION This weli was drilled under my supervision and in accordance with Minnesota Rules,Chap�er 4725. _ The information con�ained in this report is true to the best of my knowledge. � Use a second sheet,i/needed � StQ(�Q�B �11 a�iil� W�� I�. 27172 REMARKS,ELEVATION,SOURCE OF DATA,etc. Licensee Business me Lic.or Reg.Ne. _-_. dre�ve casing 25t3' to 255' f �� ,. - -- ---- � , �- _ 11-2�3_ _ Authorized Represen[ative Signature Date cr��oo� zo-a4-o3 _ _-- - ----- _ �9 6 4 8 7 Name o/Driller Date LOCAL COPY HE-01205-08(Rev.S/02) IC 140-0020 - rw� c�-y w�-� c � � � 1�,�. 617 13th Ave So � Hopkins, Minnesota 55343 • (612) 935 - 3556 10/29/2003 Stodola Well Drilling 3841 North Main St. Boni facius MN 55375 938-21 1 1 REPORT OF WATER ANALYSIS Lab #: 1000 Our Laboratory reporis these analytical results, determined on a sample taken by CLIENT on 10/27/2003 from the following location: Pete Achey 4720 Bayside Rd Orono,Mn Unique Well #696487 Coliform Bacteria <1/100 ml Nitrates Nitrogen <1.0 mg/1 The resulis of these tests indicate thar this well is producing water that meets the standards for F.Fi.A., ti'.A., or co�iventianc�l loans. This report is an analysis for coliform and nitrate only and does nor include analysis of Lead and o[her contaminants. (Unless as specified by clien[). ' � in Ciry Water Clinic, Inc. �� .�. .� Bill ale \ Lab Certitcation#027-053-119 WE��OR BORING LOCATION MINNESOTA DEPARTMENT GF HEALTH Minnesota Well and Boring H 21515 6 County Name WELL AND BORING SEALING RECORD M nnfesoNa Unique Well No. or W-series No. Henne�i n Minnesota Statutes,Chapter 1031 �QaVe��a�k��o�k��w�; Township Name Township No. Range No. Section No. Fraction(sm->Ig) Date Sealed Date Well or Boring Constructed Orono 118N 23 31 � � _C Q� GPS Latitude degrees minutes seconds / , LOCATION: Depth Before Sealing ft. Original Depth ft. Longitude degrees minutes seconds FER(S) STATIC WATER LEVEL Numerical S[reet Address or Fire Number and City of Well or Boring Location ingle Aquifer ❑Multiaquifer WELUBORING �easured ❑ Estimated 472 �`�� •` � ��(Water Supply Well ❑Monit.Well / �/1 Show exact location of well or boring �Sketch map of well or boring /� //j.� in section grid with"X" ��location,showing property ❑ Env.Bore Hole ❑Other J�ft. �below ❑above land surface N lines,roads,and bu ing � CASING TYPE(S) Steel ❑ Plastic ❑Tile ❑Other W -- - - -- - -- — — E WELLHEAD COMP�ETION � � � � � Outside: ❑Well House Inside: ❑Basement Offset �- ---- -�-- -;— --i— �/ � � � � y�m��e '� : � i t�;�� I Z Pitless AdaptedUnit ❑Well Pit ` --- -i-- -�— --�-- T` ❑Well Pit ❑ Buried S �{,��'"^° �}�' � ❑Buried I � `=i...;'.;._�... ��•,.'� PROPERTY OWNER'S NAME/COMPANY NAME . CASING(S) � Diamet r/� � Depth �1 j Set in oversize hole? Annular space initially grouted? Property owner's mailing a dress i i erent well location address indicated above /� � in.ffom to��it. �Yes [�Jo ❑Yes ❑No ❑Unknown in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown in.ff0i71 t0 ft. ❑Yes ❑ No ❑Yes ❑ No ❑ Unknown WELL OWNER'S NAME/COMPANY NAME SCREEN/OPEN HOLE f f i Well owner's mailing address if diflerent than property owner's address indicated above Screen from�_t0—_1�ft. Open Hole from f0 ft. �BSTRUCTIONS Rods/Drop Pipe ❑ Check V�ve(s) ❑ Debris ❑ Fill ❑ No Obstruction Type of Obstructions(Describe�l"��-�`•- / ��r-- ¢ /'C�/�/� GEOLOGICAI MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? eS ❑ NO Descfibe � FORMATION PUMP (//��'� �1 If not known,indicate estimated formation log from nearby well or boring TYp i-..,n �,`/y� f 1 ....,�,��„S (J i► �'./ ,_., *.._.�' � !y `' �emoved ❑ Not Present ❑Other METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: p( 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 MATERIAL(S) (One bag of cement=/94q Ibs.,one�b/ay of bgntonite=50 Ibs.) Grouting Material /��-'7� ��u r� `�" to�`+�ft, yards � bags from to ft. yards bags from to fl. 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 many7 � 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 Vue to the best of my knowledge. DON STO OLA WELL DRILLIN� eQ. , IATC. 27272 Contracror Busi s ame , - ' License or Registration No. .-' ` � �� o d epresen a e Signat��e Date „�,� �. ',,�,�° �.��SV.�� Y LOCAL COPY H Name of Person Sealing Well or Boring /?