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Home My WebLink AboutWell info.. . _. . T..� . _ _. . . ..... .� ,._ ^ _ _. T -� _ _ ,- MINNESOTA DEPARTMENT OF HEALTH M�nnesota Well and Bor�ng ` 7-� Y � WELL OR BORING LOCATION g I H 1�1 5 ( � WELL AND BORING SEALING RECORD Sealin No. Counry Name I-- — Minneso;a Unique No. � t:ti:lEl4r't.l:: Mmnesota Statutes,Chapter 1031 or W-series No. ILeave blank A nol known� Township Name Townshi No. Range No. Section No. Fracuon�sm.-►Ig.) Date Sealed Date Well or Boring Consinictea Oronc� i i€� 2:, 31 , ti N F��: �; �� Numencal Street Adtlress or Fire Number and City o�Well or Bonng locaUon � ` ,` l F4%�i.�) B$��.3.�� 3C�C.� Q�Q��i� p'�•,Gi�j �Pth Bebre Sealing �� ft. Original Depth �.l Y ft. �_ Show exad loca6on of w•ell or boring t $ketch map of well or bonng A UIFER(S) STATIC WA7ER LEVEL �� in section gnd wdh'X'. k I�cahon, showmg property Single Aqurfer � Mulfiaquiter �--'""'fines,roads,and buildings. � N . ---. . WE UBORING Measured ❑ EsNmated ; 4! � Water Suppty Well ❑Monit.Well ( - - - - - -- - -- .. �� t ❑ Env.Bo�e Hole ❑Other _ �R. �pelow ❑aprn,e land suAace � � � � � � � � : ; � � � � ! f W --�- -�-- -�-- --�-- E � � .-.._ CASINGTYPE(S) � � � � � , * � ' t --'r- -�-- -;-- —i-- � )4 � �teel � Plastic �Tile �Other ;�mde ., -._..._,._ --�- -j-- -�-- -�-- � CASING Dlamet�rr Depth � Set in overs¢e hole? Mnualar space inAialy grouled? � S /�� ,,,�y� ,� � �� in.trom � to.�_�tS.L n. O ves No ❑ves ❑No ❑un�cnown �� .�� :' ; . i..� PROPERTY OWNER'S NAME in.from to fl. ❑ Yes ❑No ❑�es ❑No ❑Unknown Davi�. Dunn Property owner's madlrg address It diHerent than well locatlon address indicated above. in.from to fl. ❑ Yes ❑No ❑�� ❑No ❑UNvawn SCREEWOPEN HOLE � � �/�f Screen from rl ��to /�� ft. Open Hole from lo fl. OBSTRUCTIONS WELL OWNER'S NAME Rods/Drop Pipe ❑Check Valve(s) ❑Debris ❑Fiil ❑No Obstruction WeN owneYs meilirp address if diflerent ihan property owner's address inCicated above. Type Ot ObStrucNions(DBSCribe) -f/f f�¢`�t �� 4'� Y�J�'!/!�'7 Obstrudions removed? Yes ❑ No Describe PUMP /' 7ype �(i1`' 1_'ti�?�:i ' (iEOLO(i1CAL MATERIAL COLOR HARDNESS OF FROM TO Remrned ❑ Not Present ❑ Other FORMATION tl rat krawn,i�EiceN estirneted formatbn log from nearby well or bonng. METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASIN('AND BORE IIOLE: -. . No Annular Space Exits ...+ ,- ..�� ' ) /`�iJ . ❑ Annular space grouled with tremie pipe -- �❑ Casing PeAoration/Removal � in.from to it. ❑ PeAorated ❑ Rertared in.from to h. ❑ Perfaated ❑ Renwred Type of perforaror a ❑ OMer GROUTING MATERIAL(S) h Grouting Matenal �C�``r�%('�,��f;�L��m � to �•.'f. p, Yerds ��,, bsgn . from to R yards beps hom to M. yards baps from to_ IL yards beps REMARKS,SOURCE OF DATA,DIFFlCULTIES IN SEALING OTHER WELLS AND BORINGS Other unsealed and unused well or boring on property? ❑Yes No How man�It L�CENSEO OR REGISTERED CONTRACTOR CERTIFICATION � ;6--E;��"��"'„'_'� This well w bonng w8s sealed in acoordence with Minnesote Fules,Chapter 1725. The iraorrt�ation confained'n tlrs�apat is true to ifie best of my knowledge. ��'�� 1 1999 ncsr� S i•UDULk WELL DkII.L�.IVG cc�. , rc�c. ��t�i�� conhacror eusiness Marne Licenss o.Reprs��aean r.o. e;i; ti „� ;.�;:,,.,.`, :, - '=' 4.,, r� ��%�� - � _ R. ed epresenranve signefwe oare .� � �, l. LOCALCOPY H 141571 �,�°'Pe,� ;,�w°"°`�;,� HE-01434-0.3 �R � . .�. WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. CountyName WELL AND BORING RECORD 615 5 6 9 � Hen�epin Minnesota Statutes Chapter 1031 Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed �rono 11$ 23 31 ,,. ,. ,. ��5 � �-22-98 House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD �i7�F� t�A ��'E �E� �r�11� 553 9 ❑ CableTool ❑ Driven ❑ Dug f ❑ Auger �i, otary ❑ Jetted Show exact location of well in section grid with"X". Sketch map of well location. ❑ � Showing property lines. roads and buildings. DRILLING FLUID WELL HYDROFRACTURED? ❑YES O i i N i i 17�'jry.�()f'��,��.s FROM ft.to ft. _i_ _�_ _i_ _i_ USE _�[ � Monitoring ❑ Heating/Cooling i i i i pFUomestic ❑ Communi PWS _i_ _�_ _�._ _i_ ❑ Irrigation � ❑ Industry/Commercial i i i i ❑ Noncommunity PWS ❑ Remedial w e� ❑ Test Well i � i � ❑ Dewatering ❑ i i r i '/ZM.ie y �� CASING Drive Shoe? �/es ❑ No - HOLE DIAM. _, , _, _ _,_ � •� 1�Steel �/Threaded ❑ Welded i -i- i i ❑ Plastic ❑ K S { } /y� �-1 Mile-� A`� �� y f Fr CASING DIAMETER WEIGHT PROPERTY OWNER'S NAME _�_in.to�R. �� Ibs./ft. �i _in.to �}�(�i{i �(}(� in.to ft. Ibs./R. /�t;in.to ��F Property owner's mailing address if different than well location address indicated above. in.to ft. Ibs./ft. �� C 1 SCREEN OPEN HOL/E Make from Z'�f� ft.to �S�ft. Type �j�j _ Diam. SIoUGauze _______Length Set behveen ft.and ft. FITTINGS: STATIC yWA9T+E�R LEVEL h WELL OWNER'S NAME 1 JG ft. elow ❑ above land surface Date measured �"�4" � PUMPING LEVEL(below land surface) /. Well owner's mailing address if different than property owner's address indicated above. �� ft. after `t hrs.pumping 3fl g.p.m. WELL HEAD COMPLETION �mf t ewa t er �Pitless adapter manufacturer ```Mo///del ❑ Casing Protection . �12 in.above grade ❑ At-grade(Environmental Wells and Borings ONLY) GROUTING INFORMATION Well grouted? ❑ Yes ❑ No HARDNESS OF Grout Material ❑ Neat cement ❑ Bentonite ❑ Concrete igh Solids Bentonite GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO g from 0 to 3� ft. � ❑ yds. �bags Topsoil hlack .g0�t {� � from_��_to�ft. �I$�131�i3� yds. ❑ bags from to ft. ❑ yds. ❑ bags L�� ellox $Q��. 9 `-� NEAREST KNOWN SOURCE OFCONTAMINATION l► � Y Y � `t ,C�_�"_�eet /�ja Q�JV direction;��T f�type � Well disinfected upon completion? �Yes ❑ No 3an� brown soft '*� U� pUMP p ❑ Notinstalled Dateinstalled ��w�o c:�.�� r�y �o�c �o ��o Red J�cket Manufacturer's name Cl.ay/raeks �?L'QW(1 $Qf� 150 '�'L(� Modelnumber IQ{�CrN�1"`I��i1yr�P� Volts �3� Length of drop pipe i�S3 ft. Capacity g.p.m. 5`g�d tl.�� SD�t G2� 23t! Type: C�ubmersible C7 LS.Turbine ❑ Reciprocating ❑ Jet ❑ ABANDONED WELLS C�a��ur�ve 1 C�i�r�� r�ed iuz� 230 240 Does property have any not in use and not sealed well(s)? O Yes �o VARIANCE Sh�� vr�(,a�s� �(�£t 2G0 2(�5 Was a variance granted from the MDH for this well? ❑ Yes C�CNo y WELL CONTRACTOR CERTIFICATION LimP s e on�,se a second 9ri��Eoi; �ed ium 2�� 2�tJ This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725 � REMARKS,ELEVATION,SOURCE O , . The information contained in this report is true to the best of my knowledge. l}on Stodola �ell I�ri27.in�; Cv. ,� Tnc. 2 I72 Licensee Business Na �,Lic.or Reg.No. uthorized Representat" Signature Date~ Chuck t�oote 5-22-98 ��5� � g Name of Driller Date LOCAL COPY HE-07205-06(Rev.9/97) � Jcvirc �itc� UVater ��inic, J"rcc. 617 13th Ave So • Hopkins, Minnesota 55343 • (612) 935 - 3556 08/26/1998 Stodola Well Drilling 15306 Hwy 7 Minnetonka MN 55345 938-2111 REPORT OF WATER ANALYSIS Lab#: 35647 Our Laboratory reports these analytical results, determined on a sample taken by CLIENT on 08/24/1998 from the following location: David Dunn 4740 Bayside Rd. Orono,Mn Unique Well#615569 Coliform Bacteria <1/100 ml Nitrates Nitrogen <1.0 mg/I The results of these tests indicate that this well is producing water that meets the standards for F.H.A., V.A., or conventional loans. This report is an analysis for coliform and nitrate only and does not include analysis of Lead and other contaminants. (Unless as specified by client). \ T i er Clinic, Inc. Bill ,� Aoalyical laborawry Conultiig Engineer Water Atilysie Reagente Boiler Water Chemials Lab CertHication!1 027-053-119