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Home My WebLink AboutWell info MINNESOTA UNIQUE WELL WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. Cchnty Name ' WELL AND BORING RECORD �, _ " R�YlE� in Minnesota Statutes,Chapter f03I � 5��q- r Township Name Township No. Range No. Section No. Fraction WELL/BORING DEPTH(completed) DATE WORK COMPLETED Oror�o lI7 23 22 �� 290 � 11-8-07 r GPS DRILLING METHOD LOCATION: Latitude degrees minutes seconds Longitude degrees minutes seconds ❑Cable Tool ❑Driven [�Dug — ❑Auger �Rotary �]Jetted ' House Number,Street Name,City,and Zip Code of Well Location or Fire Number �� c /�/ T n� �4lO 1518� vLdC� 55331 DRILLING FLUID WELL HYDROFRACTURED? ❑Yes No Show exact location of well/boring in sectidr�qrid with"X" Sketch map of well/boring location. ��t�t� From ft.To ft. ti Showing property lines, N roads,buildings,and direction. USE �Domestic ❑Monitoring �_]Heating/Cooling �. I I I � . - . ' -; __,_____A________ ______ ❑Noncommunity PWS ❑Environ.Bore Hole �_J Industry/Commercial ❑Communiry PWS ❑Irrigation ❑Remedial �:: --�-----=------=-- ---=-- ❑Elevator ❑Dewatering W E �_— CASING MATERIAL ❑ HOLE DIAM. ' � , � � � Drive Shoe? '�Yes ❑No --:--- � ---�-- ---:-- T --.-- �� , , , , nniie stic readed elded h :�� S �h ❑W te ,- , , , � ❑Pla ❑ - � --�-----�----�-- ---�-- ' i ` CASING � S � \'1 � ��y� Diameter Weight Specifications t �1 Mile—� �in.[o_�_ft. _;�Ibs./R �_in.to�aft. PROPERTY OWNER'S NAME/COMPANY NAME in.to fl. Ibs./ft. �in.to��ft. l l.'lC3.s BOZi�.S in.to n. �bs.�n. I$to'��n. SCREEN OPEN HOLE Properry owner's mailing address if diNerent than well location address indicated above. 4/.Y, HM ZZQ StWW� uRp � Make G�f�4 67V From ft. To ft. .7 Type Diam. Long Leke� MN 55355 SIoVGauze Length Set between ft.and ft. FITTINGS � STATIC WATER LEVEL Measured from � ft. Below ❑Above land surface Date measured ��n7 WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surtace) _�_ , ft.afler � hrs.pumping__� g.p.m. + � Well/boring owner's mailing address if different than property owners address indicated above. WELLHEAD COMPLETION �y�, � r Pitless/adapter manufacturer 1 � -`�,..--�-�-�-3'a-� — IOfodel ❑Casing Protection `6d�12 in.above grade ❑At-grade(Environmental Well and Boring ONLY) r� GROUTING INFORMATI N Well grouted �Yes ❑No Grout materials ❑Neat cement�Bentonite ❑Concrete ❑Other From�To�ft. �_ ❑Yds. �ags � GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO From_�_To�tj��i[IJ�ds. ❑Bags - MATERIAL From To_ fl. ❑Yds. ❑Bags ; NEAREST KNOWN SOURCE OF CONTAMINAT� *: f' t-'1S U� !�� feet l direction _. .i� . �-�� J t e ' YP gr$�, Well disinfected upon completion? ,�Yes ❑No > $li� L• a PUMP .. / ) � 1 '� ❑Not installed Date installed �-�J �'1 'f' C� Manufacturer's name - �-�`�- ��'�'��""' C�a!/� p�J• Model Number �HP � Volts �� -�,�--� Length of drop pipe /�-�� ft. Capacity g.p.m. ceddish �� Type:�_ ubmersible ❑L.S.Turbine ❑Reciprocating ❑Jet ❑ ABANDONED WELLS rea.ai$r, � Does property have any not in use and not sealed well(s)? ❑Yes �'No VARIANCE Was a variance granted from the MDH for this well? ❑Yes No TN# - � 4 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 true to the best of my knowledge. Use a second sheet,if needed. REMARKS,ELEVATION,SOURCE OF DATA,etc. Stodol8 Well Dcil2ing Co., Inc. 1692 Licensee Business N e . Lic.or Reg.No. ti...�"'� � ' �' �� .--�� ., /,�` �;,1::J -<., I e ied Representative Signature Certified Rep.No. Date LOCAL COPY 7 5 0 6� 4 J� �� Name of Driller IC 140-0020 HE-07205-10(Rev.6/O6) T'wi�vv C i,t� 1�t1 a��' C ' ' , I�,c�. y 617 13th Ave So � Hopkins, Minnesota 55343 � (612) 935 - 3556 11/13/2007 Stodola Well Drilling 3841 North Main " St. Bonifacius MN 55375 938-21 1 1 REPORT OF WATER ANALYSIS Lab #: 542BN Our Laboratory repovts these analytical results, determined on a sample taken by CLIENT on 1 1/12/2007 from the following location: Chris Bollis 470 Big Island Orono,Mn Well 750684 Coliform Bacteria Absenr Nitrates Nitrogen <1.0 mg/1 The resulis of these iests indicate that this well is producing water that meets rhe standards for F.H.A., V.A., or conventional loans. This report is an analysis for coliforrn and nitrate only and �oes not include analysis of Lead and other contaminants. (Unless as speci fied by client). Twin City Water Clinic, Inc. ' 7 1��`,;� Bill vc��i ,�� e u � Lab Ce�tification#027-053-119 WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring H ��A n� County Name WELL AND BORING SEALING RECORD Mennleso a�Unique Well No. •7" Minnesota Statutes,Chapter 1031 or W-series No. (Leave blank�A no�known) Township N Township No. Range No. Section No. Fraction(sm.�Ig.) Date Sealed Date Well or Boring Constructed l l l. �/'1 i./ t t t� `y / GPS Latitude degrees minutes seconds Depth Before Sealing �'t�"• �� ft. Original Depth ft. LOCATION: Longitude degrees minutes__ seconds A�UIFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location Single Aquifer ❑Muttiaquifer A, 1./ WEWBORING �J Measured ❑Estimated Date Measured..^�%J�'�" f.!/'�`' �Water-Supply Well [j Monit.Well Show exact location of well or boring � Sketch map of well or boring (f�' in section grid with"X" location,showing property ❑Env.Bore Hole U Other f .�-�. tt. �elow C�above land surface N i� lines,roads,and buildings. CASING TYPE(S) I � I I i . __'___ __'______`__ ___'__ - i Steel ❑Plastic ❑Tile ❑Other i ----- --------- ----- -- WELLHEAD COMPLETION � � � . � W ; ; : � ET ',. � � � � �`��r� � Outside: [J Well House f�At Grade Inside: ❑Basement Offset —�--- --�----�----.— ��M e"'� � ❑Pitless Adapter/Unit ❑Buried ❑Well Pit . , , , l �� --:--- --r----.-----:-- ^-�� ' S ' g �` [_]Well Pit ❑Buried ` �Other �1 Mile� �*' ❑Other PROPERTY OWNER'S NAME/COMPANY NAME CASING(S) Diameter � Depth ► Set in oversize hole? Annular space initially grouted? Property owners mailing address it different than well location address indicated above �� /) - �in.from U to �v R ❑Yes �No ❑Yes ❑No ❑Unknown ��O �T��U$ ��TJ "" t in.from ro ft. ❑Yes n No ❑Yes ❑No ❑Unknown ID� L3llC+ L717 S53�V in.from to _ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown WELL OWNER'S NAME/COMPANY NAME SCREEN/OPEN HOLE ' , Well owner's mailing address if diNerent than properry owner's address indicated above SCfeen from�_to_��ft. Open Hole from to ft. OBSTRUCTIONS ❑Rods/Drop Pipe ❑Check Valve(s) ❑Debris ❑Fill �No Obstruction � Type of Obstructions(Describe) GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? ❑Yes ❑No Describe FORMATION PUMP If not known,indicate estimated formation log from nearby well or boring. ',� ' TYPe '��-i" �� / ,� ❑Removed ��1Mot PreseM ❑Other ___.___ _, ,7\ METHOD USEDTO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: [�Qo Annular Space Exists []Annular Space Grouted with Tremie Pipe ❑Casing Perforation/Removal �; Jt in.from to ft. ❑Perforated ❑Removed in.from to ft. ❑Perforated ❑Removed s Type of Perforator ❑Other GROUTING MATERIAL(S) (One bag of cement=94 Ibs.,one bag of bentonite=50 Ibs.) r Grouting Material�/'��C_��✓from� to� ft. yards_�_ bags from to tt. 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 o 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 Stoclula Well Drillfng Cv,, Inc. 1691 Licensee Business Name //'� License or Registration No. ,,p �G�'��C��S{��- ...-�('. /� � �� 5 -+"'"�� ..'%" ..�.'� -r� �r C ie e resentative Signature ' . Certified Rep.No. Date i ��S ' I..00HL COPY H 2��O� _ � �. ..�"-.. _.,��-''F-1-.^r'r"-- ,. Name of Person Sealing Well or Boring � HE-01434-10 IC#140-0423 ' sio�a