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Home My WebLink AboutWell info �- . . ._. ... . � . . Y ., . . . 9 _ . :��:��:.:.,..��:.. � � WELL OR BORING LOCATiON MINNESOTA DEPARTMENT OF HFALTH Minnesota Well and Bonng I �� - � �1� FL AND BORING SEALING RECORD Sealing No �"� Counry Name �yA A� �, r� Minneso!a Unique No. � -- � L'�"e.'fIY"l�?plIl ��a '- Mmnesota Statutes,Chapter 1031 or W-senes No. (Leave b�ank i�not known� Township Name Township N�Ra�g�1 Q- $� on-,No. racuon�sm �Ig.) Date Sealed Date Well or Bonng Gonst�uctea ur�;�v i17 23 �"'� , ,. 3/i/99 Numerical Sireet Adtlress w Fire Number and City o�Well or Bonng Location .��{7 V �t�n�$ i,01 il� Lane OrJn� Depth Before Sealing �� ft Original Depth �7 n Show ezact locauon of v.�ell or boring Sketch map of well or bor�ng ApUIFER�S) STATIC WATER LEVEL � v in section grid with"X". N �. locahon, showing property ��ngle Aquiter ❑ MultiaquAer lines,roads,and buildings. N WELUBORING Measured ❑ Est�mated [.�.Water SupD�Y Well ❑Monit.Well Ct ❑ Env.Bore Hole ❑Other _ �v fl. TJ below ❑ above land suAace W --�- - -- - -- --i-- E � CASING TYPE(S) � � � � � -�- ---- -�-- - -i - � ' ; - --- [�.Steel ❑ Plastic �Tile � Other � um�re i y ._... . " . ',' -�- �- �1 - --�-- � t••----.i ._.. . _._�. CASING .. Dlameter Depth Set in oversize hole? Annualar space milially grouted? S � � �3 Ves No Unknown ��m,�� in trom to n. ❑ ves [�No ❑ ❑ ❑ � PROPERTY OWNER'S NAME in.from to ft. ❑ Yes ❑No ❑Yes� ❑No ❑Unknown 1-suO i2lttvt Properry owner's mailing atltlress ii diflerent than well locafion address indicated above. in.irom to ft. ❑ �es ❑No ❑ Yes ❑ No ❑Unknown C�U K�1�li7X SCREEWOPEN MOLE 1�`.� La ke .S�`.r�v t ►'�Z�� Screen trom a� to �� R. Open Hole trom to R. �ayzata. .ry1�Y �5:331 oesraucnoNs WELL OWNER'S NAME Aods/Drop Pipe ❑Check Valve(s) ❑ Debris ❑ Fill ❑ No Obstruction Well owneYs mailing atldress if tliHerent than proparty owner's adtlress indicatetl above. Type of Obstructions(Describe) r u��I F�1 l�� (�n a ��1 r�t'� Obstructions removed? �Yes ❑ No Describe PUMP Type ��rl�IG�r51b1� CiEOLO(i1CAL MATERIAL COLOH HARDNESS OF FROM TO �Removed ❑ Not Present ❑ Other FORMATION If not known,indicate estimated formation log trom nearby well or boring. ME�TyHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: L7'No Annular Space Exists II r 1�� y� ❑ Annular space grouted with tremie pipe � ❑Casing Perforation/Removal in.from �o k. ❑ Pertorated ❑ Removed in.tiom to R. ❑ PeAorated ❑ Removed Type of perforator ❑ omer GROUTING MATERIAL(S) Grouting Material ��r t'1'dI�Cl from �� to � R. yartls � begs from to R. yards bags from to ft. yards bags from to__ k. yards bags REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING OTHER W ELLS AND BORINGS Other unsealed and unused well or boring on property? ❑Yes �o How many? LICENSED OH REGISTEHED CONTRACTOR CERTIFICATION This well or boring was sealed in accordence with Minnesota Rules,Chapter 4725. The information contained in Mis report is true to the best of my knowledge. tL.:b ��.Ll L).fr1.I.l.1Lly L /L /C> Contracror Business Name License a R 'ha' fio. i _�+ '` :�' '�`T'--�� .�.,.. ,-�/�l .. /� .. i�.�., s'' _� / , ¢' ,/ AuMorized Repiesentative Signature Dere ��1. ....��. � �TdYf1�S TL�.'ti _ Name ol Person Sealing Wel/or Bonng � LOCALCOPY H HE-01434-04 8�98 R F . �. .. (-.. . .. . . . ,. . . . _ �. . . '1. � • + WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. CounryName WELL AND BORING RECORD 1 , Hennepin Minnesota Statutes Chapter f037 �� y � �. � ' Township Name Township No. Range No. Section No. Fraction WEIL DEPTH(completed) Date Work Completed � OrOnO 117 Z3 0$ ,,, ,, ,,, 120• ry 1-27-00 House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD ❑ Cable Tool ❑ Driven ❑ Dug � ❑ Auger O�totary_ ❑ Jetted �. Show exact location of well in section grid with"X". Sketch map of well location. ❑ ' - - . Showing property lines, WLL� roads and buildings. DRILLING FIUID WELL HYDFOFRACTURED? ❑YES ❑NO N �' x j � i i i �nt�nite FROM ft.to ft. -i -i- -�- -�- � USE ❑ Monitoring ❑ Heating/Cooling � i � � �omestic ❑ Communi PWS ❑ Irrigation ry ❑ Industry/Commercial -i- -�- -�- -i ❑ Noncommunity PWS ❑ Remedial yy E T ❑ Environ.Bore Hole i � i � ❑ Dewatering ❑ i � i -r ��ZIM,ia CASING Drive Shoe? ❑ Yes �o HOLE DIAM. i i 1_ _� ❑ Steel ❑ Threaded ❑ Welded � , � � 1 �o� ��ast;� o s S �-1 Mile-� � S CASING DIAMETER WEIGHT PROPERTY OWNER'S NAME �� 4 in.to 1 1 a ft. �.�QS Ibs./ft. 8 in.to� 3�0/�ft. Bob Ff tch in.to tt. Ibs./ft. �in.to4_`Yft. �� Property owner's mailing address if different than well location address indicated above. in.to ft. Ibs./ft. in.to ft. 11725 54th 1l�e• �• SCREEN OPENHOLE ' Plysouth, Nn.55442 Make Jo�nson from n.�o n. Type Diam. 7 M . SIoUGauze A 1 A Length e• __ � Set between �1�_ft.and__}�_ft. FITTINGS: 9��/ STATIC WATER�EVEL WELL OWNER'S NAME '�� ft. O=elow ❑ above land surface Date measured 1 Z�27� � PUM1PING LEVEL(below land suRace) 1 Well owner's mailing address if different than property owner's address indicated above. 107 R. after Z hrs.pumping SO a 1 r g.p.m. WELL HEAD COMPLETION �itless adapter manufacturer �f t.@lfSt.@7GAodel ❑ Casing Prolection _____ X] 12 in.above grade ❑ At-grade(Environmental Wells and Borings ONLY) GROUTING INFORMATION ` Well grouted? C�Yes ❑ No GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO Grout Materia� ❑ Neat cement ❑ Bentonite ❑ Concrete �High Solids eentonite MATERIAL from_�_ro��tt. _��5 yds.�] bags from to___ft. ❑ yds. ❑ bags � � from ro ft. ❑ yds. ❑ bags NEARE/ST�K^NOWN SOUFCE OF CONTAMINATION�) CY f T� • • L/( , � feet ��_O C.!! �`t _direction��type Well disinfected upon completion? Q�es ❑ No � �PUMP ❑ Notinstalled Dateinstalled 3�9�00 , Manufacturer'sname Wu�� t Model number HP 1 Volts ��O Length of drop pipe 63� ft. Capacity 1� g.p.m. Type: �ubmersible G LS.Turbine ❑ Reciprocating ❑ Jet ❑ ABANDONED WELLS - Does property have any not in use and not sealed well(s)? ❑ Yes � No VARIANCE Was a variance granted trom the MDH for this well? ❑ Yes � No TN# WELL CONTRACTOR CERTIFICATION Use a second sheet,il needed This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. REMARKS,ELEVATION,SOURCE OF DATA,eta 7he information contained in this report is true to the best of my knowledge. DON STODOLA WELL DRILLING CO. ZNC. Licensee Business Name � Lic.or Re .No. �� -r :� 3—Z1-00 �'� orize Representative S� ture Date � � ChuCk Moore 1-27-00 � 6 3 913 7 Name ol Driller Date LOCAL COPY HE-01205-07(Rev.2/99) T"w i�w C�,t� 1�V a,t�e� C ' ' , I v��,c� y 617 13th Ave So � Hopkins, Minnesota 55343 � (612) 935 - 3556 02/01/2000 Stodola Well Drilling 3841 North Main Sc. Boni facius MN 55375 938-21 1 1 REPORT OF WATER ANALYSIS Lab #: 38500 Our Laboratory reports these analytical results, determined on a sample taken by CLIENT on 01/27/2000 from the following location: Bob Fitch 3260 Bohns Pt. Lane Orono,Mn Unique Well #639137 Coliform Bacteria <1/100 ml Nitrates Nitrogen <1.0 mg/1 The results of these tests indicate that this wel! is pvoducing water rhat meets the standards for F.H.A., V.A., or conventional loans. This report is an analysis fov coliform and nitrate only and does not include analysis of Lead and othev contaminants. (Unless as specified by client). �� u�{it�� 't Water Clinic, Inc. �� J ,\ Bill Vdr��7�s ale Analyical laboratory Consulting Enginecr Water Analysis ReagenLti I3niler Wnter Chcnucnls Lab('erti�ication#027-053-1 19