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HomeMy WebLinkAboutWell info - old PID# , ,,. _ � � -��_..T , _. WEL'L OR BORI G LOCATION MINNESOTA DEPARTMENT OF HEALTH MIN AND BOR/N��G NO. ELL CountyName WELL AND BORING RECORD - . - Minnesota Statutes,Chapter 1037 ���� � � M1 Township Na Township No. Range No. Section No. Fraction WELUBORING DEPTH(completed) DATE WORK COMPLETED �� '/�� it. GP DRILLING METHOD LOCATION: Latitude degrees minutes seconds ._ Longitude degrees minutes seconds ❑Cable Tool , i Driven � Dug Auger i�otary . �Jetted House Numb,�r,Street Name,Ciry,and Zip Code of Well Location or Fire Number C � 2J�J�t DL�IC�Cs �1(rt !W� Ot�c�nc 5391 DRILLING FLUID W[�CL HYDROFRACTURED? ❑Yes o Show exact location of well/b ing in section grid with"X" Sketch m of well/boring location. ��� From ft.To ft. howing property lines, N .� roads,b �Idings,and direction. USE �omestic �J Monitoring ❑Heating/Cooling __.___ __1__ __L____:_ ��'�p�y L�Noncommunity PWS ❑Environ.Bore Hole ❑Industry/Commercial _ yn /, � ' ' ' ' ;.—�,4�.*� I—J Community PWS ❑Irrigation ❑Remedial � � , , � ..�, ! . -- -- Elevator ❑Dewatering ❑ v�/ E T �'� / � CASING MATERIAL � -- HOLE DIAM � I l � � . Drive Shoe. j�(es ❑No ,, �.� �Eteel �(fhreaded I]Welded ' ; , 'F M�ie f�� r iamet stic Wei S hons # � , , , � , j Pla � __ --�--- --�--- --�—--�- � + �. . . ; ; ; , CASING 5 � �ii D� er 'ght pecifica� 1 [� +� !y '�(� �iMiie—� , '* in.to�.�j ..._ft�� Ibs./ft.�� � in.to��'" ft. ♦ � PROPERTY OWNER'S NAME/COMPANY NAME '` � ` in.to___.__ft. Ibs./tL _ � to�tt. A._..�� � � � _ � " in.to ft. Ibs./fL ��t�ft. LLliRf. SCREEN OPEN HOLE Property owner's mailing address if different than well location address indicated above. q�� �e� _t Q�q ��� a,� � Make From � ft. To �� ft. a�t�Ji� n P��y�ti! L'i� �.79'Y7 TYPe Diam. - - - 1""""` t SIoUGauze Length Set between ft.and ft. FITTINGS STATIC WATER LEVEL Measured from fL��� elow ❑Above land surface Date measured_�x'��__ WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) . �� ft.after � hrs.pumping � g.p.m. Well/boring owner's mailing address if ditferent than property owner's address indicated above. WEL COMPLETION ��,� �—�'',4� �itless/adapter manufacturer i i�`Yf��-t-1�-�`�'AFedEI asing Protection_ _ _, __ ��'2 in.above grade � ��Abgrade(Environmental Well and Boring ONLY) e. GROUTING INFORMATION Well grouted ��Yes [�No Grout materials ,_Neat cement f�6entonite I��',Concrete ❑Other__ __ From__�To._�ft. ___._� �� '�Yds. � �ags GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO From,_�To�SS ft. ��, [�'�c�.,��,. i Bags MATERIAL From To ft. " I Yds. i I Bags NEAREST KNOWN SOURCE OF CONTAMINATION C� � �a� � � ��/ teet 1,�..3 direction t� Well disinfected upon completion? �_ es �.�]No C�I� �Cd� �OfL 9V I�S PUMP I J Not installed Date installed �� • ' �—�� ��ti@ 38tIC� �!'8j► a0� Z�'� Z� Manufacturer's name ���a��� � �� �� ��C Model Number HP 1 Volts �r' � / r Length of drop pipe f�+.! K. Capacity g.p.m. t j�„�,�� `� �� �1�"i)" �$S Type:��. ubmersible ❑L.S.Turbine ❑Reciprocating ���]Jet ❑ .xs�ri vza�wia ABA ONED WELLS Does property have any not in use and not sealed well(s)? ',]Yes ( o VARIANCE Was a variance granted from the MDH for ihis well? `J Yes o TN# 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,il needed. REMARKS,ELEVATION,SOURCE OF DATA,eta . T7an �Stodala HeII Dcilling, Ct>., ic�. 1b92 Licensee Business Name ' Lic.or Reg.No. � ��'- �� . c� � p en Si� ure� Certitied Rep.No. Date LOCAL COPY ^���6 �� ���� Name of Driller IC 740-0020 HE-01205-11(Rev.3/07) rw i�vv C i,t l itI a�"e�v' C ' ' , I�,c� y 617 13th Ave So � Hopkins, Minnesota 55343 � (612) 935 - 3556 06/13/2008 Stodola Well Drilling 3841 North Main St. Boni facius MN 55375 93 8-21 1 1 REPORT OF WATER ANALYSIS Lab #: 236BN Our Labovatory reports these analytical results, determined on a sample taken by CLIENT on 06/1 1/2008 from the following location: 1500 Bracketts Point Rd Orono,Mn Well 760617 Coliform Bacteria Absent Nitrates Nirrogen <1.0 mg/! 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 anc� nitrate only and does not include analysis of Lead and other contaminants. (Unless as specified by client). Twin City tNater Clinic, Inc. � , � � Bill Val� �1 sdale Lab Certitication#027-053-1 l9 WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring �..� 2 6 4 3 0 3 County Name W�LL AND BORING SEALING RECORD Mennlesoa�Unique Well No. ' Minnesota Statutes,Chapter 1031 or W-series No. (Leava blank�if no�known) Township am Township No. Range No. Section No. Fraction(sm.�Ig.) Date Sealed Date Well or Boring Constructed 117 23 21 3-+(�i �� /�J <,-f P o 7 , GPS Latitude degrees minutes seconds Depth Before Sealing `�✓ � R. Original Depth__ _._____ft. LOCATION: Longitude degrees _ minutes seconds UIFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location Single Aquifer `.J Muttiaquifer I ��M� � W UBORING Measured ,'Estimated Date Measured ��� Water-Supply Well ❑Monit Well � Show exact location of well or boring , -p S etch map of well or boring +� in section grid with"X" x '�c location,showing property . �Env.Bore Hole !,�Other _ �-/� ft. �below U above land surtace N � � lines,roads,and buildings. CASING TYPE(S) �: --'-- --�----`-----'-- 4 [�Steel ❑Plastic ❑Tile [I Other � � --'--- --r-----`-- ---'-- WELLHEAD COMPLETION � � W : ; : ; ET - � � � � Outside: �Well House �At Grade Inside: �Basement Offset �. 'h Mile �wQ�e �Pitless Adapter/Unit ❑Buried [�Well Pit -- - I 1���'i ❑Buried 1 ]Well Pit S ❑Other .. �t Mile—� ❑Other PROPERTY OWNER'S NAME/COMPANY NAME CASING(S) � Diarpete�� ^ � Dep� �� � Set in oversize hole? Annular space initially grouted? Proper y owners mailing a ress if i erent ihan well location address indicated above W � in.from 4� to ft. ❑Yes �No ❑Yes ❑No ❑Unknown 475 i'IdLA�r Ot� Ste 445 in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown Mirmeppolia, I�1 55405 in.from______._ to ft. ❑Yes ❑No ;J Yes ❑No ❑Unknown WELL OWNER'S NAME/COMPANY NAME SCREEN/OPEN HOIE � I� f Well owner's mailing address it ditterent ihan properry owner's address indicated above SCfeen ffom � 1 to '�' ft. Open Hole from to ft. OBSTRUCTIONS �Ftods/Drop Pipe ❑Check Valve(s) ,__]Debris �J Fill ❑No Obstruction Type of Obstructions(Describe) �N/��J` i =� 4` �U �y� ""��--- GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO �bstructians removed? Yes ❑No Describe � FORMATION PUMP If not known,indicate estimated formation log from nearby well or boring. �-+� Type S U n' PU M A �-�" �'�` � f'�f �temoved ❑Not Present ❑Other `-�� METHOD USEDTO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: [�o Annular Space Exists ❑Annular Space Grouted with hemie Pipe ❑Casing Perforation/Removal in.from to ft. ❑Perforated ❑Removed . in.from to ft. U Perforated [Removed Type of Perforator ❑Other GROUTING MATERIAL(S) (One bag of cement=94 Ibs.,one bag of bentonite=50 Ibs.) Grouting Material ��A�C_�/�=�jr�� to / � h yards� bags from to ft. 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 No 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. �bn Stodola T�e].1 Drilling Co,. Inc. 2691 Licensee Business me License or Registration No. � � ��j ''7 '�G'S.� iJ / rr' ertified epresen ative Sigrial e Certified Rep.No. Date ��,�:;j����.�� H 264303 ��m- � .�`'�.��_�.�,- Name ol Person Sealing Well or Boring HE-01434-10 IC#140-0423 � 5/a�a �. , ��.-.�_—i_ _.. . ..__ ... . ,�_ . . .. ---------- -�...- --='-'._, :.. .��..::.�..,.. _ . .. . ,... . ....._ _,...-�--.,, . . . . ...:.... . ... �,.. _ �-.::.. ....._.