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Home My WebLink AboutWell info _ �, . rw i�vv C i�t 1Na.tr�v- C ' ' , I v��,c�. y 617 13th Ave So � Hopkins, Minnesota 55343 � (612) 935 - 3556 02/19/2003 Stodola Wel1 Drilling 3841 North Main St. Bonifacius MN 55375 938-21 1 1 REPORT OF WATER ANALYSIS Lab #: 106 Our Laboratory reports these analytical results, derermined on a sample taken by CLIENT on 02/17/2003 from the following location: 960 Brown Rd. Orono,Mn Unique Well #688961 Coliform Bacteria <1/100 ml Nirrates 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 nor include anal}�sis of Lead and other contaminants. (Unless as specified by client). ,� � City Waier Clinic, Inc. �, �\ Bill 1� n�dsdale � , Lab Certifcation#027-053-1 I9 wELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring H 2 0 5 6 91 County Name WELL AND BORING SEALING RECORD MennlesoNa Unique Well No. Minnesota Statutes,Chapter 1031 or W-series No. I3�►nne in ��ea�eb�a�k,,�o�k�ow�, Township Name Township No. Range No. Section No. Fraction(sm-►Ig) Date Sealed Date Wetl or Boring Constructed �rono 118 23 27 3�0425 ' / 4%�, 1 � � , , GPS Latitude degrees minutes seconds �,�� ft. LOCATION: Depth Before Sealing /�� fL Original Depth Longitude degrees minutes seconds qpU1FER(S) � STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location ingle Aquifer ❑Multiaquifer W1,�LL/BORING �Measured ❑Estimated � IY Water Supply Weli ❑MoniL Weil � Show exact location of well or boring Sketch map of well or boring �� '!�� in section grid with"X" location,showing property ❑ Env.Bore Hole ❑Other � ft. �below ❑above land surface lines,roads,and buildings. N � CASING TYPE(S) - - - - -- -- -- — � r ,� I�Steel ❑Plastic ❑Tile ❑Other 9, T� W —�- - -- - -- -- -- E �) �-9� WELLHEAD COMPLETION t , � � � � l Outside: ❑Well House Inside: ❑Basement Offset � -�-- -�— ' �— .. � Y�mi�e �� itessAdapter/Unit ❑Well Pit �� -r- -i-- -�-- --�— _, • :.' } .... ❑Well Pit ❑Buried S �r mde� ❑ Buried PROPERTY OWNER'S NAME/CTOMPANY NAME CASING(S) S .i� Diam eff Depth � Set in oversize hole? Annular space initiall;�grouted? � Property owner's mailing address if different than well location address indicated above . in.ffOm� to�ft. ❑Yes �o ❑Yes ❑No ❑Unknown I8340 l�iinnetonka Blvd W�yzata, MN 55391 in.from to ft. ❑Yes ❑No ❑Ye5 ❑Na ❑Unknown in.from t0 ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown WELL OWNER'S NAME/COMPANY NAME SCREEN/OPEN HOLE /� / / Well owner's mailing address if different than property owner's address indicated above Screen from F-��t0��ft. Open Hole ffOtll t0 ft. OBSTRUCTIONS C�Rods/Drop Pipe ❑ Check Valve(s) ❑ Debris ❑ Fill O No Obstr/uc�tion Type of Obstructions(Describe) ...LN/V�� -�/'L �' / U�/!� GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO ObSt�UCtiOnS�emOved? 2S ❑ NO Describe FORMATION It not known,indicate estimated formation log from nearby well or boring PUMP (} n ` TYPe '`'f' U� i V M i , ��. J - ` �Removed ❑ Not Present ❑Other ; METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: y�vo Annular Space Exists ❑ Annular space grouted with tremie pipe ❑ Casing Perforation/Removal /� in.from to ft. ❑ Perforated ❑ Removed in.from to ft. ❑ Pertorated ❑ Removed Type of perforator ❑ Other GROUTING MATERIAL(S) (One bag of cement=94 Ibs.,one bag of bentonite=50 Ibs.) A' / �{�� r GroutingMaterial F�`��`��dm � to�ft. yards � bags from to ft. yards bags from to ft. yards bags OTHER WELLS AND BORINGS REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING Other unseaied 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. s� Don Stadnl a �dPt l � Contractor Busin s Name . ... License or Registration No. ¢ , - � ,. " � �- � �� t iz ep�entative Sigrtatur2 Date LOCAL COPY H 'n��Q 1 � ��3��/�^-'�\R��^' Name ol Person Sealing I or Boring . '� WELL LOCATION MINNESOTA DEPARTMENT OF HEALTN MINNESOTA UNIQUEWELL NO. CountyName WELL AND BORING RECORD 6 8� ��1 y A Minnesota Statu.es Chapter 1031 Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) � . . Date Work Compteted ,, ,, ,, 190 " 2—I4—Q3 . GPS DRILLING METHOD " Latitude degrees minutes seconds LOCATION: -- � - �_Cable Tool �]Driven ' ��.Dug Longitude degrees minutes seconds �-��Auger �Rotary �_'�Jetted House Number,Street Name,City,and Zip Code of Well Location or Fire Number �� DRILLING FLUID WELL HYDROFRACTURED? �Yes �� o Shop exact location of well in section rid wit "X", Sketch map of well location. �j$t�� FROM ft.TO ft. Showing property lines, - - roads and buildings USE �.�,Monitoring i_',Heating/Cooling � + N ; " �- � ��No community PWS ;_ s � , , I -I Environ.Bore Hole i Industry/Commercial ' --'- -�--- `"` � Irrigation ' !R d I ' ;--- ; - ---�- � _ �_ eme ia ' , � I , Lj Community PWS Dri eeShoer'n9 - Yes N ' '- '"" '` HOLE DIAM. �� . l CASING � �� w ET _ o � � �� i Steel ��'Threaded ❑Welded s, �� 4 Plastic i.� — � , , MI � -; � -.- l -°� •�-,� --,---- �---s-:-- - :: CASING DIAMETER WEIGHT `t�� _`f_in.to �S Z__it. ��Q�Ibs./ft. � in.to__�Q[. F--i Mae—� 1 .. in.to___ ft. .__.__ _Ibs./ft �in,to1QQt. PROPERTY OWNER'S NAME/COMPANY NAME in.to ft. Ibs./ft. in.to___fl. teiner � Rop�e2man SCREEN_ ___ _ OPENHOLE Property owner's mailing address if different Ihan well bcation address indicated above. Make_ �Q�na�QjL-g S�_� FROM fi. TO ft. � 83G0 Minnetonka Blvd t i�lie� --- �--- , ,--- � Type _ _ _ Diam. � '' syza t s, MN 5 5 391 S�o�GaUZe •�1� �e�9th 4 __+_4 ___ p �f « � - ----- — — Setbetween�SQ._ ft.and 1�L ft. FITTINGS.�.�3Q�j : ST�TI�V�(ATER LEVEL �_*�—O� U _ 1 � '��- ft.� �below 'above land surface Date measured_.___._—_. --..__ �: PUMPING LEVEI(b ow land surface) � WELL OWNER'S NAME/COMPANY NAME 1 79 ft after �___. hrs.pumping__3�_ g p.m. WELL HEAD COMPLETION ,.,.},�,� Well owner's mailing address if different than property owners address indicated above. Pitless adapter manufacturer_w►!1_��Q��_�_ Model __._ _ �Casing Protection ___.____. �12 in.above grade -;At-grade(Environmental Wells and 8oring ONLY) GROUTING INFORMATION Well grouted �Yes [�No Grout material �__,Neat cement �]Bentonite ` �Concrete�i High Solids Bentonite from�__to_��fL __�_ _ �..1�yds. �bags from_.�.___ro�_Q.�__ft.��(1.�'.�� '--iy�s��'bags GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO from__._ lo ft. _'�.yds. i J bags MATERIAL — -- ---- NEAREST KNOWN SOURCE OF CONTAMINATION . .� ;�., �.... ,- y lSy o�an oft fl i6 --1 � —feet =:� direction `�.-�-� ;:x` .�.�+�-,Lype Weli disinfected upon completion �Yes �.J No ::�;>"r-r 1Sj�' LEly Of t 16 gQ PUMP �Not installed Date installed 2��__ 8nd COWn �f t (�� 1 10 Manufacturer's name __ . _ _ � a Model number � H�r�_Volts Z$y r$y Of� 11� 1 30 Length of drop pipe _�4.�. ft. Capacity g.p.m. Type: Submersible 'Li L.S.Turbine �J Reciprocating [;Jet i=; �� aQd ray � oft 130 190 ABA CONEDWELLS Does property have any not in use and not sealed well(s) �j Yes �No � VARIANCE . ' Was a variance granted from the MDH for this well? =,-'Yes �No TN# WELL CONTRACTOR CERTIFICATION � �^ This well was drllled under my supervision and in accordance with Mlnnesota R��les.Chapter 4?25- � The information con[ained in ihis report is true to the best of my kno��,�ledge Useasecondsheet,i/needed �j� S`tOd�la ��1 Dcillin,� Co. , Ine• 2 172 REMARKS,ELEVATION,SOURCE OF DATA,etc. � -. _ ._---- ---------- ----�----- -- _._ ____.— . Licensee Busmess Name Lic.or Reg.No. - - :yT�� _ ---3'..20_{}3 h d enfaGve Signatw Date Chuck Moore 2-14-�3 ____ _ __ --- -- - -- - (� �� Name of Dniler � Date LOCALCOPY � HE-01205-08(Rev.5/02) IC 140-0020