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Home My WebLink AboutWell info s ` ti � WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. � CountyName WELL AND BORING RECORD 6 4 9 2 01 R�III2@ in Minnesota Statutes Chapter f03/ Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed n. Orono 117 23 03 ��. �� 1 3 House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD 6Q/� O ❑ Cable Tool ❑ Driven ❑ Dug C7V �7 Brown Rd �r�n0 5 C7 Auger �Rotary ❑ Jetted Show exact location of well in section grid with" " Sket h map of well location. ❑ 1�howing property lines, A. o,}� roa s a d buildings. DRILLING FLUID WELL HYDROFRACTURED? ❑YES �O — N — � � i � i � � FFOM_ ft.to ft. i -i- -i- -i USE fJ Monitoring ❑ Heating/Cooling i i i i � �� Domestic �j Communi PWS _I_ _J_ _L_ _I_ t„ ❑ Irrigation ry ❑ Industry/Commercial i i i i .� ❑ Noncommunity PWS ❑ Remedial yy E T -�>� � ❑ Environ.Bore Hole i i i i � ❑ Dewatering ❑ i i i -� I � CASWG Drive Shoe? ❑ Yes �lo HOLE DIAM. 'IzMne .-� _i i 1 i � ❑ Steel ❑ Threaded ❑ Welded i- -l- i i �!Plastic ❑ s �-1Mile—� ..�� CASING DIAMETEF WEIGHT PROPERTY OWNER'S NAME _�__.__in.to_��.�ft. � fl��Ibs./tt. __in.to__��tt. T ll! $ ��.co n. _ib5.in. t ��.�o�Z_�n. Property owner's mailing address it different than well location address indicated above. ___in.to__ fl. IbsJft. in.to ft. 7526 Turner �d SCREEN OPENHOLE Inde end�nce M� 55328 "'ake__�1°hns°� ``°m___ n`° n. P 1 Type�_��#�;�.��_ e�t�s�Diam �___ ��` SbUGauze� _._ Length _ � Set between _� _ ft.and R. FITTI GS: STATIC WATER LEVEL WELL OWNER'S NAME __5_5—_ R. C�below ❑ above land surface Date measured ��77.+11 PUMPING LEVEL(below land surface) Well owner's mailing address if different than property owner's address indicated above. 1_1_�___ ft. after __,___,�_ _hrs.pumping �_._g.p.m. WELL HEAD COMPLETION f�Pitless adapter manufacturer ..L.1 •....��Model • f� Casing Protection__. __._ �12 in.above grade �� ❑ At-grade(Environmental Wells and Borings ONLY) GROUTING INFORMATION Well grouted? �Yes ❑ No GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO Grout Material ❑ Neat cement f7 Bentonite I� Concrete �High Solids Bentonite MATERIAL from�__to__ 3i�.ft. ___^y_�5❑ yds.�'bags from_��--to�_'}�ft. �a��a_� f��d�1 bags i from to ft. ❑ yds. ❑ bags � NEAREST KNOWN SOURCE OF CONTAMINATION __ 1`in_feet _ _�. direction`+��y _Qn�2.pt�pe ) .��.�.. Well disinfected upon completion? ,jS�Yes f 1 No PUMP ❑ Not installed Date installed 6'1��Q Manutacturer's name - Model number_ HP �_ . Volts��8_ _ 7 Length of drop pipe___�_ ft. Capaciry _ g.p.m. Type: �Submersible ❑ L.S.Turbine f7 Reciprocating ❑ Jet ❑ _ f ABANDONED WELLS Does property have any not in use and not sealed well(s)? ❑ Yes �No VARIANCE Was a variance granted from the MDH for ihis well? ❑ Yes �No TN#_ : i - WELL CONTRACTOR CERTIFICATION Use a second sheet,il needed 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 ot my knowledge. i REMARKS,ELEVATION,SOUf10E OF DATA,etc. Licensee u*smes' s Nam��'`��fl�or'R�g.7J�� , �:.=f�,.:_....� ��-��-d.�-*�-`�10-4-00 ; - - --- - _ —_ ---- -- � � Authorized Represenlative Signature Date i Chuck Maore 5-22-00 r . _ _------ - -— - 6 4 9 2 01 Name o�Driller Date LOCAL COPY HE-01205-07(Rev.2/99) .. � T'w�vv C i�t W a,te� C ' ' , I v��,c� y 617 13th Ave So � Hopkins, Minnesota 55343 � (612) 935 - 3556 OS/25/2000 Stodola Well Drilling 3841 North Main S[. Bonifacius MN 55375 938-21 1 1 REPORT OF WATER ANALYSIS Lab #: 39105 Our Laboratory reports ihese analytical results, determined on a sample taken by CLIENT on OS/22/2000 from the following location: Tom Bren Homes 680 S. Brown Rd. Orono,Mn Unique Well #649201 Coli form eacteria <1/100 ml Nitrates Nitrogen <1.0 mg/1 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). 'ty Water Clinic, Inc. \ �� Bill \ a2 Analyicai laboratory Consulting Isn�incer lVater Malysis Reage�ts l3uiler W,ilcr('hemicals Lab Certi(ication It 027-053-1 19 ,. � _. . = � �,,... ,�.-;�.: r .,.. • . .. .., �r,;s"�'i`r' 9" ��.�,,�,f �4" ,,I"� .,.., ..,_,. , .,- �''"°' `�� .- , ;: � . �_: .. . , MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring ��C► i � WELL OR BORING LOCATION I �o��ry Name WELL AND BORING SEALING RECORD Sealing No. �H pr� Minnesota Unique Well No. ��p#Q M�nnesota Statutes, Chapter 1031 or W-series Na �— � heew denic rc�a xrow�� Township Name Township No. Range No Section No. Frad�on�sm.-►Ig.) Date Sealetl Date Well or Bormg Constructed � �ra�o i23 23 t33 ,. ,. � Numencal Street Address or Fire Number and City of Well or Bonng Location € � 600 � b=O� �„� h�.Q�� C G��(�, Depth Betore Seaiinq �� _8. Original Depth _�[.� n O D lJ .!a v Show exact location of H�ell or boring Sketch map of well or bonng ApUIFER(S) STATIC WATER LEVEL in section grid with"X". location, showing propeny �. Single Aywfer � MultiaquAer � lines,roads and i in N WELUBORING vleasured ❑ Estimated � �Water Supply Well ❑MoNt.Well � � ❑ Em.Bore Hole ❑Other _ __�_R �j below ❑ above land surface � W -- - - -- - -- -- -- E ��} CASING NPE�S) � � � � z � � � � � � '�l � --�- ---- -i-- --�-- 3 y.,�,` �teel � Plastic �Tile �Othe� � � � Yimi� '�'�'j" -;-- -�- -�-- --i-- � _,,,��f' ��_� CASING(S) Diamet�� Depth � Set In oversize hoie9 Annular space initially grouted? S �J� {/,!�� r�--i mi�e�s ''? � � in from� to�,LYL ft. ❑ Yes No ❑ Yes �No ❑ Unknown I I � PROPERTV OWNER'S NAME in.from to ft. ❑ Ves ❑No ❑ Yes ❑ No ❑ Unknown Property owner's mailing address il diflerent ihan well loca6on adtl�ess indicated above. m.from to R. ❑ Yes ❑No ❑ �es ❑No ❑ Unknown 752b Turner Ad SCREEWOPEN HOLE Iadependenc+�, � �J�6 Li Screen from�to�5� ft Open Hole from lo R OBSTRUCTIONS WELL OWNER'S NAME �Rods/Drop Pipe ❑Check Valve(s) ❑ Debris ❑�Fiyll� ❑ No Obstruction Well owrreYs mailing addreu if different than property owner's address indicatetl above. Type of ObSt�uCtionS(D05Cribe) �fI.�JI�� / �� 7"� �� Obstructions removed? Yes ❑ No Describe PUMP Type `^�i(,)��EJ M� GEOLOOICAL MATERIAL COLOR HARONESS OF FROM TO Removed ❑ Not Present ❑ Other FORMATION If not krawn,indicate estimeted formatbn log irom nearby well or bonng. METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: � �o Annular Space Exists 'r� ❑Annular space grouted with tremie pipe _ ❑Casing Perforation/Removal in.from to ft. ❑ Perforated ❑ Removed in.from �o n, ❑ Pertorated ❑ Removed Type of peAoraror ❑ Othe� GROUTING MATERIAL(S) (One bag of cement=94 Ibs.,one bag of bentonite=50 Ibs.) �� :��;�r� �' .� Grouting Material to R. yards bags from ro R. yards bags from to ft. yards bags from to—_ ft. yards bags REMARKS,SOURCE OF DATA,DIFFlCULTIES IN SEALING OTHER WELLS AND BORINGS Other unsealed and unused well or boring on property? ❑Yes No How many? LICENSEO OR REGISTERED CONTRACTOR CERTIFICATION This well or boring was sealed in eccordance with Minnesota Rules,Chapter 4725. The information contained in Mis repoR is true to the best of my knowledge. Hr�n Stodt��a Weil Dr321ing Gm., I�c. Z71.7Z Confractor Business Name -- License a Registration I'io. . c� - ;? �:� A odz e resentative Signature Oete ��1"'"y'i"'"' ��''•�Q.J.1�1^'\,.� i��f"'�d+k'_��+�'v � �� Neme o/Person Sepl ir�Well or Bodng ` ; i