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Home My WebLink AboutWell info MINNESOTA UNIQUE WELL WELL/BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. County Name WELL AND BORING RECORD 7 4 3 4 3 5 �erm�pin Minnesota Statutes,Chapter 103I Township Name Township No. Range No. Section No. Fraction WELUBORING DEPTH(completed) DATE WORK COMPLETED ' 4ccx�o II7 23 10 .,, ,,a ,,. 176 n 2-22-47 GPS DRILLING METHOD LOCATION: Latitude degrees minutes seconds �. I�Cable Tool I I Driven �.Dug Longitude degrees minutes seconds Auger �Rotary Jetted House Number,Street Name,City,and Zip Code of Well Location or Fire Number � . 920 Bro�m Rd S, VrOYIO 55356 DRILLING FLUID WELL HYDROFRACTURED? I.;Yes No Show exact location of well/boring in section grid ith"X." Sketch map of well location. �j'itflj�i te From ft.To ft. Showing property lines, 7 N � roads,buildings, � �Monitoring IJ Heating/Cooling �� ; ; ; ; and direction. � Noncommunit PWS �. Emiron.Bore Hole I �.Industry/Commercial - ' --'--- --'--- ---`— --'-- � t omestic i , i i i i . . mu y WS . . i � � emedial Y � CASING MATER ALnrt D��IrrigaCon ' '�R � P --;--- --,- -,--- ---;-- � Threaded 9,Ye —Welde 1, ' W � 1 � E T eel L I d OLE DIAM. r s ' H . , , �1St � � , � �( --�--- --'----�-- --`— - � /"7 Plastic ❑ _ '/,Mile ; ! i ! I CASING ----- --'----•-- ---•-- � � � 1 Diameter Weight Specifications ' S � \\ t �—1 Mile—� ��u' � in.to �� K. ��oa Ibs./fL � �L ,in.to �t ft. in.to _ _ ft. IbsJft. D�in.to�1U ft. PROPERTY OWNER'S NAME/COMPANY NAME in.to ft. Ibs.lft. in.to ft. StOT�O� ��p-- LE �� iti,I�+ SCREEN_�____ OPEN HOLE Property owner's mailing address if different than well location address indicated above. Make From _ ft.To _ft. � 7407 Wayzata Blvd ��c��ess st� Type _. � _ Diam. `: �- �7� i.R7�7.i..a �r� r�N SSli2b Slot/Gauze t�}L•v�� p Length_ 4 .. �� i Set between�ft.and�.�) fl. FITTINGS�� * � STATI ATER LEVEL�/ q � �` �� ft.,L^4 Below I '��Above land surface Date measured. . �+`�� PUly1P�LEVEL(below land surface)�. WELUBORING OWNER'S NAME/COMPANY NAME 1____.______ft.after � hrs.pumping � g.p.m. � WELL HEAD COMPLETION t-! '�'• ``�yy�,� ,� Well/boring owner's mailing address if different than property owner's address indicated above. �pitless Adapter Manufacturer L)--��"""�—�" - — Tvlodel _ � i�_!Casing Protection �12 in.above grade CAt-grade(Environmental Well and Boring ONLY) t i GROUTING INFORMATION.� Well grouted? ,��°Yes C No y � Grout materials . .Neat cemery,A�Bentoryjj�. .'��.Concrete �.Ot�r ____ �, "' From �'� To "Xj ft. �.r Y=d*s. �Bags ��. From�� To��ft. �� .J1�di�O Bags " GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO From__ To ft. I I Yds. f.7 Bags MATERIAL -- NEAREST KNOWN SOURCE OF CONTAMINATION � .j`-� �... .A..-� 3 Ci�y�.�� b� .�Qf� h �f�f feet _direction � �� _type x � �� Well disinfected upon completion? � Yes ❑No * t PUMP � Caa� � ��t � "� '�..I Not installed Date installed ��' ��^�`'� � C18 br{7�J[I $Q�t yo � Manufacturer'sname ��"'"^—' ' �" �tC7 Model Number HP � �� Volts �fl - � ' $$j� � �ft � 11Q Length of drop pipe � � ft. Capacity g.p.m. Type:'�.Submersible ��LS.Turbine '��.l Reciprocating I..I Jet I 1 ei� b�Q� ��t$}� �IO 2� ABANDONED WELLS Does property have any not in use and not sealed well(s)? �.:�Yes Y?No `� s$ju/ �0�� bt�l �}i r 1{W 1�(7 VARIANCE Was a variance granted from the MDH for this well? C Yes�No TNk �' c 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 knpwledge. Use a second sheet,if needed. : REMARKS,ELEVATION,SOURCE OF DATA,eta a�t�ii Stodola._�1�Dti1. Ib9i �L� Ca.. �. Licensee Business Name Lic.or Reg.No. - �� " ..��- `� G� i presentative Signature Date R1�1!`1[ M(1t11'A LOCAL COPY 7 4 3 4 3 5 Name of Driller HE-01205-09(Rev.9/O5) IC 140-0020 rw� c �-y w�-� c � � , I �,� 617 13th Ave So � Hopkins, Minnesota 55343 � (612) 935 - 3556 02/23/2007 Stodola Well Drilling 3841 North Main St. Boni facius MN 55375 93 8-21 1 1 REPORT OF WATER ANALYSIS Lab #: 70BN Our Laboratory reports these analytical results, determined on a sample taken by CLIENT on 02/21/2007 from rhe following location: 920 Brawn Rd. S Orono,Mn Wel I 743435 Coli form Bacteria <1/100 ml Nitrates Nitrogen <1.0 mg/I The results of these tests indicate rhat this well is producing water rhat 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 Le.ad and othev conraminants. (Unless as specified by clienr). Twin City Water GPinic, Inc. � �� Bill n Ars�le Lab Certification H 027-053-I 19 wELL oR BORING LOCAnON MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring '„I County Name WELL AND BORING SEALING RECORD MinnfesoNa Unique Well No. ��i� Minnesota Statutes,Chapter 1031 or W-series No. ��.�dmw n na an�m> Township Name Township No. Range No. Section No. Frac(ion(sm->Ig) Date Sealed Date Well or Boring Constructed Orono 117 23 � 12 �,. �,. Z� � . - GPS Latitude degrees minutes seconds LOCATION: Deptli Before Sealing �� ft. Original Depth ft. Longitude degrees minutes seconds pUIFER(S) STATIC WATEH LEVEL Numerical Street Address or Fire Number and City of Well or Boring Locadon ingle Aqu'rfer ❑MulUaqu'rfer 92rt �� D� S ^rO� WELUBORING �Measured ❑EsUmated d� n �� Water Supply Well ❑Monit.Well � 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. �bebw ❑above IarW surface lines,roads,and buildings. N CASING TYPE(S) , � �- � - - � � ��„' � �Steel ❑Plastic ❑Tile ❑Other -�C, �, W --�- -�-- -;-- --;- E �1 � WELLHEAD COMPLETION � .� i � Outside: ❑Well House Inside: ❑Basement Offset --i-- -;-- -;-- --i-- - - - /�� itless Adapter/Unit ❑Well Pit --�- -�-- -�-- --1- � � ` � �� ❑Well Pit ❑Buried :�, S ./ �7 �--�^"'"-�. ' ❑Buried PROPERTY OWNER'S NAME/COMPANY NAME CASING(S) Diamettt��r� � /Depth R Set in oversize hole? Mnular space initialty grouted? P er s i mg a dress � rent an we ion a ress indicated above Lf ��.,/ � in.from� to�:LL ft. ❑Yes �No ❑Yes ❑No ❑Unknawn /� 7�] ��Y7�� Bi� in.from t0 ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown St Iauis �xrk 5542b In.ffOm t0 ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown WELL OWNER'S NAME/COMPANY NAME SCREEWOPEN HOLE , r Well owner's mailing address if difterent Ma p irWicated above Sc�een ffom�to�ft. Open HOI@ ffOm t0 ft. OBSTRUCTIONS NO V 0 3 2006 �Rods/Drop Pipe ❑Check Valve(s) ❑ Debris ❑ Fill ❑ No Obstruction CITY i°� Type of Obstructions(Describe) ��J�,� ��'� �' ��m� � GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? 2S ❑ NO Describe FORMATION If not known,indicate estimated formation log irom nearby well or boring PUMP i� _ TYPe v''�,� C 1 i`� "� r''�' Removed ❑ Not Prese t ❑Other ' r r f METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: �No Annular Space Exists ❑ Annular space grouted with tremie pipe ❑ Casing Perforation/Removal in.from to ft. ❑ Perforated ❑ Removed in.from to ft. ❑ Perforated ❑ Removed r Type of perforator ❑ Other GROUTING MATERIAL(S) (One bag of cement=94 Ibs.,one bag of bmtonke=50 Ibs.) y�G � ��-^ r �/�� Grouting Material �� l�C��k6fii � to 1�l.Jft. yards � bags from to tt. yards bags from ta 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 infortnation contained in this report is true to the best of my knowledge. I�or� Stcxlais Well Drillin�; Co., In�. 1b9I Contractor Busine Name License or Registra6on No. `- �f .-�1 tJ� ✓ � Au "z s e ig t Date LOCAL COPY r,, , _�. � , ,i,� -v' H 2 517 4 4 Name o/Person Sealing Well or Boring