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Home My WebLink AboutWell info � , _ � _ _ . WELL LQCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUEWELL NO. County Name WELL AND BORING RECORD � 9� �g 8 i� Minnesota Statutes Chapter 1031 Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed Ft. o� �v 23 a �, �,. �, GPS DRILLING METHOD Latitude degrees minutes seconds _ LOCATION: � i Cable Tool nven ��'�Dug Longitude _ degrees minutes seconds �'-j Auger �otary ��J Jetted House Number,Street Name,City,and Zip Code of Well Location or Fire Number � Ji7Y3 �t AVe OCOLIO �S.7C7Y DRILLING FLUID WELL HYDROFRACTURED? �='Yes � No Shop exact location of well in section grid with"X'�. Sketch map of well location. �tCRlite FROM ft.TO ft. Showing property lines, N . / roads and buildings USE Lj Monitoring ❑Heating/Cooling ; � ; ; ; � � � `t� ,,.`_� �Domestic [ ��Environ.Bore Hole ❑Industry/Commercial , . _J�,D — r�. __'_____'_" _'_`__ ___`_ *„ ,Noncommunity PWS =,�Irrigation rl Remedial �� Communiry PWS � �i_]Dewatering _ --'--- --',--- ---`-----t-- �.? .� ASING HOLE DIAM: �,l)"' C � � Drive Shoe? r_,i Yes �No .: W � ' E T �]Steel �J Threaded ��Welded � � , , �... - ,-- �- --'�— � —, . �Plastic �J '/I Mile '- '-`--- --'--- -''-- ---i-- 1 CASING DIAMETER WEIGHT i i S i ' .—'�"._. � in.to_ �� ft �so� Ibs.ffL Q in.ro -�Yt. �--1 Mile—� � �/� _ in.ro ft. _Ibs./R `�1 in.to �-�Yt. PROPERTY OWNER'S NAME/COMPANY NAME in.to ft. Ibs./ft. in.to ft. gM, �L� � OPEN HOLE s�<��l E� SCREEN__ Property owner's mailing address if differeN than well location address indicated above. Make_ . �_`� FROM ft. TO ft. � TYPe—��41___ Diam.— ------ -- - �� SIoUGauze_.__��1�_.. .__Length�___ ______. __ �_ Set between ft.and fL FITTINGS_ M - STATIC WATER LEVEL 3� ft.�below [,above land surface Date measured____Z�_ PUMPING LEVEL(below land surface) WELL OWNER'S NAME/COMPANY NAME � ��3 1�5 hr'pumping� C74J_. g.p.m. ft.after L HEAD COMPLETION �1= Well owner's mailing address if different than property owners address indicated above. _�Pitless adapter manufacturer �1I71��t�,r__..-_ fyloylel__ Casing Protection_ _ ----__ ��12 in.above grade 'At-grade(Environmental Wells and Boring ONLY) GROUTING INFORMATION Well grouted �Yes i_-�,No �f } Grout material �]Neat cement ��Bentonite ❑Concrete,�High Solids Bentonite from O � to._� . ft. � � 'yds �ags from� to��._ft.�t�81 f��y�s ��_'bags , GEOLOGICAL MATERIALS COLOR H MA ERIAL�F FROM TO from_ to._.__ ft. __._ :��,yds. ��_]bags , NEAREST KNOWN SOURCE OF CON7AMINATION tO f� ��w`L �� ` --J feet /'� direction � ' _ � '-"'t�pe 1 8S�ll Well disinfected upon completion � Yes i__j No - PUMP cl black eaf - - ��Not installed Date installed_ _ _ 11�� . t black �f Manufacturer's name ��L�r „ ------- --- ---- Model number___-�a� HP �'�Volts__ �� ;. C�8 )� f Length of drop pipe v, _ ft. Capacity _ ___._—— g.p.m. t r Type:� �.Submersible ,]LS.Turbine �r��'Reciprocating ��-'�.Jet IJ $� L ABAN ONED WELLS U ,�./ Does property have any not in use and not sealed well(s) ' l'Yes '7'�No . VARIANCE Was a variance granted from the MDH for this well? [',Yes � ,No TN# WELL CONTRACTOR CERTIFICATION � This well was drilied under my supervision and in accordance with Minnesota Rules,Chapter 4725. . The information contained in this report is true to the best of my knoeviedge. Use a second sheet.if needed �/ REMARKS,ELEVATION,SOURCE OF DATA,etc. � Stodols We11 Dri111n�Co�� IZIC�____2�7� __ Licensee Business Name . Lic.or Reg.No � �<�� - 2I--17-{)3 � - � f��_ Authorized Representative Signature � Date Cln�CtC ML)f�L�e 20-30-03 LOCAL COPY �(��Q Name o7�riuer �ate � v HE-01205-OS(Aev.5/02) IC 140-0020 � � � , � . rw� c�-y w�-� c � � , I�,�. 617 13th Ave So � Hopkins, Minnesota 55343 � (612) 935 - 3556 11/03/2003 Stodola Well Drilling 3841 North Main St. Bonifacius MN 55375 938-21 1 1 � REPORT OF WATER ANALYSIS Lab #: 1017 Our Laboratory reporrs these analytical resulrs, determined on a sample taken by CUENT on 10/30/2003 from the following location: Brad Aurdahl 3843 Cherry Ave Orono,Mn Unique Well #696488 Coliform Bacteria <1/100 m! Nitrates Nitrogen <1.0 mg/1 The resulis of these tests indicate that this well is producing water that meets rhe siandavds for F.H.A., V.A., or conventiona! loans. This repor[ is an analysis for coliform and nitvate only and does not include analysis of Lead and other contaminanrs. (Unless as specified by clienr). ��w�n City Warer Clinic, lnc. \'��\`\\' Bill i�r��Arsdale J Lab('ertificntion t4 127_053-I 19 � WELLOR BORING LOCA710N MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring H 215176 County Name WELL AND BORING SEALING RECORD Menn'ego a�Uriique Well No. H�nc�epin Minnesota Statutes,Chapter 1031 or W-series No. (Leave blank�il not'finavnl Township Name Township No. Range No. Section No. Fraction(sm�Ig) Date Sealed Date Well or Boring Constructed Orcmo I27 �s os a�oou� p��, GPS Latitude degrees minutes seconds �/� � � LOCATION: Depth Before Sealing �r/ ft. Original Depth—��ft. Longitude degrees minutes seconds p U FER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location ingle Aquifer ❑Multiaquifer �VE�UBORING Measured ❑Estimated ��Water Supply Well ❑Monit.Well r Show exact location of well or boring Sketch map of well or boring in section grid with"X" �, �i location,shoWing;property Env.Bore Hole ❑Other /� ft. �below ❑above iand surface N M,�._.��,_�Ji��„�oads,'�n�j+�i�ui{E�gs.. CASING TYPE(S) � � � � -- - - - -- -- -- -- "—' Steel ❑Plastic ❑Tile ❑Other W -- - - -- - -- -- -- E WELLHEAD COMPLETION r � , , � � ` � � � � � �� Outside: ❑Well House Inside: ❑Basement Offset � �— i-- -;— —i-- . � � � � � �m'� � ❑ Pitless Adapter/Unit �Well Pit � -�-- -i-- -i-- --i-- I � � . 1 � ❑Well Pit ❑Buried S �r mee� ❑Buried PROPERTY`O+W,,�NER—'S NtAME/COMPANY NAME CASING(S) �� AFii.Wihl Diameter Depth r Set in oversize hole? Annular space initially grouted? Property owners mailing address if different than well location address indicated above /j �� in.from� to��ft. ❑Yes �No ❑Yes ❑No ❑Unknown ifl.ffOrr1 t0 ft. ❑Yes ❑ No ❑Yes ❑No ❑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�t0�_ft. Open Hole from t0 ft. OBSTRUCTIONS �Rods/Drop Pipe ❑ Check Valve(s) ❑ Debris ❑ Fill ❑ No Obstruction /� 3 Type of Obstructions(Describe) �/v�U�--1� /�.�/�� $�' �..f��s GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? eS ❑ NO D2SC�ibe FORMATION If not known,indicate estimated formation log from nearby well or boring PUMP C:� :�C� TYPe �� J/Y�� ' I�Removed ❑ Not Present ❑ Other 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 Type of perforator ❑ Other GROUTING MATERIAL(S) (One bag of cement=94 Ibs.,one bag of bentonite=50 Ibs.) Grouting Material /�,T �� rom�SL to��./ yards """' bags � from to R 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 o How many? LICENSED OR REGISTERED CONTRACTOR CERTIFICATION This well or boring was sealed in acwrdance with Minnesota Rules,Chapter 4725.The information contained in this report is true to the best of my knowledge. Don StActola Well Dri13�s= Co., Inc. 27172 ContractorBusiness ame �'� �'� LicenseorRegisfrationNo. _.._..--` + �� /" j` +.�✓ �... ' or e resenta ve Signafure � Date `� � LOCALCOPY H 2151 '�;�-rY_ �.z.,�, .��..,�..�.,-, Name of Person Sealing Well oi Boring .