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Home My WebLink AboutWell info � : S WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. � County Name WELL AND BORING RECORD �— c� g � � � _ i -J � � �' - ' ` Minnesota Statutes Chapter 1031 Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed � :�� :f ii . i� '? � ` � 1- 1 �. . �. �. �. House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILUNG METHOD � ;c � ,_�_�, • .,�,: , ❑ Cable Tool ❑ Driven ❑ Dug ' � �-` ' " - -' � �� - ' ❑ Auger ❑ Rotary ❑ Jetted Show exact location of well in section grid with"�;". Sketch map of well location. ❑ � � Showing property lines, . � roads and buildings. DRILLING FLUID r N J��?-��.� . _ - I I 1 I __ __' ___ _I ... ' USE ❑ Monitoring ❑ Heating/Cooling i i i i i O;Oomestic _i_ _�_ _a_ _i_ ��'.� �.r-'� �-`.5'�s. ❑ Irrigation � Community PWS ❑ Industry/Commercial �-- i i i i � - � O Noncommunity PWS ❑ Remedial � w E ❑ Test Well i i � i T -H-�_-�� . ❑ Dewaterin9 ❑ i i i i I ' CASING Drive Shoe? ❑ Yes Q-"No HOLE DIAM. '/2 Mna _�_ i _L_ _i_ � ' M � ❑ Steel ❑ Threaded ❑ Welded � �' � � � �_._ 4,�lastic ❑ S �` f--lMile� `�..,4 -- CASING DIAMETER WEIGHT PROPERTY OWNER'S NAME 1 � in.[o ft. � Ibs./ft. %u�(t0� '�h. � a �_� c.,� ..,. .. ..... _..-�1. .�_'_ — : ; ;• in.to Property owner's mailing address if different than well location address indicated above. in.to ft. Ibs./R y—in to tt. SCREEN OPEN HOLE t. . ._ . i i i_�. 1 .. .. .. . ,`i i--.._ Make .��✓i=I:e.._-r i�i from ft.to it. ' �.>, ,� .. . _, Type t::�-y ' i' �� Diam. ' SIoVGauze �i y '� (' Length " Set between � - ft.and � '''� R. FITTINGS: STATIC WATER LEVEL WELL OWNER'S NAME � ft.b below ❑ above land surface Date measured �'-' � ' r PUMPING LEVEL(below land surface) Well owner s mailing address if different than property owner's address indicated above. ft. after_ ✓. hrs.pumping _ g.p.m. WELL HEAD COMPLETION ❑,-Pitless adapter manufacturer i:.��i�•� - a��_ --�1�Aadel ❑ Casing Protection CL�2 in.above grade ❑ Ahgrade(Environmental Wells and Borings ONLY) GROUTING INFOFMATION Well grouted? Cl.Yes ❑ No HARDNESS OF Grout Material � Neat cement ❑ Bentonite � Concrete �7 High Solids Bentonite GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO ; � from to ' ft. ❑ yds. � bags from to ft. ❑ yds. ❑ bags `'c,t � � f. r,r 1,�c`�. -; 3 from to ft. ❑ yds. ❑ bags NEAREST KNOWN SOURCE OF CONTAMINATION � -:�; i ,_ x. - i � feet �-� ' direction � fi rype Well disinfected upon completion? O_Yes ❑ No � - :;i;6_./ . 3 ' l. ! �.l' i- • t ,: �UMP ��2��7 ❑ Not installed Date installed :' ;, . Manufacturer's name ��2�'�1 t Q ' `�1"F'' f � � , .Modelnumber 1 f1D/.ilfl') 7.r11�1 HP��Volts ''�y Length of drop pipe (t. Capaaty � Pressure Tank Capaciry_T(,''i zZ ��a�1 en�r Type: ❑ Submersible ❑ L.S.Turbine ❑ Reciprocating ❑ Jet ❑ ABANDONED WELLS Does property have any not in use and not sealed well(s)? ❑ Yes Lf No VARIANCE Was a variance granted from the MDH for this well? ❑ Yes O�No WELL CONTRACTOR CERTIFICATION - Use a second sheet,ilneeded This well was dnlled under my supervision and in accordance with Minnesota Rules,Chapter 4725. REMARKS,ELEVATION,SOURCE OF DATA,etC. 7he information contained in this report is true to the best of my knowledge. . . _ ! _ , . ,,..._ � .. � .. .. • s _,.. _ , Licensee Business Name �, Lic.or Reg.No. '... � ;�-%',r .� / ,�'`/�" �-=�—�1..: 1- . Authorized Representative Signature Date � ^ i ,_ �i.. _ .. .. � i � s, , � NameolOnller Dafe �� .: "_ � � � . � . �'' �'� �"`� �''6 � HE-01205-05(Rev.1/95) . Jivin �it UVater ��inic, J'`rtc. � � 617 13th Ave So • Hopkins, Minnesota 55343 • (612) 935 - 3556 01/21/1997 Stodola Well Drilling 15306 Hwy 7 ' Minnetonka MN 55345 938-2111 ItEPOR'�OP'WA I L'R ANALYSI5 Lab#: 31886 Our Laboratory reports these analytical results, determined on a sample taken by CLIENT on 01/15/1997 from the following location: Greg Johnson 3855 Cherry Ave Orono�Mn Unique 1Mell#588948 Coliform Bacteria <1/100 ml Nitrates Nitrogen <1.0 mg/l 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 inGudF: analysis of Lead and other contaminants. (Unless as specified by client). \. , ' y�Water Clinic, Inc. \ Bill a� Aoalyiw��.bowwry couaultiug F.�gioeer W�[er Antly�u RoageW� Boiler Water Chomioab Lab Cortifiwtion M 027-053-119 � � � �; WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH M/NNESOTA UNIQUE WELL NO. �- CountyName WELL AND BORING RECORD �, � � � � 3 Minnesota Statutes, Chapter 1037 Towns ip a � � Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed �,, �� , 262 `� 10-27-04� GP DRILLING METHOD LOCATION: Latitude __ degrees minutes _ _ seconds Longitude __ degrees minutes seconds '.J CableTool � �Driven �i Dug _ - ,�Auger �otary �Jetted � House Number,Street Name,City,and Zip Code of Well Location or Fire Number ' JVSS �CL� AVe� LiC�� S�J�J'f DRILLING FLUID WELL HYDROFRACTURED? ❑Yes _ o Show exact location of well in section grid with"X". Sketch map of well location. �[�L�l�e FROM ft.TO R - Showing property lines, N �_` , roads and buildings USE j]Monitoring �]Heating/Cooling �' �� ; � � ; ��'�� Domestic ��Environ.Bore Hole ❑Industry/Commercial --'--- --'-- --`-- ---'-- , i. , �`�.,,�� I Noncommunity PWS ' .Irrigation j]Remedial �� w -'-----1------`-----�- e IDri eeShoe?n9 ;�Yes NJ �~ � `! . ,� , �Community PWS : �� CASING i OLE DIAM. H � T � � � ;___ ; ._�__ ___�_ � [�Steel ��]Threaded �i elded H :. � � � � Mlle ._— � � lastic -�� '�� x � ' f � 1 CASING DIAMETER WEIGHT S � in.to ��RF ft. L�Vl Q �ft. Ibs./ft. in.to_ �--1 Mile—� » ___, in.to ft Ibs./ft �in.tob�ft. PROPERTY OWNER'S NAME/COMPANY NAME in.to ft. Ibs./ft. in.to ft. �tt� �� SCREEN T�r OPEN HOLE •, Properry owner's mailing address if different[han well location address indicated above. r'� t ' Make FROM � ft. TO ft. � �S SL7V1'C TYPe� +� . Diam. '�� SIoUGauze__��1�_�� . Length �- T `'f� _ Set between ZS2 ft.and��_ft. FITTINGS��}~_,_ STATIC WATER LEVEL ��__ ft� ��below ��`�above land surface Date measured lo-�� PUMPING LEVEL(below land surface) WELL OWNER'S NAME/COMPANY NAME � �_ ft.after__ �,��___hrs.pumping � g.p.m. - WELL HEAD COMPLETION ' Well owner's mailing address if different than property owners address indicated above. Pitless adapter manufacturer�r�3� •�-�^�=��•^- Model_. �Casing Protection '�12 in.above grade r p `�;At-grade(Environmental Wells and Boring ONLY) GROUTING INFORMATION,�,/ �t Well grouted �J'��Yes �No -�,/ Grout material r J Neat cement �--�Bentonite ��Concrete,/+High Solids Bentonite from�to. _�ft. � � . -�,yds.�ags from�__to__��ft. �a1 ',��s� ;�bags GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO from to ft. � - � MATERIAL ,...i yds. �bags _ �NEAREST'KNOWN SOURCE OF CONTAMINATION . �...._J��feet _ direction �__�.��- : .,:.''_x.�,_��. �and/clay brown sfot 0 17 _ '� . _ . . We'lr'disinfecfed upon completion Yes ❑No �� "- C�y �Ol.L ;T 1 W PUMP ..". , y . ,, __ , - - — -- � ___., : - - --- - Not in'stalled Date installed � r✓ '" �� , gf� �� b� �f�t. �DI► �fAO Manufacturer's name ` J- . __t��Js'�. _ _ ' i)u LEi) .. ._._ -- ,_ __... � - � - � �� ` � � - - � � � Model number HP_�-�_Volts %7 Q'1� b�(,� $�� 42a Zh7 Length of drop pipe ((-� ft. Capecity g.p.m. -— ._ ---_- -- _.. . ,�,,_,�w � � Type:� ;Submersible ❑LS.Turbine ❑Reciprocating �]Jet [� IOO� r�l�LL�tO�I� VCO�L� SO�i LlV Z�7�AB DONED WELLS.-- ,_--- .--_.._ _. . .,. �� Does property have any not in use and not sealed well(s) ❑Yes � �o �� VARIANCE _ , . - - � �� Was a variance granted from the MDH for this well? ❑Yes No TN# � WELL CONTRACTOR CERTIFICATION ..... _ . ' s ._. . � _ .__... . __ � � 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. . S Useasecondsheet,ifneeded ♦■ }�� h�-_ �� ; � REMARKS,ELEVATION,SOURCE OF DATA,etc. ` � �� St�� Li ��/1.11�� W�f InC• 27I7Z �� Licensee Business Name . Lic.or Reg.No. � , i �..�`.. . . � -� /`.�CJ� _ .�'. �- �" A or d- epresen ativ Sign r Date VL!{1C:RC �[� - LOCAL COPY �� p � Name of Driller � HE-01205-08(Rev.5/02) IC 140-0020 r �f �w%vv C i,try 1it1 a�t�e�r�' C ' ' , I vt,c� 617 13th Ave So � Hopkins, Minnesota 55343 � (612) 935 - 3556 10/29/2004 Stodola Well Drilling 3841 North Main St. Boni facius MN 55375 93 8-21 1 1 REPORT OF WATER ANALYSIS Lab #: 849 Our Laboratory reporrs these analytical results, determined on a sample taken by CLIENT on 10/27/2004 from the following location: Steve England 3855 Cherry Ave Orono,Mn Unique Well #711483 Coli form Bacteria <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 conver�rional loans. This reporr is an analysis for coliform and nitrate only and does not include analysis of Lead and other contaminants. (Unless as specified by client). � win City Water Clinic, Inc. � Bill sdale Lab Cert�cation#027-053-119 �' wELL oR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring I„I f��O�� County Name WELL AND BORING SEALING RECORD MinnlesoNa Unique Well No. L � �+BlAIIepin Minnesota Statutes,Chapter 1031 ��W,�e�� „,�'°-' .;,`� !'`�.-`� Township Name Township No. Range No. Section No. Fraction(sm�Ig) Date Sealed Date Well or Boring Constructed Orono 117N 23W 07 �,. ,. �,. � '/� % ` �•.� l` ! � /`� � GPS Latitude degrees minutes seconds �� k. On inal De th C �✓' ft. LOCATION: Depth Before Sealing g' p Longitude degrees minutes seconds IFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location Single Aquifer ❑Multiaquifer 38,�,j'� Cherry Lane �rOQ�t �• W ��ORING Measured ❑Estimated Water Supply Well �Montt.Well r Show exact location of well or boring � 3fi Sketch map of well or boring in section grid with"X" location,shoWing property ❑Env.Bore Hole ❑Other �ft. �below ❑above land surface lines,roacts;and buildings. N � ; r�S ,,,._ CASING TYPE(S) - - - - - -- -- -- i �' Steel Plastic ❑Tile ❑Other W —�- -i-- - -- --i— E WELLHEADCOMPLETION F :; � � � � � Outside: ❑Well House Inside: ❑Basement Offset ; � --�- -;-- -,-- --i-- �^�+ �Pitless Adapter/Unit ❑Well Pit --`- -i-- -i— --i-- � ' ❑Well Pit ❑Buried S Q �� "^A°�" i��'-�- ❑Buried PROPERTY OWNER'S NAME/COMPANY NAME CASING(S) � Di ��, �epth � Set in oversize hole? Annular space initially grouted? PropeAy owner's mailing address if diHerent than we ocation address indicated above �/ in.ffom to.��ft. ❑Yes p(Na ❑Yes ❑No ❑Unknown �� 6i2-803-3130 in.ffOm t0 ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown in.ffom t0 ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown WELLOWNER'S NAME/COMPANY NAME SCREEWOPEN HOLE Well owner's mailing address if diHerent than property owners address indicated above Screen from�t0��`ft. Open Hole from t0 ft. OBSTRUCTIONS �Rods/Drop Pipe ❑ Check Valve(s) ❑ Debris ❑ Fill ❑ No Obstruction Type of Obstructions(Describe)��j�,_�� Q �Ul1'./:� GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? YeS ❑ NO DeSCfibe � FORMATION If not known,indicate estimated formation log from nearby well or boring PUMP � �`� TYPe '�"' � Removed ❑ Not Prese t ❑Other j 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 Pertoration/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.) �7 :� Grouting Materia("'��/ �,�/�—��(�L to/�ft. yards '�^^ bags ? trom 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. DON ST4DOLA Ti+TELL DRILLING C0. ,: I�tC. 27Y 7Z Contractor Business ame � License or Registration No. ` 'r �r ( . E :/ th ed p es nt ive ign Date `"' ,,.,�.... y/�� 1�..,i' .._J:'r��.. LOCAL COPY �..� 2�$*J 2� ` Name ol Person Sealing Well or Boring