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Home My WebLink AboutWell info� r , �ECE11/�NESOTA DEPARTMENT OF HEALTH MIN AND BORIN�G NOwELL WELUBORING LOCATION ,. County Name MAY 2 9 WELL AND BORING RECORD -- 7 3 91� 7 �� 200�1�nnesota Stafutes,Chapter 103I � Township Name Township No. Range No. �tid�Yfyp� r tion WEWBORING DEPTH(completed) DATE WORK COMPLETED f 117 23 (3$J �R0��0 �ia 22$ n IZ-14-06 GPS DRILLING METHOD ,.- LOCATION: Latitude___ degrees minutes_.__ seconds _ �� ..Cable Tool l' nven �.Dug -� Congitude_._._ degrees_._ minutes__._ seconds � �Auger "�Rotary C 1 Jetted ` House Numbetrq,S�t,r.eet Name,City,and Zip C!o�d.e.�o.f.W�.e,l,l Location or Fire Number � �� ''A��J P�� v�'�� DRILLINGFLUID WELLHYDROFRACTURED? I._iYes o Show exact location of well/boring in section grid ith"X." Sketch map of well locatio . �Q� e From ft.To ft. Showing property lines, N roads,buildings, USE _ omestic CI Monitoring ❑Heating/Cooling and direction. �' �.Noncommunity PWS I I Environ.Bore Hole '-!Industry/Commercial --'--- --'-- -`- .' ; ; ; - ---'-- �-Community PWS "Irrigation „]Remedial --;--- --i--- --`-----'- _ - � I 1 Elevator ' .Dewatering CASING MATERIAL Drive Shoe? I�Yes No HOLE DIAM. a ; � � , W , , � ET + ; ; , ; ❑ hreaded C.Welded L l teel T lastic ❑ � Vz Mile -�--- --'- --�-- --'-- CASING �.. � \ Diameter Weight Specifications ; ;--S ; 1 � .'� �-1 Mile� � in.to ��v _ft. � Ibs./ft. _ � in.to � ft. _, in.to_..___ ft. Ibs./ft. �in.to�ft. � PROPERTY OWNER'S NAME/COMPANY NAME in.to___, ft. Ibs./ft. in.to ft. Vogu� Design � Realty Inc. SCREEN OPEN HOLE Property owner's mailing address if different than well location address indicated above. Make � From ft.To ft. Zfi18 Cssco Point Rd sfs�rt�s�2 ; t�� C�fA1 Type ___ _]�'� Diam. :. WByZ$tss TJC'( S1J71 SIoUGauze e�'�'L+++�+ �p Lengt��1f�#�� Set between L�__ft.and ZL.G) ft. FITTINGS G �J ��i1�I� STATI ATER LEVEL �� ___._�-+� fL�Below '.��Above land surface Date measured ____._ PUMPING LEVEL(tielow land surface) WELL/BORING OWNER'S NAME/COMPANY NAME (� e} � _ �"" ___ft.after 4 hrs.pumping _g.p.m. WELL HEAD COMPLETION � � {�'� � �' � Weil/boring owner's mailing address if different than property owner's address indicated above. . itless Adapter Manufacturer J-y�V'-+�-�"�'^�""�'�10 0�l 'J Casing Protection_ _ '�!'�12 in.above grade � ��.-At-grade(Environmental Well and Boring ONLY) GROUTING INFORMATION � Well grouted? �Yes �. i No ,/ „� Grout materials . i Neat cement A'1"Bentonite f I Concrete !I Other �� From�To__ '�R _� :_'Yds. �ags � . From_.�To�ft. __�.,+..if �21lii 1 �. :Bags HARDNESS OF [�iTiL3C ilii GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO From_. To ft. �� 1 Yds. �. �.Bags NEAREST KNOWN SOURCE OF CONTAMINATION �.'ZC'3�7 �T$12.�917 �i.Z�i � �5 ��`�, feet •�'{`� —direction �-�. , ::%s.�'"_�9P� Well disintected upon completion? I Yes f 7 No _J}_� '� y..��,,.._� clay/gravel/sanci mediu�s 35 195 PUMP . �.Not installed Date installe /� �� "f� -- fi(� �(� g�y (�1(ii� I75 2�0 Manufacturer's name �s""`^�`�..�3"� 3 Model Number HP � /a Volts "�"'�� G'�`-'Y �� Q ��" Lengih of drop pipe ��`v ft. Capacity g.p.m. ��^� Type:II�SSubmersible ��:��:L.S.Turbine ' �Reciprocating L 1 Jet �. 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[his well? �I Yes No TN# 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 knowledge. Use a second sheet,if needed. s REMARKS,ELEVATION,SOURCE OF DATA,etc. D�S�odc�la We11 _Dcillic�_Co�_. Iric. 1b91 Licensee Busines N e �� Lic.or Reg.No. ;� � � G � Aut ¢ed Representative Signature �� Date .1�IIt �t}�1�8 -- __ _— --- —. Name of Driller LOCAL COPY 7 3 g�� 7 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 12/18/2006 Stodola Well Dvilling 3841 North Main St. Boni facius MN 55375 938-21 1 1 REPORT OF WATER ANALYSIS Lab #: 812bn Our Laboratory veports these analytical resulrs, determined on a sample taken by CLIENT on 12/14/2006 fvom the following location: vogue homes 1430 cherry place orono,mn well 739167 Coli form Bacteria <1/100 ml Nitrates Nitrogen <1.0 mg/1 The results of these tesrs indicare that this well is producing water that meets the standards for F.H.A., V.A., or�onventional loans. Th,is report is an analysis for coliform and nii-rate only and does not include analysis of Lead and other contaminants. (Unless as specified by client). Twin City - aTer Clinic, Inc. � �` Bill V n Arsdale Lab Certificntion#0�7-053-119 WE1�oR BORING LOCA7loN MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring '„I Counry Name WELL AND BORING SEALING RECORD Minnle oNa Unique Well No. Minnesota Statutes,Chapter 10.?I or W-series No. (Leave dank H not known) Township Name Township No. Range No. Section No. Fraction(sm->Ig) Date Sealed Date Well or Boring Constructed orono 117 3 os 15 .,. .,. UG r GPS Latitude degrees minutes seconds �� LOCATION: Depth Before Sealing "^"' ft. Original Depth fl. Longitude degrees minutes seconds ppWFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location p Single Aquifer ❑Multiaquifer 1 t,�A �w �{� WELUBORING �v1easured ❑Estimated KJV \.e[IC ltt �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. (�pelow ❑above land suAace N c,f lines,roads,and buildings. CASING TYPE(S) - - - - - -- -- �, �Steel ❑Plastic ❑Tile ❑Other W -- - -i-- -i-- --i— E �t WELLHEAD COMPLETION r � --r�.� Outside: ❑Well House Inside:�Basement Oftset —�- ---- -;-- --i-- � ��: �� 1�� ❑Pittess Adapter/Unit ❑Well Pit --�- -�-- -i-- --i-- `� � � � ' 1�, ❑Well Pit ❑Buried �—"^�w—#` .._f �Buried P��p/PE�[�RiT�Y OW E 'S NAME/COMPANY NAME CASING(S) •�o"� & ��$1� ILl�• Diameter � Depth � Set in oversize hole? Mnular space initialty grouted? k Property owner's mailing address it different than well location address indicated above � � / � in.fromS� t0�ft. ❑Yes �Vo ❑Yes ❑No ❑Unknown 2518 �scu Poic�E Rd sv��ta! � Tj�3�1 i�.from t0 ft. ❑Yes ❑No �Yes ❑No ❑Unknown t in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown WELLOWNER'S NAME/COMPANY NAME SCREEWOPEN HOLE t t Well owner's mailing address if different than property owners address indicated above Screen from�f0�ft. Open Hole from t0 ft. OBSTRUCTIONS ❑ Rods/Drop Pipe ❑Check Valve(s) ❑ Debris ❑ Fill �j No Obstruction Type of Obstructions(Describe) GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? ❑YeS ❑ NO DeSCfibe FORMATION N not kqown,indicate estimated formation log fiom nearby well or boring PUMP p.._ � � ^� TYPe ❑ 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 Perforatlon/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 ot bentonite=50 Ibs.) Grouting Material�l��.f-��%+�' from �� ' 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 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. tkyn Stcxiola t�ell Drilifng Co, Tnc� I692 Contractor Bu hes ame License or Registratlon No. { �,�/I �,_..r �� tho d resen a ve Si n re Date _., a F � H 2 5 0��fi A_... ;� � .,.� ,,.._ LOCAL COPY �"' '."" Name of Person Sealing Well or Boring �