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Home My WebLink Aboutwell info � � � WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. County Name WELL AND BORING RECORD "7 ,, �` ��j,�j Minnesota Statutes,Chapter 103I ( � ��t``�.`='� Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed ; Orr�o 117 23 05 ,' �a �i y, ,. , GPS DRILLWG METHOD LOCATION: Latitude degrees minutes seconds 3 Longitude degrees minutes seconds _'Cable Tool ❑Driven Dug --- � Auger �Rotary i_,Jetted House Number,Street Name,CiYy,and Zip Code of Well Location or Fire Number � �J � 325 Crestviev Av�, � SJJ�� DRILLING FLUID WELL HYDROFRACTURED? ❑Yes No Show exact location of well in section grid with"X". Sketch map of well I ati �tVIUt� FROM ft.TO R. Showing proper line , roads and b Idin�s USE ` N � � 1 Monitorin Heating/Cooling I I I � \ �Domestic ❑Environ.Bore Hole ❑Industry/Commercial �� 9 �i �� j j j ; S 'i] rrigat � Remedial ��— �} ❑Noncommunity PW I ion 9 u � � � � ""- � ❑C nity P ��Dewaterin �- - -- -- ------ ----- -- j ommu WS J _ � L �3 w ; ; ; ` E T j ASWG Drive Shoe? �Yes `'�No OLE DIAM. � C H �•_ --;--- --�----�----,-- I � _ h.eaded i- elded �'.Steel ❑T � ��.W �; , , , , Mile ,� [�Plastic ❑ ; - --;-----'------�-----`- CASING DIAMETER WEIGHT �� S - 1 �� —i htiie—� p�u �' � -�—in.to_��_ft. �� Ibs./ft. '' in.to__�ft. - in.to . .___,ft. _____ Ibs./ft. in.to�_ft. .',� PROPERTY OWNER'S NAME/COMPANY NAME in.to ft. Ibs.fft. in.to ft. ��' ��t � SCREEN� OPEN HOLE 'i ' T �i Property owner's mailing address if different than well location address indicated above. Make_.`'��J^g�♦ FROM fL TO R. ri�; 1I4324 H�zriclert�ck Rd Type_ �tS1I11�$ S�tl Diam _ ��: l�a$�� !iN 55318 SlovGauze__ _T��n Lengt11�1 __ _ Set between ft.and ft. FITTINGS N � STATIC WATER LEVEL - �� ft. - below j ;above land surface Date measured �_�� PUMPING LEVEL(below land surface) WELL OWNER'S NAME/COMPANY NAME ft.after hrs.pumping g.p.m. - � WELL HEAD COMPLETION ,hj 9�� Well owner's mailing address if different than property owners address indicated above. �Pitless adapter manutacturer �}�.�'4��_�J�U�'��YvlodeL` �Casing Protection ��y[f2 in.above grade ,_At-grade(Environmental Wells and Boring ONLY) � GROUTING INFORMATION Well grouted 'I.�Yes ��No Grout material T_Neat cement ❑Bentonite [_�Concrete�High Solids Bentonite from__�_to��fl. __� I�I yds. �bags from_��to_}A�ft. ��#xc�. , �bags GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO from to fl. , .yds �]ba s MATERIAL 9 NEAREST KNOWN SOURCE OF CONTAMINATION C18v b� � 'JV �� feet f�� direction' -'.�R�'.,-x-.s..�...t+'»"'�pg � `�.� Well disinfected upon completion �- Yes [ �No " j�� f—:��..�...<;•n CLAy $CS� �I � � PUMP �Not installed Date ins�t.-a!l�le'd �y'� �./� Ci$VI� cyt'ffv i� "� �5 Manufacturer's name �--"`�"-"-^'Y��-'�"�`^' J o...�., / �� _ � Model number HP / Volts �rav�ellclsy �ay g�l t Q3 7V Length of drop pipe �..�i�� ft. Capacity g.p m. ,,,_r,� �ry /yt Type:. � ubmersible f_)LS.Turbine ❑Reciprocating ❑Jet ❑ -�. N$t�C.�7�iill �C�31 ��ZI 7L 1VJ 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 this well? r J Yes o 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 c► tL� �y,� l �/ �� REMARKS,ELEVATION,SOURCE OF DATA,etc. � .7C�OIS v�C�l .er611�1LI�j CO�r �• ��/Z Licensee Busines ame Lic.or Reg.No. �,-' ti�. �� s t rized Representati Signature Date Jirn Kohis LOCAL COPY j '} � Q F� 7 Nameo�Driller f r 0 ,.. O HE-01205-OB(Ree SI02) - IC 140-0020 rw� c�y w�-� c � � , l�. 617 13th Ave So - Hopkins, Minnesota 55343 � (612) 935 - 3556 02/09/2005 Stodola Well Dvilling 3841 North Main St. Boni facius MN 55375 93 8-21 1 1 REPORT OF WATER ANALYSIS Lab #: 66BN Our Laborarory reports these analytical results, determined on a sample taken by CLIENT on 02/07/2005 from the following location: 325 Crestview Ave Orono,Mn Well #719807 Coliform Bacteria <1/100 ml Nitrates Nitrogen <1.0 mg/I The resu/ts of these tests indicate rhat this well is producing water i-har 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 6y clienrj. Twin City Water Clinic, Inc. Bill Vdh Arsdale , d Lab Cert�cation#027-053-119 � WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring '„I l�� y Counry Name WELL AND BORING SEALING RECORD Minn1esoNa Unique Well No. L a � i� Minnesota Statufes,Chapter f031 or W-series No. ci.eew w�x n�w w�ow�� Township Name Township No. Range No. Section No. Fraction(sm�Ig) Date Sealed Date Well or Boring Constructed Or� I 2 7 23 5 14 31 �� O f� O GPS Latitude degrees minutes seconds � � LOCATION: Depth Before Sealing ft. Original Depth R. Longitude degrees minutes seconds �y�FER(S) STATiC WATER LEVEL Numerical Street Address or Fire Number and City o(Well or Boring Location J�Single Aquifer ❑Multlaquifer E UBORING Measured ❑Estimated ew �� C?ror�o 55355 �ater Supply Well ❑Monit.Well � Show exad bcation of well or boring Sketch map of well or ori in section grid with"X' location,showing pro ❑Env.Bore Hole ❑Other ft. �low ❑above land surface N lines,roads,and buil 96� CASING TYPE(S) . _. � Steel ❑Plastic ❑Tile ❑Other W —�- -i-- -i-- --i— E ' 4 .j WELLHEADCOMPLETION � � � � 1 ' A � -�� Outside: ❑Well House Inside:�if Basement Offset -=r- ---- -;-- -i-- ,¢�1-` t ! /i � �^� � ❑Pitless Adapter/Unit ❑Well Pit r ✓ _'�' '�' '�" 'i" � ` ,_ - 7 � �.� f�' � ❑Well Pit ❑Buried ��^S'a—�' i:� ' '�,� �� Buried PROPERTY OWNER'S NAME/COMPANY NAM CASING(S) R�t� ��ZQ t Diameter Depth / Set in oversize hole? Annular space initially grouted? � Property owner's mailing address rf different than well location address indicated above �; /�'� � in.from_S.� t0 ft. ❑Yes �tJo ❑Yes ❑No ❑Unknown I1�i314 �dertmar� Rd r ��f.�,� � GCht$ in.frOm t0 ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown A�3 3 J 31 in.ffom t0 ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown WELL OWNER'S NAMEJCOMPANY NAME SCREEWOPEN HO E / f 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 Type of Obstructions(Describe) GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? ❑Yes ❑ NO DBSCfibE FORMATION If rrot known,indicate es6mated formation log from nearby well or boring PUMP r,'"'� , , ;.j� TyPe l,J� ` � ❑ 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 PerforatioNRemoval 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�f +�/1(C+��/from�to�h yards �. bags from to ft. yards bags from to R. 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. �or� Stodols Well Uril.ling Co,. Inc. 27172 Contractor Bu iness Name -�� License or Registration No. -_.. � . //� �r,�� ../ ,! //f a.Y'-1 th presentativeSignatvre• Date � LOCAL COPY H ^ ,y-,-` _�'" _ S)��'e 2�^^�� Name of Person Sealing Well or Bonng �