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Home My WebLink Aboutwell info � MINNESOTA DEPARTMENT OF HEALTH M'N AEND BORIN��G NO. ELL 1NELL OR BORING LOCATION WELL AND BORING RECORD Counry Name P `� � �� " Nehrie in Minnesota Statutes,Cha ter 1037 Township Name Township No. Range No. Section No. Fraction WELUBORING DEPTH(completed) DATE WORK COMPLETED Vi.�IW �10 � ZV '/< '/. '/< lYV n� � GPS DRILLING METHOD LOCATION: Latitude degrees minutes seconds Longitude degrees minutes seconds L�Cable Tool ❑Driven ❑Dug ❑Auger �Rotary ❑Jetted House Number,Street Name,City,and Zip Code of Well Location or Fire Number � I��tS AV� OCOTIO 5535b DRILLING FLUID WELL HYDROFRACTURED? ❑Yes No Show exact location of well/boring in section id with"X" Sketch map of well/boring location. ��te From ft.To ft. Showing property lines, - N roads,buildings,and direction. USE �Domestic ❑Monitoring ❑Heating/Cooling ' __;__ __i__ .__�_____;__ '`-- ❑Noncommunity PWS ❑Environ.Bore Hole []Industry/Commercial �+� ,�, ❑Community PWS ❑Irrigation ❑Remedial ' I I I I � � �' ' . �* --�--- —;--- ---�-- ---;-- � ❑Elevator �]Dewatering ❑ ,� w ; ; ; ; E t� � CASING MATERIAL Drive Shoe? ❑Yes No HOLE DIAM. � , . , T .., .�,. � ' --'---"-'-"" -""`-- ---'-- ' ' � ❑Steel ❑Threaded ❑Welded , , , , Mlle� �� , , , , �� '� Plastic . --,-----r-- ---�-----:- 1 , /"^� ° �T ��.,,)�. CASING ,. � � S � � Diameter Weight Specifications �, R '�(� s �—i na,ie—� y�F- � in.to 132 h ��9 Ibs./ft. � " in.to�"' ft. PROPERTY OWNER'S NAME/COMPANY NAME in.to ft. Ibs./ft. �in.to��. Je�'� AL"(� _in.to _ ___ft. Ibs./R. in.to ft. Property owner's mailing La�ddress if different than well location address indicated above. SCREEN OPEN HOLE � SS aWYe Make�� From ft. To ft. Type "4i"�"�+�$ �t Diam. /r t SIoUGauze •01 . Length 4� �' �i� Set between��_ _ft.and ��ft. FITTINGS � � STATIC WATER LEVEL Measured from � ft.�Below ❑Above land surface Date measured WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) _�,�_ ft.after ��hrs.pumping g.p.m. Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION �Pitless/adapter manufacturer. ��-�"�--blodel �]Casing Protection �12 in.above grade ]At-grade(Environmental Well and Boring ONLY) GROUTING INFORM�ITJON Well grouted ��Yes U No Grout materials ❑Neat cement�Bentonite ❑Concrete ❑Other From_�To�ft. _�_ ❑Yds. �Bags GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO From__�To__1.,�,2_ft�$1"i7�.�Aids. ❑Bags MATERIAL From To ft. ❑Yds. ❑Bags e �f� O �� NEAREST KNOWN SOURCE OF CONTAMINATION - �Y 8�Y // .--- 1 (�.� feet �.� direction '-,.J-^'�''' • � ¢_��/�_y_ ��0� �� Well disinfected upon completion? es ❑No d CV\�iCD PUMP } % ❑Not installed Date installed �f ��yr J � , Manufacturer'sname �-•T'x—�`� �� J Model Number HP��L Volts ::�-�'G Lengih of drop pipe f �.,� ft. Capacily g.p.m. Type: Submersible ❑L.S.Turbine ❑Reciprocating ❑Jet ❑ ABANDONED WELLS Does property have any not in use and not sealed well(s)? ❑Yes pi No VARIANCE Was a variance granted from the MDH for this well? ❑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. REMARKS,ELEVATION,SOURCE OF DATA,etc. �1 �'CO1Lti3 �C�1 L�i��p ��• InC• ICT71 .�� Licensee Business Name Lic.or Reg.No. ,.f_ :, "�l i Representative re Certified Rep.No. Date LOCAL COPY 750659 `�` �°°� Name of Driller IC 140-0020 HE-01205-10(Rev.6/06) � � rw� c�-y w�-� c � � � r� 617 13th Ave So � Hopkins, Minnesota 55343 � (612) 935 - 3556 08/21/2007 Stodola Well Drilling 3841 North Main � St. eoni facius MN 55375 938-21 1 1 REPORT OF WATER ANALYSIS Lab #: 363BN Our Laboratory reports rhese analytical results, determined on a sample taken by CLIENT on 08/20/2007 from the following location: Jerry Arne 940 Dakota Ave Orono,Mn Well 750659 Coli form Bacteria Absent Nitrates Nirrogen <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 conventional loans. This report is an analysis for coliform and nitrate only and does not inciude analysis of Lead and other contaminants. (Unless as specified by client). Twin City Wat��Clini Inc. �� l, Bill Van Arsd�le Lab Certification#027-053-119 MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring �C /� �� WELL OR BORWG LOCATION Sealing No. H Q+�-f � � County Name WELL AND BORING SEALING RECORD Minnesota Unique Well No. Minnesota Statutes,Chapter 103/ or W-series No. Nec� in «aa�eb�e�k„�o,k�ow�, Township Name Township No. Range No. Section No. Fraction(sm.-»Ig.) Date Sealed Date Well or Boring Constructed 4ror�o 118 23 26 '' '' '' Q [�,�� GPS Latitude__ degrees minutes seconds Depth Before Sealing T�i _ft Original Depth ft. LOCATION: Longitude__ degrees__ minutes seconds � IFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location , ingle Aquifer ❑Multiaquifer .�+ J1�r 7"iV iJ�1Wt8 ti�� Clccmo 55356 WELUBORING �Measur fd ❑Estimated Date Measured.��'` � Water-Supply Well ❑Monit.Well Show exact location of well or boring Sketch map of well ort�o r�j � in section grid with"X:' location,showing prQy�r�"' �..)Env.Bore Hole ❑Other � ft. �below ❑above land surface N lin . , d buildi�s. CASINGTYPE(S) --'-----"--- '--`— --'-- ., Steel �Plastic r�Tile r]Other_ � --'--- --�--- ---�-- ---`- WELLHEAD COMPLETION �� : W ; ; � : ET _ � ;__ _._�. � Outside: ��Well House I ]At Grade Inside: ❑Basement Offset ': '/'M'�" �Pitless Adapter/Unit �]Buried ❑Well Pit 1 ❑Well Pit J Buried �—i nn�ie--� i'"� �,�� Other ��Other i_..-� �. .}.. P PERTY OWNER'S NAME/COMPANY NAME CASING(S) er � Diam tef� � Depth � Set in oversize hole? Annular space initially grouted? Property owner's mailing address if different than well location address indicated above ��n.from � to�_ft. ❑Yes �No ❑Yes ❑NO ❑Unknown in.from to ft. ❑Yes ❑No ;_J Yes ❑No �]Unknown �i � in.from to ft. (�Yes ❑No ❑Yes n No �.j Unknown WELL OWNER'S NAME/COMPANY NAME SCREEN/OPEN HOLE � t !� Well owner's mailing address if different ihan properry owner's address indicated above SCreen.from �j�. to_��i+ ft. Open Hole from to ft. OBSTRUCTIONS []Rods/Drop Pipe ❑Check Valve(s) �,�Debris ��'�Fill �No Obstruct�on Type of Obstructions(Describe) GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? ❑Yes ❑No Describe FORMATION PUMP If not known,indicate estimated formation log from nearby well or boring. / // Type a.,..-� ( � rY7p ❑Removed Not Present ❑Other .___ METHOD USEDTO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: No Annular Space Exists ' �Annular Space Grouted with Tremie Pipe j�Casing Perforation/Removal in.from to ft. ❑Perforated ❑Removed in.from to fl. �]Perforated (�Removed Type of Perforator h ❑Other GROUTING MATERIAL(S) (One bag of cement=94 Ibs.,one bag of bentonite=50 Ibs.) Grouting Material f(�f�/ C_..'�� rom � , to � ft. yards__�__ bags from to ft. yards___ bags irom to ft. yards bags OTHER WELLS AND BORINGS REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING Other unsealed and unused well or boring on properry? [�Yes o 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 hue to the best of my knowledge. da� Stvdola i+kll Driliing Co., Inc, 1691 Licensee Business Name License or Registration No_ ,�' _ � _�r"7 � 7 � Certified Representative Signature Certi/ied Rep.No. Date i.oc:,,�cu�v H /� _..._ �� '�,��.� 2��i.�� Name ol Person Sealing Well or Boring ' HE-01434-10 IC#140-0423 � � 5/o7a �