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Home My WebLink AboutWell info WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIc7UEWELL NO. County Name WELL AND BORING RECORD Minnesota Statutes,Chapter 1037 �� . Towns ip ame Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed ft. �� ,� ,� GPS DRILLING METHOD � LOCATION: �Latitude degrees minutes seconds ^ Longitude degrees minutes seconds ❑Cable Tool 'i_;Driven I_'�Dug ❑Auger '�Faotary �"Jetted House Number,Slreet Name,City,and Zip Code of Well Location or Fire Number � 7� DRILLING FLUID WELL HYDROFRACTURED? ❑Yes 14'No J-� Show exact location of w in section grid wit 'X".� Sketch map of well location. FROM ft.TO ft. Showing property lines, N �� roads and buildings USE � , -, � [,Monitoring ❑Heating/Cooling I � � I I `� omestic ❑Erniron.Bore Hole ❑Industry/Commercial i Noncommunity PWS �]Irrigation ]Remedial ; ; ' ' � ❑Communiry PWS ]Dewatering � , � --'-----'------`-----6— ....,-yst .a ; ; ; ; =1. ' ASING Drive Shoe7 ;�Yes ��No OLE DIAM. W , . , , ET __,_____;___ __�___;__ -� �, ❑Steel r,Threaded �]Welded '/nniie +�Y`- {.-.----� Plastic � - _ � � � � • '': ' � � � -� 1 '� CASING DIAMETER WEIGHT �` S '* in.to ��s+ ft. �+�1+� Ibs./ft � in.to �it. � �1 Mile� � �,� -� �('�\ in.to ft Ibs./tt. �in.to�ti^+tt. PP,OPERTY OWNER'S NAME/COMPANY NAME in.to ft. Ibs./ft. in.to ft. �+� �"'s`++��' SCREEN t OPEN HOLE Property owner's mailing address if different than well location address indicated above. Make �iL7� FROM R TO ft. TYPe ��Ai�l�i'�'$ �� Diam. _ � � S� SIoUGauze A1 A Length �!�T_�w� Set between ft.and ft. FITTINGS STATIC WATER L �� 12G ft. elow �,above land surtace Date measured �"'� PUMPING LEVEL(below land surface) WELL OWNER'S NAME/COMPANY NAME y�6 q - ifHI ft.after L hrs.pumping � g.p.m. ' WELL HEAD COMPLETION .� � Well owner's mailing address if different than property owners address indicated above. dless adapter manufacturer_ °�s.`�.-�G-....�_r�..�._s^��+MedW �asing Protection �12 in.above grade �At-grade(Environmental Wells and Boring ONLY) - GROUTING INFORMATION Well grauted �Yes ��:��No Grout material i Neat cement ❑Bentonite ',_Concrete �1 iigh Solids Bentonite from Q to 3Q n. 3 ❑yds. �Dags from�to�ft�4��__��Is. �bags - GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO from to_ ft. �'�yds. [bags MATERIA� NEAREST KNOWN SOURCE OF CONTAMINATION �.� �l�g �i� �� O 15 feet � direction type .�, Z " Well disintected upon completion Yes ❑No - C� 5�� r �J PUMP � i � � :�� ❑Not installed Date installed � �/ t$�� b�� 1�$ 9J 7V� Manufacturer's name `-.�.t�+-.;�1...^...�.+-, ---".,'.".�„`__--• Model number HP � <.. Volts � y (.`I j�i� � I$� Length of drop pipe f�� ft. Capacity g.p.m. Type:__� ubmersible � �LS.Turbine ❑Reciprocating ❑Jet ❑ �fK1/ . I br�� f� �� 2� ABAN ONED WELLS � Does property have any not in use and not sealed well(s) ❑Yes o VARIANCE Was a variance granted from the PADH for this well? r_'��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,il needed � REMARKS,ELEVATION,SOURCE OF DATA,etc. � �fi_.�`�� 3• Y1�111 jn�. �.� T�' +fY1 T�f IJC�J 1.L 11LJ.i3i..,E� i 4/3/4 Licensee Business Name Lic.or Reg.No. f � . � �� A i s2nfefive gnature Date �b �s �. � �� Name of Oriller LQCAL COPY HE-01205-OB(Rev.S/02) ic,ao-oozo 7"w iw C i,ty litl a,��v' C ' ' , I v��,c�i. 617 13th Ave So � Hopkins, Minnesota 55343 � (612) 935 - 3556 03/07/2006 Stodola Well Drilling 3841 North Main St. Boni facius MN 55375 938-21 1 1 REPORT OF WATER ANALYSIS Lab #: 115BN Dur Laboratory reports these analyrical results, deiermined on a sample taken by CLIENT on 03/06/2006 from the following location: Hank Radintz 720 Dickey Lake Dr. Orono,Mn Well #735744 Coli form Bacteria <1/]00 m! Nirrares Nirrogen <1.0 mg/1 The results of these tesrs indicaie that this well is producing water that meers ihe standards for F.H.A., V.A., or conventional loans. This report is an analysis for coliform and nitrate or,ly and does no� include analysis of Lead and other contaminants. (Unless as specified by client). T►�vin City Water Clinic, Inc. � '� BrU\Wq. ��dale �,�� Lnb Certifcntion k 027-053-I 19 ,.�'.;:..,�,,?" ,:�;•� �'�:;�: .—�":" .,. ..„ - ... ,, u. ,� ___.__ _._ WE�L OR,BORING lOCA7iON MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring I„' Counry Name WELL AND BORING SEALING RECORD Minnle ota Unique Well No. Minnesota Statutes,Chapter 1031 or W-series No. c�.�e e�x a�w,ow�� Township N e Township No. Range No. Section No. Fraction(sm�Ig) Date Sealed Date Well or Boring Constnicted �ra�c� li� 23 22 ' 3 '. ,. ac:� C� . C�PS Latitude degrees minutes seconds Depth Before Sealing � �f�tt. Original Depth ft. LOCATION: Longitude degrees minutes seconds pQUIFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location Single Aquifer ❑Multiaqu'rfer WELLBORING Measured ❑Estimated �Water Supply Well ❑Monit.Well � 3W xac w ng ketch a o weilorboring � in section grid with"X" location,showing property ❑Env.Bore Hole ❑Other 7�i ft. �below ❑above land surface N lines,roads,and buildings. CASING TYPE(S) ''t; ,� teel ❑Plastic ❑Tile ❑Other W --'r -i-- -i-- --i-- E�`ti��. WELLHEAD COMPLE710N � � � � ``��, Outside: ❑Well House Inside: ❑Basement Offset _ � � � -r- '--- -r' --�-- i 1� � 1�^� `y7'" �Pitless Adapter/Unit ❑Well Pd --�- -�-- -�-- --i-- I i � ❑Well Pit ❑Buried S �-�'"M°-�'� ❑Buried PROPERTY OWNER'S NAME/COMPANY NAME CASING(S) Diameter � Depth Set in oversize hole? Annular space initially grouted? r o er's mai mg a ress i i erent than well location address indicated above � /� //�'+? � in.from�to L`1{„�ft. ❑Yes �'Na ❑Yes ❑No ❑Unknown in.f�Om t0 ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown in.f�Om to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown WELL OWNER'S NAME/COMPANY NAME SCREEWOPEN HOLE e � 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? ❑YBS ❑ NO DBSCfIbe FORMATION If not known,indicate estimated formalion log from nearby well or bonng PUMP _,�.,j Type r � f� ❑ Removed �+IVot Present ❑Other � METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: I�lo Annular Space Exists ❑ Annular space grouted wi[h tremie pipe ❑ Casing Perforation/Removal in.from to ft. ❑ Perforated ❑ Removed in.from to ft. ❑ Perforated ❑ Removed Type of perforator ❑ Other GROUTING MATERIAI(S) (One bag of cement=94 Ibs.,one bag o}bentonite=50 Ibs.) ' Grouting Material�,/e�� E'zy`y.y�_�r_ from�.� to l�f�"-ft 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 CERTIPICATION - This well or boring was sealed in accordance with Minnesota Rules,Chapter 4725.The information contained in this report is true to the best oi my knowledge. 11on Stodola tdell DrilZin� ct�:. Inc. 271721 Contraclor Business Name f License or Registration No. i ,/ _. �.,,� %._.� ;;,: (c` e' Signa Date � � � �. `ti� 244442 � �J,: IOCAL COPY H �.�' Name ol Person Sea/ing Well or Bonng �