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Home My WebLink Aboutwell info . : �r �m� � � _ . �: �� . . � � � T _ . WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH M�N AND BORING NO. ELL `�ounty Name WELL AND BORING RECORD 7 7 0 0 2 6 �� i� Minnesota Statutes,Chapter f037 Township Name Township No. Range No. Section No. Fraction WELL/BORING DEPTH(completed) DATE WORK COMPLETED Ut� i�� 0� �w r� s�+� " a"Z�-�s GPS DRILLING METHOD Latitude degrees minutes seconds LOCATION: -- i, - Longitude degrees ___ minutes seconds � Cable Tool I �Driven :�'Dug �Auger �Rotary ❑Jetted House Number,Street Name,Ciry,and Zip Code of Well Location or Fire Number �; 1305 Elnn�ood Ave viV�aV ��"'' DRILLING FLUID WELL HYDROFRACTURED? �Yes �;�Vo Show exact location of well/boring in section grid with"X:' ;,,�F Sketch map of well/boring location. From ft.To ft. Showing property lines, N roads,buildings,and direction. USE �pomestic �]Monitoring �i Heating/Cooling __L___1__ __L____i_ ��.� ' I Noncommunity PWS ❑Environ.Bore Hole ❑Industry/Commercial ' ' ' ' -�� --�„ � !-.J Community PWS ❑Irrigation ��Remedial I � � I .� .;� � --i--------- ---=-- ---+-- '�„'- i �Elevator `_Dewatering ] W , , , ; E � CASING MATERIAL Drive Shoe? '�I Yes '�,�fGo HOLE DIAM. ------ ----- ---�-----:-- T , , , , Mile I � ee _ hreaded _ elded ;, ;st i � r �w �� lastic � --,-----'----�-----:- 1 ;�. ,� �� ; ; ; ; CASING S a.,y� Diameter Weight Specifications �-1 Mile—� � �T in.to �•� ft ��16s./ft. �� .to��R. PROPERTY OWNER'S NAME/COMPANY NAME in.to ft Ibs./ft. _ in.to ft. � � � y.� in.to ft Ibs./tt. in.ro ft. ��' OPEN HOLE Property owner's mailing address if different than well location address indicated above. SCREEN ._ �� Make__�Tow3.w� w�� From ft. To ft. 5832 Li.ncol.n Dr, �t 12� Type _ Diam. �--- SbUG u3ze�-q�-��— Le ty �y(�$� t�+I 5543fs Setbetween ��1`l_ ft.and_ ft. FI�NGS STATIC WATER L Measured from r� �/� �� _ft.I�Below r�Above land surface Date measured�6�—'V7 WELL OWNER'S NAME/COMPANY NAME , PUMPING LEVEL(below land surface) I�� ft.after �� hrs.pumping � g.p.m. Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION � �Pitless/adapter manufacturer �, '� �_ � -' AAodel Casing Protection ��Y �12 in.above grade [J Abgrade(Environmental Well and Boring ONLY) �� GROUTING INFORMATION Well grouted �es ❑No 'i Grout materials ��–�.Neat cement ;�entonite � ��'Concrete [_�Other From�To�t,d/rt. � �-�Yds. �Bags GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO From��To�.�t j��$��. �Bags MATERIAL From��To��t. �_ �_,'Yds �}�ags NEAREST KNOWN SOURCE OF CONTAMINATION ell� ��t Q �� feet �� 3� direction � . type Well disinfected upon completion? es L�No $Q�t IS � PUMP , � c '�'Not installed Date installed � � � �� 1� � �� Manufacturer's name � � � �� O t�� Model Number HP�Volts � � 1 Length of drop pipe � � ft. Capacity g.p.m. 1 1� � 1''f� ,� Type:[��Submersible ❑LS.Turbine ❑ReciprOca[ing �.�Jet ❑ 1.7CV�7 L ABANDONED WELLS - Does property have any not in use and not sealed well(s)? I J Yes o VARIANCE ��(, �.i Was a variance granted from the MDH for this well? � es ��'�.No TNq ��-�''��? WELL CONTRACTOR CERTIFICATION This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. The information contained in this report is true ro the best of my knowledge. Use a second sheet,il needed �� + REMARKS,ELEVATION,SOURCE OF DATA,etc. R�Fr�,.7. Well, 1?till#.t� Ca�� CK:. a divfsitm of Don Stodola Well Drilling Co., Inc• 169I � . Licensee Business Name . Lic.or Reg.No. ' I '�� / 1 � , i . pre§entati e SiQq2( . Certified Rep.No. Date � 770026 ��` �e LOCAL COPY Name of Driller IC 140-0020 HE-01205-11(Rev.3/07) WELL OR BORING LOCATION MINNE$OTA DEPARTMENT�,OF HEALTH Minnesota Well and Boring („I �Q. Q WELL AND BORING SEALING RECORD Sealing No. V t,3 Counry Name Minnesota Unique Well No. ' ,�� in Minnesota Statutes,Cha ter 103/ or W-series No. /� � "`�� (Leava blank I(nol known) `J�� - Township Name Township No. Range No. Section No. Fraction(sm.–�Ig.) Date Sealed '�. Date Well or Bonng Constructed �� 3 o r�ww r�s s� � v9 /9t� / , //�/ GPS Latitude_ degrees_____, minutes _ seconds Depth Before ealing �� ft. Original Depth /f} ft. LOCATION: Longitude___ degrees__ __ minutes____ seconds pUIFER(S) � STATIC WATER LEVEL Numerical Street Address or Fire Number and City oF Well or Boring Location . ingle Aqu er ❑Multiaquifer �,w��f /�,> W UBORIN �leasured ❑Estimated Date Measured ��i �r t A� � Water-Su I Well � p{}y ❑Monit.Well `�,/ Show exact location of well or boring Sketch map of well or boring i �C,{ in section grid with"X." location,showing property ❑Em.Bore F�ole ❑Other ft. �elow ❑above land surface N � 1 lines.��d bu�di j� CASING TYPE S) � f�?� v --�-----j--- --�— ---�- � I j j ; el ,J stic ❑Tile ❑Other te ' la � '"'"'-"''-'- ---`-- ---`-- � WELLHEAD COMPLETION �� W E � � � ' � __�_ ___;__ Outside: ❑ ell House ❑At Grade Inside: ❑Basement Offset ; --�-----�-- - T �11 '" �e s� �P tless Adapter/Unit ❑Buried ❑Well Pit --,-----r----.-�---:-- 1 � ❑V�ell Pit ❑Buried S ❑Other �-1 Mile—� ❑Other PRp��ER/T� WNpE R' ��}E�/CpOMPANY NAME CASING(S) � """�� " �"""" Dia e P! � Depth � Set in over1size`hole? Annular space initially grouted? Property owner's mailing address if diflerent than well location address indicated above �J I]�CI L]No n UnknoWn �in.fr m � to�ft. Yes ,�`.o � 1 Yes in.fr to ft. ❑Yes ❑No �]Yes �No ❑Unknown in.fr to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown WELL OWNER'S NAME/COMPANY NAME SCREEN/OPEN OLE /'') Well owner's mailing address if different than property owner's address indicated above SCreen from � to �y�h Open Hole ffom to ft. OBSTRUCTION ❑Rods/Drop Pi ❑Check Valve(s) ❑Debris ❑Fill �o Obstruction Type of Obstruct ns(Describe) GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions rem ved? �]Yes ❑No Describe FORMATION PUMP If not ku�own,indicate estimated formation log from nearby well or boring. U ( TYPe �]Removed Not Present ❑Other _ M_ETjiOD USED O SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: S�o Annular S ce Exists I_�Annular Space Grouted with Tremie Pipe ❑Casing Perforation/Removal in.trom to ft. ❑Perforated ❑Removed in.from to ft. ❑Perforated ❑Removed �k Type of Perfor�ator ❑Other___ GROUTING MATE IAL(S) (One bag of cement=94 Ibs.,one bag of bento�ite=50 Ibs.) /jry .,.► �} /j�+//} / C Grouting Material �� r'r '��rom �✓ ' to�L�ft. yards� bags I � from to ft. yards bags i ._ from to ft. yards bags OTHER WELLS A D BORINGS REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING Other unsealed an�l unused well or boring on property? ❑Yes �!o How many? __ _ LICENSED OR RE ISTERED 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. R.E.S. Well Dcilling Co,. Inc. a divisio� of Don Stalola WeI2 Drilling Co., Inc. 1691 � Licensee Busines$Na e `/ � � � License or Registration No. �'' •�''� �.�/ — t� , V � � / i' epreser�tative Signature – Certilied Rep.No. Date E % j. 1Q 1 � �.J�+.��- � LOCAL COPY H �H i V O i — -- I -- --- ---- Name ol Person ealing Well or Boring HE-01434-11 IC#140-0423 2ioea � Laboratory Test Report Engel Water Testing, Inc. 9300 County Rd. 15 * Minnetrista, MN 55359 Phone: (952) 955-1800 Fax: (952) 955-1806 Minnesota State Certified Laboratory#027-003-105 * Wisconsin State Certified Laboratory#105-10115 Don Stodola Well Drilling Co., Inc. 3841 North Main Street St. Bonifacius, MN 55375 Water Test Location: Report Issue Date: August 5, 2009 1305 Elmwood Ave. Year: 2009 Orono, MN Date/Time: Sample Collection: 8/3 8am Datc/Time: Sample Recd. in La6: 8/3 6pm Wcll Unique Number: 770026 Laboratory Test Number(s): 09-6947 �Required when critical to the validity and application of ihe results Laboratorv : Date/Tiine Date/Time Test Resiilts Matrix ' i A}�proved Method Test No.�� Sample;�Prep. � Anal}�sis� �(units)__ � 09-6947 Coliform g�3 6pm 8/4 6pm Negative sni�z23 B is'�ED Bacter�a Colisure� Allowable Limits: ➢ Nitrate Nitrogen,mg/L Maximum allowable liinit is 10.0 mg/1 or Less ➢ Coliform Bacteria: Allowable Lunit is NEGATIVE ➢ Lead,ppm:Maximum allowable limit is 0.015 ppm or Less ➢ Arsenic,ppm: 0.010 ppm or Less—(0.010 ppm or more exceeds the IvIDH-recomtnended health limit for long-tenn consumption of arsenic in drinking water. Subco�n racted test results: � No samples were subconiracied;or ❑ The above test result(s)witlt"**"designation were produced by Stearns DHIA Laboratories,825 12�'St. S.,Sauk Center, MN 56378(MN Cert.No.027-145-378).1'he subcontracted laboratory maintains MDH certification for the field(s)of testing performed. Discussion/Notes: These test results are within the allowable limits for. Report authorized by: ,� /� Date: August 5, 2009 Kathryn M. Engel, Laboratory irector Tl�e results listed within the report relate oi�ly to the samples received on the dates indicated. Tlus report must not be reproduced,eYcept in fiill,�vithout the written approval from Engel Water Testing,Inc. Created by Engel Water Testing,Inc.October,2008 Page 1 of 1 ° ��A�. Laboratory Test Report Engel Water Testing, Inc. 9300 County Rd. 15 * Minnetrista, MN 55359 Phone: (952) 955-1800 Fax: (952) 955-1806 Minnesota State Certified Laboratory#027-003-105 * Wisconsin State Certified Laboratory#105-10115 Don 5todola Well Drilling Co., Inc. 3841 North Main Street St. Bonifacius, MN 55375 Water Test Location: Report Issue Date: August 4, 2009 1305 Elmwood Ave. Year: 2009 Orono, MN Date/Time: Sample Collection: 7/27 4pm Date/Time: Samplc Recd. in Lab: 7/28 8pm Well Unique Number: 770026 Laboratory Test Number(s): 09-6902 & 09-6902A �Requued when critical to the validity and application of the results _ __ _ ___ _ _ Laboratory; ' Date/Time Date/'i'ime Test Rcstilts Matrix ' � Approved Metliod Test NQ. �� Samplc_Prep. �� Ai�alysis �� (umfs} �� 09-6902 Coliform ��2g 8pm 7/29 8pm *Positive sM 9z23 B is'�FD Bacter�a cot;su�eo 09-6902 Nitrate 7/28 8pm 7/28 8pm <1.0 mg/I pe��sE Ivtetnod�SM 4500- NO3 D 18 ED 09-6902A **Arsenic 8/4 8:15am 0.002 ppm Allowable Limits: ➢ Nitrate Nitrogen,tng/l: Maximum allowable limit is 10.0 tng/1 or Less ➢ Coliform Bacteria: Allowable Lunit is NEGATIVE ➢ Lead,ppm:Maximum allowable limit is 0.015 ppm or Less ➢ Arse�vc,ppm: O.v 10 ppm or Less—(0.010 ppm or more exceeds the MDH-recommended health lunit for long-term consumption of arsenic in dtinking water. Subcontracted test results: ❑ No samples were subcontracted;ar �1'he above test result(s)with"**"designation were produced by Steanis DHIA Laboratories,825 12�'St S.,Sauk Center, MN 56378(MN Cert.No.027-145-378).Tlte subcontracted laboratory maintains MDH certification for the field(s)of testutg performed. Discussion/Notes: These test results are not within the allowable limits for Coliform Bacteria. � Report authorized by: � Date: August 4, 2009 Kathryn M. Engel, Laboratory irector The results listed within the report relate oiily to the samples received on the dates indicated. This report inust not be reproduced,except in fiill,without the written approval from Engel Water Testing,Inc. Created by Gngel Water 1'esting,Inc.October,2008 Page 1 of 1 ,_�_ I