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Home My WebLink Aboutwell info � r � � MINNESOTA UNIQUE WELL �E!L:,�l30RING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. County Name WELL AND BORING RECORD .� � �6� � Minnesota Statutes,Chapter f031 � in Township Name Township No. Range No. Section No. Fraction WELL/BORING DEPTH(completed) DATE WORK COMPLETED I27 23 07 �� 186 h 5-25-47 GPS DRILLING METHOD LOCAI'ION: Latitude degrees __ minutes seconds � Longitude degrees minutes seconds ❑Cable Tool ❑Driven ❑Dug �Auger �Rotary ❑Jetted House Number,Street Name,City,and Zip Code of Well Location or Fire N mber C _ A A••ab 5T'',�/i ' DRILLING FLUID WELL HYDROFRACTURED? ❑Yes � No VL .iv-r Show exact location of well/boring in section grid with"X" Sketch map of well/boring localion. �BCet" From ft.To ft. ' Shov�itte property lines, N „ '''' -�-._,.�,,�,,,,�, buildr]�C„pad��irvction. USE �Domestic ❑Moniroring ❑Heating/Cooling __.___ __1__ ___L__ ___:__ ❑Noncommunity PWS ❑Environ.Bore Hole ❑Industry/Commercial �� ❑Community PWS ❑Irrigation ��Remedial --'-----.------F----`-- I ❑Elevator ❑Dewatering [-]-- ,- w ; ; ; ; E T CASING MATERIAL Drive Shoe? ❑Yes �No HOLE DIAM. i � --;---�-----%'---"�-- ... I ❑Steel ❑Threaded ❑Welded � ; ; ; ; 1M,�a st�� , , ---•- �Pla n : --;----;------;- ; ' CASING g • �y�, Diameter Weight Specifications �-7 Mile� �7'a �__in.to 17R ft. z.ai IbsJft. a�'� [ l//d to�ft. 1 Q� PROPERTY OWNER'S NAME/COMPANY NAME in.to ft. Ibs./ft. in.t��+ft. in.to ft. Ibs./ft. in.to fl. Property owner's mailing address if different than well location address indicated above. , SCREEN 7�,t.._�,�..., aPEN HOLE ��. Make From ft. To ft. � g'B $�e Type Diam. SIoUGauze • * Length 4 f � /i� Set between�ft.and 1 � ft. FITTINGS �� STATIC WATER LEVEL Measured from 75 ft�Below ❑Above land surface Date measured � WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) 170 ft.after 1�S hrs.pumping �1 g.p.m. Well/boring owner's mailing address if different than property owner's address indicated a ove. WELLHEAD COMPLETION ��jf. � Pitless/adapter manufacturer Mlll`�gt�r Model ❑Casing Protection ____ �12 in.above grade ❑At-grade(Environmental Well and Boring ONLY) GROUTING INFORMATION Well grouted �Yes ❑No Grout materials ❑Neat cement Bentonite ,/�i/C�oncrete ❑Other From � To_ 1�pN ft. 6w�5� ❑Yds. �Bags GEOLOGICAL MATERIALS COLOR HARDNESS OF FRO TO FromilA,�7 To I�V fl. ��iL1 ��. ❑Bags MATERIAL From To ft. ❑Yds. ❑Bags ' NEAREST KNOWN SOURCE OF CONTAMINATION ^ / 4�..�:..,.. � �f t � 2� _ _ �'��.-� feet /V direction ��"�'� -^; " ,•,^type Well disinfected upon completion? Yes ❑No ,/!!)-f- ,�,�.,_ T',;;y_,c�,J�-. � $3 PUMP ❑Not installed Date installed �G7�/l �a �� Manufacturer's name e t.s..� �G[I�Cr�-��-- Model Number HP��4_Volts � �� ' �� Length of drop pipe 105 ft. Capaciry g.p.m. £ �� Type:�Submersible ❑LS.Turbine ❑Reciprocating ❑Jet ❑ I 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? Yes C 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,il needed. REMARKS,ELEVATION,SOURCE OF DATA,etc. �� S`��,18 �G�� /L�llin� W s� i�.'a 1691 ..�<� Licensee Business Name Lic.or Reg.No. _`---; ✓ ti-ZQ-t�� erti ied Representative S' ature Certified Rep.No. Date LOCAL COPY 7 �0627 � �re Name of Driller IC 140-0020 � HE-01205-10(Rev.6/O6) � � `'+ rw� c�-y �� c � � � .��,� 617 13th Ave So � Hopkin�, Pllinnesota 55343 � 612 935 - 3556 �__�—_--- OS/31/200' Stodola Well Drillrng 3841 North Main Sr. Boni facius MN 55375 938-21 1 1 ' �� I REPOA T Ci1F WATER ANALYSIS Laib #: 192BN Our Laborarory repovrs these anal��tir_,al results, determined on a sample [aken by CLIENT on OS/�9/2007 from th�� folr'vwing location: Gardon Nelson 131[i E_Imwood Ave. C)rono,Mn 'VJeI I 750627 Coliform Bacteria .lbse�it Nitraies Nitrogen -�1,0 mg/1 The results of these tests indicate thut this well is producing water thar meets the standards for F.H.A., V.A., or conw�r��io��al loans. This report is an analysis for ;cltfcrm and n;trate c�r.!y an� de�s ,nc,- !hcic;de c�nal��src af Leo.d and other contaminanrs (Unless as specifieu by,�lient). Twrn Ciry Warer Clinic, lnc. � , � Bill c�n rsdale , � ' i; �� f �' `'�' 4' I � ; ' � �i ' Lnh CcrliliceLiml ll 027-USa-I 19 �::.,3�:i�h41 I . ._ . ' MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring �(.�c O O WELL OR BORING LOCATION Sealing No. H ;,,) J County Name WELL AND BORING!SEALING RECORD Minnesota Unique Well No. Minnesota Statut�s,Chapter 1031 or W-series No. . (Leave Olank�i�no�knownJ Township Name Township No. Range No. Section No. Fraction(sm.-+Ig.) Date.ealed Date Well or Boring Constructed ii� 2� a� �� 9 � r.� � GPS Latitude __ degrees minutes seconds Dept Before Sealing C:(/ ft. Original Depth_ ft. }; LOCATION: Longitude degrees minutes _ seconds AQUI ER(S) STATIC WATER LEVEL - Numerical Street Address or Fire Number and City of Well or Boring Location ,_�.Si gle Aquifer ❑Multiaquifer ��,� �fa r WELWBORING 'Measured �J Estimated Date Measured�� .Water-Supply Well [,'�Monit.Well � Show exact location of well or boring Sketch map of well or boring -- �j� �/ in section grid with"X:' location,showing property _.Ern.Bore Hole ❑Other ft/�l�'�below ;�above land surface lines,roads,and buildings. N CASING TYPE(S) ' >. �.rCS'C%'� .�' . � � � � :_ __'_____'___ "'`_ ___'" �. _ .. . 'Steel ,-_j Plastic �.I Tile L]Other__.. _ --'--- --'--- --'`"'---`-' WELLHEAD COMPLETION W ; � ; � ET ., __� ; � r Outsipe: ❑Well House ❑At Grade Inside: ❑Basement Offset �� I U Pitless Adapter/Unit ❑Buried ❑Weil Pit '- -- -- �_M.. ❑Buried S ` �Well Pit ❑Other � i Mile� �� y�� ❑Other Y PROP�[��t TY O NER'g7�[y A E/COMPANY NAME CASING(S) `av�� `c�'�n Diam tgrf t Depth � Set in oversize hole? Annular space initially grouted? Properry owner's mailing address it di(ferent than well location address indicated above < �f� in.from � to L.J�--� ft. ❑Yes �No ��Yes ❑No ❑Unknown in.from to ft. ❑Yes _,No ❑Yes [f No ❑Unknown .in.from to ft. ❑Yes ❑No ❑Yes ❑No � ,,.Unknown WELL OWNER'S NAME/COMPANY NAME SCRE N/OPEN HOLE � � � Well owner's mailing address if different ihan property owrer's address indicated above SCree ffom � to �`� ft. Open Hole ffom to_. _ft. O ST UCTIONS � ]Ro s/Drop Pipe ❑Check Valve(s) ❑Debris ❑Fill ❑No Obsfruction Type obstructions(Describe)�N/V'6��' ��rf�`� 4� T�v� `�%� J�� _ GEOLOGICAL MATERIAL COLOR HARDNESS oH FROM TO Obstr tions removed? �Yes ❑No Describe FORMATION If not known,indicate estimated formation log from nearby wetl or boring. PUMP 1�/ Type ��T U/� � ��'J"' '--� �� f Re oved f_�Not Present ❑Other __,. e � METH D USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: o nnular Space Exists �r;Annular Space Grouted with Tremie Pipe ❑Casing Perforation/Removal in.from ._to ft.' ❑Perforated ❑Removed �` _in.from to _ ft. ❑Perforated []Removed Ty e of Perforator x. ❑OTh r GROU ING MATERIAL(S) (One bag of cement=94 Ibs.,one bag of bentonite=50 Ibs.) Grouti Material��-�jC.��I/ ��om � , to ��' ,ft. yards C�_ bags from _ to ft. yards _ bags from to ft. _ yards _ bags � OTHE WELLS AND BORINGS REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING Other nsealed and unused well or boring on property? ❑Yes �� No How many? __ - LICEN ED OR REGISTERED CONTRACTOR CERTIFICATION This w II or boring was sealed in accordance with Minnesota Rules,Chapter 4725.The information contained in this report is true tlo the best of my knowledge. Dac� Stodola Well Drilling Co., Inc. 2691 � Contr ctor Busine Name �� License or Registration No. ;� ��r� .'•.,.� '� �, , '��: .�-' !'=� :�, — . e i d�Representative S' ature Certilied Rep.No. Date f - '. . ,,,,.._.. � LOCAL COPY H 2 5 8 5 0 0 � ��— /'�r ��r�,/�,�/Y1� Nam of Person Sealing Well or Boring HE-01434-09 IC#140-0423 � � � s/osa ' rt�,��i� �