The URL can be used to link to this page

Home My WebLink Aboutwell info . � � - � WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. County Name � WELL AND BORING RECORD 6 2 4 9 7 9 � �iennep i n Minnesota Statutes Chapter f031 Township Name Township No. Range No. Sgction No. Fraction WELL DEPTH(completed) Date Work Completed fl. r�� 'I< 'l. 'l. � House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD ❑ Cable Tool ❑ Driven ❑ Dug 'rJ�7 Fernda C� R aa • ❑ Auger �l Rotary ❑ Jetted : Show exact location of well in section grid with"X". Sketc map of well location. ❑ ___ _ S owing property lines, roads and buildings. DRILLING FLUID WELL HYDROFRACTURED? ❑YES C NO N , , , , Wa t e r FROM n.to n. -,- -,- -,-- -,- - USE ❑ Monitoring ❑ Heating/Cooling � i i i i x �l Domestic ❑ Communit PWS _i_ _�_ _x_ _i_ Y ❑ Industry/Commercial i i i i „l`�� ❑ Irrigation ❑ Noncommunit PWS W E T W L ❑ Environ.Bore Hole Y ❑ Remedial i i i � ❑ Dewatering n i i i i +ZIM_ie CASING Drive Shoe? O�es ❑ No HOLE DIAM. _i_ _ i _i_ _i_ I � Steel Z(I Threaded ❑ Welded � �- � � 1 ❑ Plastic ❑ S �-1 M�ile--I CASING DIAMETER WEIGHT PROPERTY OWNER'S NAME { 4 in.to �17�n. ibs.in. 7�,5� 30n. X"�� dJ.��d i in.to ft. Ibs./tt. 1 in.to�.�ft. Property owner's mailing address if different than well location address indicated above. in.to ft. Ibs./ft. �,��F�{�. SCREEN OPEN HOLE w Make_�� from �1 7 ft.to �"�5 ft. - Type Diam. SIoUGauze Length Set belween ft.and ft. FITTINGS: STATIC WATER LEVEL WELL OWNER'S NAME g�� ft.1X below ❑ above land surtace Date measured ��3�99 PUMPING LEVEL(below land surtace) Well owner's mailing address if different than property owner's address indicated above. 2�S� ft. after 5� hrs.pumping 4� g.p.m. WELL HEAD COMPLETION �i��W�te r �J Pitless adapter manufacturer Model ❑ Casing Protection � 12 in.above grade ❑ At-grade(Environmental Wells and Borings ONLY) GROUTING INFORMyATION � Well grouted? '`�7 Yes ❑ No GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO Grout Material ❑ Neat cement � Bentonite ❑ Concrete �High Solids eentonite MATERIAL from_�_to_�Q_ft. �_'�___ ❑ yds.�(1 bags from to ft. ❑ yds. ❑ bags 5 Cla -Gravel Y�LZ�� from to R. ❑ yds. ❑ bags NEARE9'Ff N SOURCE OF CONT�AMINATION � Cla Gre S 20 $5 { J feet Y--311✓� � direction �^�i ' ��"' rype Well disinfected upon completion? f+J Yes ❑ No Cla Grav�l Arown S g5 �,g PUMP 9_9_9g ❑ Not installed Date installed t.'Ic3 Gre S 1 rJ0 190 Manufacturer'sname GOu'ld Modelnumber Z'92111972 HP 1'� vorcs �30 ��' Sand Tan S 19fl 2�.5 Length of drop pipe 147� ft. Capacity �'2 g.p.m. y Type: 49 Submersible ❑ L.S.Turbine ❑ Reciprocating ❑ Jet ❑ Sandstone varied M �d � ABANDONEDWELLS y Does property have any not in use and not sealed well(s)? ❑ Yes t?No VARIANCE Was a variance granted from the MDH for this well? ❑ Yes 1�No TN# WELL CONTRACTOR CERTIFICATION Use a second sheet,if needed This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. REMARKS,ELEVATION,SOURCE OF DATA,etc. The information contained in this report is true to the best of my knowledge. DON STODOLA WELL DRILLIAIG CO. , INC. Licen Business N e c.or Reg.No. 2'�I'�2 r � � 9-15-99 Authorized Reprp�sen �ve Signature Date Fred L�*iby 9-5-99 Name ol Driller Date LOCAL COPY 6�L�.9 7 9 HE-01205-06(Rev.7/98) k ' • � l�w i�vv C i,t� 1Na,t��v- C ' ' , I�t,cr. y 617 13th Ave So � Hopkins, Minnesota 55343 � (612) 935 - 3556 09/09/1999 Srodola We11 Drilling 3841 North Main St. Bonifacius MN 55375 938-21 1 1 REPORT OF WATER ANALYSLS Lab #: 37737 Our Labora[ory reports ihese analyrical resulis, determined on a sample iaken by CLIENT on 09/07/1999 from the following location: Ari Sajjadi 507 Ferndale Rd. Orono,Mn Unique Well #624979 Coliform Bacieria <1/100 ml Nitrates Nitrogen <1.0 mg/1 The results of these tests indicate ihai this well is producing waier thar meets ihe srandards for F.H.A., V.A., or con��ent:onal loans. This report is an analysis for coliform and nitrate only and does nor inclade analy�srs of Lead c�r�d other contaminanrs. (Unless as specified by client). ��,C_ir kJla r Clinic, Inc. ,� �., �� ,, ��' �� 8;�� van''� � naaly�callaboratory consw eer 1u�6 Eng�n Water Annlys�s Rcagrnls Boiler Water Chcmicals Lab CeridtcaUon N 027-053-1 19 • WELL OR BORING LOCA71oN MINNESOTA DEPARTMENT OF HFALTH M�nnesota Well and Bonng i �� WELL AND BORING SEALING RECORD Sealing No H 7 County Name Minnesota Urnque No. � --- � Iiennegin Minnesota Statutes,Chapfe�1031 oeW berkes�NooWn' Township Name Township No. Range No. Secfion No. Fracuon�sm.-i Ig.) Date Sealed Date Well or Bonng Constructetl Orono 118 23 36 1�3-a00 j' aCj �i� Numerical Street Address or Fire Number and Ciry of Well or Boring Localion s,, / ♦ Sd7 Ferndale Rd N� Orono 5539I Depthee�oreSeai�ng ��/J n OriginaiDepth f� n Show exact location of N�ell or boring Sketch map of well or nng ApUIFER(S) STATIC WATER LEVEL in section grid with"X'. location, sho p rty Single A�uifer ❑ Multiaquifer lines,roa ,and buil N WELUBORING Measuretl ❑ Estimated � �y�� az Water Suppty Well ❑Monit.Well � t _T_ _T_ _'__ 1 `.J . - ' � ❑ Env.Bore Hole ❑Olher ft �]below ❑ above land surface W --i-- -i-- -i— --i— E � � CASING TYPE�S) � � � � � � � � .: —�- -i-- -i-- --�- �; Steel ❑ Plastic ❑Tile � Other ,�mee --`- 1 ._.._.._.,___ _ h.` CASING -�-- -�-- --i-- ' ' ' � Diameter Depih / Set in oversize hole7 Annualar space inilially grouted? �\ ,�,� ��m;�� = in trom Q to � 1 n. ❑ Yes �No ❑ �es p No ❑ Unknown PROPERTV OWNER'S NAME in.from to R. ❑ Yes ❑No ❑ Yes ❑ No ❑ Unknown Prope owner s m •a res if diflereM than well 1 ti ddr s �a d above. in.from [o ft. ❑ Yes ❑No ❑ Yes ❑No ❑ Unknown SCREEWOPEN HOLE / � L Screen from � �/ to r ys R Open Hole from to ft. OBSTRUCTIONS - WELL OWNER'S NAME ❑ Rods/Drop Pipe ❑ Check Valve(s) ❑Debris ❑ Fill �No Obstruction Well ownefs mailing adCress if tlitterent than property owner's atlAress indicated above. Type of ObsVUCtions(Describe) Obstructions removed? ❑Yes ❑ No Describe PUMP Type 6EOLOfi1CAL MATERIAL COLOR HARDNESS OF FROM TO � Removed �Not Present ❑ Other FORMATION II not known,indicate estimated formatbn log from nearby well or bonng. MET OD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE MOLE: � �No Annular Space Exists �� 1 ° �� ❑ Annular space grouted with tremie pipe f � ❑ Casing Perforation/Removal in.trom �o ft. ❑ PeAorated ❑ Removed in.trom to ft. ❑ PeRorated ❑ Remrned Type o�peAorator ❑ Omer GROUTING MATERIAL(S) / �! .�•- Grouting Matenal N�/�`/ ��-��'`I from � to� tt. yards /� begs irom to ft. yards beys from to ft. yards bags from ta__ R. ya�ds bags ' REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING OTHER WELLS AND BORINGS Other unsealed and unused well or boring on propeAy? ❑Yes No How many? LICENSE6 OR REGISTERED CONTRACTOR CERTIFICATION This well or boring wes sealed in accordance wiM Minnesota Rules,Chapter 4725. The information contained in lhis repat is true to ihe best of my knowledge. 8on Stodo3.a Well Drillin� CQ. , Inc. 27I72 Conhactor Bus� ess Name License a Regishafion�:o. > .�� F��.-�`� .f�J �L' � ./� AuMo ed Representefive Signeture Date ,''\ �y-.,.., ��y ...�;Y:f�i�Y\� LOCAL COPY H 15 8 fi 7 9 Name o/Person Seeling WeU Bvnng HE-01434-04 8/98 R