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Home My WebLink Aboutwelll info s wELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring H 10 6 7 3 5 � WELL AND BORING SEALING RECORD M nnlesoNa Unique No. ` County Name " Minnesota Statutes,Chapter 1031 or W-series No. (Leave blank it not known) Towns ip a e Township No. Range No. Sedion No. Fraction(sm.�Ig.) Date Sealed Date Well or Boring Constructed % '/< � � Numerical Street Address or Fire Number and City of Well or Boring Location � � Depth Before Sealing �Q`� ft. Original Depth �V1�! ft. Show exact location of well or boring Sketch map of well boring A� IFER(S) STATIC WATER LEVEL in section grid with"X". �ocation, showing roperty ingle Aquifer ❑ Multiaquifer l lines,roads,and bui in� N ��' � WELUBORING �uleasured ❑ Estimated � � ater Supply Well ❑Monit.Well _T_ _T_ __,__ __l__ � � � `�v �Env.Bore Hole ❑Other _�_ft. [�elow ❑above land surface � � � � _..` --�- -�-- --i-- --i-- J') W E ,_....._'4 � CASING TVPE(S) � i � � I � i i i i .� —�- -i-- -�-- --�- �� Steel ❑ Plastic ❑Tile ❑Other Y.mile ---- � -�-- -�-- -�-- --�-- � . —... �'.Y CASING .__......___ �. Diameter Depth Set in oversize hole? Annualar,pace initially grouted? l� """��J""" J �r mile—�e � � in.from� to�� ft ❑ Yes `C7No ❑Yes ❑No ❑ Unknown � )r.t PROPERTY OWNER'S NAME . _ in.from to ft. ❑ Yes ❑No ❑ Yes ❑ No ❑ Unknown Property ner's mailing address if diHerent ihan well location address indicated above. in.from to ft. ❑ Yes ❑ No ❑ Yes ❑ No ❑ UnknoWn SCREEN/OPEN HOLE 1 � Screen from��to�p_ ft. Open Hole from to ft. OBSTRUCTIO WDEBRIS/FILL WELL OWNER'S NAME glObstruction ❑ Debris ❑ Fill ❑ No Obstruction /� � ,, � /� /� Well owner's mailing address if diHerent than property owner's address indicated above. Type of Obstruction/Debris/Fill T„�,/��,��`"'T Q. T_�'j�/� Obstruction/Debris/Fill removed? es ❑ No PUMP Type f✓1/a Iv/lm/" GEOLOGICAL MATERIAL COLOR HARDNESS OF FROM TO emoved ❑ Not Present ❑ Other FORMATION If not known,indicate estimated formation log from nearby weli or boring. METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: . �No Annular Space Exits �� '� � Annular space grouted with tremie pipe i'.� ❑ Casing Perforation/Removal in.from_ to ft. ❑ Perforated ❑ Removed in.from to ft. ❑ Perforated ❑ Removed Type of perforator ❑ Other GROUTING MATERIAL(S) ;+� t Grouting Material ��d+��/9'�LEqrtl �_ to��ft. yards � bags from to ft. yards bags from to ft. yards bags from to ft. yards bags REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING UNSEALED WELLS AND BORINGS Other unsealed well or boring on property? ❑ Yes o LICENSED OR REGISTERED CONTRACTOR CERTIF ATION 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. Dan stc��1� �aAt� �-i�� -� r,�..Tlr�c. •27172 Contractor Business Name f License or Reg tration No. �---'�� , / r', e �"n e Signatur Date ----�-;` Ar° -_.�._.• �Z4... i._. LOCALCOPY H °� n � 7 � � Nameo�alingWel/oreodng �✓ � HE-01434-02 10/95R . _._. : . _ . .. .. . . .. .q,. _ . . ._ . . r. .. .ti.� � . a= -.... .;... MINNESOTA DEPARTMENT OF HFALTH M�nnesota Well and Bonng � ■ � r wn�� WELL OR BORING LOCATION i � /� �( WELL AND BORING SEALING RECORD Sea�ing rvo H County Name Mmneso!a Unique No. Nennepin Minnesota Statutes,Chapter 7031 or W-senes No �_ � ILeave b�ank il no�known) Township Name Township No. Range No. Secuon No. Fraction�sm.-s Ig.) Date Sealed Date Well or Bonng Construded Orona l I 8 23 36 � '� ,f f.�C� 9�} Numencal Sireet Adtlress or Fire Number and City of Well or Bonng Location � � � ! �75 Ferndale Ra$E� North, Wayeat 4��Pi�OreSealing � "' _N. OnginalDepth /� N Show exact location of N•ell or boring Sketc�map of well or oring AOUIFER�S) STATIC WATER LEVEL m section grid wrth"X`. location, showing p rry �Single Aywfer ❑ Muhiaquiter lines,roads,and buil N �-- WEIUBORING Measured ❑ Esumated � � �� Water Supply Well ❑Monit.Well � � ❑ Env.Bore Hole ❑Other _ ��! R. � below ❑ above land surtace � � � �! W —�- -?-- -�-- --;— E -� CASING TVPE�S) � � �� . -�-- -'-- 'r:- Steel ❑ Plastic �Tile �Other i � 'i" '_�_' � � � u mde � ��. �� --�- ' ' ' � ._. �,.� CASING -�-- -�-- --i-- Diametey Depth / Set in oversrze hole7 Annualar space ini6ally grouted? S , � �,i �" Ves No ❑ Yes ❑No ❑ Unknown �i mi�e—{. '�'�_.. m.irom � to � ft. ❑ � i PROPERTY OWNER'S NAME in.from ro fl. ❑ Yes ❑No ❑ Yes ❑No ❑ Unknown Jim b Mea� en Da to PropeAy owner'S mailing atldress rf tllHerent than well loca6on address indicated above. in.hom to fl. ❑ Yes ❑No ❑ Yes ❑No ❑ Unknown �d4-2553 SCREEWOPENHOLE r � Screen from to ft. Open Hole irom `�� ro �� ft. OBSTRUCTIONS WELL OWNER'S NAME Rods/Drop Pipe ❑ Check Valve(s) ❑Debris ,❑y'�Fill ❑No Obst/r�y�tion Well owner's meiling address if diflerent tl�an property owner's address indiceted above. Type ot ObslruCtionS(Describe) ��"' " /'� � " f��Y��1 Obstruclions removed? �/J`Yes ❑ No Describe PUMP 5��= ('umr TY� . OEOLO(i1CAL MATERIAL COLOR HARDNESS OF FROM TO �Removed ❑ Not Present ❑ Other FORMATION If rat krawn,indicate estimated formatbn bg trom nearby well or bonng. MET OD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: � � �No Annular Space Exists �� /� ❑Annular space grouted with tremie pipe f � ❑ Casing Pertoration/Removal in.irom to ft. ❑ PeAorated ❑ Removed in.from to fl. ❑ PeAorated ❑ Removed Type of peAorator ❑ omer GROUTING MATERIAL(S) r / � /_i l�<;.��tf�'� � ,F � /� Grouting Material �'� from to fl. yards bags trom ro ft. yards bags from to tt. yards begs from to-- ft. yards bags REMARKS,SOURCE OF DATA,DIFFlCULTIES IN SEALING OTHER WELLS AND BORINGS Other unsealed and unused well or boring on property7 ❑Yes �YJo How many? {J��' �;,.�,f f�-' �,} ,. �/ 1 �;:f ; LICENSED OR REGISTERED CONTRACTOR CERTIFICATION jJ' Fi"� b This well or boring was sealed in accordance with Minnesota Rules,Chapter 4725. The infortnation conteined in Mis repat is 7'^`�i�f i( . ,, -7 ) r _ true to the best of my knowledge. � . -/ /1f ` "`-' � �~ DON STODflLA WELt DRILLING C�, , INC. �7172 / �� / �� Contractor Busine�ame . . Licgnse w Registiation I'ro. 1..--�� - � � r �..� � ��, , _ . �- 'L1��- � � _ , 4 , � ,n� , . � , ..� �� ,�" „�.,� � f''r::.� � ''! ^'�• Authonzed Representative Signature Dete � "...., �a�} �' ',. ' •' •. �`. �../\.^1-y.. .._�. Name o/Person Sealing Well or Bcring �oca�coPY H HE-01434-04 $9$R � � - WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH M/NNESOTA UNIQUE WELL NO. ' CounryName WELL AND BORING RECORD 6 2 4 916 F Hennepf n Minnesota Statutes Chapter 103! Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed n. Orono 118 23 36 ��. ,. ��. 148' 2-16-99 House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD ❑ Cable Tool Driven ❑ Dug �75 Aiol th Ferndale Rd. Ozotlo Mn.55392 ❑ Auger � Rotary ❑ �etted - Show exact location of well in section grid with"X". Sketch map of well location. ❑ _ Showing property lines, N � t,��S and buildings. DRILLING FLUID WELL HYDROFRACTURED? ❑YES ❑NO '��`{� Bentonite , , , , FROM n.co n. -,- -;- -,-- -,- ., USE ❑ Monitoring ❑ Heating/Cooling i i i i [�CDomestic _i_ _�_ _�_ _i_ ❑ Community PWS ❑ Induslry/Commercial i � i i ❑ Irrigation ❑ Noncommunit PWS w E T ❑ Environ.Bore Hole Y ❑ Remedial i i � i ❑ Dewatering ❑ -r -�- -r- -r i � i i �ZIMie CASWG Drive Shoe? ❑ Yes C�No HOLE DIAM. _i_ _i_ _i_ _i ❑ Steel ❑ Threaded ❑ Welded i i i i � S 1 � ,/'),Q�� ;�] Plastic ❑ �-1Mile-� �� J' CASING DIAMETER WEIGHT PROPERTY OWNER'S NAME '4 in.to 192 ft. +�D�'2� Ibs./ft. ? 7�� 3Q Jim � '�Ieagt�n Dayton ��.�o n. ibs.ih. 6�,�.t�,98n. Property owner's mailing address if different than well location address indicated above. in.to ft. Ibs./ft. in.to ft. SCREEN OPEN HOLE Make from ft.to ft. � Type Stainiess St�Cl. Diam. SbUGauze 'Ap Length_�� Set between ft.andy�ft. FITTINGS:3� STATIC WATER LEVEL WELL OWNER'S NAME �00 ft.�l below ❑ above land surface Date measured 2�1��9 PUMPING LEVEL(below land surface) . Well owner's mailing address if different than property owner's address indicated above. 1 y 0 ft. after 3 hrs.pumping �� g.p.m. WELL HEAD COMPLETION �Pitless adapter manufacturer Model ❑ Casing Protection C�12 in.above grade ❑ At-grade(Envirbnmental Wells and Borings ONLY) GROUTING INFORMATION Well grouted? g Yes ❑ No GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO Grout Material ❑ Neat cement C�Bentonite ❑ Concrete ❑ High Solids Bentonite MATERIAL from�to�Q_ft. �� O yds. �C bags from to ft. ❑ yds. ❑ bags Sandy Clay Brown S 0' 20• from io n. ❑ yds. ❑ bags NEAR NSOURCEOFCONT ATpI ,N J g ) f�, Clay {jj'@�f S 20� �r'j� � feet � [/L.�' direction �+ type Well disinfected upon completion? es ❑ No Ciay-Grav�Y Bro�rn � 4�� y�� PUMP 8l��w9� ❑ Not installed Date insta ed Sand �`il'tl'V��. T21i1 S �7cJ� 48r� Manufacturer'sname Re� ac e Model number HP Volts length of drop pipe 1�6 ft. Capaciry 1 8 g.p.m. Type:�E7 Submersible ❑ L.S.Turbine ❑ Reciprocating ❑ Jet ❑ ABANDONED WELLS X 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? 1J Yes ❑ No TN# WELL CONTRACTOR CERTIFICATION Use a second sheet,i�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. DOId STODOLA WBLL DRILI.ING C0. , INC. Licensee Busin s Name Lic.or Reg.No. � 9-10-99 � ,_.-` Authorized entative Signature Date Fred Lefby 2-15-99 Name ol Driller Date LOCAL COPY 6 2 4 916 HE-01205-06(Rev.7/98) � �, Twin �ity Water CI inic , Inc . 617 13th Ave So � Hopkins, Minnesota 55343 � (612) 935 - 3556 OS/19/1999 Stodola Well Drilling 3841 North Main St. Bonifacius MN 55375 938-21 1 1 REPORT OF WATER ANALYSIS Lab #: 37018 Our Laboratory reports these analytical results, determined on a sample taken by CLIENT on OS/16/1999 from the following location: Jim Dayton 515 N. Ferndale Rd Orono,MN Unique Well #624916 Coliform Bacteria <1/100 ml Nitrates Nitrogen <1 . 0 mg/1 The results of these tests indicace that this well is producing wacer ihar meets ihe standards for F.H.A., V.A., or conventional loans. This report is an analysis for coliform and nitrate only and does not include analysis of Lead and other coniaminar,ts. (Unless as specified by c(den[). � City Water Clinic, Inc. \ � ',.� ;\'� Bill Vit�►�da1e Analy�cal laborawry Consuituig Engineer Water Malysis Reagents Boiler Water Chemicals Lab Certdication tl 027-053-119 '