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Home My WebLink Aboutwell info � WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. CountyName WELL AND BORING RECORD � g� � � 7 Hecx�epin Minnesota Statufes Chapter 1031 Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Compteted Orono 118 Z3 3b ,, ,, �, 226 � 6-20-43 GPS DRILLING METHOD LOCATION: Latitude degrees minules seconds .. ._ Longitude degrees minutes seconds �r_I Cable Tool J nven __Dug _]Auger �otary ,_.Jetted House Number.Street Name.City,and Zip Code of Well Location or Fire Number ��'�. �� WS �� i�� Ococw 55331 DRILLING FLUID WELL HYDROFRACTURED? ��,_;Yes � No Shop exact location of well in section grid with"X". Sketch map of �cation. �$te� FROM_ ft.TO ft. Showing op lines, N roads nd ildings USE 1 Monitoring 'Heating/Cooling ; . , ,.� �yr pomestic i�J Environ.Bore Hole _Industry/Commercial �'Commun y PWSWS `-_Irrigation I_j Remedial _ Y Dewatering ❑ -'''"'--'--- --`-- --"`"- ASING y( OLE DIAM W � E `� � � �� Drive Shoe? _ �Yes F�`�No H � � ; .'� �� , [�Steel i�Threaded =Welded -� -,--- --- -� -�-- T � _ � �.' Plastic i_.� '/Mile ¢ � '\ ------ ------ ------ ---=-- 1 �-- z � CASING DIAMETER WEIGHT S � �____in.to�,_jq _ fc L•lil Ibs./ft �in.to_._�t. �--1 Mlle—j � '. '. �,,.,_.) .,C�(.. E f �'-��'� . in.to__ ft. Ibs./ft. �in.to..�bft. PROPERTY OWNER'S NAME/COMPANY NAMP. ' in.to ft Ibs./ft. in.to ft. ~111111II11T1�Ba'7t 1SE11S SCREEN OPEN HOLE Propertv�wner's mailing address if differect tiian�:vell location address indicatad abovc Make�(� FROM ft. TO ft. —_.----�-- S8�1P_ a.S above Type__��$��& ,$��_ Diam._ _ �N_ SIoUGauze Length � Set between ��d it. FITTING� � STATIC WATE EL ��____ft. - below .above land surface Date measured � PUMPING LEVEL(below land surface) WELL OWNER'S NAME/COMPANY NAME � ��__ ft.after_ _ _�,��__hrs.pumping _�� g.p.m. WELL HEAD COMPLETION Well owner's mailing address if different than property owners address indicated above. �p�tless adapter manufacturer_ �t�$te� Model _ Casing Protection_ �12 in.above grade ❑At-grade(Environmental Wells and Boring ONLY) GROUTING INFORMATION Well grouted �Yes [i No Grout material ❑Neat cement �` �Bentonite . �Concrete�High Solids Bentonite from_�__.�to_�_. it. _�.. �__]yds. '�bags from�_to�&_(L �.�8�_��i� �. �,bags .�� GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO from to ft __yds. � �bags MATERIAL — — —--- - -- ' NEAREST KNOWN SOURCE OF CONTAMINATION Z.'�8�1 yellau� $�yt Q �2 ��'' feet .�._, f� direction ��_:.J�` �..: type Well disinfected upon completion Yes �No �$y �v .�Ost � � PUMP ) 1 C�A�-1fg �Not installed Date installed_ 0'��i�{{'�1��_ _ ___._._ `►i��/�� Q� ��.t� M1 1ffA Manufacturer's name __ ____. _.___—._.___ - p Ii�C�li 7lJ 1�\J Model number __ HP��._.._ Volts�.__.. �" $�� bt�j'1 j�1� '�7V 226 Length of drop pipe.__�+�(__ __ft. Capacity ________ g.p.m. Type: �Submersible f��.L.S.Turbine ��,Reciprocating ❑Jet ❑ ABA DONED 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? Lj Yes � No TN# WELL CONTRACTOR CERTIFICATION This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. IThe 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. �(3 t�}`t(��. �11.D i 11 illP � t__ •f 11'lA____ ��:'. �iR:� L{_;-Fi. Licensee Busin2ss Name Lic.or Aeg.No- i 7�� ---- - - - — "---- — . __ __.---- - - epr'esent tive Si t e Date t�Ck 1'�cOre fr'20"t13 ('� (1 O �� Name of Driller Dare LOCAL COPY �;�d p HE-01205-OB(Ra¢SPo2) IC 140-0020 � ` rw� c�y w�-� c�;� r�,� 617 13th Ave So � Hopkins, Minnesota 55343 � (612) 935 - 3556 06/24/2003 Stodola Well Drilling 3841 North Main St. Boni facius MN 55375 938-21 1 1 REPORT OF WATER ANALYSIS Lab #: 556 Our Laboratory reports these analytical results, determined on a sample raken by CLIENT on 06/23/2002 from the following location: 665 Ferndale Rd. N Orono,Mn Unique Well #688997 Coli form Bacteria <1/100 ml Nitrates Nitrogen <1.0 mg/1 The results of these tests indicate that this well is producing water ihat meets the 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 contaminants. (Unless as specified by clienr). � ' �'t Water Clinic, Inc. , � Bill r � Lab Certification#027-053-119 �y — MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring �„� WELL OR BORING LOCATION Sealing No. �o��H Nema WELL AND BORING SEALING RECORD Minnesota Unique Well No. tze�ssKyic� ti,;.,.,esora Statutas,Chapter ios� o�W-�senes�No. Township Name Township No. Range No. Section No. Fraction(sm�Ig) Date Sealed Date Well or Boring Constnicted .,, �,_ ��f.r� � GPS Latitude degrees minutes seconds -� � LOCATION: Depth Before Sealing ��`'� ft. Original Depth ft. Longilude degrees minutes seconds ppUIFER(S) STATIC WATER LEVEL Numerical Street Address or Fre Number and City of Well or Boring Location ingle Aquiter ❑Multlaquifer � WELUBORING �easured ❑Estimated ��' '+_�lNVater Supply Well ❑Monit.Well � � Show exact location of well or boring Sketch map of well or bo'ng �r � in section gnd with"X" location,showing prope '�. ❑Env.Bore Hole ❑Other �� ft. �below ❑above land surface N lines,roads,and buildin � CASING TYPE(S) - - - - - -- - -- ._�.._...i ;k. +. � ` �teel ❑Plastic ❑Tile ❑Other _tt W --�- - - - -- --i-- E .. WELLHEAD COMPLETION � -- Outside: ❑Well House Inside: ❑Basement Offset _Y_ ____ 'j__ _�_' � �tmirs � ' �YPitless AdaptedUnit ❑Well Pit --�- -�-- -�— -i-- I ,�� 7t 1 - ` ❑Well Pit ❑Buried S �—�'"�----� , �.\' \ ' �` ❑Buried ia PROPEyR*TY.tOWNcER'S NAME/COMPANY NAME CASING(S) �1 ti t? t4 � Diameter, � Depth � Set in oversize hole? Annular space initialty grouted? Property owner's mailing address H diflerent than well location address indicated above � � in.ffOm_t� t0��ft. ❑Yes 19iIVo ❑Yes ❑No ❑Unknown 11401 Cty Rd. 3 '` �Slj.s�' � ��.�)�g in.from t0 ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown r��.� J�tJ in.f�om to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown WELLOWNER'S NAME/COMPANY NAME SCREEWOPEN HOLE r � Well ownei's mailing address N different than property owner's address indicated above Screen from�t0 z.,� ft. Open Hole from t0 ft. OBSTRUCTIONS '�Rods/Drop Pipe ❑ Check Valve(s) ❑ Debris ❑ Fill ❑ No Obstruction Type of Obstructions(Describe) �,R/�t��, '�_�j� ¢ �� GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? 2S ❑ NO Describe FORMATION If not known,indicate estimated tortnation log from nearby well or boring PUMP �-�� ,r;� � TYPe �C7`.I2'�, �tl�l`1(J Removed ❑ Not Present ❑Other �' METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: �[fJo Annular Space Exists ❑ Annular space grouted with iremie pipe ❑ Casing PeAoradon/Ftemoval !� in.from to R. 0 Perforated ❑ Removed in.from to ft. ❑ Perforated ❑ Removed Type of perforator ❑ Other GROUTING MATERIAL(S) (One bag of cement=94 Ibs.,one bag of bentonRe=SO lbs.) ,,�y' /� � -ry�.,,� ' Grouting Material ,l�/�C,!" '-U� from � to�:L„�t. yards �� bags fram to ft. yards bags from to k. yards bags OTHER WELLS AND BORINGS REMARKS,SOURCE OF DATA,DIFFlCULTIES IN SEALING Other unsealed and unused well or boring on property? ❑ Yes o How many? LICENSED OR REGISTERED CONTRACTOR CERTIFICATION This well or boring was sealed in accordance with Minnesota Rules,Chapter 4725.The infortnation contained in[his report is true to the best of my knowledge. I�n Stalola �e12 Dril2ick; Co,. Inc. 2727.?. Contracfor Business am License or Registratlon No. :_—� r _ �' � . - : _ .. . _,: A riz e resentafive Signature• Date � � R, . �✓ ,��.... . ...--�,-�.,.f��y' LOCALCOPY H 5� Name of Person Sealing Well or Boring