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Home My WebLink Aboutwell info 1-VELL OR BORING LOCATION. MINNESOTA DEPARTMENT OF HEALTH M/N AND BORIN�G NO. ELL County Name a_ WELL AND BORING RECORD , ��Lepia Minnesota Statutes,Chapter 1037 �� Township Name Townsfiip No. Range No. Section No. Fraction WELUBORING DEPTH(completed) DATE WORK COMPLETED 4rono � 1I? 23 OT �� 120• " +�-30-48 GPS � DRILLING METHOD LOCATION: Latitude degrees minutes seconds _ , Longitude degrees minutes seconds ��Cable Tool �� Driven �Dug — � J Auger [PRotary Jetted House Number,Street Name,City,and Zip Code of Well Location or Fire Number �� .� k,_,;.� VVV �DZ��t AiaN �IIA OrOIIOJ- • 35364 DRILLING FLUID T WELL HYDROFRACTURED? ❑Yes o Show exact location of well/boring in section grid with"X" Sketch map of well/boring location. Y From fl.To ft. Showing property lines, roads,buildings,and direction. USE N I j Domestic _ .Monitoring �, J Heating/Cooling ___ __ ��-�--��---.,_ �� ! I 'i Noncommunity PWS �Environ.Bore Hole .._j Industry/Commercial �":-� �� - f Community PWS ❑Irrigation _�Remedial .1 -- .�` �- �f�/ � '�Elevator ❑Dewatering �� ___ `/�/ , , � ` E "`" �" CASING MATERIAL � � HOLE DIAM � ; T I�'�� Drive Shoe. �Yes �No --�-----�-----�-- � - I ...-�"""'a ___ _ . . . .. , ; ; ; �r� . .} �;�S hrea e elded teel i�T d d �W NI� , , , '/Miie �'� � ! �— - -� , , , , � - I lastic �_j --;-----T-----%-----�-- CASING S � Diameter Weight Specifications ~� �1 Mile� �j 1 ,�__ in.to___��ft. ��_�_,Ibs./R �� _ $_ _in.to.�ft. �� _ PROPERTY OWNER'S NAME/COMPANY NAME � in.ro __,___ft. Ibs./k. __ in.to_ ___ft. �{is�►'� �i��6 �it �1"AAE,�a Piltt.AwtiOII in.to___ n. �bs.�tt. _ in.to 2 Z! Property owner's mailing address if different than well location address indicated above. SCREEN OPEN HOLE Make �Q� From ft. To ft. � TYpe �tas��ir�Diam. '�M � SIoUGauze_.. s��$___.. __. Length__ . $t Set between_ ft.and it FITTINGS STATIC WATER LEVEL Measured from�Q*_L�• 9� it.[�iBelow ' Above land surface Date measured WELL OWNER'S NAME/COMPANY NAME PUMPWG LEVEL(below land surface) � l�i ft.after �a� hrs.pumping �� g.p m. �WelUboring owner's'mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION t,�j � L� - �Pitless/adaptermanufacturer wlii�.�Y�Lv�odel `,�Casing Protection �, �2 in.above grade '�' —'At-grade(Environmental Well and Boring ONLY) -�,4� GROUTING INFORMATION Well grouted �Yes ❑No Grout materials ',_j Neat cement [�entonite [Concrete ❑Other From�__To�ft. � ❑Yds. [}�ags GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO From To ft. ']Yds. �Bags MATERIAL From To ft. ❑Yds. I^Bags s` A NEAREST KNOt W�N SOURCE OF CONTAMINATI N _'.t,f 4f .f_., �. � Clag �_�� a�+ V* �+�` feet --�� direction i�i r 7 4'r.: 'J�:.W�e — F . �"� �.� ��—�;-�. �j nr�� SO" �Qn*��q Well disinfected upon completion? j�+res ❑No �� f r f PUMP i ;Not installed Date installed ��0�. Manufacturer's name Model Number HP�_Volts Length of drop pipe �V ft. Capacity g.p.m. Type:��ubmersible ❑LS.Turbine �Reciprocating ❑Jet �.�.j � ABANDONED WELLS Does property have any not in use and not sealed well(s)? ❑Yes � �No VARIANCE Was a variance granted irom the MDH for this well? ❑Yes ��lo 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. � 31'�DOLl1 iiSLL DB�IrLIi�6 6'4. r: I�.`. Licensee Business Name "� Lic.or Reg.No. 1892 - --�5��- S"1"�g - � �61 r n i ign Certified Rep.No. Date LOCAL COt'Y 7 6 0 6 21 Name of Driller IC 140-0020 HE-01205-71(Rev.3/07) ` 7�w i�r�v C i,t� 1Na�"�v' C ' ' , I v�,c� y 617 13th Ave So � Hopkins, Minnesota 55343 � (612) 935 - 3556 OS/02/2008 Stodola Well Drilling 3841 North Main St. Boni facius MN 55375 938-21 1 1 REPORT OF WATER ANALYSIS Lab #: 157BN Our Laboratory reports these analytical results, determined on a sample taken by CLIENT on 04/30/2008 from the following location: Rusty Mayes 800 Forest Arms Lane Orono,Mn Well 760621 Coli form Bacreria Absent Nitrates Nitrogen <1.0 mg/1 The results of these tests indicate that this well is producing water that meets the StGi1t�QYt�S fOY F.N.r"1., V.A., Oi' COi1VeYlt"IOi1ai IOL7YIS. This veport is an analysis for coliform and nitrate only and does not include analysis of Lead and other contaminants. (Unless as specitied by client). , Twin City Wa��v�Clinic, Inc. i/%� . t Bill Vqn Arsdale Lab Certification#027-053-119 W�LL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring I„I ��O(� 1 WELL AND BORING SEALING RECORD Menneso a�Unique Well No. �, County Name �@j��lepiQ Minnesota Statutes,Chapter 1031 or W-series No. (Leave blank II not known) Township Name Township No. Range No. Section No. Fraction(sm.-�Ig.) Date Sealed Date Well or Boring Constructed �, ,, ,, 2 � GPS Latitude degrees minutes seconds Depth Before Sealing �� / ft. Original Depth ft. LOCATION: Longitude_ degrees minutes__ seconds QQUIFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Loca[ion yRSingle Aquifer ❑Multiaquifer '��)�� L/BORING �Measured ❑Estimated Date Measured��j�� F�.4��R �: 800 Foreat l�rm� Lane Orono I�i �Water-Supply Well ❑Monit.Well { Show exact location of well or boring 55364sketch map of well or boring �� . �{ � - wS in section grid with"X" =location,showing property U Env.Bore Hole ❑Other � ft. ��below above land surface lines,roads,and buildings. N CASING TYPE(S) --'--- --'-----`----'- U �4' Steel [J Plastic ,�Tile �Other __ • -'-- -'' " -'--- -- WELLHEAD COMPLETION ' - - ` - --F ' W ; : : : ET � __;__ _,____�__ __�_ ` Outside: ❑Well House ❑At Grade Inside: ❑Basement Offset � , , , , 'h Miie itless A p r/Und ❑Buried �]Well Pit , , , , � �P� da te ' --;----T-- --�-- ---�-- � 1\ � , � � ❑Buried ' ' S ' ' [f Well Pit ❑Other �-i Miie-� ;7 Other PROPERTY OWNER'S NAME/COMPANY NAME CASING(S) Diam t� � � Depth � Set in oversize hole? Annular space initially grouted? Properry own s mailing dress�f di erent a w c ad / ,�,,(' �in.from� to � ! ft. ❑Yes �xrvo ❑Yes ❑No ❑Unknown . � in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown _in.from to ft. ❑Yes �]No ❑Yes ❑No ❑Unknown , WELL OWNER'S NAME/COMPANY NAME SCREEN/OPEN HOLE r � Well owner's mailing address if different than property owner's address indicated above SCreen from�_�to�f�_ft. Open HOIe ffOm to ft. OBSTRUCTIONS �tods/Drop Pipe ❑Check Valve(s) L]Debris ❑Fill ❑No Obstruction 7� Type of Obstructions(Describe)�/�� ¢� �C1�,f...�" GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO �bstructions removed? Yes []No Describe FORMATION PUMP If not known,indicate estimated formation log from nearby well or boring. /'� � �c TyPe 4.t_...�1-, ��'`�� `--� �� Removed ❑Not Present ❑Other _ , METHOD USEDTO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: �o Annular Space Exists ❑Annular Space Grouted with Tremie Pipe []Casing Perforation/Removal �� in.from to ft. jJ Perforated ❑Removed in.from to R. ❑Perforated ❑Removed Type of Perforator ��Other_ GROUTING MATERIAL(S) (One bag of cement=94 Ibs.,one bag of bentonite=50 Ibs.) �„ /�/ ( / f �/� Grouting Material �f�� /f�1'� Yrofi � to /��R_._ yards�/ bags from to ft. yards bags _._ from to ft. yards bags OTHER WELLS AND BORINGS REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING Other unsealed and unused well or boring on property? ❑Yes No How many? LICENSED OR REGISTERED 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. D011 �TODOLA �TBLL DxZLLIPit3 CO.,,. INC-. 1691 -- —_—.__ Licensee Business N e . License or Registration No. ./ � �' .s / 5.5$ `,;,- � Clv Ce "�ed ep sen(ati�Signatu e • Certified Rep.No. Date LGCA!_CCPY �"� ��Q��O ��-^'C� y Name ol Person Sealing Well o�Boring HE-01434-10 IC#140-0423 .. 5i0�q