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Home My WebLink Aboutwell info WELL OR BORING�OCA71oN MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring H �2 6 5 9 2 WELL AND BORING SEALING RECORD Sealing No. Counry Name Minnesota Unique No. ��enne�in Minnesota Statutes,Chapter 1031 or W-series No. (Leave blank it not known) Township Name Townshi No. Range No. Section No. Fraction(sm.�Ig.) Date Sealed Date Well or Boring Constructed Orono O�7 23 07 , ,, ,, � �.� � Numerical Street Address ir Number and City ot Well or Boring Location � , 2 � 92 5 F or�s t �rr$:� Lane �r�n0 Depth Before Sealing �.�� ft. Original Depth �_.i� R. Show exact location of well or boring S�� Sketch of well or boring IFER(S) STATIC WATER LEVEL in section grid with"X". loc�!(i, slt`owing property Single Aquifer ❑ Multiaquifer N �s,roa ,and buildings. WELUBORING �Measured ❑ Estimated ' ' ' � Water Supply Well ❑Monit.Well /� � _ _ _Y_ _1__ __l__ �( t �� ❑ Env.Bore Hole ❑Other ft. �below ❑ above land surface ,s --�- -i-- -i-- --i-- W E �{, � CASING TYPE(S) i � � � � i � � �\, --�- --�- -�-- --�-- - �.� Steel ❑ Plastic �Tile �Other ' ' I ' ;G mile � .y ,. � � � � ` � CASING ---- -�-- -�-- --�-- , e ryl .\,.. 1 / DiameteJr Depth � Set in oversize hole? Annualar space initially grouted? LL"" S / J �f-, � �f� ��,,----JJ p�i mae� `` �7 in.from i� to�5.,� R. ❑ Yes �No ❑Yes ❑No ❑ Unknown I PROPERTY OWNER'S NAME in.from to fl. ❑ Yes ❑No ❑Yes ❑No ❑ Unknown Len .iane Adass �72-3519 Properry ownefs mailing address B diHerent than well location address indicated above. in.from to ft. ❑ Yes ❑No ❑ Yes ❑No ❑ Unknown �C��YU SCREEWOPEN HOLE i ,�' / � �� Screen from�_to fl. Open Hole from to ft. -p�;-' OBSTRUCTIOWDEBRIS/FILL WELL OWNER'S NAME �� '�- ❑ Obstruction ❑ Debris ❑ Fill�No Obstruction .n' Well owner's mailing address if ditterent�t��pro� rty wn�ds ress indicated above. Type of ObstructioNDebris/Fill �� ObsiructioNDebris/Fill removed? ❑ Yes ❑ No -` ._ - • � PUMP Type GEOLOGICAL MATERIAL COLOR HARDNESS OF FROM TO � Removed �Not Present ❑ Other FORMATION If not known,indicate es6mated formation log from nearby well 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 _J ❑ Casing PerforatioNRemoval in.from to ft. ❑ PeAorated ❑ Removed in.from to ft. ❑ PeAorated ❑ Removed Type of perforator ❑ Other GROUTING MATERIAL(S) � Grouting Matena �"`�r %<ry�� l �� / / V�"�'� N from � to�.e_G� tt. yards �L— bags from to tt. 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 �No 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. Don Stodols �Iell Urillin� eo. , Inc. 2717j2 Contrador Business Name License or Regishation No. ..r' r��' l-,;�'� `+ �" �,r�-, .f'� /�C✓ `� � , ..% � uthonzed Representative Signature Date f � �`��,,,_" �..._ __•�-�,-��S�r�./�.�d'v'1. LOCAL COPY H 12 6 5 9 2 Name o/Person$qkling Well or Bonng HE-01434-02 10/95R . � �w�� c�t� �a�� c�� ,�. 617 13th Ave So • Hopkins, Minnesota 55343 • (612) 935 - 3556 09/05/1997 Stodola Well Drilling 15306 Hwy 7 Minnetonka MN 55345 938-2111 REPORT OF WATER ANALYSLS Lab#: 33371 Our Laboratory reports these analytical results, determined on a sample taken by CLIENT on 09/OZ/1997 from the following location: Len Adams 915 Forest Arms Lane Orono,Mn Unique 1Mell#596651 Coliform Bacteria <1/100 ml Nitrates Nitrogen <1.0 mg/I The results of these tests indicate that this w�ell is p�oducing water that 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 client). ity�Water Clinic, Inc. \ Bil � e Aiulyical►abowary c�W�� Wator Analyeis Reagonta Boiler Water C6omicam I.ab Cettif'ication y 027-053-119 WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. CountyName � WELL AND BORING RECORD 5 � ��j 51 ��nr��'�� Minnesota Statutes Chapter 103! Township Name TownshiP No. Range No. Section No. Fracfion WELL DEPTH(completed) Date Work Completed i3ronc, i i / � � t�7 1 ?� � " 8-29-9? ��. ��. ��. HoCu�se Number,Street Name,City,and Zip Code of Welrl iLocation or Fire Number�]L DRILLWG METHOD 7��J �'�Q.��ut �rm L��sn� y� �i��I�lU� �N. J::-JV'4 ❑ CableTool ❑ Driven ❑ Dug ❑ Auger �9 Rotary ❑ Jetted Show exact location of well in section gri with"X". Sketch map of well location. ❑ Showing property lines, — N Oh roads and buildings. DRILLING FLLUID WELL HYDROFRACTURED? ❑YES ❑NO D$nt.t'i f i :. _i i i i_ � � FROM ft.to_ ft. _ _i_ _i_ _i y� USE Y ❑ Monitoring ❑ Heating/Cooling _S 2�Domestic ❑ Communit PWS _i_ _�_ _�_ _i_ Y ❑ Indusiry/Commercial ❑ Irrigation ❑ Noncommunit PWS w � � � � E T � ❑ Test Well v ❑ Remedial i i � i � � ❑ Dewatering ❑ -r -�- -r- -r / i i i i ��zM�ie � / CASING Drive Shoe? ❑ Yes No HOLE DIAM. _i_ _ i _i_ _i_ � _.� �Steel ❑ Threaded ❑ Welded i i- i i + S ��LC t_t.� Plastic ❑ �-1 Mile-� CASI G DIAMETER WEI T PROPERTY OWNER'S NAME � in.to t`� ft. �� Ibs./ft �' /}� 'jfj��, _, Lynry b i3ctl"1� �C�i�Iil� in.to ft. _ Ibs./ft. ��!toY— t ffj� Propeity owner's mailing address if different than well location address indicated above. ��to K� Ibs./ft. in.to ft. SCREEN OPEN HOLE Make �� from ft.to ft. Type S�c�lT1 ��"+v � - -� Diam. SIoUGauze Length . �,`.,_._...�.`��j Set between ft.and ft. FITTINGS: ' '-� STATIC WATER LEVEL a_,2{�`��7 J WELL OWNER'S NAME 2 �99 � � ft. ��f'elow ❑ above land surface Date measured ��Q�• � PUMPING LEVEL(below land surface) Well owner's mailing address if different than properry owner's address�mdicated above. ��L ft. after � hrs.pumping 3�1 i..1I� g.p.m. ` .: .. u'� � WELLHEADCOMPLETION W�i��W�3teT Q�itless adapter manufacturer Model ❑ Casing Protection �F2 in.above grade ❑ At-grade(Environmental Wells and Borings ONLY) GROUTING WFORMATION Well grouted? �1 Yes ❑ No HARDNESS OF Grout Material ❑ Neat cemen ❑ Bentonite Concrete i h Solids Bentonite GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO � 3 �9 ]�� from to . ❑ yds.YJ bags � from to ft. ❑ yds. ❑ bags C�-t_!�7 Brown � �) i from to ft. ❑ yds. ❑ bags 17 o NEARE NOW�J SOURCE OF CONT�AG�'.1 ATIONT^ e j T �-1 u�� s L��1L'�1 Brc��n �� .�V ��l � __ feet G.� � / direction �"C.�type Well disinfected upon completion? Yes ❑ No � y�� ; Gr�vel Cc,l�re� i� f u 6 PUMP �� T�� y-2-97 ❑ Not installed Date installed `�-"�1.Zt�' `,�-';.tltt; $TC3WI3 ? E'� � nnanufacturer'sname Red 3�cket �i 8 .s a ivlodel number HP � Volts :3.ilty 5and Brown `' �� 1 � 105 ' 1 t; Length of drop pipe ft. Capacity g.p.m. wc3ter �c�T1t�w ��e� � . .C'JYJY2 J ��% '�?j �YPe: �Submersible ❑ LS.Turbine ❑ Reciprocating ❑ Jet ❑ ABANDONED WELLS Does property have any not in use and not sealed well(s)? ❑ Yes u'roo VARIANCE Was a variance granted from the MDH for this well? ❑ Yes L7 No WELL CONTRACTOR CERTIFICATION Use a second sheet,il 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 S�'E��OL�: itiELL I3RILLING C:C;. , Iltic:. Licensee Business Name Lic.or Reg.No. �� '�.� 1 / � �G �"�' � �;--d.5'-7 � �i _;-�`.' ��. Authorized Representative Signature Date � C�1UC'K i�lc,�t:yre 1�-2`�-9/ 5 9 �� 51 Name ol Driller Date L��L vO�� HE-01205-06(Rev.9/96)