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Home My WebLink Aboutwell info _ v,��-�,�. , : _ . , _ ._._ .__ _ ._, � . _ w__. ._ :,� �_.. . w.�. _ .. ,_ ._ : �,.. .. .. :_ � . . ,x ,. .. .: _ , �; � wEL�OR BORING LOCnT1oN MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring '„I f�� County Name WELL AND BORING SEALING RECORD Minn'e oNa Unique Well No. L � �� Minnesota Statutes,Chapter f031 or W-series No. pm.e o�a�a�o.�> Township Name Township No. Range No. Section No. Fraction(sm->Ig) Date Sealed Date Well or Boring Construded �rono fl 7 23 07 ,. ',. ',. 12 f1 t�G C.� GPS Latitude degrees minutes seconds LOCATION: Depth Before Sealing z� ft. Original Depth ft. Longitude degrees minutes seconds p FER(S) STATiC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location �Single Aquifer ❑Multiaquiter WELUBORING Measured ❑Estimated 7 �Water Supply Well ❑Monit.Well t Show exact location of weil or boring ketch map of weli or boring � � in section grid with"X" location,showing property ❑Env.Bore Hole ❑Other ft. below ❑above land surtace N lines,roads,and buildings. CASING TYPE(S) -Y' ,./ �p Steel ❑Plastic ❑Tile ❑Other ♦� W —�- - -- - -- --;-- E WELLHEAD COMPLETION Outside: ❑Well House Inside: ❑Basement Offset -�-- ---- -r- --i-- � `,� � �meM �Pitless Adapter/Unit ❑Well Pit --�- -i— -i-- --�-- I 1 ❑Well Pit ❑Buried S �--�^"»—� ❑Buried PROPERTtY�.O,�WNER'S NAME/COMPANY NAME CASING(S) �.t u)i18t�l1Ct�� Diameter i Depth � Set in oversize hole? Annular space initially grouled? Property owner's mailing address if different than well ocation address indicated above �,�f � in.from Q to�'��ft. ❑Yes �No ❑Yes �No ❑Unknown 87� I,1H18�C.� I�Siik.' in.ffOm to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown Eden Prairfe, N�T 55347 in.frOm t0 ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown WELL OWNER'S NAMEICOMPANY NAME SCREEWOPEN HOLE -7 f.` 7 I Well owner's mailing address if dittere�t than properry owner's address indicated above Screen from t0 ft. Open Hole from 4 � t0�ft. OBSTRUCTIONS Rods/Drop Pipe ❑Check Valve(s) ❑ Debris ❑ Fill ❑ No Obstruction Type of Obstructions(Describe!- 1�1�� -(/'"� �` ��n"� GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? YeS ❑ NO Describe � FORMATION Ii not known,indicata estimated formation log from nearby well or boring PUMP /} Type �� t'v(7't�7 a�ifc o �s Removed p Not Present ❑Other METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: � C�Jo Annular Space Exists ❑ Annular space grouted with tremie pipe ❑ Casing Perforation/Removal in.from to ft. ❑ Perforated ❑ Removed in.from to ft. ❑ Pertorated ❑ Removed Type of perforator ❑ Other GROUTING MATERIAL(S) (One bag of cement=941bs.,one bag of bentonite=50 Ibs.) Grouting Material�L�� -��T from Q to SS_�L R. yards LS�.� bags from to ft. yards bags (rom to ft. yards bags OTHER WELLS AND BORINGS REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING pther 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 infortnation contained in this report is tme to the best of my knowledge. Ibn Stodola Well Drillfn� Co,. Inc. 27172 Contractor Business Name License or Registration No. _ �-I�-{35 _f,. Au ri d Representative 'nature Date �oca�coPv H 3��►� �+ ster�ec Name of Person Sealing Well or Boring --� � w WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIOUE WELL NO. �o��,y N�me WELL AND BORING RECORD ��p�.n I'Ainnesota Statutes,Chapter 103I � �� Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed o� ii� z3 0� tt ,, ,, ,, . GPS DRILLIN6 METHOD LOCATION: Latitude degrees minutes seconds Longitude degrees minutes seconds �� Cable Tool ��-]Driven �Dug ��Auger �Rotary �,_,Jetted House Number,Street Name,City,and Zip Code of Well Location or Fire Number �� .t DRILLING FLUID WELL HYDROFRACTURED? ❑Yes �1Vo Show exact location of well in sectio grid with'X". Sketch map of well location. �ter FROM fL TO ft. ..--�� Showing property lines, : N -�'s roads and buildings USE - . � � ;� � ^- `� []Monitonng L;Heating/Cooling . � � � � t(�. j�Domestic ❑Environ.Bore Hole ��r';Industry/Commercial --'----'--- ---`-- ---`-- �� ,�� . `__-Noncommunity PWS n Irrigation —'Remedial � Community PWS ❑Dewatering ' --i----'--- --`-- ----- : � w ; j ; ? E . ` ASIN Drive Shoe? Yes ❑No � OLE DIAM. C G H � ' , r r 'h nniie �( `LJ Plastic �Threaded�❑Welded . ' � � � � 1 � CASWG DIAMETER WEIGHT ` ; ; S � k ��'� __�__in.to _2Z�ft. �,1 Ibs./ft �in.to�t. s �1 Mile —� . in.to .. ___ft IbsJft �in.to��ft. PROPERTY OWNER'S NAME/COMPANY NAM � in.to ft. Ibs./R. .to 's SCREEN OPEN HOLE Proper?y owner's mailing address if different than well ocation address indicated above. Make � FROM ft. TO ft. t�79t� Lunski i.ane Type Diam. '�t 55347 SIoVGauze Length F.�c}en Praicie, r Set between ft.and ft. FITTWGS STATIC WATER LEVEL �I ft. below �j above land surface Date measured��I PUMPWG LEVEL(below land surface) - � WELL OWNER'S NAME/COMPANY NAME 1�� ft,after � hrs.pumping �O g.p.m. W LL HEAD COMPLETION � �(� t � Well owner's mailing address it different than property owners address indicated above. Pitless adapter manufacturer 1..�-�'*�-`�..�-f"�`�"^— Model_ J Casing Protection 1�12 in.above grade ❑At-grade(Environmental Wells and Boring ONLY) ,�. GROUTING INFORMATION Well grouted es ❑No Grout material �eat cement [;Benronite ❑Concrete�High Solids Bentonite from__Q_to___�ft. �_ �:yds. �.bags from__ �to_'��tt. �� risl ❑bags GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO from to_ ft. _ []yds. �'i ba s MATERIAL 9 NEAREST KNOWN SOURCE OF CONTAMINATION C�a� b�� .�ft � 1� J�'� feet � �1� direction ,J".-'s ra-' ,=' �e Well disinfected upon completion Yes ❑No :_�_,,,a„" -„�,� ��.U��..: � -�; C18Y Or`�Y SOlt 12 YV PUMP ! ,._-....� f.'�-_..� �.ly.o..r.�. ) `../v `�.) ',Not installed Date installed �.! J S$1]d �CSy $Of t �i �Manufacturer's name �.�L—N�'�.�' — * Madel number HP / Valts " .✓� Cl$y,� �i�y `��t � 275 Length of drop pipe �`�' ft. Capacity g.p.m. y,,� Type:, �Submersible ❑LS.Turbine ❑Reciprocating ❑Jet �_J 1f1I'�SCO� � iY�� 27S ZSS qgqNDONED WELLS Does property have any not in use and not sealed well(s) �]Yes o VARIANCE Was a variance granted from the MDH for this well? ❑Yes No 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,if needed � �t y�II �11 �1.,.j 1 7 j n{ , REMARKS,ELEVATION,SOURCE OF DATA,etc. . C7pU 11 aiLiyli��t� � . z� Zn�t Licensee Business Name Lic.or Reg.No. j /` � . �� epr entative 'nature Date s W l�ll:.� �� 7 �� ^ �y� Name ol Driller �.00AL COPY T L HE-01205-08(Rev.5/02) IC 140-0020 ! � . T+LU W li C I,�" �tJ G�.t"P�v' ' , ,y C , �IiI�C� 617 13th Ave So � Hopkins, Minnesota 55343 • (612) 935 3556 10/07/2005 Stodola Well Drilling 3841 North Main St. Bonrfacrus MN 55375 938-21 1 1 REPORT OF WATER ANALYSIS Lab #: 6056N Our Laborarory reporis these analytical results, determined on a sample taken by cleinr on 10/OS/2005 from the following location: 4460 Forest Lake Lar�ino� Orono,Mn Well #726422 Coli form Bactevia <1/100 ml Nitrates Nitrogen <1.0 mg/1 The results of ihese tests indicate rhat this well rs producrng water that meets rhe standards for F.H.A., V.A., or conventiona! loans. This reporr rs an analysis for coliform and nitrate only and does not include analysis of Lead and other contaminants. (Unless as specified by clrent). in City Water Clinic, Inc. , B��! ,�rsda/e Lnb Ccrtificntion Ir 027-053-�19