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Home My WebLink Aboutwell info c, WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UN/QUEWEII NO. County Name WELL AND BORING RECORD , � �'2 � in Minnesota Statutes,Chapter f031 � „J_ ��"�� `""' , � Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed � 4s�no lI7 23 t�i �,, �� , " _ � GPS DRILLING METHOD - LOCATION: Latitude degrees minutes seconds Longitude degrees minutes seconds �Cable Tool ' J Driven _ Dug ��Auger �Rotary ,Jetted - House Number,Street Name,City,and Zip Code of Well Location or Fire Number � �-- 31L� r� ��C Ocon� 5S356 DRILLING FLUID WELL HYDROFRACTURED? ❑Yes No Show exact location of well in section grid with"X". Sketch map of well location. �t�r FROM ft.TO ft. Showing properry lines, N roads and buildings USE � �Monitoring ❑Heating/Cooling = � � � � �Domestic ��'Environ.Bore Hole ❑IndusVy/Commercial � � --'--- —'--- --`-- ---`- `� ;J Noncommunity PWS �—]Irrigation ]Remedial � I I I ' ❑Community PWS ❑Dewatering '] � , J CASING Drive Shoe? ��Yes ��. N HOLE DIAM. W - -- - - E T - _ ° ❑Steel ❑Threaded ^'��We�d 'h nniie �� Plastic � �� --�-- —�-----�-- ---%-- 1 '� ___ 5 CASING DIAMETER WEIGHT I I S I I �_.✓� ' _.._ `�� . `� _�__in.to��ft. '�� Ibs./ft �_in.to '.. ,� �—i nn�ie—� �,� � _ in.to ft. _ .____ Ibs./ft �in.to_��. =� PROPERTY OWNER'S NAME/COMPANY NAME in.to_. tt. Ibs./ft. in.to ft. Jeff Nelscm C.anstt�ctfon SCREEN y OPEN HOLE Property owner's mailing address if different than well location address indicated above. Make �� J"`��i FROM tt. TO ft. 515 lst A�re �t TYpe ��.�1��$__$tl Diam. _. .--- ,. .. ;�nt�' � QGnLA SIoUGauze ___�rn n__ Length�� .�.�,�� J.)IJ�K) Set between ft.and ft. FITTINGS �► M STATIC WATER LEVEL �� ft. below U above land surface Date measured 12�� PUMPING LEVEL(below land surface) `�� -:�WELL OWNER'S NAME/COMPANY NAME � � . � �� n f ft.after ` hrs.pumping � g.p.m. WELL HEAD COMPLETION f.�.s '� Well owner's mailing address if different than property owners address indicated above. �Pitless adapter manufacturer w`�t�te� Model _Casing Protection ___ �j 12 in.above grade ��,J At-grade(Environmental Wells and Boring ONLY) GROUTING INFORMATION Well grouted �Yes [No Grout material ❑Neat cemeM �_J Bentonite ;]Concrete�i High Solids Bentonite from�.to�ft � � �yds. �bags from_�to��#_ft. �� jcjMs� r]bags HARDNESS OF Y:ill GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO from to ft. 'I yds. ❑bags NEAREST KNOWN SOURCE OF CONTAMINATION la ell� f _ � ,� feet direction � � 4 rype Well disinfected upon completion Yes ❑No \ C18. � p PUMP . j '�, �Not installed Date installed �`�" " ' t��.�� Manufacturer's name__ �y�-tf�tj�� Model number li�Li C.1Ciat1T� HP�Volts LJl! Length of drop pipe �Zvt T� ft Capacity g.p.m. Type:�Submersible �:J�L.S.Turbine ;f-�Reciprocating ❑Jet [_] ABANDONED 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? [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 ihe best of my knowledge. t Use a second sheet,ii needed TM_ REMARKS,E�/��jION,SOURCE OF DATA,etc. sM! �taioia Well Dcilli.ng Co,. lj�• 2��, `��A Licensee Business Name Lic.or Reg.No. :��R ��F�, �._.. � � .� � ''- 1-28-�'}S ��O^ �oOC A h �ed Representative Sig/raiure Date ✓ r �� -- � .�� LOCAL COPY �� (;� Q � 5 Name of Driller �.,t <1 HE-01205-OB(Rev.5/02) IC 740-0020 rw i�vv C%tr 1Na,t��' C ' ' , I v��'i. y 617 13th Ave So � Hopkins, Minnesota 55343 � (612) 935 - 3556 12/07/2004 Stodola Well Drilling 3841 North Main St. Bonifacius MN 55375 938-21 1 1 REPORT OF WATER ANALYSIS Lab #: 929 Our Laboratory reporrs these analytical results, determined on a sample taken by CLIENT on 12/06/2004 from the following location: 3125 Fox St. Orono,Mn Unique Well #719805 Coliform Bacteria <1/100 ml Nitrates Nitrogen <1.0 mg/1 The results of these tests indicate that this well is producing water that meets the standards for F.H.A., V.A., or conventional loans. This report is an analysis for coli form and nitvat� on(y Gnd does r;ot include analysis of LeUd and at�her co;�Taminants. (Unless as speci fiec� by client). � � City Water Clinic, Inc. - ��, \+ `4 Bill� ��`�rsdale ,� J Lab Cert�cation#027-053-119 wELL OR BORING LOCA7ION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring '„' n I�� County Name WELL AND BORING SEALING RECORD MinnlesoNa Unique Well No. L L Minnesota Statutes,Chapter 1031 or W-series No. (Leeve dank il nd knonn) Township Na e Township No. Range No. Section No. Fraction(sm->Ig) Date Sealed Date Well or Boring Constructed flrono 127 23 t� �,. �,. .,. O c.. GPS Latitude degrees minutes seconds ` � � LOCATION: Depth Before Sealing ` �� ft. Original Depth�� ft. Longitude degrees minutes seconds ppUIFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location Single Aquifer ❑Multiaquifer 31�� cL�a, !�s vi� 5535b ELUBORING �lvleasured ❑Estimated Ea.... r� Water Supply Well ❑MoniL Well � t l Show exact location of well or boring Sketch map of well or boring C, in section grid with"X" location,sho ing property ❑Env.Bore Hole ❑Other 7 ft. �below ❑above land surface lines,roads,tand buildings. N � _ CASING TYPE(S) �. z.� __...�'--'_'""_� _ -. �Steel ❑Plastic ❑Tile ❑Other W -- - -�-- -;-- --,-- E WELLHEAD COMPLEl10N r � Outside: ❑Well House Inside: p(Basement Offset -�- ---- -i-- -i-- �� j� ��y ! ❑Pitless Adapter/Unit ❑Well Pit --�- -�- -�-- -i-- I Z ❑Well Pit ❑Buried �,�..—�. �-'�_��: ❑a�� PROPERTY OWNER'S NAME/COMPANY NAME CASING(S) Diamet�r Depth / Set in oversize hole? Annular space initially grouted? Property owner's mailing address if diNerent than well location address indicated above �(�,',�/ �_ in.frOm� t0_,C�.aL ft. ❑Yes �No ❑Yes ❑No ❑Unknown 515 lst Av+� N in,f�Ort1 t0 ft. ❑Yes ❑Na ❑Yes ❑No ❑Unknown Isanti, �T S5t14f) in.f�Ofn t0 ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown > WELL OWNER'S NAME/COMPANY NAME SCREEWOPEN HOLE � � r Well owner's mailing address if diHerent Man property owner's address indicated above Screen from t0��ft. Open Hole from t0 ft. OBSTRUCTIONS `Q�Rods/Drop Pipe ❑Check Valve(s) ❑ Debris ❑ Fill ❑ No Obstruction /'� /� Type of Obstructions(Describe) � .t//,� �r/.�6 � �""(J/)')!� GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM 70 Obstructions removed? Yes ❑ No Describe FORMATION If not known,indirate estimated formation log from nearby well or boring PUMP - � � � TYPe ,� � Removed ❑ Not Pr sent ❑Other METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: � Lyf No Annular Space Exists ❑ Annular space grouted with tremie pipe ❑ Casing Perforation/Removal /' in.from to ft. ❑ Perforated ❑ Removed in.from to ft. ❑ Perforated ❑ Removed Type of perforator ❑ Other GROUTING MATERIAL(S) (One bag of cement=941bs.,one bag of bentonite=50 Ibs.) f Grouting Material�f�r��,'��'�,�+�from�—ro��jt. 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. dcx� Stodflla Well llrillin� Co,. �, znr� Contractor Business Name License or Registration No. r---- � /; � .�.. �-� . ,� f ;� f A o ed epresentative Sig�77atm�e Date -A.�� H '2�?61 �. ; .:,_,.,�. LOCALCOPY � Name of Person Sealing Well or Bonng �