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Home My WebLink Aboutwell info _ .� , . _. , . .qn,. < , .. ,.. ; _. . . ;, . . , wELL oR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring '„� w . County Name WELL AND BORING SEALING RECORD Minne9oNa Unique Well No. !�' Minnesota Statutes,Chapter 1031 or W-series No. .i ia vc biank�i�not known) �� Township Name Township No. Range No. Section No. Fraction(sm->Ig) Date Sealed Date Weli or Boring Constructed : Orono 1 7 2 09 �1-�t�01� Q GPS Latitude degrees minutes seconds � LOCATION� Depth Before Sealing �� _ft. Original Depth �� ft. Longitude degrees �' minutes seconds p UIFER(S) S7ATIC WATER LEVEL � Numerical Street Address or Fire Number and Ciry of Wel!or Bo�ing Location �ingle Aquifer ❑Multiaquifer 2465 Fc�ench Lake Rd, Orona 55391 WE4L/BORING vleasured ❑Estimated �Water Supply Well ❑Monit.Well �.. � � Show exact location of well or boring Sketch map ot well or b ing �t in section grid with"X" location,showing prope y ❑ Env.Bore Hole ❑Other �� ft. �low ❑above land surface lines,roads,and buildin s. N CASING TYPE(S) � � � � � ;. � -'�— —� i teel ❑ Plastic ❑Tile ❑Other � � � � W -- - - -- -i-- --i— E A` i WELLHEAD COMPLETION � � � � � i` ``y (C _ � � � � � Outside: ❑Well House Inside: ❑Basement Offset �� -;- ;-- -;-- --�-- � �.. ' �'"'� � �'itless Adapter/Unit ❑Well Pit ' ,. -�-- -i-- -�-- --i-- � � /J . � S � j ' ❑Well Pit ❑Buried lll�� f �I�--r mde� ��/ �Buried I ' PROPERTY OWNER'S NAME/COMPANY NAME CASING(S) Diamet �{ Depth ! Set in oversize hole? Annular space initially grouted? � Property owner's mailing address if erent ihan well location address indicated above L_ /� � in.fromS� to�ft. ❑ves �o ❑ves ❑ No ❑unknown in.from to ft. ❑Yes ❑No ❑Yes ❑ No ❑Unknown i in.f�Om t0 ft. ❑Yes ❑No ❑Yes ❑ No ❑Unknown WELL OWNER'S NAME/COMPANY NAME SCREENlOPEN HOLE � t f �� Well owner's mailing address if different than properry owner's address indicated above Screen from_��t0__i�.�ft. Open Hole from to ft. OBSTRUCTIONS ❑ Rods/Drop Pipe ❑ Check Valve(s) ❑ Debris ❑ Fill �IVo Obstruction l� Type of Obstructions(Describe) GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? ❑YES ❑ NO DOSC�ibB FORMATION � If not known.indicate estimated formation log from nearby well or boring PUMP � � / Type ❑ Removed [�lot Present ❑Other METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: �No Annular Space Exists ❑ Annular space grouted with tremie pipe ❑ Casing Perforation/Removal in.from to ft. ❑ Perforated ❑ Removed O oA'O in.from to ft. ❑ Perforated ❑ Removed �v Type of perforator ❑ Other GROUTING MATERIAL(S) (One bag of cement=94 Ibs.,one bag of be,ntonite=50 Ibs.) r /'� Grouting Material �'��f�f��t�om_�to /� ft. yards _-�[�1 bags - from to ft. yards bags Y 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 seaied in accordance with Minnesota Rules,Chapter 4725.The information contained in this report is true to the best of my knowledge. $ n«� stoaoia c��.� n�lz� eo,. I�. 27272 Contracfor Business Name License or Registration No. > .�- 1. � � z epresenta�ve Si ture Date LOCAL COPY H 2 2 2 614 �� s~~ Name of Person Sealing Well or Boring ...�.:,R,j ,. ��r,��t'��.!!',t� t��1.1 ' . , . f _ � ' WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIc7UE WELL NO. � County Name WELL AND BORING RECORD Minnesota Statufes, Chapter f037 7� � � � � To Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed Ii7 23 09 �� I28 " �-11-04 GPS DRILLING METHOD LOCATION: Latitude degrees minutes seconds Longitude degrees minutes seconds ��Cable Tool ��Driven Dug _ — �Auger j�Rotary �]Jetted House Number,Street Name,City,and Zip Code of Well Location or Fire Number - � f' . � IIlRC � Oicocio 55391 DRILLING FLUID WELL HYDROFRACTURED? ❑Yes No Show exact location of well in section grid with"X". Sketch map of well location. �n�� FROM tt.TO ft. Showing property lines, N roads and buildings USE ` ❑Monitoring []Heating/Cooling � � � � �j Domestic Ty �Environ.Bore Hole ❑Industry/Commercial � --'-----'------`—--`- � 9 ❑ , � I j j j � Noncommuni PWS Irri ation Remedial � W � ; j j E �� CASING�I Community PWS DjIDeShoe?n9❑Yes No HOLE DIAM. �� , � , T s _.�.. _ -- -- - - --- -- --- _J Steel [J Threaded I� elded .. --,--- - �- - ' .-- - �.; I ; � I I Mi�e , ('ti4 E.�� ,1 � �' �u� � �Plastic ❑ � --�--- --�-- --•- � �. _ � � S � � CASING DIAMETER WEIGHT F--i nniie—� �in.to 120 ft. 4a Vl Ibs./ft. v in.to �ft. in.to ft. __ Ibs./ft. �in.to��+tt. PROPERTY OWNER'S NAME/COMPANY NAME in.to_,_ ft Ibs./ft. in.to ft. SCREEN OPEN HOLE Property owner's mailing address if different than well location address indicated above. Make_.�� . ._ FROM ft. TO ft. - � 8� a� TYPe—��—��-.. Diam._�— —_.. _ SIoVGauze____ � _ Length L�_�� __ Set between ft.and_ fL FITTINGS STATIC WATER �,rf � i below �]above land surface Date measured 5—i1—Q4 PUMPING LEVEL(b_ow land surfaA) � ' WELL OWNER'S NAME/COMPANY NAME �;p ` - [7 ft.after hrs.pumping g.p.m. �HEAD COMPLETION 1. �� Well owner's mailing address if differen�,t�.��Q�er�s address indicated above. Pitless adapter manufacturer �L��t�� Model ��' iV Casing Protection �2 in.above grade ❑At-grade(Environmental Wells and Boring ONLY) �C�I 6 �};1(1� GROUTING INFORMATION . ^ 4 e11tj Well grouted �Yes �� No CITY OF pR Grout material ,�Neat cement ❑Bentonite ❑Concrete�High Solids Bentonite D�O from�to.__�ft � ' 'yds. I� ags from�toyy�Rj��jj��,�s. �ags GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO from to ft. ❑bags MATERIAL ❑yds. NEAREST KNOWN SOURCE OF CONTAMINATION P'� — � ` Q t �.l feet �� direction � � type � 1 r� Well disinfected upan completion (_,-1 Yes ��No PUMP mediu�a k 80 � S-1I-04 �Not installed Date installed t !!11 r}L ManufactureYs name CRJ 7� +1�lA Model number __ HP__�_��Volts �.�l �� (�� '�� Length of drop pipe C7�i ft. Capacity g.p.m. Type: Submersible ❑LS.Turbine I�Reciprocating jJ�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? ❑Ves 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,i1 needed ` REMARKS,ELEVATION,SOURCE OF DATA,etc. �(i SCU42O�� NCli ��1� LV�• 1t�{,;a Z/l� -- Licensee Business Na e Lic.or Reg.No. : .. . ; , .._.....�. ,. .r�� C—*p�� --"'"�� TiL7—l!Y i ri e resentative Signature Date � �� - � � � � � � Name oi Driller LOCAL COPY HE-01205-OB(Rev.S/02) IC 140-0020 � 4 rw� c�-y w�� c � � , r�� 617 13th Ave So � Hopkins, Minnesota 55343 � (612) 935 - 3556 OS/13/2004 Stodola Well Drilling 3841 Novth Main St. Boni facius MN 55375 938-21 1 1 REPURT�F WATER ANALYSIS Lab #: 353 Our Laboratory repovts these analytical results, determined on a sample taken by CLIENT on 05/1 1/2004 from the following location: Robert Dayton 2465 Frech Lake Rd. Orono,Mn Unique Well #711452 Coliform Bacteria <1/100 ml Nitrates Nirrogen <1.0 mg/I The results of these tests indicate that this well is producing water rhar meets the standards for F.H.,a., V.A., or conventionA! loans. This report is an analysis for coliform and nitrate only and does not include analysis of Lead and other contaminants. (Uniess as specifiea by client}. � ", City Water Clinic, Inc. ,� �, , Bill V' ;. dale � Lab Cert�cation#027-053-119