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Home My WebLink Aboutwell info * " ' MINNESOTA UNIQUE WELL WELL OR BORIh„�'.,LOCATION MINNESOTA DEF:ZRiT,1ENT OF HEALTH AND BORING NO. co„�ty hdme WELL AND F�(�R�NG RECORD �' Minnesota St$f,�i?Bs,Chapter 103I ��`.�� a �,.. �4 :�i.. Township Name Township No. Range No. Section No. Fraction WELUBORWG�DEPTH(completed) DATE WORK COMPLETED 8 3S �'/ /�.�� lb3 n 8—l�-()S GPS DRILLING METHOD LOCATION: Latitude degrees minutes ___ seconds _ "`�"� Longitude degrees minutes seconds �.-Cable Tool Driven Dug _ �Auger ��Sota,ry .Jetted House Number,Sheet Name,City,and Zip Code of Well Location or Fire Number . �-_ DRILLING FLUID WELL HYDROFRACTURED? ❑Yes , o Show exact location of well/boring in section gri with"X° Sketch map of well/boring location. �� From R.To Showing property lines, N � roads,buildings,and direction. USE . �omestic �..�Monitoring �]Heating/Cooling � ___ _ _ __ �.� � :�Noncommunity PWS �_.�Environ.Bore Hole ❑Industry/Commercial }'� �� , i_'�Community PWS �]Irrigation ❑Remedial f � ,/� --- - �i, r� '-i Elevator L]Dewatering ❑ � � � . ,1 J" w , , , E T "� � CASI{��'.,MATERIAL Drive Shoe? [I Yes �'�IQo HOLE DIAM. � � --;-----;-----�- --*- n , I � "" ' Steel I]Threaded ❑Welded . �.. � � � � .. � � - '"' " �Mila ��www,,��"""'' �lastic `� - __;_____r__ __;_ � �, .� CASING S � �, Diameter Weight Specifications �—i Miie� �in.to�_ft ._��Ibs./ft. �$�� in.to�J[. PROPERTY OWNER'S.,(yAME/COMPANY NAME _—_ in.to ft. Ibs./ft. �in.to ��. in.to ft. Ibs./ft. in.to ft �'� Property ownersmailing address if different than well location address indicated above. SCREEN�__ OPEN HOLE � 6� � 7� �t Make___ _ From eft To ft. �z A Type � Diam. _.-- ___- '� �I�$=af � ��1 Slot/Gauze # Length�� Set between��ft.and�1 ft. FITTINGS 4 iL�'f �f/._� _ STATIC WATER LEVEL Measured from � � ft�elow �_,'��Above land surface Date measured � WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) �� ft.after I..S hrs.pumping �� g.p.m. Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION .{�� itless/adapter manufacturer��4---�--��"��.`!!�I asing Protection ��2 in.above grade ❑At-grade(Environmental Well and Boring ONLY) GROUTING INFORMATION � Well grouted �(es �_]No �,,�C � Grout materials _�Neat cement (�ttentonite �_�Concrete ❑Other From � To � ft � !��..Yds �ags GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO From�To�f�f.a�w� ��Cds. ;]Bags MATERIAL From To ft. [�Yds. �Bags � NEAREST KNOWN SOURCE OF CONTAMINATION � 4 1 �._�f'1 feet 3► direction rf% e �_ Well disinfected upon completion? �es ;J No � UMP �.-��;�� . �.'� �� ., �Sz-�� .]Not installed Date installed ! � 1� Manufacturer's name �r:.�-�._?.J--1 )��,., Model Number HP__�.�JCVolts �� /� s- Length of drop pipe �{..f� ft. Capacity g.p.m. Type:�� ubmersible ❑LS.Turbine ❑Reciprocating ❑Jet U ABANDONED WEILS 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 [�Q�o TNp 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. Dt�n SLGdOla �11 DCiIIiclg t0,. it�e. 2�33 <� Licensee Business Name � � Lic.or Reg.No. __ �� 'i �� Ce ied RepresentativeSigFiature Certified Rep.No. Date , � LOCAL C�PY � � �� '} Name of Driller � � IC 140-0020 HE01205-11(Rev.3/07) • - � � Tw i�v C i,t� 1Na•t�v' C ' ' , I v�c�. y 617 13th Ave So � Hopkins, Minnesota 55343 • (612) 935 - 3556 08/OS/2008 Srodola Well Drilling 3841 North Main St. Boni facius MN 55375 938-21 1 1 REPORT OF WATER ANALY5IS Lab #: 353BN Our Laboratory reports these analytical results, determined on a sample taken by CLIENT on OS/06/2008 from the following locarion: 460 East Long Lake Rd. Orono,Mn WelL 760644 Coli form eacteria Absent Nitrates Nitrogen <1.0 mg/1 Arsenic 3.46 ppb Twin �i Water linic, Inc. Bill t sdale Analyical laboratory Consulting Engincer F Water Analysis Reagents Boiler Water Chemicals Lab Certification#027-053-119 WELL OR EfORING LbCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring H ��c�] County Name , WELL AND BORING SEALING RECORD Mnnlesoa�UniqueWellNo. C' ` Minnesota Statutes, Chapter 103I or W-series No. (leeve blank'ii not known) Township Name Township No. Range No. Section No. Fraction(sm.�Ig.) Date Sealed Date Well or Boring Constructed 28 23 3� .�� 'l� /Z �v , O� , GPS Latitude degrees__ minutes seconds Depth Before Sealing �� ft. Original Depth ft. LOCATION: Longitude degrees minutes seconds p�p[�.FER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location IGfSingle Aquifer �_�Multiaquifer �^� /�,.��/ �i� L�68� Lake Rd �/�,6�[1V WELUBORING �Measured ❑Estimated Date Measured --�� y � 1 Water-Supply Well ❑Monit.Well Show exact location of well or boring � Sketch map of well or boring in section grid with"X" � location,showing property ❑Em.Bore Hole ❑Other � ft. �J below ❑above land surface N `G_y lines,ro dc�aad�Ndild� gs. CASINGTYPE(S) --'--- --'-----`-- ---'- � �} �` Steel ❑Plastic ❑Tile U Other ; ; ; ; �,�r `-.��\ i -- --- --------- -- ----- 5�- '" • WELLHEAD COMPLETION � , � . W ; ; : ; ET .` „ __�_____;_____�__ __;__ �i ,i Outside: L]Well House ❑At Grade Inside: i�Basement Offset �1 , , , , 'h nniie itless A p UUnd ��Buried ❑Well Pit , , , , � U P� da te � —�--—T----%-- --�- ❑Well Pit ❑Buried S ❑Other �—1 Mile� � . ❑Other PROPERTY OWNER'S NAME/COMPANY NAME CASWG(S) � Diameter� Depth ' Set in oversize hole7 Annular space initially grouted? Property owner's mailing address if different Ihan well localion address indicated above � / / �, _,_�in.from_C to GL� ft. ❑Yes �o ❑Yes �]No U Unknown 620 Beaver Usn �� in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown Wayzata, I� 55391 :;�� in.from to __ft. j�Yes [�No [�Yes �]No ❑Unknown WEIL OWNER'S NAME/COMPANY NAME SCREEN/OPEN HOLE �f�,, /•��,��/ Well owner's mailing address if different than property owner's address indicated above SCfeen from �-�+`s' to �" ft. Open Hole from to ft. OBSTRUCTIONS ods/Drop Pipe ❑Check Valve(s) ❑Debris ❑Fill ❑No Obstruction i` Type of Obshuctions(Describe) 11[//�L� �� ' �4-� GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? Yes ❑No Describe FORMATION PUMP If not known,indicate estimated formation log from nearby well or boring. Type F"` �Removed ��Not Present n 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/Femoval in.from to _ ft. ❑Perforated ❑Removed in.from to ft. ❑Perforated �.�]Removed Type of Perforator �f Other____ _ GROUTING MATERIAL(S) (One bag of cement=94 Ibs.,one bag of bentonite=50 Ibs.) ,/� �,,,/�� I � Grouting Material��°./'7� /�/!/^NArom� to� ft._ 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. Don Stadole �te2l Drilling Co., Inc. 1691 Licensee Busi y s ame .. License or Registration No. ,..J; , ,.i � -f" .' ,, fr-13"'{)8 rti ied Representative Signature Certified Rep.No. Date �ac�,_�Q�Y H 27o2s7 J� �� - - - Name ol Person Sealing Well or Boring HE-01434-10 IC#740-0423 - 5/o�a i : WELL OR�OaING LOCATION MINNESOTA DEPARTMENT OF HEALTH ^^ Minnesota Well and Boring '„I ��O��C Cor'nty Name " WELL AND BORING SEALING RECORD Mennleso a�Unique Well No. �, J Minnesota Statutes, Chapter f03� or W-series No. u�f1�'f�[��T (Loave blank If nol known) A saa4 r H Township Name Township No. Range No. Section No. Fraction(sm.—�Ig.) Date Sealed Date Well or Boring Constructed qt�og�oa�ta 118 23 3S 1�4-0003 � �- �� , GPS Latitude degrees mi�dl�� ''��sgcb�� Depth Before Sealing �� ft. Original Depth k. LOCATION: Longitude degrees minutes seconds UIFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and G1t�of Well or Boring Location _ Single Aquifer ❑Multiaquifer ��iyfL /�/1// 60 �ia�t LOA_ yia a0$u �L/BORING Measured �]Estimated Date Measured.a �� 7 � '� �� -- � � �J ater-Supply Well (]Monit Well . Show exact location of well or boring � � -s; Sketch map of we or boring �/ in section grid with"X:' - � location,showing property �Env.Bore Hole []Other � ft. �[y below �]above land surface N ��^�'� lines,roads,and buildings. CASINGTYPE(S) +� � � � � �, --'-----'--- --`----'-- ' At� I�Steel []Plastic ❑Tile ❑Other __ � --'--- --'--- --`-----'-- �ir �j • ELLHEAD COMPLETION W ; ; ; ; ET � "" __�___ __;__ __�__ __r__ �.'S f, Outside: �Well House ❑At Grade Inside: ❑Basement Offset 'h Mii �1� �Pitless AdaptedUnit ❑Buried ❑Well Pit --�--- --�----�-- --�-- ❑Well Pit n Buried S � ❑Other �i M�ie� �;Other PAOPERTY OWNER'S NAME/COMPANY NAME CASING(S) Diam �� ,'}I Depth e Set in oversize hole? Annular space initially grouted? ProperTy owner's mailing address if different than well bcation address indicated above �in.from C� to�ft. ❑Yes �No ❑Yes ❑No ❑Unknown � �� in.from to ft. ❑Yes ❑No []Yes ❑No ❑Unknown � in.from to tt. ❑Yes (-]No ❑Yes ❑No ❑Unknown WELL OWNER'S NAME/COMPANY NAME SCREEWOPEN HOLE Q� � � er' er w ess b e Screen from CJ Z to � ft. Open Hole from to ft. V�� Beaver Df1$� ►�i�.• ,O�,BS,[TRUCTIONS �y�riods/Drop Pipe ❑Check Valve(s) ❑Debris [�Fill �_l No Obstruction /� n �i�Y`ti��i��• � 55391 Type of Obstructions(Describe) �N��-✓�- �r _ ¢ �u•' KY GEOLOGICAL MATERIAL COLOR HApoNEss oR FROM TO Obstructions removed? I�Yes ❑No Describe FORMATION PUMP If not known,indicate estimated formation log from nearby well or boring. !� f ' Q �� Type SV,` �L)n"l�� ti� �emoved ❑Not Present [�Other METHOD USED TO 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. ❑Perforated ��Removed in.from to ft. ❑PeAorated []Removed Type of Perforator ..__ ['Other_ GROUTING MATERIAL(S) (One bag of cement=94 Ibs.,one bag of bentonite=50 Ibs.) ,t ,? /} ,�y�� r Grouting Materiall�L/�� `'��/'_U�from_�_ to�� ft. yards� bags from to ft. yards bags from to ft. yards bags OTHER WELLS AND BORINGS REMARKS,SOURCE OF DATA,DIFPICULTIES 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. � Don S�odola well Dsillin� Co. ,. Inc. 1691 Licensee Business Name �-- License or Registration No. J%. ,,9,�' � ? , /�' /.i -�� Ce�ed Representative Signature Certilied Rep.No. Date I�GCkL CQ�Y H � ! O Z V� �\' ;`"";, ti ��, . .Ii�a�r_w- % Name ol Person Sealing Well or Boring HE-01434-10 IC#140-0423 �'� 5/07R