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Home My WebLink AboutWell info _.� �� WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUEWELL NO. County Name WELL AND BORING RECORD Minnesota Statutes, Chapfer 1037 �� Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed ft. ��J �� '� � �—ll�'} GPS DRILLING METHOD LOCATION: Latitude degrees minutes seconds I-I Cable Tool i.��,Driven �:_i Du Longitude degrees minutes ____ seconds 9 L I Auger .�yFtotary �'Jetted House Number,Street Name,City,and Zip Code of Well Location or Fire Number � j�• DRILLING FLUID WELL HYDROFRACTURED? ❑Yes o Show exact location of well in sec[ion grid with" ". Sketch map of we!I location. ��e� FROM ft TO ft. Showing property lines, N roads and buildings USE �-, ___s [Monitorin g [�Heating/Cooling � � � � _ k Domestic ��Industry/Commercial ______ ________ __ _ �]Environ.Bore Hole � � Noncommunity PWS �Irrigation �]Remedial I I I I - ' unity PWS ❑Dewatering `� Comm [� --'-- --�-----�-- ---`-- W i i i i E� ASING Drive Shoe? �Yes �]No OLE DIAM. ,�_.._..� �. C H --�--- --;-- --�-- --%- e_r,A {,t.�E el hreaded�••.❑Welded , ; ; , '/nniie j. �' lastic _ �S �T P ❑ , � � , �T ------ ------ --.-- --.- 1 � � � � CASING DIAMETER WEIGHT � � S � � � �1 Mile—� .,i.. �in.to�_ft. __ il _Ibs./ft. �in.to_,�ft. �•� in.to_ fL . __Ibs./ft �.in.to�Qft. PROPERTY OWNER'S NAME/COMPANY NAME in.to tt. Ibs./ft. n.to�ft. SCREEN OPEN HOLE Property owner's mailing address if different than well location address indicated above. Make FROM�Q ft. TO_ 6.�L ft. � 8$ $y,� Type Diam. [AIYC Slot/Gauze Length Set between ft.and ft. FITTINGS STATIC WATER LEVEL e� � �� fC below ❑above land surface Date measured ` '� PUMPING LEVEL(belbw land surface) WELL OWNER'S NAME/COMPANY NAME x 4� ��O ft.after v hrs.pumping w g.p.m. WELL HEAD COMPLETION 1 Well owner's mailing address if different than property owners address indicated above. itless adapter manufacturer l..t�7�� t.k..7 d��d� Model �asing Protection �2 in.above grade J At-grade(Environmental Wells and Boring ONLY) GROUTING INFORMATION '� , Well grouted �Yes '._,�No Grout material ' [J Neat cement ❑Bentonite [I Concrete�High Solids Bentonite from_�to_�_ft. �.__ '_yds. �ags from�' _to�" �_ft�.��is. I]bags GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO from to ft. � MATERIAL �J yds. ❑bags NEAREST KNOWN SOURCE OF CONTAMINATION i-f r..� `�_.�': feet � direction -�:-:��- �.�-+� type Well disinfected upon completion Yes ❑No PUMP �.' �" � ❑Not installed Date installed - +.j ' (1 Manufacturer's name � '-r Model number HP�Volts '� �w�� Length of drop pipe f�Jw,i ft. Capacity g.p.m. Type: Submersible ❑L.S.Turbine � I Reciprocating ❑Jet '�] ABA DONED 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 well7 ❑Yes o 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 � �taiola �e12 Iarilling Co,. Il�(.`• �717G REMARKS,ELEVATION,SOURCE OF DATA,etc. Licensee Business Name ' Lic.or Reg.No. .- `/ � �`� o e ta -A.�� re � Date Ctnick Moare 3-4-04 7 � � �� Name of Driller LOCAL COPY He-o,zos-oa�ae�.aioz� ic iao-oozo .. � rw�. c�-y w�-� c � � � , � r�,� 617 13th Ave So • Hopkins, Minnesota 55343 • (6'l2) 935 - 3556 03/OS/2004 Stodola Well Drilling 3841 North Main St. Bonifacius MN 55375 938-21 1 1 REPORT OF WATER ANALYSIS Lab#: 137 Our Laborarory reports these analytical results, determined on a sample raken by CLIENT on 03/04/2004 from the following location: Richard James 1075 Knoll Rd Orono,Mn Unique Well#705920 Coliform Bacreria <1/100 ml Nitrates Nirrogen <1.0 mg/1 The results of these tests indicate that this well is producing water rhar meets the standards for F.H.A., V.A., or conveniional loans. This report is an analysis for coliform and nirrate only and does not include analysis of Lead and other contaminants. (Unless as specified by clienr). , ' City� Water Ginic, lnc. �,�;1� Bill. ` dale Lab Cert�cation#027-053-1]9 v i WELL OR BORfNG LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring I,,,' County Name WELL AND BORING SEALING RECORD Menn'egoNa Unique Well No. �p�� Minnesota Statutes,Chapter 1031 or W-series No. �Le�ve blank il nol knowii) Township Name Township No. Range Na Section No. Fraction(sm�Ig) Date Sealed Date Well or Boring Constructed Oronc3 11� 23 26 1-0011 ' Z� tl L�, Q `. � , �� GPS Latitude degrees minutes seconds LOCATION: Depth Before Sealing /✓� ft. Original Depth �„J ft. Longitude degrees minutes seconds pp��FER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Weil or Boring Location �Q�6ingfe Aquifer ❑Multiaquifer 1075 Knoll i�r�ar Rd, f3rc�no 55� �UBORING �uleasured ❑Estimated Water Supply Welt ❑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. [�ielow ❑above land surface N lines,roads,and buildings. CASING TYPE(S) �� teel ❑Plastic ❑Tile ❑Other W -�- -�-- -�-- --�- E 9 �� ,-,�� WELLHEADCOMPLETION � � � � ,,�� putside: Well House Inside: � -y� ❑ ❑Basement Ottset -;-- � -;-- --i-- �;� V �^�� '! � �"�� [�Pitless AdapterlUnit ❑Well Pit � � -i-- --�-- � � �� T ❑Well Pit ❑Buried S �-r^"�°—�' i e�' ❑ Buried '` PROPERTY OWNER'S NAME/COMPANY NAME CASING(S) Diam �, Dep�h ,� � Set in oversize hole? Annular space initially grouted? Property owner's mailing address if difterent than well location address indicated above /� / in.f�Ofn `-" t0 + ft. ❑Yes �No ❑Yes ❑ No ❑Unknown 88t� A8 8� in.frOm t0 ft. ❑Yes ❑ No ❑Yes ❑No ❑Unknown in.f�om t0 ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown WELL OWNER'S NAME/COMPANY NAME SCREEN/OPEN HOLE � � Well owner's mailing address if different than property owner's address indicated above Screen from �� f0-�-.--a.,c-1—ft. Open Hole from SO ft. OBSTRUCTIONS ❑ Rods/Drop Pipe ❑ Check Valve(s) ❑ Debris ❑ Fill [�Vo Obstruction Type of Obstructions(Describe) GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? ❑Y2S ❑ NO Describe FORMATION It not known,indicate estimated formation log from nearby well or boring PUMP t�I�._� r,� '.J TYPe /�'�� ❑ Removed �Not 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 in.from to ft. ❑ Pertorated ❑ Removed Type of perforator ❑ Other GROUTING MATERIAL(S) (One bag of cement=94 Ibs.,one bag of bentonite=50 Ibs.) ` J /f r,�/ yy l �1 { 2 � /�9 Grouling Material ,v�r-t� L.'-�i��,�rom `� to LaL�ft. yards �L.c 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 welt or boring on property? ❑ Yes o 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 Stodola t�ll Drilling Co., Inc, 27172 Confractor Busi ss ame License or Registration No. � :�,'� �� or d p e ative Si atur Date 1Q 1 -_J�,....rl' ../`."a�..,,.�.<JlS�`V-�...... LOCAL COPY H Z 1 V 1 Z� �� '� Name of Person Sealing Wel!oi Boring