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Home My WebLink Aboutwell info WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. CountyName WELL QND BORING RECORD � Minnesofa Sfatutes, Chapter f037 � � � ��-¢ � s� Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed Q6 �� 105 " 3-16-Q6 GPS DRILLING METHOD LOCATION: Latitude degrees minutes seconds . Longitude degrees minutes seconds i-'i Cable Tool �J Driven �_j Dug — _�Auger ,r�Rotary �]Jetted House Number,Street Name,City,and Zip Code of Well Location or Fire Number �-� DRILLING FLUID WELL HYDROFRACTURED? ,_i Yes �No Show exact location of well in section grid with"X". Sketch map of well bcation. �te�► FROM tt.TO tt. Showing property lines, N 9 {. � roa s an w in s E �En ironl Bore Hole � Heating/Cooling � _._____---�"�� h �.�t s r� D ' ' ' � � [�Domeshc Ty ❑ g �I Industry/Commercial --'-----'------`---`-- j j j j � rl Noncommuni PWS Irri ation i Remedial 1 I ; ; � `t ,,,��""'^- �Community PWS ❑Dewatering �J --'--- --i--- ---;-- ---`- � � � : Y#' CASING w ; ; ; ; e T � Drive Shoe? �, �Yes � o HOLE DIAM. � --;--- --;----�-- ---;-- I �_J Steel �_`J Threaded �'� ��Welded 'h Mile 18StiC _ � �� __.__- - --;-----'------f-----�-- 1 CASING DIAMETER WEIGHT S �in.to_��_�ft. 2 s W IbsJft. S7 in.to -�Jt. �—,M,�e� ---- 6 5 10�,. in.to ft. Ibs.fft • in.to 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 tiA�� FROM ft. TO � ft. c/c�Grant Wenketern Type �s..��.4....s$t�_ Diam.� 71� �rt� ��' �r � � SlobGauze__��y�__ Length /t_� L� 47t IV if 1 V —�"F-- s�T 'l Set between _tt.and it FITTINGS �� ,�'�v ��T STATIC WATER L � �� 3!.� elow ;-��above land surface Date measured .7-1lJ�lJV PUMPING LE'C�L(below land surtace) WELL OWNER'S NAME/COMPANY NAME . -- �,,,. �'-� ' �~ - ' �� ft.after �,�� hrs.pumping 13 g.p.m. WELL HEAD COMPLETION � Well owner's mailing address if different than property owners address indicated above. -Y itlessadaptermanufacturer 'u1.��.' _ -��=_�-r--�Model � -� � _'Casing Protection I�2 in.above grade � -- ;At-grade(Environmental Wells and Boring ONLY) GROUTING INFORMATION Well grouted-� I�Yes []No Grout material ❑Neat cement ❑Bentonite i=�Concrete I-SVI-ligh Solids Bentonite from_�to�g�ft _� [_;yds. r�bags from__�to_�Z�,�t. �$��J��,bags HARDNES OF FROM TO � hom__ to ft. � �� ds. ' ��ba s GEOLOGICAL MATERIALS COLOR tijATER AL —Y 9 NEAREST KNOWN SOURCE OF CONTAMINATION �..r.. / � � _ �;,;,, feet I.AJ direction i�-a�._�. type Well disinfected upon completion �,Yes !=,�No � PUMP ;Not installed Date installed "� �'��J v� Manufacturer's name � '.J�-�_-`.• •'�•.1�`�+-��'�--- Model number HP�Volts -� �.�r� Length of drop pipe �4 tt. Capacity g.p.m. Type:[ ubmersible ❑LS.Turbine ❑Reciprocating [_i Jet r� ABANDONED 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 if 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,il needed REMARKS,ELEVATION,SOURCE OF DATA,etc. ��r(�ALA We11 �?rj I7 in� ��' �(�`• L71TG Licensee Business Name Lic.or Reg.No. i � I� :.�/ ��o A z s tati e Signature, Date C�AtCIC Mi00C@ LOCAL COPY � �y �� NameolDriller �3 HE-01205-OB(Rev.5/02) ic�ao-oozo i � T"w%vv C�,t 1Na�"�' C ' ' , I v�� y 617 13th Ave So � Hopkins, Minnesota 55343 � (612) 935 - 3556 03/20/2006 Stodola Well DriHing 3841 North Main Sr. Bonifacius MN 55375 938-21 1 1 REPORT OF WATER ANALYSIS Lab#: 145BN Our Laborarory reports Chese analyiica! resufts, deiermined on a sample taken by CLIENT on 03/16/2006 from the following location: Lakeview Golf 405 North Arm Dr. Orono,Mn Well#735745 Coli form Bacreria <1/T 00 m! Nitrares Nitrogen <1.0 mg/1 The resu/rs of these tests indicate that rhis weN is producing water that meers the siandards for F.H.A., V.A., or conventional loans. This report is an analysis for coliform and nitrate only and does not include analysis of Lead and other contaminants. {Unless as specified by client). ' �'ity Water Clinic, lnc. ,` �`•, �. Bil�� lrsdale � La6 Ccrtification Il 027-053-I 19 WELL OR BORING LOCanON MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring Sealing No. H County Name WELL AND BORING SEALING RECORD Minnesota Unique Well No. �� Minnesota Statutes,Chapter f031 or W-series No. c�w�aerv�n�w a�ow�,� Township Name Township No. Range No. Section No. Fraction(sm->Ig) Date Sealed Date Well or Boring Constructed v. v. v. � GPS Latitude degrees minutes seconds �/ � LOCATION: Depth Before Sealing l a`x ft. Original Depth fl. Longitude degrees minutes seconds ppUIFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location ingle Aquifer ❑Multiaquifer WELL/BORING Measured ❑Estimated �Water Supply Well ❑Monft.Well � Show exact location of well or boring Sketch map of well or boring in seclion grid wfth"X" Ixation,showing property ❑Env.Bore Hole ❑Other �tt. �below ❑above land surface lines,roads,and buildings. N ;',! CASING TYPE(S) 1 � '��_.,=�:�. -T- -T- -;-- ;-- �... ,��;�\, , �Steel � ❑Plastic ❑Tile ❑Other W —�- -�-- -�-- --;-- E `"'�.1�`/ ��^ WELLHEADCOMPLETION � � � � � � � � �"�.. Outside: ❑Well House Inside: ❑Basement Offset -;r- ---- -;-- --i-- � � 1�^� '�Pitless Adapter/Unit ❑Well Pit --�- -�-- -i-- --�-- I �' 1 ❑well Pit ❑Buried S �—�"M1°—�' ❑Buried PROPERTY OWNER'S NAME/COMPANY NAME �s CASING(S) Lakevi.�w Goi f cou�cse �rQ 4T�'$(�� r � � Depth � Set in oversize hole? Annular space initially grouted? Property owner's mailing address if different than well location address indicated above � � in.ffORl�to�G)�ft. ❑Yes IOINo ❑Yes ❑No ❑Unknown 71� �3Ct�i �lOt£�! F3t W �, /\..�' p� Gt�7G! in.ffOm to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown LL .7 �71GW in.ffOm to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown WELL OWNER'S NAME/COMPANY NAME SCREEWOPEN HOLE � �/�}� � ��, �/ Wel�owner's mailing address if different than property owner's address indicated above Screen from�.cL t0�ft. Open Hole from t0 ft. OBSTRUCTIONS ❑ Rods/Drop Pipe ❑Check Valve(s) ❑ Debris ❑ Fill �/No Obstruction Type of Obstructions(Describe) GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? ❑Y2S ❑ NO D@SCfib@ FORMATION If rrot known,indicate estimated formation log from nearby well or boring PUMP Type ✓ ❑ Removed f�Vot Present ❑Other J METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: L�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=94 Ibs.,one bag of bentonite=50 Ibs.) / , Grouting Material�� fi�i from�to�ft. yards � bags from to fl. 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 properry? ❑ Yes o How many? LICENSED OR REGISTERED CONTHACTOR 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 ot my knowledge. non sc«toz.a wQll T�rillfn��.�. rr,c 27�72 Contractor Business Name License or Registration No. , , ___. - -� _�' �y :�� h 'e se ive Sign Date :. __ �,^'',. H 2��J�S� % �� .s�.. LOCALCOPY ' Name o/Person Sealing Well or Bonng _