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Home My WebLink Aboutwell info�.w, ; . MINNESOTA UNIQUE WELL WIl�L/BORIT7l.',LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. CountyName WELL AND BORING RECORD Bermepin Minnesota Statutes,Chapter 103I 7 4 3 41� Township Name Township No. Range No. Section No. Fraction WELL/BORING DEPTH(completed) DATE WORK COMPLETED Occx�o i17 23 07 ,,. ,,. ,,a 1Q� n 9-22-�06 GPS DRILLING METHOD Latitude degrees minutes seconds I Cable Tool i nven !Dug LOCATION: ; Longitude degrees___ minutes_ seconds [Auger ,�otary .!Jetted House Number,Street Name,City,and Zip Code of Well Location or Fire Number L 1tJl1S ■•■�� 1J�lIC� Or+o�o 55361i DRILLINGFLUID WELLHYDROFRACTURED? Yes No � Show exact location of well/boring in section grid with"X." Sketch map of well location. NaL�r From $.To ft. Showing property lines, - N •� �s,buildings, USE _ omestic I !Monitoring '�_;Heating/Cooling ��„�.,, �pd..dif�',tion. ��Noncommunity PWS I !Environ.Bore Hole '_'Industry/Commercial � --'--- --'--- --`-- ---'-- ' C'Community PWS I..'��Irrigation �_'�Remedial '�:Elevator I '�.Dewatering ` ; ? �� -��"' ASIN ERIAL Drive Shoe? �...I Yes _ o HOLE DIAM. �� C G MAT W E T � � ��Steel I J Threaded I I Welded � � �Plastic I Vz Mile � : --:--- --�-------- ---=-- 1 CASING � , S , , Diameter Weight Specifications �—1 Mile—� �_in.to.__l0i ft. �_�Ibs./ft. $$��! �_in.to,gL ft. _ _ in.to______ ft. Ibs./ft. ____ _ �in.to�_R. PROPERTY OWNER'S NAME/COMPANY NAME in.to ft. Ibs./ft. in.to ft. Sto�ne+�aoci Design &iild �,C SCREEN OPEN HOLE Property owner's mailing address if different than well location address indicated above. Make �� From ft.To ft. �' 7�FtJ7 ��t8 B�� Type _. .. �t�� $t� Diam._2� �' T,.. L�T r` __— i' S� LMji$ P$�� j�y,� �J'{2� Slot/Gauze __ . ___ _��,{� Length_ 1� ,} � �Y-_.___._ Set between ft.and ft. FITTINGS „ R STATIC WATER LEVEL �� _____�}�___ ft.�Below '=��Above land surface Date measured__�(,(,�_.______ PUMPING LEVEL(below land surface) WELUBORING OWNER'S NAME/COMPANY NAME A 9� ft.after_ G hrs.pumping 35 g.p.m. WELL HEAD COMPLETION �� yl�, }''� ��.�,.�,�, ' Well/boring owner's mailing address if different than property owner's address indicated above. itless Adapter Manufacturer�,�-'"'•�`-''-"�'"''"- Model . I Casing Protection �12 in.above grade -��At-grade(Environmental Well and Boring ONLY) GROUTING INFORMATION Well grouted? �Yes I I No ,/ Grout materials '. Neat cemennt WBentonite I I Concrete 'Other From_y_._ To_�.ft. __� ��Yds. -Bags From�To��_ ft.�� Bags _ GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO From To ft. s. MATERIAL - NEAREST KNOWN SOURCE OF CONTAMINATION r i �'�7 yellaw },f�� Q I C/� (eet � direction �'1" �pe Well disinfected upon completion? '..Yes �--1 No <"�,,,� � i� �� A PUMP U t� (_ //,� I 1 Not installed Date installed /� " `y 1`�+' `►�p �� f� �$ Manufacturer's name 1 f� ,� Model Number HP�. Votts � g�y �f t � 1� Length o(drop pipe �"� ft. Capacity .g.p.m. Type: . ubmersible f]LS.Turbine -Reciprocating '..'�.Jet .�� ABANDONED WELLS Does property have any not in use and not sealed well(s)? �.Yes j�No VARIANCE Was a variance granted from the MDH for this well? �. '�.Yes ' .No TN/t 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. �i�, *�� j �r REMARKS,ELEVATION,SOURCE OF DATA,etc. � SCW(J�$ 1�C�� 1�� ZLIC• lU7I � _._----- -.. .._. - __ _ • Licensee Business Na e � Lic.or Reg.No. f�- ;�C"�j O� A z epresentative Si ature Date �� LOCAL COPY 7 4 3 410 Name of Driller i HE-01205-09(Rev 9/05) IC 140-0020 r � a � rw� c�-y w�� c � � , r�� 617 13th Ave So � Hopkins, Minnesota 55343 � (612) 935 - 3556 09/26/2006 Stodola Well Drilling 3841 North Main St. Boni facius MN 55375 938-21 1 1 REPORT OF WATER ANALYSI5 Lab#: 6406N Our Laboratory reports these analyrical results, determined on a sample taken by CLIENT on 09/25/2006 from the following locarion: 1005 Linden Lane Orono,Mn Well #743410 Coliform Bacteria <1/100 ml Niirates Nitrogen <1.0 mg/1 The results of these tests indicate t�►at this well is producing warer that meets the standards for F.H.A., V.A., or conventional loans. This report is an analysis for colifnrm and nitrate only and does not include analysis of Lead and orher contaminants. (Unless as speci�ed by clienr). Twi City Water Clinic, Inc. � r s `,� \ Bill dn�sdale � Lab Cert�cation#027-053-119 WELL OR F�ORWG LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring '„I ` WELL AND BORING SEALING RECORD Menn'esoNa Unique Well No. � �� ' County Name r � ` Minnesota Statutes,Cha ter 1031 or W-series No. P (Leavo blank il no[known) �` Township Na e Township No. Range No. Section No. Fraction(sm.�Ig.) Date Sealed Date Well or Boring Constructed '' '' '' 22 5�(' O(o /'}/� , GPS Latitude degrees minutes seconds Depth Before Sealing �`-�'�u ft. Original Depth_ ft. LOCATION: Longitude degrees minutes seconds AQ IFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and Ciry of Well or Boring Location �ingle Aquifer ��]Multiaquifer �/ �.,,c. �Q WELUBORING Yy Measured �Estimated Date Measured�l/�_. /�� Water-Supply Well ❑Monit.Well Show exact location of well or boring S h map of well boring :—�Env.Bore Hole Other ft. �y{below above land surface in section grid wiih"X" �o ' erty ❑ � A� C� N ` in� oads,and buil ingsj CASINGTVPE(S) 'S �1 --'--—'--- I I ;. ; ; ; ; � `�y3 eel ❑Plashc ❑Tde ❑Other ---`— '. St :. ` --'-----�--- ---�-- ---'-- � WELLHEAD COMPLETION � W : ; : ; ET __ _ � Outside: �_I Well House i.�At Grade Inside: ❑Basement Offset ; � ; : '{�Mile itless A p rNnd �_�Buried ❑Well Pit , , , � �P� da te � „ . --.--- --r-- --�- - � l , : ' ' ' ' []Well Pit ❑Buried S �—i Miie—� �� [�Other ❑Other P�PERTYO�fWNE-'SdQME/GpMPANXNADAF.� �T^ CASWG(S) 1�1��1oyt SSU11 i�u�.. G" Diam ef� � Depth � Set in oversize hole? Annular space initially grouted? Property owner's maiiing address if different than well location address indicated above �_in,from D to/�� ft. �]Yes �No ❑Yes [�No ❑Unknown 7�►(37 W8qZaC8 $1VL1 St !J[)LLl$ �lir�� I�i+ffi5426 in.from to ft. �]Yes [�No ❑Yes ❑No ❑Unknown in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown WELL OWNER'S NAME/COMPANY NAME SCREEWOPEN HOLE � /� ��/� 1 Well owner's mailing address if diflerent ihan property owrer's address indicated above Screen(rom �v� to�J(�!_ft. Open Hole ffom to 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? ❑Yes ❑No Describe FORMATION PUMP If not known,indicate estimated formation log trom nearby well or boring. tf� �.�CV TYPe '� ❑Removed I�Not Present ❑Other r� METHOD USEDTO 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 ro_.__.___._ft. ❑Perforated ❑Removed in.from to .___ft. ❑Perforated ❑Removed Type of Perforator_ [l Other _ GROUTING MATERIAL(S) (One bag of cement=94 Ibs.,one bag of bentonite=50 Ibs.) ' + � Grouting Materia �A' V—�� from �� yards bags � � to R_---- 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,Chapfer 4725.The information contained in this report is true to the best of my knowledge. ' Don Stodola Well Dcillin� Co., Inc. I691 Contracfor Business Name License or Registration No. ; //. �� c� i ie e resentative Signature Certilied Rep.No. Date LOCALCOPY H �``' �-Y��— ��y`�-�Y� 2 5 4 9 6 2 Name of Person Sealing Well or Boring � HE-01434-09 IC#140-0423 � s/asa