The URL can be used to link to this page

Home My WebLink Aboutwell info � � �,a: .. ., v�. �_=_ .. _. MINNESOTA DEPARTMENT OF HFALTH Minnesota Well and Bonng � � .. WELL OR BORING LOCATION 9 I H �4��' WELL AND BORING SEALING RECORD Sealin No ,� � � Counry Name Minneso:a Unique No � - � i{2T1D2�31 Tl Minnesota Sta�utes.Chapter 1031 or W-senes No. ILeave Dlank it nol known) Township Name Township No. Range No. Section No. Fractwn�sm.-s Ig J Date Sealed Date Well or Bonng Constructetl � Orona 2�85 23 35 � ~ '' _� Jtsrv� �'ic? �.Numerical Street Address a Fire Number and City of Well or Bonnq Location / t�O r3 Lon� Lake BL VC�. Orono, �jj� Depih Bebre Sealing�_N. Original Depth � n� f Show exact location of N�ell or bonng 5�3 5 5 Sketch map ot well or bonng AO IFER(S) STATIC WATER LEVEL in section gnd wrth"X' . bcation, showing property Single Ayurfer ❑ Multiaquder � lines,roads.and buildings. N �'�_j', y WELUBORING �Measured ❑ Esnmated � � � � r .. . Water Supply Well ❑MoNt.Well I/ � -�- -�-- --;-- --� : . L./ I I � `�� : ❑ Env.Bore Hole ❑Other _ � r R. �below ❑ above land surtace ' � � f W --�- -i-- -;-- --i-- E CASING TVPE(S) `, � � � � � � � T , —�- -;-- -i-- —�-- � �� k Steel ❑ Plastic ❑Tile ❑ Other � � � ' � u mr�e � j --`- -- ' CASING -� --I-- --i-- I � � � � � Diam ter J Depih � Set in oversize hole7 Annualar space initially grouted7 LL�� S J� 1-�4! � � �� ves �No ❑ ves ❑No ❑ unknown �t mr�e—�e 3 in.irom to �ft. ❑ I �� PROPERTY OWNER'S NAME in.from to R. ❑ Ves ❑No ❑ Yes ❑No ❑ Unknown �{urt Greenl.� Proparty owner's mailing a0dress B tliffereN than well location adaress indicated above. in.from to tt. ❑ �es ❑No ❑ Yes ❑No ❑ Unknown SCREEWOPEN MOLE� r Screen from �� to� R. Open Hole from to R. OBSTRUCTIONS � WELL OWNER'S NAME ❑ Rods/Drop Pipe ❑Check Valve(s) ❑ Debris ❑Fill �No Obstruction Well owoer's mailing aAdress if diflerent than property owner s atldress mdicated above. Type of ObsttuCtionS(Describ6) Obstructions removed? ❑Yes ❑ No Describe PUMP Type OEOLOOICAL MATERIAL COLOR „ARDNESS OF FROM TO � Removed �Not Present ❑ Other FORMATION If rat known,inOitate estimeted formation log from nearby well or boring. M1�ETF�IOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BOHE HOLE: R�J No Annular Space Exists / ��3 �� ❑ Annular space grouted with tremie pipe . � ❑ Casing Perforation/Removal I in.from to R. ❑ Pertoreted ❑ Removed in.irom �o ft. ❑ PeAorated ❑ Removed Type of perforator ❑ Other GROUTING MATERIAL(S) / 1'- /j�� /� Grouting Material L�-�� 'f'�"'`��r'(rom �^" ro�t� ft. yards � bags from to ft. yards bags from to ft. yards begs irom ta_— ft. yards bags REMApKS,SOURCE OF DATA,dFFICULTIES IN SEALING OTHER WELLS AND BORINGS Other unsealed and unused well or boring on property? ❑Yes No How meny? LICENSED OR REGISTERED CONTRACTOR CERTIFICATION This well or boring was sealed in accordence wfth Minnesota Rules,Chapter 4725. The information contained in Mis repoh is true to itie best of my knowledge. �UN STODOLA WELL DRILLIN� C(J. , INC. 27172 Contractor Business N me License or Registrafion fa. ;�"�� ,-_ �.- ''i '�" / _ o epresentetive Signature Dete �\.rl ��_. .. ., �. �" .a.f LOCAL COPY H 9 8 9 Name ol Person Sealing Well a Boring � �i HE-01434-04 8/98 R f f WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. � County Name WELL AND BORING RECORD 6 2 4 9 0 6 - He nne�i n Minnesota Statutes Chapter 1031 Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed fl. Orono 118 23 35 ,,. ,. �,. � 136• 4-6-99 House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD 14$5 LQYl� Lake BiVd. rORO ��SJ3.J ❑ AuberTool ❑ Driven ❑ Dug g �1 Rotary ❑ Jetted Show exact location of well in section grid with"X". Sketch map of well location. ❑ Showing property lines, roads and buildings. DRILLING FLUID WELL HYDROFRACTURED? ❑YES O " Bentonite i � i i FROM ft.to ft. _i_ _i_ _i_ _i_ USE ❑ Monitoring ❑ Heating/Cooling i i i i �1 Domestic _i_ _�_ _x_ _i_ ❑ Irrigation ❑ Community PWS ❑ Industry/Commercial i i i i ❑ Noncommunity PWS ❑ Remedial w E T ❑ Environ.Bore Hole i i i � ❑ Dewatering ❑ i i i i I � �� , CASING Drive Shoe? ❑ Yes ❑ No HOLE DIAM. VzMae _i � i i_ � � � `� .,�'�L . ❑ Steel ❑ Threaded ❑ Welded i -i- -i - -i O � �,,, � v � Plastic ❑ �-1Mile-� V ' CASING DIAMETER WEIGHT PROPERTY OWNER'S NAME � in.to Z 27 n SDR21 Ibs./ft. ?�� 3�}g Rurt Gr�e�ley ��.�o n. �bs.�n. ' ��.�01�. Property owner's mailing address if different than well location address indicated above. in.to ft. Ibs./ft. in.to ft. - SCREEN__y�,Tl$_jS�_ OPEN HOLE Make from ft.to ft. Type tainlese .�f'r�@Z Diam. SIoUGauze Length � Set between 1� ft.and 1 ft. FITTINGS: '� STATIC WATER LEVEL y WELLOWNER'SNAME 70� tt. P?below ❑ abovelandsurtace Datemeasured 4�5�9 PUMPI�G�EVEL(below land surtace)i �n Well owner's mailing address if different than property owneYs address indicated above. 1 ft. after hrs.pumping u g.p.m. WELL HEAD COMPLETION � Pitlessadaptermanufacturer Whitevater Model __ ❑ Casing Protection �I 72 in.above grade ❑ At-grade(Environmental Wells and Borings ONLY) GROUTING INFORMATION Well grouted? �Yes ❑ No GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO Grout Materia� ❑ Neat cgtnent RI Bentpnijg ❑ Concrete � High Solids Bentonite MATERIAL from � to 3 U R. ❑ yds.�1 bags Cla�—G1'dvel Y8I1QW S �� 3�j from to n. ❑ yds. ❑ bags from to ft. ❑ yds. ❑ bags NEAg� OyJN SOURCE OF CONTAMINATiQ,� f'7`a Gravel—Clay Grey !� 3� �� J� feet ��J�l direction � �type Well disinfected upon completion? �Yes ❑ No �""��''�"' S�IZC� Tt�.Tl M 9� 1�� PUMP 4-9-99 ❑ Not installed Date installed Manufacturer'sname R@y J8Ck2'�. Model number �15 g � HP � 4 vons 2 3 Length of drop pipe ft. Capacity �'� g.p.m. Type: f9 Submeisible ❑ L.S.Turbine ❑ Reciprocating ❑ Jet ❑ ABANDONED WELLS y Does property have any not in use and not sealed well(s)? ❑ Yes Q No - VARIANCE Was a variance granted from the MDH for this well? ❑ Yes �No TN# WELL CONTRACTOR CERTIFICATION Use a second sheet,i/needed This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. REMARKS,ELEVATION,SOURCE OF DATA,etc. The information contained in this report is true to the best of my knowledge. DON STODOLA WELL DRILLING CQ. , INC. en e Busines Nam or Reg.No. 5-�#-99 Authorized Repres� ive Signature Date Fred L�iby 5-4-99 6 2 4 9 0 6 Name of Dnller Date LOCAL COPY HE-01205-06(Rev.7/98) � � c7 n Jwin �itc� �ater ��irtic, J�rr.c. 617 13th Ave So • Hopkins, Minnesota 55343 • (612) 935 - 3556 T 04/08/1999 Stodola Well Drilling 3841 North Main St. Bonifacius MN 55375 938-2111 REPORT OF WATER ANALYSIS Lab#: 36812 Our Laboratory reports these analytical results, determined on a sample taken by CLIENT on 04/06/1999 from the following location: Kurt Greenley 1485 Long Lake Blvd. Orono,Mn Unique 1Mell�624906 Coliform Bacteria <1/100 ml Nitrates Nitrogen <1 . 0 mg/1 The results of these tests indicate that this w�ell is producing water that meets the standards 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). at�r Clinic, Inc. Bill \ ,4odyial l.bowtory coosultins F�em WaterAmlysis Reagenta Boilor Watot Chemiwle Lab Cert�cationll 027-033-119