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Home My WebLink Aboutwell info ,. . .. _ , _ .. . ..� . ��-� ;.�. � �. . ...,,. . ,. . , . ,�,< �� . , 4 -'� ,�m,�,,.r..,,� WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HFALTH � Minnesota Well and Boring ��'} � Counry Name WELL AND BORING SEALING RECORD°?�,�ea''"9"°. i H � lNmnesota Unique Well No. g��$+p�� Minnesota Statutes, Chapter 1031 or W-series No. �Leeve tleM tt nM known) �__ � Township Name Township No. Range No SeUion Na F�act�on�sm.-s Ig.) Date Sealed � � � �� " ' � �- �Date Well or Bonng Constructetl ��toao 118 x3 �6 33—Q�7. Numeancal Street Adtlress or Fire Number and Giry of Well or Bonng Location � � 1.i�4 .YRiiLQ �� A10�� V=0�0 Depth Betore Sealing � R Oriqinal Depth ft Show exact location of v.�ell or bonng ¢,a��r Sketch map of well or bonng O IFER(S) STATIC WATER LEVEL m section grid with"X". �� Q bcahon, showing property Single Aywfer ❑ Multiaqude� lines,roads,and buildings. N WELUBOr71NG Measured ❑ Estimated ----I� �Water Supply Well ❑Monit Well � � � � �i ❑ Env.Bore Hole ❑Other _ _��R �below ❑ above�and suriace =� � t ; ' ; ' W -- - - -- - -- -- -- E CASING TYPE(S) � � � � � � � � � � �� -�-- -�-- —;-- --;— � Steel ❑ Plastic �Tile � Other t jlmile -�-- -�— --�-- --�- � CASING(S) Diameter Depth f Set in oversize hole7 Annular space initially grouted7 S �? �� r� � �� Yes �/No Yes No Unknown �r miie� '� a.t 1 in.from to ft. ❑ � ❑ ❑ ❑ '`. . r i ,�. i,i`.�xCr�. PROPERTY OWNER'S NAME � in.from to ft. ❑ Yes ❑No ❑ Yes ❑No ❑ Unknown �ab�a cra�fora 473-�a�� Property owner's maihng address d diHereN than well location address indicated above in.Irom to ft. ❑ Ye5 ❑No ❑ �e5 ❑No ❑ Unknown SCREEWOPEN HOLE t j� ( Screen irom ifl� to_j_L� ft. Open Hole from to tt. oesraucnoNs ' _�r- WELL OWNER'S NAME �(Rods/Drop Pipe ❑ Check Valve(s) ❑ Debris ❑ Fill ❑No Obstruction Well owner's meiling address if dilferent than property owner's atltlress indicated above. Type of Obstructions(Describe) WVC-l� �� 7"' f^�Tf� ��^-./C,.� Obstruclions removed? Yes ❑ No Describe PUMP Type GEOLOOICAL MATERIAL COLOR HARDNESS OF FROM TO � Aemoved ot Present ❑ Other FORMATIOH If not known,irWicate estimated formation log�from nearby well or boring. 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. ❑ PeAorated ❑ Removed in.from �p h. ❑ Perforated ❑ Removed Type of pertorator ❑ Other GROUTING MATERIAL(S) (One bag of cement=94 Ibs.,one bag of bentonite=50 Ibs.) .. / i � Grouting Matenal from � to�� ft. yards � bags from to ft. yards bags from to ft. yards bags from to_ ft. ya�ds bags REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING OTHER WELLS AND BORIITfiS -0ther unsealed and unused well 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 infortnation contained in this repoA is true to the best o4my knowledge. i�a Stodola t1ei1 Dri12i� Co., Inc. 2719x Contractor Business Name � License w Registration I'ro. � f �� . .,.,/' �.� r o R presentafive Sign Dafe ��, .. „._.... ``�.a.�-„-„-.. �,,��. ,4�q��,� �1��,� w �/R�A� Name ol Person eling Well a Bonng H 1 v x ,% _ _ . �� ' WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. .' County Name WELL AND BORING RECORD ,. Aec�pin Minnesota Statutes,Chapter f031 � � �g� � �� Township Name Township No. Range No. Section No. Fraction �. WELL DEPTH(completed) � Date Work Completed ? fl. { �� '� l ��J � GPS Latitude degrees minutes seconds _ DRILLING METHOD � LOCATION: � Longitude degrees minutes seconds �Cable Tool [Driven !��Dug ❑Auger �Rotary � �Jetted ' House Number,Street Name,City,and Zip Code of Well Location or Fire Number � �— DRILLWG FLUID WELL HYDROFRACTURED? �Yes � o � Show exact location of well in section grid with"X". Sketch map of well location. � �t� FROM ft.TO ft. Showing property lines, � N �� roads and buildin� USE Domestic � �Environ.Bore Hole I��Heating/Cooling ' ' � � � � Y l] 9 �Industry/Commercial � Monitorin ' '--- --'-- `-- —`- � -�� I Noncommunit PWS �,Irri ation Remedial _ I I I I _ munity PWS ;Dewatering ❑ ,�y Com [ --'----,------`—--`-- / < CASING HOLE DIAM. � � -�- - ---1— ,h M�ie -)�' � �.:�� y�c..,:.•�Plastlic �i Threaded � L s �No . w E ` Drive Shoe� Ye __ �- � ,Welded � I �J ,., . . . . 1 :. : � ' S � � �.` CASING DIAMETER WEIGHT i .� ' � \, �__.in.to 1Q5 fl. 2�� IbsJft. �in.[o__�ft. i 1 Mile—� _ in.to _.__, ft. , __ Ibs./ft. �in.to1.1.�ft. :RROPERTY OWNER'S NAME/COMPANY NAME in.to ft. Ibs./ft. in.to ft. SCREEN OPEN HOLE '.Property owner's maihng address if different than well location address indicated above. Make --��}$��-- FROM ft. TO ft. � Type_��_ Diam._ �yw _ _ SbUGauze��,_ __ ,Length�� _�� Set between ft.and tt. FITTINGS'i}` i� STATIC WATE EL • ft.�below [�above land surface Date measured PUMPING LEVEL(below land surface) WELL OWNER'S NAME/COMPANY NAME ft.after hrs.pumping g,p.m, p WELL HEAD COMPLETION � Well owner's mailing address if ditterent than property owners address indicated above. i }-�� y �Pitlessadaptermanufacturer ;.._�.:��k,�. ?;-��_�*.'�.J"�'-Model .Casing Protection �JC12 in.above grade "" ��=�At-grade(Environmental Wells and Boring ONLY) GROUTING INFORMATION Well grouted �Yes r�No Grout material ❑Neat cement r 1 Bentonite ��Concrete Q�High Solids Bentonite from_�to,��ft. �__ ��_yds. �ags from_'�__to_��ft. ��y�� bags GEOLOGICAL MATERIALS COLOR H MAT RSA OF FROM TO from to ft. �..J yds. ❑bags NEAREST KNOWN SOURCE OF CONTAMINATION .i ��y-a.-.J l y ~ _J feet f''J direction '�� ::u�ype Well disinfected upon completion Yes J No ��,_,-..,.,,��,�.� ,�„�. �;�y,,;;,,.�,� PUMP � i�]Not installed Date inslalled -^ ..7 "'` Manufacturer's name � �..�c_.__ �--�._S"�-F-��^-� � Model number HP f Vol[s �-tJ Lenyth of drop pipe �..�j�r ft. Capacity g.p.m. Type:�'. ubmersible ❑L.S.Turbine r��.Reciprocating �','Jet LJ ABANDONED WELLS Does property have any not in use and not sealed well(s) �;Yes �i No VARIANCE Was a variance granted from the MDH for this well? [j Yes �Jo 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 REMARKS,ELEVATION,SOURCE OF DATA,etc. �a•T��. ��^ 6 Licensee Business Name Lic.or Reg.No. i i �V epresentative Si ature Date .. 4l H� ��Q' LOCAL COPY f NameofDriller 71 �� 9 HE-01205-OB(Rev.5/02) IC 140-0020 � . . . rw�. c�-y w�� c � � , r� 617 13th Ave So � Hopkins, Minnesota 55343 • (612) 935 - 3556 OS/04/2005 Stodola Well Drilling 3841 North Main St. Boni facius MN 55375 938-21 1 1 REPORT OF WATER ANALYSIS Lab #: 2366N Our Laboratory reports these analytical results, determined on a sample raken by CLIENT on 05/02/2005 from the following location: Wiiliam Grandy 1540 Long Lake Blvd. Orono,Mn Well #719849 Coliform Bacteria <1/100 ml Nitrates Nitrogen <1.0 mg/1 The results of rhese tests indicate thar rhis well is producing warer thar meets the standards for F.H.A., L!A., or conventional loans. This report is an analys;s far coliform and nitrate only and does not include analysis of Lead and other conraminants. (Unless as specified by client). * rT�cvin City Water Clinic, Inc. �'� .:�� :;�'� Bill� ��4�sdale � Lab Cert�cation#027-053-119 ` WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring H ��O�a i County Name WELL AND BORING SEALING RECORD Minnlesota Unique Well No. " i ��i� Minnesota Statutes,Chapter 1031 0�� Township Name Township No. Range No. Section No. Fraction(sm->Ig) Date Sealed Date Well or Bonng Constmcted nroc� I I8 23 26 3�7 �,. O � t3�u� C�'� . g� • GPS Latitude degrees minutes seconds Depth Before Sealing �� tt. Original Deptti ft. LOCATION: tt Longitude degrees minutes seconds �UIFER(S) STATC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location Single Aquiter ❑Multiaquffer � is4o � B�� rQ� 5��j WELUBORING Measured ❑Estimated � Water Supply Well ❑Monit.Well � r Show exact location of well or boring Sketch map of well or boring �j in section grid wiUi"X" location,showing property ❑Env.Bore Hole ❑O[her �`� ft. �(bebw ❑above land surface lines,roads,and buildings. /� N CASING TYPE(S) �J Steel ❑Plastic ❑Tile ❑Other W —�- - - - -- --i-- E �+� WELLHEAD COMPLEIION � Outside: ❑Well House Inside: ❑Basemerrt Oflset _Y_ ____ _l__ __i__ � �� ` �Pitless Adapter/Unit ❑Well Pit --�- -�-- -i-- --i-- I A`�'}L 1 ❑Well Pit ❑Buried S �'—""r°�' -� i„�� ❑Buned 4..*5 i..-d' �,�/:.�--.�. ',..� QFjOP O�E��A�/�OMP4INY NAME �, CASING(S) 1'� � 4 �i $2�1y Diameter DepUi � Set in oversize hole? Annular space initially grouted? Property owner's mailing address if dilferent than well location address indicated above � /� in.ffOm � t0�_ft. ❑Yes �No ❑Yes ❑No ❑Unknown : 1540 Long Lai�. Blvr� � �/i.�R�4+: �9I�T 55356 in.f�om to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown ; ir1.f�Om to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown ' WELL OWNER'S NAME/COMPANY NAME SCREEWOPEN HOLE . t Well owner's mailing address if difFerent ihan property owners address indicated above Screen from�t0�ft. Open Hole from t0 ft. OBSTRUCTIONS ❑ Rods/Drop Pipe ❑Check Valve(s) ❑ Debris ❑ Fill '�No Obstruction Type of Obstructions(Describe) GEOLOGICAL MA7ERIAL COLOR HARDNESS OR FROM 70 Obstructions removed? ❑Yes ❑ No Describe FORMATION H not krawn,indica[e estimated formation log from nearby well or boring PUMP '_ � �� TYPe N ❑ 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. ❑ Perforated ❑ Removed Type of perforator ❑ Other GROUTING MATERIAL(S) (One bag of cement=94 Ibs.,one bag of beMonite=501bs.) t Grouting Matenal��'1"� from�to��R. 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. DOil StClf�lA W��.�. �L'�Z�.�['i� {"A.i �flC. 2�.7z Contractor Business Name License or Registratlon No. .-� �� `�� E' A n p eSefi a Ye Siyfi r ` Date � , _� : H 2 3 4�2 8 `��„ . � _.�,�,..._ � LOCALCOPV " � � Name of Person Sealing Well or Boring