The URL can be used to link to this page

Home My WebLink Aboutwell info � __ _ _ _ __ � � . MINNESOTA DEPARTMENT OF HFALTH M�nnesota Well and Boring „ � WELI OR BORING LOCATION � i H / WELL AND BORING SEALING RECORD Sealing No ��Q�_ 3 � ' Counry Name Minneso!a Unique No r � . Minnesota Statufes.Chapter 1031 or W-series No I ILeave blank if nut known) L_ Hvrme in � Township Name Township No. Range No Section Na Fiacuon�sm.-►Ig.) Date Sealed Date Well or Boring Construded Oroncr I18 23 31 �4-C100' S �-s Numerical Street Adtlress or Fire Number and Ciry of Well or Boring Location / / 1�� LuC� L�� A�� Ot�na 5 5 3 Depth Before Seahng �� R. Ongmal Depth �� n Show exact Ixafion of N�ell or bonng Sketch map of well or bonng A UIFER(S) STATIC WATER LEVEL m section grid with`X'. � � . � QrtY Single Aywfer ❑ Mulhaqwter li es,roads,and buildi gs. N WELUBORING Measured ❑ Estimated `� Water Supply Well ❑Monit.Well �2 j p,(y ❑ Env.Bo�e Hole ❑Olher _ / `� R `[_j below ❑ above land suAace Y� W —�- - -- -i-- --i-- E CASING TVPE(S) � � � � � ` � � � t ' ' I ,,;�.,r:...A..�""- ��^x-.•!,-s\ �Steel ❑ Plastic �Tile �Other �. --�- --r- -r- —�-- ' ' ' ' ,�m,�a ) --`- -j-- -�-- --�-- � , I CASING Dia e�f Depth � Set in oversize hole? Annualar space milially grouted7 S �y ,/� ��m;�� L� in.trom1E� ro� R. ❑ Yes �No ❑ ves ❑No ❑ unknown PROPERTV OWNER'S NAME in.from to H. ❑ Yes ❑No ❑ Ves ❑No ❑ Unknown JOe C � - P.operty owner's mailing address it Aifferent than well location adtlress�ndlcated above. in.hom to ft. ❑ Yes ❑No ❑ Yes ❑No ❑ Unknown SCREEWOPEN HOLE Screen irom�to ��""� tt. Open Hole from to ft. OBSTRUCTIONS �( WELL OWNER'S NAME ❑ Rods/Drop Pipe ❑ Check Valve(s) ❑ Debris ❑ Fill �IJo Obstruction Well ownefs mailing address if diMerent than properry owner's address indicated above. Type of ObslruCtions(Describe) Obstruclions removed? ❑Yes ❑ No Describe PUMP Type GEOLOOICA�MATERIAL COLOR HARDNESS OF FROM TO � Removed �Not Present ❑ Other FORMATION If not krawn,indcete eslimated formatio�log from nearby well or boring. M�TJiOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: 7�fi �y _ )�j t> No Annular Space Exists \,,,) �'�--'� �J '/ /� ❑ Annular space grouted with tremie pipe � ❑ Casing Perforation/Removal in.from to ft. ❑ PeAaated ❑ Removed in.from to h. ❑ PeAorated ❑ Removed Type of peAoretor ❑ other GROUTING MATERIAL(S) Grouting Material ��'" � from � to /�� tt. yards � bags from to fl. yards bags rrom to n. yaros bags from ta_— ft. yards bags REMARKS,SOURCE OF DATA,DIFFlCULTIES IN SEALING OTHER WELLS AND BORINGS 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 accordence with Minnesota Rules,Chapter 4725. The information contained in Mis repoA is - true ro[he best of my knowledge. Don Stadola Well Drillin� Co. , Inc 27172 Contractor Business Neme �� -�.�,.��-� License or Regrshafion fq. �,��, '�.,f -� �i`� ��.F-: ---Z�.�� / .,J �? > / Jfuthonied Representafive Signature Dete �. ��,��^y-.,-,, `�'i ��`r�O.�sY`.-. Name ol Person Seeling Well Jr�onng LOCALCOPY H HE-01434-04 8�98 R rw�, c�-y w�-� c � � , r�,� 617 13th Ave So • Ho�kins, Minnesota 55343 • (612) 935 - 3556 � 07/22/1999 Stodola Well Drilling 3841 North Main St. Boni facius MN 55375 938-21 1 1 REPORT OF WATER ANALYSIS Lab #: 37444 Our Laboratory reports ihese analytical results, determined on a sample taken by CLIENT on 07/19/1999 from ihe following locaiion: Joe Church 165 Luce Line Rd. Orono�Mn Unique Well#6Z4949 Coliform Bacteria <1/100 ml Nirraies Niirogen <1.0 mg/I The results of these Cests indicate that this well is producing waier thai meets the standards for F.H.A., V.A., or conventional loans. This report is an analysis for , coliform and nirraie only and does not incfude a;,�:ysis of Lend anc�o�her contaminanrs. (Unless as specified by clienr). \ er Clinic, Inc. Bill V s le � a�r�ien��ry co�c�,8�� Water.4nalysis Reegents Boila Watu Chemrcals Lab Certification p 02�-053-I 19 • x � � .� � WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. Counry Name � WELL AND BORING RECORD 6 2� 9� 9 Henn�pi n Minnesota Statutes Chapter 1031 Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed Orono 118 23 31 :. . . 25Q• " 7-19-99 House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD 165 Luce Line Rf��e Road Ot� 0� �'♦ ❑ CableTool ❑ Driven ❑ Dug ❑ Auger �Rotary ❑ Jetted Show exact location of well in section grid with"X". Sketch map of well bCation. ❑ Showing property lin�s, �� roads and buildings: � DRILLING FLUID WECL i�YDROFRACTURED? ❑YES ❑NO �� " .$entonite i i � i FROM. , ft.to ft. __ _i_ _-_ _i_ USE ❑ Monitoring 0 Heating/Cooling i i i � �.Domestic ❑ Communit PWS _i_ _a_ _i_ _i_ � Y • � p.�ndustry/Commercial � i i i ❑ Irrigation ❑ Noncommunit PWS `N E �� ❑ Environ.Bore Hole y Q fl8f�'i@dial i i i i 1/�E• , ❑ Dewatering ❑ . -r -�- -r- -r T x . -- i i i i ,�zM�e CASING - �� Drive Shoe? ❑ Yes No . HCS�E'DIAM. _i_ _ i_ _i _ _i_ ❑ Steel �.'O Threaded ❑ Welded � i i i i � l I�Plastic ❑� _�i t;� g �-iMile� �� G/�w� . i CASING DIAMETER WEIGHT �� sF�'�.' PROPERTY:OWNER'S NAME � in.to 2�Z R. Z�Q� Ibs./ft. {�,ta 3� n. Joe � Stephanie Church ;�.,o ft. Ibs./ft. �;�.,025�. Property owner's mailing address if different than well location address indicated above. in.to ft. �� Ibs./ft. in.to ft. SCREEN OPEN HOLE � � Make 0 ns0� from___. tt.to ft. Type Stainless .CltEB'�. Diam. SIoUGauze .Q I p Length 8� Set between 2�2 ft.and�_ft. FITTINGS: Z~ x �O�w!k STATIC WATER LEVEL WELL OWNER'S NAME 1 4 Q� ft. �below ❑ above land surface Date measured��q PUMPING LEVEL(below land surface) Well owner's mailing address if difterent than property owner's address indicated above. 1 3�] ft. after ,2 hrs.pumping 1$ a�,L g.p.m. YWELL HEAD COMPLETION nl Pitlessadaptermanufacturer TAT�If t�WBtE.'rModel ❑ Casing Protection �12 in.above grade • ❑ At-grade(Environmental Wells and Borings ONLY) GROUTING INFORM+A�TION Well grouted? �4J Yes ❑ No HARDNESS OF Grout Material ❑ Neat ceme t ❑ Bento ite ❑ Concrete yi h Solids Bentonite GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO (� 3f� 2�7 y from to V ft. • ❑ yds.f? bags Op Soll B1�Ck S d• 2 1 from co n. ❑ Yds. ❑ bags from to ft. ❑ yds. ❑ bags NEAR6s��c N SOURCE OF CONT INATION �,l��j"�iC �.3�/ Ye 1 I c� $ �� 3� / �� teet ��Jn r� direction "�"� type Well disinfected upon completion? [�[Yes ❑ No and Clay Grey M 3$ 220 pUMP 7-2Q-99 ❑ Not installed Date installed lay Gravel Brown M 2�U 240 HOMEOh�tE Manufacturer's name a��' E LrQar��'� �1„dWTl 5• ,Z4� 25Q Modelnumber HP votts Length of drop pipe g v� ft. Capacity g.p.m. Type: Q'Submersible ❑ L.S.Turbine ❑ Reciprocating ❑ Jet ❑ ABANDONED WELLS y Does property have any not in use and not sealed well(s)? ❑ Yes Fl No VARIANCE Was a variance granted from the MDH for this well? ❑ Yes O-No TN# WELL CONTRACTOR CERTIFICATION Use a second sheet,if 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 STC3DOLA �v'ELL DRILLI�iG C0. , IIdC. Lice ee Busine Na Lic.or Reg.No. 8-26-99 Authorized�rtsentative Signafure Date Chuck Moore 7-19-99 - F 6�4 9 4 9 Name olOril/er Date LOCAL COPY HE-01205-06(Rev.7/98) �