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Home My WebLink Aboutwell info WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring I„+ � Coui4ty Name � WELL AND BORING SEALING RECORD Minneso a�Unique Well No. � iA Minnesota Statutes, Chapter 1031 or W-series No. (Leave blenk II not knownJ Township Name Township No. Range No. Section No. Fraction(sm.�Ig.) Date Sealed Date Well or Boring Constructed c� 11� 23 � s� s� s� ia �v o . GPS Latitude__ degrees _ minutes_____ seconds Depth Before Sealing � ft. Original Depth ft. LOCATION: Longitude_.__ degrees minutes____ seconds p U FER(S) STATIC WATER LEVEL E Numerical Street Address or Fire Number and Ciry of Well or Boring Location , �ngle Aquifer ❑Multiaquifer ` p� IZC7lJ Li [�� 0� 5539I WELUBORING �leasured ❑Estimated Date Measured ✓�� —y7 �Vater-Supply Well f—J Monit.Well � Show exact location of well or boring Sketch map of well or boring �) in section grid with"X." location,showing property ❑Env.Bore Hole [!Other_.__ _. ft. �elow ❑above land surface _ N lines,roads,and buildings. CASING TYPE(S) ; 1 1 I __'_____'___ ___`__ ___'__ t [�teel �lastic [__]Tile ❑Other �� a --�-----�--- ---�-- ---`-- WELLHEAD COMPLETION W : � ; � ET : � � _;_____�__ � �� Outside: ❑Well House ❑At Grade Inside: ❑Basement Offset � � � � 'h M'ie `ly � �itless Adapter/Unit ❑Buried ❑Well Pit --.-----� ; ; 1 ,� r-- ---�-- ---.- ❑Weil Pit ❑Buried S ❑Other �-7 Mile-� �'�._fi� ❑Ofh2f _ Yr.,��, \. PROPERTY OWNER'S NAME/COMPANY NAM - CASING(S) - C Diam�te�� Dept�� t Set in oversize hole? Annular space initially grouted? Property owner's mailing address if different Ihan well location address indicated above /''� {� �_in.from�/ to �`v V ft. ❑Yes �o �_.j Yes ❑No ❑Unknown in.from to R ❑Yes �_�:No ��_'�Yes ❑No ❑Unknown in.from to ft. ❑Yes ❑No ❑Yes U No ❑Unknown i WELL OWNER'S NAME/COMPANY NAME SCREEN/OPEN HOLE � t Well owner's mailing address if ditterent than property owner's address indicated above Screen from �� to /�� ft. Open Hole from to ft. OBSTRUCTIONS ,�,` L�Rods/Drop Pipe ❑Check Valve(s) ❑Debris ❑Fill I J�10 Obstruction r- Type of Obstructions(Describe) GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? ❑Yes U No Describe FORMATION PUMP If not nown,indicate estima[ed formation log from nearby well or boring. - , � � TYPe _'�,Removed j��Vot Present ❑Other j ... METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: �o 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 ben�nite=50 Ibs.) .�yT f } +� Grouting Material��`/ �L�� from_� to��ft. yards �,G.bags a from_ to ft. yards bags _._ from to ft. yards bags OTHER WELLS AND BORINGS s REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING Other 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 information contained in this report is true to the best of my knowledge. l�n Stoclola tiell Drilling Co., Inc. 169I � __ _ . __ __ ------ - — Licensee Business Name License or Registration No. �f ',_ . //—/..�� :� �. epresentati S�n e �� Certified Rep.No. Date " _c��Pv • H 27J�462 � --- � ,..,.. �,..��.� _ ' �� Name of Person Sealing Well or Boring i ' _ __ . .-----.—.�_ HE-01434-11 IC#140-0423 -' tioeR , � ., ,. _ .� ,:. . ,. � MINNESOTA UNIQUE WELL WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. - CountyName WELL AND BORING RECORD 7 � 5 516 Hennep in Minnesota Statutes,Chapter 1037 Township Name Township No. Range No. Section No. Fraction WELUBORING DEPTH(completed) DATE WORK COMPLETED tkoa�o 118 23 35 SE S� �, 1�0 n 12-6-{38 GPS DRILLING METHOD LOCATION: Latitude degrees minutes seconds ,_ _ Longitude degrees minutes seconds :._i Cable Tool f�Driven �,Dug --- �Auger j�Rotary =.�Jetted House Number,Street Name,City,and Zip Code of Well Location or Fire Number �--� / �,�� jj� ��s �d(p ��I DRILLING FLUID WELL HYDROFRACTURED? �I Yes o Show exact location of welUboring in section grid with"X" Sketch map of well/boring loca[ion. �t��e From ft.To ft. Showing property lines, — N roads,buildings,and direction. USE ��Domestic (�Monitoring ��Heating/Cooling ' y '�— ; '�Community PWSWS �`-'Environ.Bore Hole �Industry/Commercial � �,,,,� _ ',]Irrigation �,�Remedial � --1-----'------5-----'-- t �` � j Elevator ��Dewatering �� ... �' ; ; ; ; E T ASIN Dri ThSho�e tl �,J Yes `�`N�o OLE DIAM.-- � � C G MATERIAL H � ------ ---------�-- ---*-- � 'a �(�. �M� J '_�'Steel �_I rea e ��Welde --�--- --�--- --�-- --�-- 1 Plastic �] CASING I g � Diameter Weight Specifications �1Mile—� �� -Y,.�-e H��- �in.to�7�ft. �IbsJR. �� in.to �llft. PROPERTY OWNER'S NAME/COMPANY NAME in.to __ft. IbsJft. _____ �in.t�"*�ft. �.li�t JCIi ppr�q in.to ft. IbsJft. _ in.to ft. �"� �� OPEN HOLE Property owner's mailing address if different than well location address indicated above. SCREEN _ � � �� Make �� From ft To ft. Type 111Cl�'�AIPR� f1tAP� __Diam. ___ SIoVGauze _�� Length�.#, �f Set between ft.and it. FITTINGS t! N STATIC WATER LEVEL " Measured from 62 tt(�Below �I Above land surface Date measured� � WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) �� ft.after L hrs.pumping 7V g.p.m. Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION t ,��,Pitless/adapter manufacturer i,�,j�•�4_a7[�T�.� Model �]Casing Protection j�](12 in.above grade [l At-grade(Environmental Well and Boring ONLY) GROUTING INFORMATION Well grouted `�Yes �j No Grout materials f I Neat cement �entonite Concrete ❑Other_ From O To �ry ft. 3 ❑Yds ��(Bags HARDNESS OF From � To �3�+ h.naturetl f�.�b1�. �]Bags GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO _ From To ft I._Yds ❑Bags NEAREST KNOWN SOURCE OF CONTAMINATION to fI bi8ck soft �0 2 / "" [[[,,, � / ...:s feet ��\ direction ---p� ��type \ a� Well disinfected upon compleJipn? � Yes I�;�No CZSy yC�lO�ii �LBJ 4 � PUMP C��/ r�� +� � t^� �Not installed Date instal� �/ � - �:� mC�2.1 iV Manufacturer's name � Y\ ! ( � Model Number HP 1�Volts �J r., 9tttK�� 9'iTE'� ��iIA ZQ� 1�� - .-- Length of drop pipe �..J..: ft. Capacity g.p.m. �t�� ♦�q �yn Type:�Submersible ❑LS.Turbine I�`l Reciprocating ❑Jet L� 1 t `f� qgqNDONED WELLS Does property have any not in use and not sealed well(s)? ❑Yes j o VARIANCE Was a variance granted from the MDH for this well? ❑Yes '� No 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. � �Tf St�fll R �+11 � Licensee Business Name L c.or Reg.No. fi r`'-� � �� L.!� Cer� d � pr entative �gnalure� � = Certified Rep.No. Date � Jim K.�hls LOCAL C�PY 7 6 5 516 Name of Driller IC 140-0020 HE-01205-11(Rev.3/07) , . . rw� c�-y w�-� c � � , r�. 617 13th Ave So • Hopkins, Minnesota 55343 • (612) 935 - 3556 11/10/2008 Stodola Well Drilling 3841 North Main Sr. Boni facius MN 55375 938-21 1 1 REPORT OF WATER ANALY5IS Lab #: 5006N Our Laboratory reports these analytical results, derermined on a sample taken by CLIENT on 1 1/06/2008 from the following location: Clinton Jurgens 1180 Lyman Ave. Orono,Mn W eLL 765516 Coli form Bacteria Absent Nirrates Nitrogen <1.0 mg/1 Arsenic <2.0 ppb Twin C4t. Water,,Clinic, Inc. ;�-� Bill.[/ari��r ale � Malyical laboratory Consulting Engineer Water Analysis Reagents Boiler Water Chemicals Lab Cert�cation#027-053-119 _ _. _ L �,��.�.v, ;,, WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. CounryName WELL AND BORING RECORD ,, ,,' ,;. 6 4 31 g 3 H�nnepin Minnesota Statutes Chapter f03/ Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) � , . � Date Work Completed Orono 118 23 35 �,. ,. ,, 140 " 5-25-40 House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD 1 Z�+Q L 8� ��/� �r�n0 5 5 39I ❑ Aug e Tool ❑ Driven ❑ Dug C�Rotary ❑ Jetted Show exact location of well in section grid with"X". Sketch map of well location. ❑ _ _ Showing pr erty lines, roads an ildings. DRILLING FLUID WELL HYDROFRACTURED? ❑YES O " N$t@C � � � � FROM n.to n. ` -; -;- -;- -r ; �� USE �./ ❑ Monitoring ❑ Heating/Cooling ; i i i i Ya Domestic ❑ Communiry PWS ❑ Industry/Commercial � -�- -�- -�- -�- ❑ Irrigation r i � i i � �� NoncommunityPWS ❑ Remedial r W E x � ❑ Environ.Bore Hole ❑ Dewatering ❑ i i i i T i _, i i ,�'Mie CASING DriveShoe? ❑ Yes No HOLEDIAM. _i _ i_ _L_ _i_ I � ❑ Steel ❑ Threaded ❑ Welded � � � � 1 J�` �Plastic ❑ �--t Mile-� � CASIN DIAMETER WEIGHT � P OPERTY OWNER'S NAME � in.to i�a ft. �"�� IbsJft. $ in. 0 3 �rchetype Builders Inc. �� p �� +�.�o ft. Ibs./ft. s t � e owner's mailing address if different than well location address indicated above. _in.to ft. � Ibs./ft. in.to_ft. ��0 Quebec Ave N SCREEN,'O�n�� OPEN HOLE MinneBpolis, � S54L./ Make from ft.to ft. TYPe 8 � ��$ gteel Oiam. L SlotlGauze r 0 Length �� ♦' 4� - Set between L�� ft.and��ft. FITTINGS:__7 K��~_v_�� STATIC WATER LEVEL �� WELL OWNER'S NAME �5 ft. C�below ❑ above land surface Date measured��Q PUMPING LEVEL(below land surface) Well owner's mailing address if different than property owner's address indicated above. �R ft. after 2 hrs.pumping��g.p.m. �WELLHEADCOMPLETION Whitewater Model Pitless adapter manufacturer ❑ Casing Protection �2 in,above grade ❑ At-grade(Environmental Welis and Borings ONLY) GROUTING INFORMATION � Well grouted?�'V'es 'Q No ,�� f ; HARDNESS OF Grout Material q N�at ce C�6en i Cl Concrete �High Solids Bentonite GEOLOGICALMATERIALS COLOR MATERIAL FROM TO ,;�' ,- � � ,�• .�em.�- _��' ..��.�-ft. �_�_� ❑ Yds.�bags from_,__,��'to�,ft. �as.�..�t BjvlslO bags «i�.f�i i:l l �.+la� from'� � -t9 ft. ❑ yds. ❑ bags NEARES r WN SOURCE OF CO AMI AUO S'eC�+� 1� ,�� f - • feet ��.�-�direction type - S Well disinfected upon completion? �'es ❑ No PUMP ��0 ❑ Not installed Date installed Manufacturer's name Model number HP �� Volts 23� - Length of drop pipe O I ft. Capacity g.p.m. Type: �Submersible ❑ L.S.Turbine ❑ Reciprocating ❑ Jet ❑ i ABANDONED WELLS Does property have any not in use and not sealed well(s)? ❑ Yes .�No VARIANCE Was a variance granted from the MDH for this well? ❑ Yes �lo TNk WELL CONTRACTOR CERTIFICATION Use a second sheet,il needed This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. �' REMARKS,ELEVATION,SOURCE OF DATA,eta The information contained in this report is true to the best of my knowledge. Don Stodo2.a Well Urill3ng Co. , Inc. 2 172 Licensee B iness Name J,ic.or Reg.No. ,.,._ ..r-�-�, j �_ s A thbrized'epre tativ�Signature Date Chuck Aioore 5-I5-OU 6 4 319 3 Name ol Dril/er Date LOCAL COPY HE-01205-07(Rev.?/99) � ^ 7rwi�vv C i,t" W a�"e�' C ' ' , I v�,c� y 617 13th Ave So � Hopkins, Minnesota 55343 � (612) 935 - 3556 05/18/2000 Stodola Well Drilling 3841 North Main St. Bonifacius MN 55375 938-21 1 1 REPORT OF WATER ANALYSIS Lab #: 39033 Our Laboratory reporrs these analyrical resulis, determined on a sample taken by CLIENT on OS/I S/2000 from the following location: Archetype Builders 1280 Lyman Ave Orono,Mn Unique Well#643193 Coliform Bacteria <1/]00 ml Nitrates Nitrogen <1.0 mg/1 The resulrs of these cests indicate thar rhis well is producing water thar meets the srandards for F.H.A., V.A., or conventional loans. This report is an analysis for coliform and ni[rate only and a`oes not incliide analysis of Lead and other contaminanis. (Unless as specified by client). � ► Wa r Clinic, Inc. �� Bill Va s a� Malyical laboratory Consulting Engineer Waler Malysis Reagenls Boiler Water Chemicals Lab Certitication#027-053-I 19