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Home My WebLink Aboutwell info MINNESOTA UNIQUE WELL WELUBORING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. ° Counry Name RECEIVE[�ELL AND BORING RECORD �7 4 3 4 4 8 ' Minnesota Statutes,Chapter 103I Hennepin Township Name Township No. Range No. tion o. F WELUBORING DEPTH(completed) DATE WORK COMPLETED UrOi10 117 'L3 O8 ��: v< v< 1C?O n 1—ZZ—Q7 GPS ��0 DRILLING METHOD LOCATION: Latitude__ degrees te ___. s . _ Longitude degrees minutes seconds___ �_l Cable Tool '� I Driven ��-Dug �° ' L.Auger �Rotary I 1 Jetted '�� House Number,Street Name,Ciry,and Zip Code of Well Location or Fire Number - 1535 Minnie Ave, OL�OTIO 553 4 DRILLINGFLUID WELLHYDROFRACTURED? 7Yes ' No �'. Show exact location of well/boring in section grid with"X." Sketch map of II location. �8�e C From ft.To_ ____ R '�� Showing pr erty lines, N �V buil.ings, USE _Domestic �_!Monitoring u Heating/Cooling a d tion. `-Noncommunity PWS J Environ.Bore Hole . �Industry/Commercial � --'�"- "�J-�- --`-- ---�-- _Community PWS J Irrigation '�_Remedial ❑Elevator `�Dewatering -------- --- ------ --- -- f CASING MATERIAL Drive Shoe? I.�Yes No HOLE DIAM. --'--- --�--- ---`-- ---`- yN'�astic LThreaded . Welded w ET ( � , � i Vz Mile " ' ; ' ! CASING --.--- --�--------- ---=- 1 � � Diameter Weight Specifications ; S ' � 4 92 2.01 ast� 8 30 �—1 Mile� in.to ft. Ibs./ft. -��4��-in.to��(�ft. in.to ft. Ibs./ft. "• in.t0'"" ft. PROPERTY OWNER'S NAME/COMPANY NAME in.to ft. Ibs./ft. �� in.to ft. Lisa t'lSLIWSCL�L� SCREENT OPENHOLE Property owner's mailing address if different than well location address indicated above. Make J_Qhn s�� _ From ft To_, ft. 8a�� a$ abone TYPe �.LLl,LI1.�PA1l4 !X�'� . - Diam. ZN � ----�---- ', Slot/Gauze_ _. ��. Length �! ,�, ��__ Set between ft.and it. FITTINGS # Q STATIC W�LEVEL �'��I ft.�Below , .Above land surface Date measured_____ PUMPING j.��L(below land surfacej � �� WELUBORING OWNER'S NAME/COMPANY NAME ___._ �l ft.after �'� hrs.pumping g.p.m. WELL HEAD COMPLETION Well/boring owner's mailing address if different ihan property owner's address indicated above. �piUess Adapter Manufacturer _'^�`Tllodel__ '��Casing Protection_ __ �92 in.above grade ❑At-grade(Environmental Well and Boring ONLY) � Z GROUTING INFORMATION Well grouted? �Yes ! I No y Grout ma�erials . �Neat ceme��l"Bentonite q�6pncrete I I Other�____. ___ From To_�Qa��ft. �'�[�Yds r]��7 gs From�To �"tt. n u af�}Yd��.'��Bags GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO From_ To ft. '�. !Yds. ...Bags MATERIAL ? NEAREST KNOWN SOURCE OF CONTAMINATION clay/sand brown soft � I$ --- �� eet � direction � ��-�� Well disinfected upon completion? ��. es CI No ',�..�� ; CISy F;CH}� SOfC iS US PUMP �-t�.3 G�O I I Not installed Date installed � Manufacturer's name `� �'�-�" �-^' �" � sand brsy soft 85 I00 J�� o�ts ��a Model Number HP Length of drop pipe CLr� _. ft. Capacity_ _ g.p.m. Type:'� ubmersible '.�1�.S.Turbine �. �.Reciprocating i.'Jet i�� ABANDONED WELLS Does property have any not in use and not sealed well(s)? i.I Yes y*No + VARIANCE Was a variance granted from the MDH for ihis 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 ihe best of my knowledge. Useasecondsheet,i/needed. �n �'�Q(��la W�,fIZ Drilling Co, s .71��• �6 L i; REMARKS,ELEVATION,SOURCE OF DATA,etc. — - . _ _ _ —__9-- —. Licensee Business Name Lic.or Re No. _ :.� {.3-�'� : A o epresentative 5ignarure��.- Date i� Ch�ck Mooce ... -.__ _. ....__- ._ -- ...... �f LOCAL COPY 7 4 3 4 4 8 Name of o�iuer HE-01205-09(Rev.9/05) IC 140-0020 rw�. c�-y w�� c � � , r� 617 13th Ave So � Hopkins, Minnesota 55343 � (612) 935 - 3556 01/24/2007 Stodola Well Drilling 3841 North Main Si. Boni facius MN 55375 938-21 1 1 REPORT OF WATER ANALYSIS Lab #: 46BN Our Laboratory reports ihese analytical resulrs, determined on a sample taken by CLIENT on 01/22/2007 from the following locarion: LISA MANWARREN 1535 MINNIE AVE ORONO,MN WELL 743448 Coli form Bacteria <1/100 ml Nitrates Nitrogen <1.0 mg/I The results of these test-s indicate that this well is producing warer that meets the standards for F.H.A., V.A., or conventional loans. This reporr is an analysis for coliform and nitrat-e only and does not include analysis of Lead and other contaminants. (Unless as specified by client). Twin Cit arer Clinic, lnc. Bill Van Arsdale Lab Certification#027-053-I 19 A111NNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring � � WELL OR BQRING LOCA710N...-' t Sealing No. H �o��,v Name WELL AND BORING SEALING RECORD Minnesota Unique Well No. � � Minnesota Statutes,Chapter 1031 or W-series No. , ��aeve eiane u no�Nnow�) Township Name Township No. Range No. Section No. Fraction(sm.�Ig.) Date Sealed Date Well or Boring Constructed arono 117 23 08 3—�0(�4 '� � 1 J` � �j 7 " , GPS Latitude degrees minutes seconds Depth Before Sealing �� _ft. Original Depth _ft � LOCATION: Longitude degrees__ minutes__ seconds pQUIFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and Ciry of Well or Boring Location Single Aquifer ❑Multiaquifer �sf �f � ✓ WELUBORING ,�nJ Measured ❑Estimated Date Measurec�� / vf7Water-Supply Well '�Monit.Well � Show exact location of well or boring Sketch map of well or boring �C 7 in section grid with"X" location,showing property ❑Env.Bore Hole ❑Other �:Z ft. �below �above land surface " N lines,roads,and buildings.rj� CASING TYPE(S) il � � � � � � Steel ,��..Plastic n Tile ❑Other s � , � � 1 WELLHEAD COMPLETION W - ,------- --,-----,-- E T �� - - -;- ; ' ; Outside: ; -��Well House �]At Grade Inside:�Basement Offset : � � � � (� , , , , 'h nniie ,l rtless A p dUnit U Buried ❑Well Pit - , , , , � . [�P� da te --�-----�-- ---�-- --%- �,. �, � ❑Buried ' � 5 � ' [ ]Well Pit �� » � ❑Other �1 Mile� ��-�' � [�Other PROTP,E�RTY OWvN_ER'S NAME/COMPANY NAME CASING(S) ••■� i'iiin�rren Diameter � Depth / Set in oversize hole? Annular space initially grouled? Properry owner's mailing address if different than well location address indicated above �� to 1 � � �__in.from !�'�U ft. ❑Yes �]No ��j Yes i�No ]Unknown in.from to ft. ��Yes ❑No ❑Yes (_�No J Unknown _in.from _ to ft. j_;Yes ❑No ❑Yes ❑No ❑Unknown WELL OWNER'S NAME/COMPANY NAME SCREEWOPEN HOLE � / Well owner's mailing address it different ihan property owr,er's adtlress indicated above SCfeen from��_to ��ft. Open Hole from__ _to ft. OBSTRUCTIONS Rods/Drop Pipe �Check Valve(s) ❑Debris ❑Fill ❑No Obstruction Type of Obstructions(Describe) ,r/�/�L� Jf�� Q' ��1 GEOLOGICAL MATERIAL COLOR HAHDNESS OR FROM TO Obstructions removed? �Yes j�_J No Describe PORMATION — � PUMP If not known,indicate estimated formation log from nearby well or boring. �f` /�um� TYPe " 'f � � � l� �� Removed ❑Not resent '._'�,Other � METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: „� _ J No Annular Space Exists ❑Annular Space Grouted with Tremie Pipe ❑Casing Perforation/Removal _in.from to ft. ❑Perforated ❑Removed s k in.from to ft. ❑Perforated ❑Removed Type of Perforator ��,_j Other GROUTING MATERIAL(S) (One bag of cement=94 Ibs.,one bag of bentonite=50 Ibs.) � r t Grouting Materi�L�� (._�!/P_��from � to �2 ft. _ 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 RF_GISTERED CONTRACTOR CERTIFICATION This well or boring was sealed in accordance with Minnesota Rules,Chapter 4725.The information contained in this report is true to ihe best of my knowledge. Don 5todola tdell Dcillin,�C__e.;InC. 1691 Contractor Business Name License or Registration No. i / / _ . ! _�- `�` '� / _ — - ------ C f' . Sren at ve 'igna, re� Certilied Rep.No. Date '! H A ^ A ,.,` ,_._,,.� ..?_., �,..,.<, ,.,��...- LOCAL COPY J�}�O 7 j( i� �r y Name ol Person Sealing Well or Boring HE-01434-09 IC#140-0423 � s/osa