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Home My WebLink Aboutwell info � r1�cLL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. oo� Name WELL AND BORING RECORD �`ennepin Minnesota Statutes Chapter 103/ 6 7 3 8 91 Towqs�ONanmeO Tow4sFup�. Range�p� Sectio�No. Fraction WELL DEPTH(compieted) Date Work Completed tJ 11 L 94 ry �i-8-02 v. v, v. Hou�ej�yipbe�$treQt=�me,G�tv and Zip1C=euo�f Wuell Loc�Si�p�� or Fire Number DRILLING METHOD �t��, iv e� t7C, u 7� ❑ Cable Tool ❑ Driven i i Dug I� Auger �Rotary ❑ Jetted Show exact location of well in section grid with"X". Sketch map of well location. I I ._.____ ' Showing property lines, roads and buildings. DRILLING FLUID WELL HYDROFRACTURED? ❑YES O N �uper gei-x � i � i FROM fl.to ft. -� -i- -i- -i- USE ❑ Monitoring ❑ Heating/Cooling i i � i �omestic _i_ _�_ _�_ _i_ ❑ Irrigation ❑ Community PWS ❑ Industry/Commercial i i i i ❑ Noncommunity PWS ❑ Remedial w e T ❑ Environ.Bore Hole i i i i I ❑ Dewatering � -r -�- -r- -r i i i i ��M.i ,�� CASING Drive Shoe? ❑ Yes No HOLE DIAM. z _i i i i_ � p� ❑ Steel ❑ Threaded — ❑ Welded i i i i /V. � �lastic ❑ S �--1 Mile-� �,�,,, CASItNG DIAMETER WEIGHT s� PROPERTY OWNER'S NAME "� in.to 87 R. sdr`L1 Ibs./ft. 7�,� Q Ct$t t tiDy in.lo----Ft ---- Ibs./ft. �in.to y Property owner's mailing address if different than well loca[ion address indicated above. —____in.to_____fl. Ibs./ft. __in.to ft. $8�e a$ SUdV� SCREEN��/+r OPEN HOLE Make �'a.�� from ft.ro ft. � — �—r -___._---- Type__ P i C Diam. __ __ � SIoUGauze__..___�,�1.fl_____. Length __7� Setbe[ween ��/ ft.and_ ft. FITTING��i 1��`—o1s_7�G,", �•kC= �t----- �-1}— � STATIC TER LEVEL �� WELL OWNER'S NAME �� ft.�below ❑ above land surface Date measured �r��02 PUMPI (L'�EVEL(below land surface) q Well owner's mailing address if different than property owner's address indicated above. _ �V __ft, after _ ` hrs.pumping �S g.p.m. WELLHEADCOMPLETION Qhitewater � ❑ Pitless adapter manufacturer ____.____ Model _ � ❑ Casing Pro[ection ❑ 12 in.above grade ❑ At-grade(Emironmental Wells and Borings ONLY) � GROUTING INFORMATION Well grouted? �Yes ❑ No �/ HARDNESS OF Grout Material ❑ Neat cem�t ❑ Bentonite O❑ Concret� X?High Solids Bentonite GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO from to 3p�R ❑ yds.�bags from�_to__�_�7_L n.118 t tlt�il_.f d�� bags �� SQiZ black s�lt � � trom to ft. ❑ yds. ❑ bags NEAREST KNO,�yN SOURCE OF CONTAMW9 TION ,{^" feet �+ '�� dlrection �rype C18 ��IDi�i 1S0$C Z� �.7 Well disinfected upon completion? �Yes ❑ No CIS C8 ISOft ].'� 78 PUMP ❑ Not installed Date installed � l�O� sand ts� .��lt 7C? 74 Manufacturer'sname ___ ___ae=��t�r Model number � HP Volts Length of drop pipe � ft. Capacity g.p.m. Type: ❑ Submersible f7 LS.Turbine ❑ Reciprocating ❑ Jet ❑ ______ ABANDONED WELLS Does property have any not in use and not sealed well(s)? C Yes �No VARIANCE Was a variance granted from the MDH for this well? ❑ Yes D.G No TN# f 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 intormation contained in this report is true to the best of my knowledge. Dors Stodoia_�iell Dcil.2i�g Co. , Inc. Z 172 . Licensee Business Name ic.or Reg.No. �- .�- 7�L�V 4 uthorized Representatiy Signature ' - Date Duane Mathe�►s 4�-8-02 Name ol Driller Date� LOCAL COPY �7 3 g g 1 HE-01205-07(Rev.2/99) IC#140-0020 � s �• - rw�. c�-y w�� c � � � r�,� 617 13th Ave So • Hopkins, Minnesota 55343 • (612) 935 - 3556 04/10/2002 Stodola Well Drilling 3841 North Main St. Bonifacius MN 55375 938-211 1 REPORT OF WATER ANALYSIS Lab #: 322 Our Laboratory reports rhese analytical results, derermined on a sample taken by CLIENT on 04/08/2002 from the following location: Matt Hoy 500 N.Arm Dr. Orono�Mn Unique Well#673891 Coliform Bacteria <1/100 ml NiCraies Niirogen <1.0 mg/I The results of these iests indicuce that ihis well is producing warer 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 nor include analysis of Lead and other coniaminanis. (Unless as speci�ed by client). ' City Water Clinic, Inc. , eill ale I.ab Caiscation#027-053-I 19 MINNESOTA DEPARTMENT OF HFALTH Minnesota Well and Boring +4 ��.{ �� WELI��BOFING LOCATION S281ing NO. j H 1 1 CoUnty Name WELL AND BORING SEALING RECORD Minnesota Unique Well No. ��G=Cl11'��.Cl M�nnesota Statutes,Chapier 1031 or W-series No. �_ _ � �sew a�n ooi k�owo� To ship Name Township No. Range No Section No. FracLon�sm.-►Ig.) Date Sealed Date Well or Borirg Consiructetl �COY�O �.�� ? ��—��i�fs � '� ""' fui Numerical Street Address or Fhe Numbei and Cily of Well or Bormg Location „/ , ` / �� (�$ ,A X'7.Ij �[� il r Q�0 J��i�'� Depth Belore Seal�ng �C.!% ft. Onginai Depth ��(� __n Show exad Iceafion of v.•ell or boring Sketch map of weil or bonng AOUIFER(S) STATIC WATER LEVEL in section gnd wtlh"X". locahon, showmg property "Single AyuAer ❑ Muttiaqwfer lines,roads.and buildings. N .__.____,.,__�._.o..__..._.___ WELUBORING �iMeasured ❑ Eshmated �� Water Suppry Well ❑Monit.Wetl ' _ _ __ ' '" __ _' 4 / �� ❑ Env Bore Hole ❑O�her �.-•-�� ft. �below ❑ above land surtace W --�- - -- - -- -- -- E � CASING TYPE(S) � � � � � � � } .__ .. .. i i i � . ..3.,._ i -i- -;— —i— —i-- �£ i ' �'1 Steel � Plastic �Tile � Other y '.. J_ }�2RIIIB -�-- -i-- -�-- --i— � CASING(S) Diame r f Depth t Set in oversize hole� Annular space initially grouted7 1 P /� Yes �lo ❑ Yes ❑No ❑ Unknown �i mxe—Ae f/ , �� in.irom_.�� to� ft. ❑ � � PROPERTY OWNER'S NAME in.from to fl. ❑ Yes ❑ No ❑ Ves ❑No ❑ Unknown Piope owner's mai in address if diHerem than well localion address Ind�cated above. in.from to ft. ❑ Ves ❑ No ❑ �es ❑No ❑ Unknown SCREEWOPEN MOLE r�r ^+ r � i Screen trp� ��,'�� to ��l f,�'� R. Open Hole from to k. OBSTRUCTIONS WELL OWNER'S NAME ❑ Rods/Drop Pipe ❑ Check Valve(s) ❑ Debris ❑ Fill �No Obstruction Well ownai's maiting eddress if diflerent ihan property owner's atldress indicated above. Type ot Obstructions(Describe) Obstructions removed? ❑Yes ❑ No Describe PUMP Type 1 GEOLOGICAL MATEHIAL COLOR HARDNESS OF FROM TO � Removed Not Present ❑ Other FORMATION It not known,indicate estimated formatbn log from nearby well or bonng. METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: � _� �'fJo Annular Space 6cists ��. ❑Annular space grouted with tremie pipe ❑Casing Perforation/Removal in.trom �o n. ❑ Perforated ❑ Removed in.from to h. ❑ Pertorated ❑ Removed Type of perforator " ❑ aner GROUTING MATERIAL(S) (One bag of cement=94 Ibs.,one bag of bentonite=50 Ibs.) !" ..� . P l l � Grouting Material ��!�� -� f��""�h� �-i to ��('C ft. yards bags 4 from to N. yards bags f�om to It. yards bags from to_ tt. yards bags REMAHKS,SOURCE OF DATA,DIFFICULTIES 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 accordance wiM Minnesota Rules,Chapter 4725. The information contained in this repoh is true to the best of my knowledge. ��n .>tc�c�a�.a ��11 ?�e�illin�;, Cc�. , Inc ?.7172 Confractor Business Name License or Registration fio. '/` . ._._�'-'-" .- ._. 1 . fy ��Authonzed Representative Signature - Dete _r 19�i 3 3 Name ol Person Sealing Well or Bonng LOCALCOPY H