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Home My WebLink Aboutwell info . , . . Jt . . .. .. . , , . . . .. • � . . _ . . . �' wELL oR BORwG LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring H 3 3 818 County Name WELL AND BORING SEALING RECORD Minn�esoNa Unique Well No. Minnesota Statutes,Cha ter 1031 or W-series No. �pin P (Leave blank�I not known) Township Name Township No. Range No. Section No. Fraction(sm�Ig) Date Sealed Date Well or Boring Constructed 4rcmcr li7 tt�G6 4 _ � SF (� U � GPS Latitude degrees minutes seconds �t„� � '�. LOCATION: Depth Before Sealing ft. Original Depth ft. Longitude degrees minutes seconds pUIFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location Single Aquifer ❑Multiaquifer .�n � �� W1E�LU�BORING �easured ❑ Estimated /4V �7�vvater Supply Well ❑ Monit Well �-1 � �' Show exact location of well or boring Sketch map of well or boring 7` �y..� 'i in section grid with"X" location,showing property ❑Env.Bore Hole ❑Other �fL �below ❑above land surface lines,roads,and b ings. . N f; � CASING TYPE(S) _ �1-!vro !` teel ❑ Plastic ❑Tile ❑Other W —�- - -- - -- -- — E - - - WELLHEAD COMPLETION , , .._�_ � � � � � ��='>�'"�� Outside: ❑Well House Inside: ❑Basement Offset -�-- -�-- -;— - i— � � � � � �mile ,,,.,_.�,.._.._ , , M,�.,_ 1 ❑ Pitless Adapter/Unit �`Well Pit -;-- -�— -1-- --i-- � �� ❑Well Pit ❑Buried S �r m�e� �__,_._� ❑Buried .. � PFOPERTY OWNER'S NAME/COMPANY NAME CASING(S) � Dia�er�! O Depth �� Set in oversize hole? Annular space initially grouted? :'. Property ow er s mai i g a s i an w ion d ss� e above in.from t0 ft. ❑Yes �i1 No ❑Yes ❑No ❑Unknown T` in.frOm to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown in.f�Om t0 ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown , WELL OWNER'S NAME/COMPANY NAME SCREEN/OPEN HOLE �/� r � '�Well owner's mailing address if different than property owner's address indicated above Screen from�t/ 10 ( ` ft. Open Hole from t0 ft. OBSTRUCTIONS �Rods/Drop Pipe ❑ Check Valve(s) ❑ Debris ❑ Fill ❑ No Obstruction � _� Type of Obstructions(Describe) �/�,L2,!/�r� /�''r �� - �j�F�� r GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? BS ❑ NO Describe FORMATION �'.� If not known,indicate estimated formation log from nearby well or boring PUMP ^ � ,�� Type J F 1 { �� f � �"� � 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 bentonite=50 Ibs.) ; � / ��( � G Grouting Material N��L��,Arom�—to�.LJ 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 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. Don Stodols Wel.l I}c311ing Co., Inc. 27i72 Contractor Business Name License or Registration No. � � � ori presentative Signature Date � 1 1 ,4`- �%�7 �: t.�.-��,,,?-�Y..�-- : ' LOCAL COPY H +i. + �s � ` Name of Person Sealing Well or Bonng �y . � WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. �� County Name WELL AND BORING RECORD _ �i� Minnesota Statutes,Chapter 103I � � � � � � - Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed � �COfIQ 117 Z� �i y �i y, ��g n �ZQ"�+� GPS � DRILLING METHOD LOCATION: Latitude degrees minutes seconds Longitude degrees minutes seconds l.i Cable Tool r;Driven ��Dug I i Auger �Rotary �]Jetted House Number,Street Name,Ciry,and Zip Code of Well Location or FRe Number �-� � P - + DRILLING FLUID WELL HYDROFRACTURED? �j Yes o Show exact locahon o well in section id iih'X". Sketch m�p of well location. W$ter FROM tt.TO ft. � � Showing properry lines, — - roads and buildings USE -- � N i ��Monitoring �;Heating/Cooling � I I 1 _ I j�Domestic [,Environ.Bore Hole �i �'�Industry/Commercial , --'-----'------`- �-��' [1 Noncommunity PWS �;Irrigation ;]Remedial ❑Community PWS ❑Dewatering ��li .. --'--- --�- ---- - �— ` - --'F - � � � , ��,,..// CASWG w , � � ; ET � Drive Shoe? �]Yes �:�No OLE DIAM. H ; ^ � ' �_ ' I ❑Steel ❑Threaded ❑Welded y --�--- --�-- --%-- � , � � � , I Mile --- ,� �� PlaStiC ❑ _ � ' -' ' � I 11 � CASING DIAMETER WEIGHT � � � S � L � , -T in.to �`"' ft. ��0� Ibs./ft. " in.to� ft. �-�M�ie-� ----- t in.to fL IbsJft. �in.toa�ft. -'� PROPERTY OWNER'S NAME/COMPANY NAME in.to__ k. Ibs./ft. in.to ft. �efl/utiL"S ffiebarth SCREEN OPENHOLE �+. Property owner's mailing address it different than well location address indicated above. Make_ �� FROM ft. TO ft. Type �l'�8i1'i1�S14 S�__ Diam. �_ SIoUGauze �(�_,___Lengih ,�� * ��__ Set between__ ft.and it. FITTINGS M A STATIC WATER LEVEL 74 ft. below �_;above land surface Date measured �� PUMPING LEVEL(below land surface) � WELL OWNER'S NAME/COMPANY NAME 17? ft.after 2 hrs.pumping 2� g.p.m. WELL HEAD COMPLETION (� �• � ~ Well owner's mailing address if different than property owners address indicated above. �pitless adapter manufacturer�_z.J-��f--.-��%��-e-.:��J�hel ��,J Casing Protection �j�y'f2 in.above grade �]At-grade(Environmental Wells and Boring ONLY) � GROUTING INFORMATION - Well grouted �Yes ❑No Grout material � �,Neat cement [;Bentoni't'�e(r��Concrete High Solids Benionite from_ 0 to t�"�ft. ��__ .?yd8.��bags from � to a�fL �t1��8� g�� I,I bags GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO irom to tt. � _yds. i`]bags MATERIAL NEAREST KNOWN SOURCE OF CONTAMINATION ��p$�ll bl��lC $�iC V G -"—.�;..� feet J �J� direction ;,.,.1�.._' ... , :�pe��rl Well disinfected upon completion � Yes �No -�...% C�By bCOiil� AOIt L 1�? PUMP r / -� , �; � [j Not installed Date installed („� � 7..1 � (�+xgV p�V $�€= 15 �� Manufacturer's name -�---a:i� l d J 3 Model number HP'��Volts �✓ � � �t�� t'$y �Ql t 1� 1 i0 Length of drop pipe /t�J� _ft. Capacity_ g.p.m. /�► C Type: - ubmersible !]L.S.Turbine [-�Reciprocating �_I Jet �I e�y grsy �f= ill! 1�J ABA ONEDWELLS Does property have any not in use and not sealed well(s) r;Yes nq No ; sand/�;tavel bt�m soft 175 I88 �AR�AN�E Was a variance granted from the MDH for this well? i_�Yes No TNIt 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 T�,..� ��;- REMARKS,ELEVATION,SOURCE OF DATA,etc. W/iStod.ola '�tel.IDtillicig Co,. 1�IC• �T112 .;; Licensee Business Name Lic.or Reg.No. `� / ' �it '�.? `��( Au z Re e"serita�e Signatu(e%� Date C�nu'� r'�'�tC LOCAL COPY ''' ^ �� NameofDriNer 7 � � � � � HE-01205-08(Rev.5/02) �� IC 140-0020 FROM : FA� N0. : Aug. 27 20�4 10:12AM P1 7"w i�v C�y 1�c��` � ' ' , �rt,�`r. 617 13th Ave So • Ho�kins, Minnesota 55343 � (612) 935 - 3556 08/Z7/2004 Stodala Well Drilling 3841 North Main St� Boni facius MN 55375 938-2111 ��QRT QF WATER ANALYS�S Lab #: 651 Our Laboratory reports these analytical re.sulrs, determined on a sample Cpken by CL.l�N7on 08/18/2pQ4 from the following locatian; JefF Zeibarth 706 N. Arm Dr. Orono,Mn . Unique Well #711469 Coliform Bacteria �l/100 ml Nirrates Nitrogen �1.0 mg/! The resulrs of these r�srs indicate [hai ihis we!!is producing water thaf rrr�ets the st�nd�rds for F.H_A_, V.A., or conventional loans. This report is an ctnplysis for caliform and nitrare nnly and does not include analysis of Lead and other contamrnants. (Unless ns specified by cllenr). ' y Water Clinic, Inc. Bil1 dale La1+C:Crtificntirny�027-453-I 19 . • WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring I„I �ij�� County Name WELL AND BORING SEALING RECORD MinnlesoNa Unique Well No. C Minnesota Statutes,Chapter 1031 or W-series No. c�ea�e aa�a n�a�� a Township Na e Township No. Range No. Section No. Fraction(sm-►Ig) Date Sealed Date Well or Boring Co�structed o�«� i�� 3 4 �,. �,. � GPS Latitude degrees minutes seconds � � LOCATION: Depth Betore Sealing � ft. Original Depth ft. Longitude degrees minutes seconds qqUIFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and Ciry of Well or Boring Location Single Aquifer ❑Multiaquifer WELUBORING Measured ❑Estimated Water Supply Well ❑Monit.Well Show exac loca ion o we or ring Sketc map of well or boring + *�..1 in section grid with"X" location,showing property ❑Env.Bore Hole ❑Other �ft. �below ❑above land surface �ines,roads,and buildings. .� N _..__..__........____._...�_..._.,._,_._}� CASINGTYPE(S) . Steel ❑Plastic ❑Tile ❑Other �- -�-- -� - - � WELLHEAD COMPLETION W � E � ,. � `(}, Outside: ❑Well House Inside: ❑Basement Offset -'r- --;-- -;-- --i-- �}! �^"b �j Pitless Adapter/Unit ❑Well Pit —�- -�-- -i-- --i-- I � ❑Well Pit ❑Buried h S �'—�nM1°—�`� ❑Buried 1 S PROPERTY OWNER'S NAME/COMPAN NAME ` CASING(S) Diam t�r DepM � Set in oversize hole? Annular space initially grouted? Properry owner's mailing address if different than well location address indicated above i�.from�_ t0��ft. ❑Yes �No ❑Yes ❑No ❑Unknown s in.f�Om t0 ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown in.ffOm to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown WELL OWNER'S NAME/COMPANY NAME SCREEWOPEN HOLE � i Well owner's mailing address if different Man property owners address indicated above SCf@2n ffOm�_t0�ft. Open Hole from t0 ft. OBSTRUCTIONS � Rods/Drop Pipe ❑Check Valve(s) ❑ Debris ❑ Fill ❑ No Obstruction Type of Obstructions(Describe)�/�S,L�`��/��L'Q. f[e��' r/ GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM 70 Obstructions removed? Yes ❑ No Describe FORMATION If not known,indicate estimated formation log from nearby well oi boring PUMP Type C f� 1 ( `�Removed ❑ Not Pre ent ❑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 hentonite=50 Ibs.) /� ( GroutingMaterial/(��f�mlLto�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 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. Dor� Stvdala t�11 nrillin� Co., Inc. 27172 Contractor Business ame License or Registration No. �' � `� Ni � �i u ze e e �ve Signa ure Date � ,.� r ��.-t' t'.�...�5'+`..' LOCAL COPY H 2 2 6 i ,5 6 Name of Person Sealing Well or Boring � ��, `5