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Home My WebLink AboutWell info WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. �o��YName WELL AND BORING RECORD 6 5 5 0 2 8 Henne in Minnesota Statutes Chapter f03/ Township Name - Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed n. Orono 117 23 OT ,. ,. ,. 247 IO-23-00 House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD 112 5 N Arm Dr Orono 5 5 3b4 ❑ Cable Tool ❑ Driven [] Dug � . ❑ Auger ti[yl4otary ❑ Jened !:. Show exact location of well in section grid with"X". Sketch map of well location. ❑ _ /� � ----__ --... � Showing property lines, S �and buildings. DRILLING FLUID WELL HYDROFFACTURED? ❑YES�O N �cI t..�...�,Y�. � i i i i uick� el FROM fl.to ft. - _i_ _i_ _i' _i_ USE ❑ Monitoring ❑ Heating/Cooling i i i i �omestic ❑ Communit PWS -�- --�- -�- -�- ❑ Irrigation Y �J Industry/Commercial i i i i r -^� ❑ Noncommunity PWS ❑ Remedial w i l e T �� ! ❑ Environ.Bore Hole ❑ Dewatering ❑ i , i i '/zIM e +�1` CASING �Drive Shoe? ❑ Yes 6 No HOLE DIAM. _i i i _�_ � .._,,,_,�„�„�„_ ❑ Steel ❑ Threaded _ �� ❑ Welded � � � � �.plastic ❑ s �1 Mila� CASING DIAMETER WEIGHT PROPERTY OWNER'S NAME �in.to �A_ft. __ BfI t"��_ Ibs./fl. L��_� ; Valerie Fetersen —_ ��.to-----h __ _ �bs�h. ��.�0��47 Property owner's mailing address if different than well location address indicated above. _.__ in.to ft. ___ Ibs./fl. in.to__tt. SCREEN�� OPEN HOLE Make uv�l�t3�7i1 irom ft.to ft. .... ----------. .. -. Type S t A�i!� 14 t;�_t_��_Diam. __ SbUGauze'.v1(1 Length�l_ ,� � f _ Set between _ ft.and it. FITTINGS: -_-�---- �- STATIC WATER LEVEL t WELL OWNER'S NAME 8� ft.�.below ❑ above land surface Date measured 10�'23 0 /C PUMQPING LEVEL(below land surface) Well owner's mailing address if different than property owner's address indicatetl above. Z C7� _ ft, after 2 hrs.pumping_ 2�_g.p.m. WELL HEAD COMPLETION �Pitless adapter manufacturer vjf��evs t o r Model l7 Casing Protection �12 in.above grade , ❑ At-grade(Environmental Wells and Borings ONLY) � GROUTING INFORMATION Well grouted?�Yes ❑ No GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO Grout Materia� !] Neat cement ❑ Bentonite f 1 Concrete �Fligh Solids Bentonite MATERIAL from to �Q ft. ❑ yds� bags �-_ �V. ._��i� from to ft bags f „J from� _ to�ft. �8 �r8 ��.� bags NEAREST KNOWN SOURCE OF CONTAMINATION feet direction type f. a --- Well disinfected upon completion? �Yes ❑ No PUMP ❑ Not installed Date installed Manufacturer's name ° Model number _ HP� Volts_9 9 A iti7V- Length of drop pipe 1[�S _ ft. Capaciry ________g.p.m. Type:�ubmersibie G LS.Turbine ❑ Reciprocating ❑ Jet ❑ ABANDONED WELLS Does property have any not in use and not sealed well(s)? ❑ Yes �No VARIANCE Was a variance granted from ihe MDH for this well? ❑ Yes �o TN# 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,etC. The information contained in this report is true to the best of my knowledge. y .� �._y L�b�� ine JJi A1�1 Li. sg.iVo.li�<� L/ 7� �: < r : " .._.....« ,,� -� �. : �,;;�-. _ ' 11–I-00 � � Authorized Representahve Signature � � � Date Duane Mathevs IQ-23-00 6 5 5 0 2 8 Name oi Driller Date LOCAL COPY HE-01205-07(Rev.?J99) � r t� rw�;�, c�-y w�-� c � � � r�,�. 617 13th Ave So � Hopkins, Minnesota 55343 � (612) 935 - 3556 t o/25/2000 Stodola Well Drilling 3841 North Main St. Bonifacius MN 55375 938-21 1 1 REPORT OF WATER ANALY5I5 Lab#: 512 Our Laboratory report-s rhese analytical results, determined on a sample taken by CLIENT on 10/23/2000 from the following location: Valerie Petersen 1125 N.Arm Dr. Orono,Mn UNique Well #655028 Coliform Bacteria <1/100 ml Nitrates Nitrogen <1.0 mg/1 The resulis of[hese tests indicate thaC this well is producing water 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 not include analysis of Lead and orher contaminanis. (Unless as speciFed by client). i ater Clinic, Inc. Bill n dale Lab CeRification#027-053-119 . • ` MINNESOTA DEPARTMENT OF HFALTH Minnesota Well and Boring +� ")'�/'�� WELL OR BORING LOCATION S@811f19 NO. II H j � � �o��Y Name ---- — WELL AND BORING SEALING RECORD M;��esota u��q�e wen No. r ----- -- Minnesota Statutes,Chapter 1031 or W-series No. I - - I e�ne�pin �,�.a�,k n��k�,�, �- _J Township Name�.Townsh�p No �Range No�Sect�on No Fracuon fsm -s Iq.) Dale Sealed Date Well or Boring Constructed I I �*� � � � —v-LL_� - Numerical Street Adtlress or Fire Number and Ciry of Well or Bormg Location Q � � Depth Before Seal:ng t�„�N O�iqinal Depth �� n. Show exact location of well or bonng Sketch map of we�l or onng AQUIFER(S) STATIC WATER LEVEL in section grid with"X". location. showing pr perty Single Aqwfer ❑ Multiaqwfer lines,roads,and build gs.. N WELUBORING Measured ❑ Estimated ','� � � � � Water Suppry Well ❑Monit.Well � \ � ❑ Ern.Bore Hole ❑Other _ ft. �below ❑ above land surtace l �� W -�- -i-- -i-- --i— E CASING TVPE�S) � � � � ^� . , , � ' -;-- -;-- -;-- --�-- � (((��-�\\\�� Steel � Plastic �Tile � Other � � I I Ylmile F+ —�- -�-- -1-- --�-- � 1� CASING(S) --�,R i� Diameter Depih � Set in oversize hole? Annular space initially qrouted7 S • !t 1� 4 „�;�—�, `� � in.from.�_ to� tt. ❑ Yes �No ❑ Yes ❑No ❑ Unknown I PROPERTY OWNER'S NAME in.trom to tt. ❑ Yes ❑ No ❑ �es ❑No ❑ Unknown � w Property owner's mailing address B diflerent than well location address indicaled above. m.from to ft. ❑ Yes ❑ No ❑ Yes ❑No ❑ Unknown SCREEWOPEN HOLE '� Q+�' f Screen from�_to�� ft. Open Hole from to R. OBSTRUCTIONS WELL OWNER'S NAME Rods/Dro Pi l� ❑ p pe ❑Check Valve(s) ❑Debris ❑ Fill yp No Obstruction I� Well owner's mailing address if diflerent ttian property owner's add�ess indicated above. Type o(Obstructions(Describe) Obstructions removed? ❑Yes ❑ No Describe PUMP Type OEOLOOICAL MATERIAL COLOH HARDNESS OF FROM TO � Removed Not Present ❑ Other FOHMATION if not known,indicate estimate0lormatan log from nearDy well or bonng. METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: . � , o Annular Space 6cists ❑Annular space grouted with tremie pipe ❑Casing Perforation/Removal � in.from �o n. ❑ Pertorated ❑ Removed in.from �o tt. ❑ Perforated ❑ Removed Type of perforator < ❑ Other GROUTING MATERIAL(S) (One bag of cement=94 Ibs.,one bag of bentonite=501bs.) f GrouGng Material rom _� to�� ft. yards _�_ bags from to ft. yards bags from to ft. yards bags from to__ R. yards bags REMARKS,SOURCE OF DATA,DIFFlCULTIES IN SEALING OTHER WELLS AND BORINGS ��T Other unsealed and unused well or boring on property? ❑Yes c How many? LICENSED OR REGISTERED CONTRACTOR CERTIFICATION � This well or bonng was sealed in accordanca with Mincsso'a��.,�e�.Chanter a72` 1'�e IMorrriatio^