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Home My WebLink Aboutwell info � �_�. WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH MIN AND BOR/N'�G NOWELL ' co,;,,tYN-ame '' WELL AND BORING RECORD � r: H�er�epin Minnesota Statutes,Chapter 1037 P � �� 7 Township Name Township No. Range No. Section No. Fraction WELUBORING DEPTH(completed) DATE WORK COMPLETED Ot'Cl[l0 117 �� Q? ,i y, y, n _ GPS DRILLING METHOD LOCATION: Latitude degrees _ minutes seconds Longitude degrees minutes seconds ❑Cable Tool ❑Driven ❑Dug ❑Auger T�Rotary ❑Jetted House Number,Street Name,City,and Zip Code of Well Location or Fire Number � � � 31b9 Nocth Atm �r, vLV�iV SS.7V'i DRILLING FLUID WELL HYDROFRACTURED? ❑Yes No Show exact location of well/boring in section grid with"X" Sketch map of well/boring lo ationl� �t�ute From R.To ft. Showing propert line � .; N , . roads,buildings,and dir ctio ' USE �dt Domestic �_j Monitoring ❑Heating/Cooling � � � � � � �- C 'ci . __;__ __,___ ___�____i__ ❑Noncommunity PWS �]Environ.Bore Hole ❑Industry/Commercial • ��'�"� � ❑Community PWS �_.]Irrigation ❑Remedial � , � � � ; I I I �� ` '-'--- '-i--- ---`'----t- � - � ❑Elevator LJ Dewatering ' w � � ; ; E CASING MATERIAL Drive Shoe? �Yes ❑No HOLE DIAM. �� --�--- --�--- ---�-----:— T �Steel ❑Threaded ❑Welded � , , , , Miie 'h � ' I ' I ❑P ❑ --:--- ---.------�-----.-- 1 lastic ; ; � � i CASWG S �� Diameter Weight Specifications �1 Mile� •yFy �in.to�ft. 11 Ibs./ft. � in.to .7V ft. �j PROPERTY OWNER'S NAME/COMPANY NAME in.to ft. Ibs./ft. _ �in.t�65 n. an lS1�83 in.to ft. Ibs./ft. in.to ft. � SCREEN OPEN HOLE Property owner's mailing address if different than well location address indicated above. 4,.� �O� `��y=� n��' �� y�O� Make �lAl$� From ft. To ft. A1 kSill D �1 Type ��t�i ral� � gt1 Diam. �! � 55�+ SIoUGauze ��ll n Length ,�� .F (�� Setbetween ft.and_�_ft. FITTWGS M STATIC YJATER LEVt Measured from 11� ft Below ❑Above land surface Date measured w WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) �� ft.after � hrs.pumping `fJ g.p.m. Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION .p.. � �Pitless/adapter manufacturer L]��s��-x"i"'""""�`'�`� ❑Casing Protection �12 in.above grade ❑At-grade(Environmental Well and Boring ONLY) GROUTWG INFORMp,T}ON Well grouted �'Yes ❑No Grout materials ❑Neat cement �Bentonite Concrete ❑Other From O To � ft. � ❑Yds. (�Bags HARDNESS OF From � To �� .natucal f�l,.�. ❑Bags GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO From To ft. ❑Yds. ❑Bags NEAREST KNOWN SOURCE OF CONTAMINATION r cla Ilv� ieedi�n 0 22 ' - � ,�� _ . ° y � feet direction '� � type a� Well disinfected upon completion? �Yes ❑No �.+u-.��. ��v-��---� ; CI8 I� ��1� GZ 1ZO PUMP ^--� q �Not installed Date installed ��j /l( �"� ( ��[� silt/sand � .�ft ZG� 235 Manufacturer'sname `—�--�-�''�"� '-4'�'-' ` t C�8 /� �`t �� n�� Model Number HP � '� Volts �"�� a � L' ''7 Length of drop pipe !7 ! ft. Capacity g.p.m. � ��t�C, � �� q/Q ^LC Type: Submersible ❑LS.Turbine ❑Reciprocating [�Jet ❑ ��3 �� ABANDONED WELLS Does property have any not in use and not sealed well(s)? ❑Yes No VARIANCE d 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. ikm Stadola WE11 Drilling Co,. Inc. 169I Licensee Business Name Lic.or Reg.No. /� ��-�� rti epresentative Signat Certified Rep.No. Date 7 �o V lJ � Name of Driller J� �� LOCAL COPY --- -- IC 140-0020 HE-07205-70(Rev.6/O6) � 1 rw�,�. c�-y w�� c � � , r� 617 13th Ave So � Hopkins, Minnesota 55343 � (612) 935 - 3556 09/17/2007 Stodola Well Drilling 3841 North Main ~ St. Boni facius MN 55375 938-21 1 1 REPORT OF WATER ANALYSIS . Lab#: 426BN Our Laboratory reporrs these analytical resulis, determined on a sample taken by CLIENT on 09/12/2007 from the following location: Ryan Ainess 1169 North Arm Dr. Orono,Mn Well 750667 Coliform Bacteria Absenr Nitraies Nitrogen <1.0 mg/1 The results of these tests indicate that 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 nirrare only and does nor include analysis of Lead and other contaminants. (Unless as specified by client). Twin C'ty Water Clinic, Inc. ' 8�� n rsdale . Lab Cert�cation#027-053-119 WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesofa Well and Boring I„I �(,��Q �`ountyNarr� WELLAND BORING SEALING RECORD Minnle9oa�UniqueWellNo. `''� �� p f� Minnesota Statutes,Chapter 1031 or W-series No. (Leave Dlank'i�not knownJ Township Name Township No. Range No. Section No. Fraction(sm.-�Ig.) Date Sealed Date Well or Boring Constructed Ocvc�o 1I7 23 O7 '' '' '' 2l0 < Ga � GPS Latitude degrees minutes seconds Depth Betore Sealing ft. Original Depth_ _fi. �� LOCATION: Longitude degrees minutes seconds Q IFER(S) STATIC WA7ER LEVEL ��y Numerical Street Address or Fire Number and Ciry of Well or Boring Location ingle Aquifer �MWtiaquifer � ,��'" � WF�L/BORING �vleasured �._Estimated Date Measured�/T��_ - �rWater-Supply Well ❑Monit.Well i Show exact location of well or bonng Sketch map of well or nn — in section grid with"X° location,showing prop ❑Env.Bore Hole ❑Other �R. �below _,�above land surface lines,roads,and buildi gs.� CASING TVPE(S) N �. _''_____'__' _"`"'__`__ �Steel !J Plastic ❑Tile �_]Other __ _ I ----- ----' -' ' -- -- 4,,` WELLHEAD COMPLETION , ' ' '`- a W ; ; : - ` ET �.� _ . �i __;.__ __;__ __�__ ___�__ � Outside: I, �;Well House ❑At Grade Inside: ['��..Basement Offset �� , � � � � '�. � � � � less A p dUnrt ❑Buried ❑Well Pit '�M'� �it da te •' --�-----�--- ---�— --�- I ❑ uned B ' � � S � � L ,-]Well Pit 'r—i Miie—� []Other ❑Other i. P 08 PERTY NER'S NAME/COMPANY NAME CASING(S) 1 Rvan �� ,�o�•�+ Dia1nate�� f Depth r Set in oversize hole7 Annular space initially grouted? � Properry owner's mailing address it diKerent than well location address indicated above �1 � y/� T in.from� to�ft. �]Yes o ❑Yes �'�.No ❑Unknown aPfll7 Q��il� D1Y(1 f �t ��2 . �� y� ee.�`t in.from to h. ❑Yes I ��;No ❑Yes �I No ❑Unknown YM7 aJ,7V't in.from to ft. ❑Yes �_I No f�Yes ;]No ❑Unknown WELL OWNER'S NAME/COMPANY NAME SCREEN/OPEN HOLE • � We�l owner's mailing atldress if different than property owner's address indicated above SCreen from_�to�ft. Open Hole from to ft. OBSTRUCTIONS � ❑Rods/Drop Pipe !�]Check Valve(s) [-'��;Debris ❑Fill �lo Obstruction Type of Obstructions(Describe) _ GEOLOGICA�MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? ❑Yes [i'No Describe FORMATION PUMP If not known,indicate estimated formation log from nearby well or boring. . ( ' � ` �� TYPe �. ❑Removed Not Present ❑Other METHOD USEDTO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: �lo Annular Space Exists U 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.) Grouting Material��=Q/ �//,1"��or m u ` to �-+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 o How many? LICENSED OR REGISTERED CONTRACTOR CERTIFICATION This well or boring was sealed in accordance with Minnesota Rules,Chapter 4725.The information wntained in this report - is true to the best of my knowledge. ik�st Stodoltt t+1�I1 Ikilling Co., Inc. 1.69I Licensee Busine s e -�. License or Registration No. ^ ,�- / /' / �� ..�'� �� '-..J t, erC d epresenta roe Signature Certified Rep.No. Date . LOCF,L CCPY H �_._..._.. --�..=, �, .. .r..��'"�..✓ 2 6 4 2 9 9 Name ol Person Sealing Well or Boring HE-01434-10 IC#140-0423 . 5/a�a