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Home My WebLink Aboutwell info � s a WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. • County Name WELL AND BORING RECORD 6 4 9 2 4 3 Aenn�pin Minnesota Statutes Chapter 103/ � Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed n. �a v. v. � House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD Cl Cable Tool ❑ Driven ❑ Dug � [] Auger f�Rotary ❑ Je[ted '�� Show exact location of well in section grid with"X". Sketch map of well iocation. ❑ _____._ ..__ . `. Showing property lines, - � �� roads and buildings. DRILLING FLUID WELL HYDROFRACTURED? ❑YES �NO N i i i i � FROM_ ft.to_ _fl. _i_ ___ ___ _i_ r` USE ❑ Monitoring ❑ Heating/Cooling i i i i C Domeslic � ❑ Communiry PWS ❑ Industry/Commercial i i i i �� ❑ Irrigation ❑ Noncommunit PWS �� yy E T � ❑ Environ.Bore Hole Y ❑ Remedial � i � i i ❑ Dewatering ❑ _ i -, i i +ZIM1e CASING Drive Shoe? ❑ Yes ❑ No HOLE DIAM. - _i i i _�_ ❑ S�eel �.".i Threaded ❑ Welded - i - i- -i - i 1 x[7 Plastic �F� ��.sA _ S �—,M,�e_� �/ �``� ��"��`�--'�""� � --f^� CASING DIAMETER WEIGHT � PROPERTYOWNER'SNAME �_in.to..�.��__ft. SI�g��. Ibs./R �J ��t� 3� �lC�iar� Ot Dariene Yiarki� in.to tt. Ibs./ft. �y� in.t�1��ft. F�r - Property owner's mailing address it different than well location address indicated above. in.to____ ft. ____ Ibs./ft. in.to ft. _ SCREEN OPEN HOLE Make_��]� from ft.to ft. Type��a�-a-i$��__��r�� Diam. „ � SIOVGauze Length ��_ ______.___. ._.. • � Set between __.. __ft.and_'�'_¢'�___ft. FITTINGS:'�_g_� � STATIC WATER LEVEL ' WELL OWNER'S NAME a� _____ .__ n.� below ❑ above land surface Date measured 8�_�_�� PUMPING LEVEL(below land suAace) ", Well owner's mailing address if differeM than property owner's addiess indicated above. �___________ft. aRer__�� hrs.pumping____�. __ g.p.m. : Y; WELL HEAD COMPLETION t ' �Pitless adapter manufacturer�,,,a,JY\,��u�[��fi r Model ._....______._ ❑ Casing Protection______ _ T�12 in.above grade - ❑ At-grade(Environmental Wells and Borings ONLY) 6 GROUTING INFORMATION Well grouted? f�i Yes ❑ No GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO Grout Materia� wNeat cement ❑ Bentonite ❑ Concrete ]Q High Solids Bentonite MATERIAL from__�_ to�Q___ft. _"�_� ❑ yds. C�bags from��__td�4.�..__tt. �$�.�}.�llyds. [.1 bags Cla ys,ll Y 3 0! $81 from [o ft. ❑ yds. ❑ bags NEAREST KNOWN SOURCE OF CONTAMINATION ,-,� Ci� Qr$ S Zii� 7V� ,r,:a feet s� ___direction _ ,�.-�_3 .Iutle�,.. Well disinfected upon completion? �� Yes ❑ No �... � Gravei& Cla Gra S 'Q� g � PUMP .^, Notinstalled Dateinstalled R��7�nn l Sand S� CLa B Qm at � �Manufacturer's name ______ _ Modelnumber HP_��.__ Volts L�� F��e Saad b S 1 � �Length of drop pipe_ ZOS� ft. Capacity _____. .,._... _.__g�p.m. �� Type:�I Submersible .�.� LS.Turbine ❑ Reciprocating CI Jet ❑ aIId � ABANDONED WELLS Does property have any not in use and not sealed well(s)? ❑ Yes 'F�'No VARIANCE Was a variance gran[ed from the MDH tor ihis well? ❑ Yes '�1'No TN# _ f` WELL CONTRACTOR CERTIFICATION Use a second sheet,il needed This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. The information contained in ihis report is true to the best of my knowledge. REMARKS,ELEVATION,SOURCE OF DATA,etc. DOI�L_�T�DAL� iTSLL DRt?.T.TItG �/,�./v��-� jj�jC.___ � t Licensee Busines ame Lic.or Reg.No. , 87172 — ___ - uthorized Repres ative Signature Date 6 4 9 2 4 3 Name o ri er ate LOCAL COPY HE-01205-07(Rev.2/99) � , . f . . . rw� c�-y w�-� c � � , r�,� 617 13th Ave So � Hopkins, Minnesota 55343 • (612) 935 - 3556 OS/22/2000 Stodola Well Drilling 3841 North Main St. Bonifacius MN 55375 938-21 1 1 REPORT OF WATER ANALYSIS Lab #: 224 Our Laboracory reports these analytical results, deiermined on a sample taken by CLIENT on OS/21/2000 from the following location: Richard Durkin 1216 N. Arm Dr. Orono,Mn Unique Well#649243 Coliform Bacteria <1/100 ml Nitrares Nitrogen <1.0 mg/I The results of ihese tests indicate that this well is producing water that meets the standards for F.H.A., V.A., or conventional loans. This repor[is an analysis for coliform and nitrate only and does not include analysis of Lead and other contaminants. (Unless as specified by client). �� '_ ity Wacer Clinic, Inc. \� Bill �rs ale Lab Certification#027-053-119 . ;� . . WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HFALTH MIf1118SOtd W811 2fld BOflfl9 'I ��o��/"� � WELL AND BORING SEALING RECORD sea��9 No. i H � County Name Minnesota Unique Well No. � Hensepta M�nnesota Statutes,Chapter 7031 o�W-�erc�SnNo. N �—-- - � Township Name 'Townsh�p No�Fange No Section No. Fraction(sm -i Ig) Date Seaied Date Well or Bonng Consvucred i?COIIO 1�f ,�Z �7 ��Q�.��. Ntumerical SVeet Adtljress or Fire Number a^nd Ciry ot Well or Boring Location / � L�� Ar� �_� VrO�d .7 J iV� Depth Before Sealing_�_� fl. Onginal Depth �l�tl Show exact location of well or boring Sketch map ot wen or bonng qpUIFER(S) STATIC WATER IEVEL in section grid with"X". locauon, showing property Single Aquifer � Multiaqwfer lines,roads,and buildings. N WELUBORING (�leasured ❑ Esamated ater Supply Well ❑Monit.Well r Env.Bore Hole ❑Other _ _�_R. [�elow ❑ above land surface W --�- -i-- -i— --i— E ` CASING TYPE(S) � -i-- -�-- -i-- --i-- � ��A Steel ❑ Plasfic ❑Tile ❑ Other yimi —�- -�-- -�— --�— � GISING�S) Diameter Depth � Set in oveisize hole? Annular space initially grouted? S 't// ,�,�r! �y,-,m;��, � m trom � �o_��.� ft. ❑ Yes ��vo ❑ Yes ❑ No ❑ Unknown �� PROPERTV OWNER'S NAME in.irom to tt. ❑ Yes ❑No ❑ �es ❑No ❑ Unknown Property owner's mailing address A different Ihan well location address indicated above. in.�rom to R. ❑ Yes ❑No ❑ �e5 ❑No ❑ Unknown �g�� Sg a{�.��e SCREEWOPEN HOLE {�S r / Screen from_�_to�� ft. Open Hole from ro ft. OBSTRUCTIONS WELI OWNER'S NAME �Rods/Drop Pipe ❑ Check Valve(s) ❑ Debris ❑ Fill�No Obsiruction Well owner's mailing address if diHerent than property ownefs aatlress mdicated above. Type of Obsiructions(DesCribe) Obstructions removed? ❑Yes ❑ No Describe PUMP Type GEOLOCICAL MATERIAL COIOR HARDNESS OF FROM TO � Removed �Not Present ❑ Other FORMATION If not krawn,indicate estimated fortnation log from nearby well or bonng. METMOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND 80RE HOLE: No Annular Space Exists ❑Annular space grouted with tremie pipe � ❑Casing Perforation/Removal in.from �o ry. ❑ Perforated ❑ Removed in.from }o n. ❑ PeAorated ❑ Removed Type of peAorator ❑ omer - GROUTING MATERIAL(S) (One bag of cement=94 Ibs.,one bag of bentonite=50 Ibs.) � / Grouting Material i��F� �from �_. ro� ft. yards �� bags irom to ft. yards bags from to ft. yards bags from to__ ft. yards bags REMARKS,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 bonng was seated in accc:rdance with Mirnesota Rules,Chapter 4725. The information contained in this report is true to the best ot my knowledge. �n Stodo2e�i�il�'.��iQ�Cc�., 2nc._.--27172 Contractor Business Name License or Registranon l:o. .�C� -,.:3�� :J�l t � epresentative Si� ture Defe £ �'`'.,`' iti�,..,.,,�,��l..�S�v"�,.. .�..._.s__ --_ _. _ LOCAL�C7 E� H 3 7 0 0 5 9 Name ol Person liqg Well or Boring