The URL can be used to link to this page

Home My WebLink Aboutwell info r � WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. � County Name WELL AND BORING RECORD �,qt Qn �nnepin Minnesota Statutes Chapter 1031 � �� `�' �-% r Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed .� Q�0[I� }�1.7 Z� 7 ,/< '/< '/ 2�1 n �.1"'12�� GPS DRILLING METHOD LOCATION: Latitude degrees __ minutes __ seconds _, .� r�Cable Tool i] riven � '�.Dug Longitude degrees minutes sewnds �� Auger �otary ❑Jetted Hous'e LNumber,StAree,,t�NamTe�,City,aAnd Zip Code of Welt�Lo�ca/tion or Fire Number �Cl 1,7Y� N [iL`II VL� VCOT�I �S.7Vy DRILLWG FLUID WELL HYDROFRACTURED? ❑Yes o Shop exact location of well in section grid with"X°. Sketch map of w I location. �teC FROM ft.TO_ ft. Showing pro erty lines, N roads an bw�s USE - '�Monitoring ❑Heating/Cooling ; , i '��DomLstic �'Environ.Bore Hole ��'_I Industry/Commercial --- -- I��,_ � I.]Noncbmmunity PWS � '�Irrigation l Remedial Comrtiunity PWS ❑Dewatering `;_ : '-""'' ` `- � CASING � HOLE DIAM. W � E -i !. Drive Shoe? �]Yes �No ._� ; T ' hreaded u elded ,. -�- - � � I —. --� � i S �I T teel �'W PI C '/Mile _ ..` as Ic _ _ 's - -- 1 ` �+' t� �f t p �� j�- ` CASING DIAMETER WEIGHT > c S � � � -/�_in.to_�yL __ Ga�l Ibs./ft. g__in.to�. . �-1 Mile—� „�,I �, 2 in.to_ ____-_ ft. Ibs./R �in.to��t. PR�O+PERTY OWNER'S NAME/COMPANY NAME in.to tt. Ibs./ft. in.to__ft. � �.7L-.OLC �e1S SCREEN OPEN HOLE Property owner's mailing address if different than well location address indicated above. Make ��[f�� FROM _._ ft. TO ft. ,.,. TYPe ._- tY�'" _ --- Diam. ,' SIoUGauze__�VbSt—_-- _Length�� _ Set between�nt ft.and_ �_�__ft. FITTINGS� ~ STATIC WATER LEVEL � `�� ____.� ft.�below �above land surface Date measure��_-�� , PUMPING LEVEL(belo�land surtace) WELL OWNEF'S NAME/COMPANY NAME � __�� ft.after 2_ hrs.pumping � g.p.m. WELL HEAD COMPLETION �y� - Well owner's mailing address if different than property owners address indicated above. �pitless adapter manufacturer_11111t�'117flteC .. M�o/del__ _ '�Casing Protection _ . __ ./'�12 in.above grade ��.,__j At-grade(Environmental Wells and Boring ONLY) r GROUTING INFORMATION ,� Well grouted �Yes ��No � � Grout material �� Neat cement , I Bentonite 'L;,Concrete �High Solids Bentonite � i from�. to�ft. _�_ '._I yds. �bags from�__.to l4b ft.[�$�j]L$�_��. _��bags GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO from to ft. �I_i yds. �`��bags MATERIAL — -"-"-- NEAREST KNOWN SOURCE OF CONTAMINATION � rt 11� �� V �3 �.) ...""' feet -- '�-' direction -.��X�.a ,,._:5:�.,��e Well disinfected upon completion � Yes �_�No ~ PUMP ra soft 13 t30 _ - �_Not installed Date installed __ __��_ f ra $Qr� � 103 Manufacturer's name �C1�t�t ___ ____ _ 1 Model number _.__ ___HP 1 Volts `� f � i88 Length of drop pipe___r n� _ft. Capacity__ . . g.p.m. Type:��, .Submersible �-��LS.Turbine [ �Reciprocating �_�Jet ❑ 1� ZO ABAN ONED WELLS Does property have any not in use and not sealed well(s) ❑Yes � o � VARIANCE >e 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. Useasecondsheet,ifneeded �Z �18 �1�. D=iAli� �� I11�.•• 271T2 3 REMARKS,ELEVATION,SOURCE OF DATA,etc. Licensee Business Name Lic.or Reg.No. Auth��/, j� .. �__ �;��t=� _'_ 12-1 S-Q3 _ ntative Signature Date Ctn�ck Mooce 11-i2-03 �� 4 g� Name of Driller Date _ ; LOCAL COPY He-o,zos-oa�ae�.sioz� � IC 140-0020 # � 7�w%vv Ci,ty litl a,t��r�' C ' ' , I v�►� 617 13th Ave So • Hopkins, Minnesota 55343 • (612) 935 - 3556 1 1/17/2003 Stodola Well Drilling 3841 North Main - St. Bonifacius MN ;5375 938-2111 REPORT OF WATER ANALYSIS Lab #: 1048 Our Laboratory reports these analytical results, determined on a sample taken by CLIENT on 1 1/13/2003 from [he following location: Scott Shekels 1345 N. Arm Dr. Orono,Mn Unique Well#696492 Coliform Bacteria <1/100 ml Nirrates Nitrogen <1.0 mg/1 The resulrs of these tesis indicate that this well is producing warer that meets the srandards for F.H.A., V.A., or conventional loans. This report is an analysis for coliform and niiraie only and does not include analysis of Lead and orher contaminants. (Unless as speci�ed by client). 1 Twin City Water Cli►tic, Inc. c� ,`,\', ' +. Billy ,�sdale \� �, Lab Certification#027-053-119 ,.-R� �. . �.�.; __ _ _._.: , _ _ . __ _ wELL OR BORING�oCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring I„' � Sealing No. CountyName WELL AND BORING SEALING RECORD Minnesota Unique Well No. ��i� Minnesota Statutes,Chapter f031 or W-series No. (Leave blank�I not known� Township Name Township No. Range No. Section No. Fraction(sm-i Ig) Date Sealed Date Well or Boring Constructed 4rono I l l 23 6 41-0086 � �F L a GPS Latitude degrees minutes seconds � � LOCATION: Depth Before Sealing �� ft. Original Depth �� ft. Longitude degrees minutes seconds IFER(S) STATIC WATER LEVEL Numerical SVeet Address or Fire Number and City of Well or Boring Location ingle Aquifer ❑Multiaquifer 1345 I� Ar� D�c �L'Qj�Q ��7� UBORING ,�leasured ❑Estimated �VJater Supply Well ❑MoniL Well t Show exact location of well or boring SkeYch map of well or oring in section grid with"X" location,showing pro rty ❑ Env.Bore Hole ❑Other �ft. �elow ❑above land surface N line�,and buii ngs� CASING TYPE(S) � Steel ❑Plastic ❑Tile ❑Other W -- - - - - -- --;- E � WELLHEAD COMPLETION d � � r , � � �_^—� Outside: ❑Well House Inside: ❑Basement Oftset '� --- -�-- -;-- -�-- �, � y�mi�e i� � Pitless AdaptedUnit ❑Well Pit � -�-- -i-- -i-- --�- � . �� '� � •f.i� \ ❑Well Pit �Buried s 'r � �—""'b—--� � ❑Buried P PERTY O ER' NF�AE/COMPANY NAME CASING(S) �Cat C �ze�Cet.� Diam ter�� Depth,r��ry t Set in oversize hole? Annular space initially grouted? Property owner's malling address if diflerent ihan well location address indicated above }��y+( in.from� t0�L ft. ❑Yes �No ❑Yes ❑No ❑Unknown in.from t0 ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown in.fforrl t0 ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown WELL OWNER'S NAME/COMPANY NAME SCREEN/OPEN HOLE � � Well owner's mailing address if different than property owner's address indicated above Screen from�t0 �� ft. Open Hole from t0 ft. OBSTRUCTIONS �Rods/Drop Pipe ❑ Check Valve(s) ❑ Debris ❑ Fill ❑ No Obstruction Type of Obstructions(Describe) —�/tf/�`� /---�'� �" • U�� GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? Y2S ❑ NO DeSC�ib2 FORMATION If not known,indicate estimated forma�ion log from nearby well or boring PUMP Type �C�, pV�� 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 r Type of perforator ❑ Other GROUTING MATERIAL(S) (One bag of cement=94 Ibs.,one bag of bentonite=50 Ibs.) I, /j��/� /'� t Grouting Material,N��-/��•'�-'�from�S.L 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 �Jo 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 Stodola t�ell Drillin�, Co., Ir�. 27172 � � Contractor Business Name License or Registra�ion No. __ /�% �� :.� A ori presentative Signatur�__ Date ' C`�y l- -- LOCAL COPY H ��O V V r � ��"�..�'Y~� :-V.,. �. Name of Person Sealing Well or Boring ,