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Home My WebLink Aboutwell info MINNESOTA UN/QUE WELL WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BOR/NG NO. ICountyName WELL AND BORING RECORD / ` Minnesota Statutes,Chapter 1037 [ � �J� � 3 Township Na e Township No. Range No. Section No. Fraction WELUBORING DEPTH(completed) DATE WORK COMPLETED ,, ,, ,, 228 tt 8-27-07 GPS DRILLING METHOD LOCATION: Latitude degrees minutes seconds � Longitude degrees minutes seconds ❑Cable Tool ❑Driven ❑Dug ❑Auger �'Rotary ❑Jetted House Number,Street Name,City,and Zip Code of Well Location or Fire Number � 1377 North Arm Dr, VLV[R7 S�JVY DRIL�ING FLUID WELL HYDROFRACTURED? ❑Yes No Show exact location of well/boring in section grid with"X" Sketch map of well/boring location. ��er From ft.To ft. Showing property lines, �' N �� -�-.__-�/T�s,buildings,and direction. USE l �No cosmmuni PWS -�Monitoring ❑Heating/Cooling 1 � � � � � _ � '� ty Environ.Bore Hole ❑Industry/Commercial � --'-- '------` --•- j;, j i i i !` ommu WS ion emedial i ❑C nity P J IrrigaT ❑R �� ❑Elevator ❑Dewatering ❑ , �'" , , , , E� ' 1 ASIN IAL OLE DIAM. C G MATER ve Shoe? ❑Yes �No H Dri � --,--- --�--- --�-- ---%— :. 1 � + ❑Steel �]Threaded ❑Welded < , , ; ; Mile Plastic '� � � � --.-- --,--- --.-----:-- 1 „ l y o V, CASING S � v� � Diameter Weight Specitications M p �1 Mile� ^ ^ � � in.to Z� ft. 1�9 Ibs./ft. �� 7 in.to �e� ft. PROPERTY OWNER'S NAME/COMPANY NAME in.to ft. IbsJft. `�4 in.t�`" ft. in.to ft. Ibs./ft. in.to ft. Property owner's mailing address if different than well location address indicated above. SCREEN OPEN HOLE Make 4 From ft. To ft. a4� a� 8� Type.4��1e.4� �t! Diam. _,_____ SIoUGauze �Q�,Q Length�� Set between ft.and ft. FITTINGS p « STATIC WATER LEVEL Measured from �,�-r��-/�� 65 g,�gelow j]Above land surface Date measured�J'�Gl—lJ/ — WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) 2�" ft after ��+ hrs.pumping ��+ g.p.m. WelUboring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION ,.�, �Pitless/adapter manufacturer' .' � - �-� �� '��-•Model ❑Casing Pwtection �12 in.above grade ❑At-grade(Environmental Well and Boring ONLY) GROUTING INFORMATION Well grouted �Yes ❑No Grout materials ❑Neat cement�Benronit�Concrete ❑Othe� From To�(��ft. p�Yds. �Bags � s ❑Bags HARDNESSOF From�To"'^' ft�t�81 j � . GEOLOGICAL MATERIALS COLOR FROM TO +��p �y MATERIAL From Gv� To`��1� [�'ds. Q'�ags NEAREST KNOWN SOURCE OF CONTAMINATION I / J `. `r?�_.J _feet l��l,[J direction �s...�>.r .. 11..�.}--.r�!YP ! � �� e Well disinfected upon completion? �,'�Yes ❑No -��t�-..,.��-��`""� PUMP .� ' I� �� /, '��_�Not installed Date installed '. l Manufacturer's name t �"�� Model Number HP ��Volts `��"�--'� � � � Length of drop pipe '.J`� ft. Capacity g.p.m. " Type: Submersible C 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 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. �_ �t�18 �t t �C,t 71�n�, �•' r�• I691 !. 1 L 111 �,�� —..—_._.-------- — ` Licensee Business Name Lic.or Reg.No. :- /�-�.i' G �t' rt'' d Representative Sigrfatu Certified Rep.No. Date LOCAL COPY � ��6 6 � -- �� — Name of Driller IC 140-0020 HE-07205-10(Rev.6/O6) � l�wi�vv C%t� litl a�"�r�' C ' ' , I v��,c� y 617 13th Ave So � Hopkins, Minnesota 55343 � (612) 935 - 3556 OS/30/2007 Stodola Well Drilling 3841 North Main � St. Boni facius MN 55375 938-21 1 1 REPORT OF WATER ANALYSI5 Lab #: 394BN Our Laboratory reports these analytical results, determined on a sample taken by CLIENT on 08/28/2007 from the following location: �ar��g �Williams 1377 North Arm Dr Orono,Mn Well 750663 Coliform Bacteria Absent Nitrates Nitrogen <1.0 mg/I The results of these tests indicate that this well is producing water that meets the srandards for F.H.A., V.A., or conventional loans. This report is an analysis for coliform and nitrate only and does nor include analysis of Lead and other contaminants. (Unless as speci�ed by client). � :� Twin;��y Water Clinic, Inc. I i ;; ` ,; Bill rsdale Lab Certification#027-053-I 19 MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring �{,� /� �� ? WELL OR BORING LOCATION Sealing No. H L)'�t '" � County Name WELL AND BORING SEALING RECORD Minnesota Unique Well No. ' Minnesota Statutes,Cha ter 1031 or W-series No. +�� P Leave blank�ii no�known) 1 Township Name Township No. Range No. Section No. Fraction(sm.-•Ig.) Date Sealed Date Well or Boring Constructed , OCOII� I17 � U7 � "I�U9� � �Y � C�rI ; . GPS Latitude degrees minutes__ seconds Depih Before Sealing_�ft. Original Depth ft. �OCATION: Longitude degrees minutes__._ seconds IFER(S) STATIC WATER LEVEL ¢ Numerical Street Address or Fire Number and City of Well or Boring Location � ingle Aquifer ❑Multiaquifer �n�` A�� easured i,- i Estimated Date Measured �7��T' �Y`T s I377 North Arm �, Ocorb 55364 �,"B�R�"G � —_ ater-Supply Well ❑Monit.Well l' Show exact location of well or boring Sketch map of well or r g� , �LJ � in section grid with"X° location,showing prop ty �� _,Env.Bore Hole []Other �ft. ' `pelow !]above land surface N lines,roads,and. s. � CASINGTYPE(S) --'-- --'--- --`----`-- � �Steel [1 Ptastic �J Tile ❑Other ��- � --'-----'--- ---`-- ---`-- ELLHEAD COMPLETION W � � , � E — W . __�_____;.__ __�__ .__�__ T �!y Outside: I�_1 Well House �,r]At Grade Inside: �_!Basement Offset � '/M;ip r ,Well Pit I I I I � „ �� -� � � � � � a k ess AdaptedUnd �. Buried �_ , , , , 1 �P�� ------ ------ --.-----:- ; ; ; ; o � � ,_ ❑Buried �Well Pit S � 'Other �t Mile—� �]Other y P P WNER'S1N�A�MEt/CtOs P NY NAME CASING(S) ��il� r�l�� Diam�►ey� � Depth f Set in oversize hole? Annular space initially grouted? Property owner's mailing address if different than well location address indicated above �J / in.from D to �� ft. ❑Yes ;�o �Yes ❑No �]Unknown in.from to ft. I]Yes ��,No [l Yes ❑No rJ Unknown in.from to 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 indica�ed above Screen from_�O to + �ft. Open Hole from to fl. OBSTRUCTIONS [�Rods/Drop Pipe ❑Check Valve(s) J Debris [�Fill ��o Obstruction Type of Obstructions(Describe) GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? ❑Yes �.J No Describe FORMATION PUMP If not known,indicate estimated formation log from nearby well or boring. !,�^�►� '7(/ Type V �'`j' 'J ! 7 ��Removed Not Present ❑Other .__ � i METHOD USEDTO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: I�Jo Annular Space Exists ❑Annular Space Grouted with Tremie Pipe [i Casing Perforation/Removal S� in.from to __ft. ;J Perforated , i J Removed i - in.from to ft. ❑Perforated [;Removed Type ot Perforator . x j_j Other GROUTING MATERIAL(S) (One bag of cement=94 Ibs.,one bag of bentonite=50 Ibs.) i' n /�/ � � Grouting MateriaJ/��/+�� CJ�.' ��rom�� to� ft, yards_� bags 7 ' � _ from to ft. yards bags from to _ tt. yards bags OTHER WELLS AND BORINGS REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING Other unsealed and unused well or boring on property? ❑Yes I o 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 Stadt�la �lI Driilf.ng Co., Inc. i692 Licensee Business Name ' � e/"S License or Registration No. , -�`'� ��_ f� �,Z. �? � � d epiesentative Signature Certilied Rep.No. Date � : 't r.-_ , LGCAL.�GPti' H i��Z� 1 `'�"Y-y.,.. �_.�., ,,��;y�,C.fy � Name ol Person Sealing Well or Boring . HE-01434-10 IC#140-0423 ' . S�p�R WELL O�i BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring H 2�5 312 �County Name WELL AND BORING SEALING RECORD Minnego a�Unique Well No. Minnesota Statutes, Chapter 1031 or W-series No. ' (Leeva�lenk�il not knownJ Township a e Township No. Range No. Section No. Fraction(sm.�Ig.) Date Sealed Date Well or Boring Constructed �� y �� 1 r� i GPS Latitude degrees minutes seconds Depth Before Sealing ��,'�„ ft. Original Depth ft. LOCATION: Longitude degrees minutes seconds A IFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and Ciry of Well or Boring Location , ingle Aquifer [�Multiaquifer /� A W LL/BORING I�,Measured �1 Estimated Date Measured S�f't� !1� � � Water-Supply Well ❑Monit.Well � Show exact location of well or boring Sketch map of well or bo� � in section grid with"X" location,showing pro er - . ❑Env.Bore Hole ❑Other_.___ �ft. �]below ❑above land surtace N lines,roads,and b i in � _, CASING TYPE(S) � --'-----'--- --L----- -- " ' � � � � I I t I th `� --'--- --;--- ---� —`_ `�`J ELLHEA ]P as ic ❑Ti e ------- ��Q1 te [ ❑O er � f W D COMPLETION W , � � � E �� I__ ___;_ � T `� � Outside: ❑Well House �t Grade Inside: [�Basement Offset , --- - - - ---- -- � i - �--' __ � .: ; i ' : 11e 0 �. itless A p r/Und ❑ uried (_,Well Pd a � � 1M O !]P da te B s '�� (]Well Pit i-�Buried �--t Miie—� ❑Other ❑Other PROPERTY OWNER'S NAME/COMPANY NAME CASING(S) � . Di�ayme�r �� / Depth t Set in oversize hole? Annular space initially grouted? Properry owner's mailing address if diflerent than well location address indicated above / '? in.from to ft. Yes No Yes r No � � �._y� o � [] �j ❑ �] �J Unknown in.from to ft. ❑Yes [l�:No ❑Yes ❑No []Unknown in.from__ to ft. ❑Yes ❑No ❑Yes ❑Na ❑Unknown WELL OWNER'S NAME/COMPANY NAME SCREEN/OPEN HOLE � r � � Well owner's mailing address if tlifferent than properry owner's address indicated above SCreen from � �� to � � � ft. Open Hole ffom to ft. � OBSTRUCTIONS ❑Rods/Drop Pipe ❑Check Valve(s) ❑Debris ❑Fill �o Obstruction Type of Obstructions(Describe) GEOLOGICAL MATERIAL COLOR HARONEss oR FROM TO Obstructions removed? ❑Yes ❑No Describe FORMATION If not known,indicate estimated formation log from nearby well or boring. PUMP � dilit 0 �� Type ❑Removed �Not Present ❑Other i� j METHOD USEDTO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: A� No Annular Space Exists []Annular Space Grouted with Tremie Pipe [_I Casing Pertorafion/Removal f in.from to ft. []Perforated [J Removed in.from to ft. ❑Perforated ❑Removed Type of Perforator U Other GROUTING MATERIAL(S) (One bag of cement=94 Ibs.,one bag of bentonite=50 Ibs.) N`�j��,�� /',r /`�� i Grouting Material from__ .� tof 2i`;_ ft. yards�_ bags _ irom 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? [j Yes o How many7 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. tlnn �+tOdO�8-�� 13��CA.� TA�. �$�� L�censee Busness Name icense or Registrahon No. J - io-2-o� i�d epresentative Signature - Certified Rep.No. Date 2 fi 5 312 _'� '�`°"�' LOCALCOPY H Name of Person Sealing Well or Boring HE-01434-70 IC#140-0423 slo7a �