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Home My WebLink Aboutwell info MINNESOTA DEPARTMENT OF HEALTH M�nnesota Well and Bor�ng ` MIELL OR BORING LOCATION Sealing No. i H 14 6 0 6 5 Counry Name H��n� �� WELL AND BORING SEALING RECORD Minnesota Unique No. ---- � Mmnesota Statutes,Chapter 1031 or W-series No. � ILeave dank�1 rwt known) Township Name Township No. Range No. Sec6on No. Fraction(sm.�s Ig.) Date Sealed Date Well or Boring Constnictetl ro�o 117 23 08 " ` � RJ �}r'? Numerical Street Address or Fire Number and Ciry of Well or Bonng Lowtion � � IJ�� r�.�l L�r� Drive Orono, � DepthBeforeSealmg N. OrigmalDepth �it. Show e:ad locatio�of w•ell or boring l� Sketch map of well or bonng A�UIFER�S) STATIC WATER LEVEL in section gnd with'X'. location, showing property Smgle Aywter � Muqiaqwfer ` } lines,roads,and buildmgs. N i � WELI/BORING Measured ❑ Estimated ' "� - Water Supply Well ❑Monit.Well �+r / - - - - - — - -- �. � � ❑ Env.Bore Hole ❑Other _ _� � fl. �]pelpw ❑abovg la�d suAace t W —�- -i-- -i-- --i-- E � f CASING TYPE(S) � � � � ` -r- -�-- -i-- --�-- � :�—��, �Steel ❑Plastic ❑Tile �Other .o u m�ie . � � , , � � � : - .___...._-. CASING --�- -�-- -i-- --i-- . : � �"'--�� Diamet/r� Depth f Set in overslze ho1e7 Arrriaiar space Krtielly grouled7 ' g 1 � t �_r,,,�,—�. �—- � m.irom� ro �� R. ❑ves �No ❑ves ❑No ❑u�rawn PROPERTV OWNEH'S NAME in.from to fl. ❑ Yes ❑No ❑ Yes ❑No ❑UNcnown Mar ar�t Pelto�ra Property owner's mailirg address if diflerent than well IocaUon address indicated above. in.from to fl. ❑ Yes ❑NO ❑Yes Q No ❑UnWlOwn SCREEWOPEN HOLE ��f � f Screen from�`�to� fl. Open Hole from b 11. OBSTRUCTIONS YVELL ONMER'S NAME Rods/Dr Pi oo ve ❑cn�vanrecs) ❑��5 ❑ F�n ❑nio oo�� Well ownefs meilirg address N ditterent than propeAy owner's address inAicateA above. Type of ObslruCtions(DeSCtibe) �,L iF'�,Y�,1 /_/.��Cl� /— /`��C/�� Obstructions removed? Yes ❑No Describe PUMP Type ST��f. �Uml' fiEOlO(i1CAL MATERIAL COIOR HARDNESS OF FROM TO Removed ❑ Not Present ❑ Other FORMATION M na1 kravm,indica�e estimeted lortnatbn log from nearby well or bonng. METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINCS,OR CA,��MK'AND BORE HOLE: ...1 . t / ., No Annular Space Exits ; fi ,.� r 1 __ ❑ Annular space grouled wiM tremie pipe ❑ Casing PeAaataNRemoval in.from to fl. ❑ PeAorabd ❑ Renqred in.from to fL ❑ Pbrbrabd ❑ Rertwr'ed - Type of pertorata ❑ Otl�er GROUTING MATERIAL(S) �3n ',�T �� Grouting Material N�...I��//��'�lrom � ro R. ya�ds� bags frOm to R. Yards baps rr«o m a ya�as e.gs nom m a ra�es wyc REYARKS,SOURCE OF DATA,DIFFlCULTIES IN SEALING OTHER WELLS AND BORINGS Olher unsealed and unused well or boring on propertyl ❑Yes No How ma�� LICENSED OR RE('a1STERED CONTAACTOR CERTIFICATION This well or boring was sealed in accordence wilh Minnesorta Rules.Chapter 4725. The irom�etion oor�nad n tlrs iaport e tn,e ro me test a my know�edge. - DUN STQDOLA WELL DRILLING CO. , INC. 27172 Contractw Business Name i" �iosrrsr or Repstwon r:o. r• �,. �,;` � !'� A epresentatnre SigneNre' " Q�M x ,�` ..�: .,� LOCAL COPY H 1,4�iJ�S ��a P��W��e HE-01�34-03 2/97 R � , � N�ELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. �o��,Y Name WELL AND BORING RECORD 6 2 3 5 5 2 H�nne�i n Minnesota Statutes Chapter f03/ - Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed Orono 11? 23 OS �. �. ,�. t01 ' " 11-5-98 House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD � � 1550 North Al`11! Drive �L�OIlO♦ . ❑ CableTool ❑ Driven ❑ Dug ❑ Auger �[Rotary ❑ Jetted Show exact location ot well in section grid wi[h"X". Sketch map of well location. ❑ Showing property lines, � roads and buildings. DRILLING FLUID WELL HYDROFRACTURED? ❑YES NO N ,:.;.. _i i i �_ � Bentonite FROM ft.to ft. i_ ___ ___ _i .. l�• � USE Y ❑ Monitoring ❑ Heating/Cooling . i � i i �i � fi3 Domestic _i_ _�_ _�_ �_ � ❑ Community PWS ❑ Industry/Commercial ; i i � i w ❑ Irrigation ❑ Noncommunit PWS W E T a. � ❑ Environ.Bore Hole Y ❑ Remedial � i i � I �,` ❑ Dewatering ❑ -r -�- -r- -r i i i i +/ZMia � � CASING Drive Shoe? CJ Yes No HOLE DIAM. _i i _L_ _i_ � � ❑ Steel ❑ Threaded ❑ Welded i - i- i i l �Plastic ❑ S �-1 Mile-{ CASING DIAMETER WEIGHT PROPERTY OWNER'S NAME � 92 SDR.21 Margaret Peltola '" `° ft. Ibs./ft. in.to n. in.to ft. Ibs./ft. in.to ft. Property owner's mailing address if different than well location address indicated above. in.to ft. Ibs./ft. in.to ft. SCREEN OPEN HOLE �� Make Johnson from ft.[o ft. " TyPe Stair►less St..�Q.�Diam. � ,�h SIoVGauze Length � � Set between ft.and it. FITTINGS: - STATIC WATER LEVEL WELL OWNER'S NAME '�J rJ� ft. �elow ❑ above land surface Date measured �1'�5�9 PUMPING LEVEL(below land surface)t 1 Well owner's mailing address if different than property owner's address indicated above. 8� ft.�afler 1 hrs.pumping 1� g.p.rri. WELLHEADCOMPLETION �itevater � l�Pitless adapter manufacturer Model k ❑ Casing Protection 12 in.above grade ❑ At-grade(Environmental Wells and Borings ONLV) GROUTING INFORMATION Well grouted? ❑ Yes ❑ No GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO Grout Material ❑ Neat cement ❑ eentonite ❑ Concrete ❑ High Solids eentonite MATERIAL from to ft. ❑ yds. ❑ bags (,`1 a y Ye 1 bc� �J (�� from to ft. ❑ yds. ❑ bags from to ft. ❑ yds. ❑ bags �],a�I Grey �' �Q� � fNEARESTKNOWNSOURCEOFCONTAMINATION feet direction type Well disinfected upon completion? �1 Yes ❑ No Gravsl Yello S 50' S ' PUMP I3-5-98 C13It Grey S ��• g �� Notinstalled oR��ue �C e � Manufacturer's namy� � Sal�a +i+a� �' C37 1 �4 tModel number t) HP voics Length of drop pipe ft. Capacity g.p.m. Type:4�] Submersible ❑ L.S.Turbine ❑ Reciprocating ❑ Jet ❑ ABANDONED WELLS y Dces property have any not in use and not sealed well(s)? ❑ Yes t'9 No VARIANCE Was a variance granted from the MDH for this well? [1 Yes ❑ No TNM �� 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,;e1C The information contained in this report is true to the best of my knowledge. j D4N ST�DQ�LA WELL DRILLIIdG C0. , INC. i � , _�;_,� � � V � License Business Name Lic.or Reg.No. 2'T;'7 2 . � 1-I9-98 - �- ,; , Authorized Representafive Signature Date .,�. .. Frec� Lefby 11-5-98 Name of Driller Date - LOCAL COPY 6 2 3 5 5 2 HE_o,2o��,Re�.,�e, 1 �Y c7 � ,� / n Jwin �it I/Vater ��ircic, J"ric. � 617 13th Ave So • Hopkins, Minnesota 55343 • (612) 935 - 3556 11/07/1998 Stodola Well Drilling 3841 North Main St. Bonifacius MN 55375 938-2111 REPORT OF WATER ANALYSIS Lab#: 36087 Our Laboratory reports these analytical results, determined on a sample taken by CLIENT on 11/04/1998 from the following location: Margaret Peltola 1550 N. Arm Dr. Orono,Mn Unique Wiell#623552 Coliform Bacteria <1/100 ml Nitrates Nitrogen <1 . 0 mg/1 The results of these tests indicate that this w�ell 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 other contaminants. (Unless as specified by client). it W er Clinic, Inc. . Bill le , Aoalyiwl labonwry CoroultiWg F�g�roer Wator AnAyeie ReageuU Boilar Watar Chomioale Lsb Certification�027-053-119