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Home My WebLink Aboutwell info � \ 1 — ' � � WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIC?UE WELL NO. -�� CountyName WELL AND BORING RECORD / � C Minnesota Statutes,Chapter 103I r ��,E Q'� � Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed n. y, y, �i �, GPS DRILLING METHOD LOCATION: Latitude degrees minutes seconds �� _ Longitude degrees minutes seconds �__�Cable Tool i nven ,;Dug ��Auger ��,Rotary ��Jetted House Number,Street Name,City,and Zip Code of Well Location or Fire Number U ��"DRILLING FLUID WELL HYDROFRACTURED? ��i Yes ` � o Show exact location of well in section grid with"X". Sketch map of well locati�� $t�r FROM fL TO ft. Showing property lin '� roads and buildin s�. USE N ,��Y� ,,,/// ❑Monitoring ❑Heating/Cooling �Domestic �,i Environ.Bore Hole� [;Industry/Commercial -- -- - -- v J Noncommunity PWS r�Irrigation ,_,'Remedial - � � � ; ❑Dewateri ❑ , , , €� ,.�.. ❑Community PWS ng � --i--- --�------;-- ---`-- ' ' CASING HOLE DIAM. ; W � ; ; ; E T Drive Shoe7 �]Yes _--No � �Q -- -- -- - -- I . �-- -_ p ��.Steel ❑Threaded i Welded '/z Mile 11StiC ❑ ___ -i- ' : i ; __'___ _"___ __�__ ___;__ 1 4,1 CASING DIAMETER WEIGHT S Z/\ � in.to �� ft. ��01 IbsJft. � in.to -��}f - �1 Mile� b � . _ .___ — . __—_ �� Q� • - � � - in.to __ft. IbsJft. "7 in.to ��4f. � PROPERTY OWNER'S NAME/COMPANY NAME in.to ft. Ibs./ft. in.to ft. ,�, SCREEN OPEN HOLE Property owner's mailing address if different than well location address indicated above. Make FROM_ ft. TO ft. � � �� Type St '�f1 �S��.l,___ Diam. ,_ SIoUGauze______�� ._____Length� .R �t Set between ft.and it FITfINGS � STATIC WATER LEVEL 1� ft. below [�above land surface Date measured 1��ZTV.J PUMPING LEVEt(below land surface)• ' ' WELL OWNER'S NAME/COMPANY NAME ZpV ft.after 3 hrs.pumping 18 g.p.m. WE L HEAD COMPLETION �.L.t Well owner's mailing address if diFferent than property owners address indicated above. itless adapter manufacturer R[ilt��.£�P �M��o�d I______ - � =1 Casing Protection _ '��12 in.above grade �i At-grade(Environmental Wells and Boring ONLY) � GROUTING WFORMATION � Well grouted �Yes ❑No � � . Grout material . i_;Neat cement [,i Bentonite �;;Concrete�High Solids Bentonite from O to_�p fL � [ !yds. �bags from � to �p3 ft. ��81 �� ]bags GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO from to tt. MATERIAL ❑yds. i��bags � NEAREST KNOWN SOURCE OF CONTAMINATION � F �=� feet ��. directi6n r �� type Well disinfected upon completion � Yes ❑No PUMP ��Not installed Date installed Z"'7�i Manufacturer's name � Model number _ HP�__Volts i Length of drop pipe 1�7 ft. Capacity g.p.m. � Type:�Submersible ��LS.Turbine []Reciprocating ❑Jet ❑ ABA ONED 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? ! i 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 irue to the best of my knowledge. Use a second sheet,il needed �+ � REMARKS,ELEVATION,SOURCE OF DATA,etc. � .7tc�dola Well 1�iI lia� Co,• iQC• �/1/{, Licensee Business Name � Lic.o eg.No. 7 x-��w ho resentative Signatur� Date C�C MDOL'+� iZ�Z9—�3 LOCAL COPY � NameofDriller �� 59 .�1 HE-01205-08(Rev.5/02) � IC 140-0020 � • , . • i i i i rw�. c�-y w�� c , r�� 617 13th Ave So � Hopkins, Minnesota 55343 • (612) 935 - 3556 ' Ol/05/2004 Srodola Well Drilling 3841 North Main St. Bonifacius MN 55375 938-21 1 1 REPORT OF WATER ANALYSIS Lab #: 1150 Our Laboratory reports these analyiical results, determined on a sample taken by CLIENT on 12/29/2003 from the following location: Don Winter 4620 N.Arm Dr Orono,Mn Unique Well #705901 " .. Coliform Bacteria <1/100 ml Nirrates Nitrogen <1.0 mg/I � The resulis of these iests indicaie ihai chis well is producing water ihai meeis rhe 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 contaminanis. (Unless as specifed by client). `T in City Water Ginic, Inc. Bill sdale Lab Certification N 027A53-I 19 �' t WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH P�linnesota Well and Boring I„' C � Sealing No. CountyName WELL AND BORING SEALING RECORD Minnesota Unique Well No. ��n Minnesota Statutes,Chapter 1031 or W-series No. �Leave blank ii not known� Township Name Township No. Range No. Section No. Fraction(sm->Ig) Date Sealed Date Well or Boring Constructed Orono 117 23 06 . � � GPS Latitude degrees minutes seconds l / LOCATION: Depth Before Sealing��ft. Original Depth ft. Longitude degrees minutes seconds pUIFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location Single Aquifer ❑MWtiaquifer ' 4��oiT A� � Ya n� �C.�L' �E}�-�BORING �Measured ❑Estimated = P d]LW po u �JLW I-Y�Nater Supply Well ❑ Monit.Well Show exact bcation of well or boring Sketch map of well or boring �� //�r ,y, '£ in section grid with"X" ocati ,showina prooerty ❑Env.Bore Hole ❑Other �fL �below ❑above land surface ines, oa s,and buildi s. �� N � ` CASING TYPE(S) � -- - -- - -- -- -- � 'Ok Steel ❑ Plastic ❑Tile ❑Other W -- - - — - -- --,-- E �p� WELLHEAD COMPLETION r , � � ��"' Outside: ❑Well House Inside: ❑Basement Oftset ± -�- —� `- --i— � ��^�� Pitless AdaptedUnit ❑Well Pit —�- -i-- -�-- --i— � �\ ' ❑Well Pit ❑Buried S "''''� { ,, � �—'m"°--_�' � �� f JY� � �'^r+ ❑Buried PROPERTY OWNER'S NAME/COMPANY NAME CASING(S) Diame r�� Depth ( Set in oversize hole? Annular space initially grouted? Property owner's ai i g a dress it different than well bcation address indicated above `' � in.from__�__ t0��ft. ❑Yes f�No ❑Yes ❑No ❑Unknown T` in.f�oi71 t0 ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown in.from to ft. ❑Yes ❑No 0 Yes ❑No ❑Unknown WELL OWNER'S NAME/COMPANY NAME SCREEN/OPEN HOLE / Well ownels mailing address if different than property owner's address indicated above SCf@en ffom��t0��ft. Open Hole from t0 ft. OBSTRUCTIONS _ ❑ Rods/Drop Pipe ❑ Check Valve(s) ❑ Debris ❑ Fill �o Obstruction Type of Obstructions(Describe) GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed7 ❑Y05 ❑ No DBSCribe FORMATION If not known,indicate estimated formaiion log from nearby well or boring PUMP � "� TYpe ❑ Removed ot Present ❑ Other METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: �No Anrular Space Exists ❑ 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 MA7ERIAL(S) (One bag of cement=94 Ibs.,one bag of bentonite=50 Ibs.) ,.y�,�n/fj� ! Grouting Material�� ///��✓, rrom_�_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 No How many? LICENSED OR REGISTERED CONTRACTOR CERTIFICATION This well or boring was sealed in accordance wiih Minnesota Rules,Chapter 4725.The information contained in this report is true to the best of my knowledge. Dcn3 Stc�odla Well Drilling Co,. Inc. 23172 Contractor Business Name License or Registration No. .._ j �� ' .�� ;.,.>� r d ep sentative-Sign � " Date `� � .�,r�SY�..l LOCAL COPY H ��V O i � ��~ Name of Person Sealing Well or Boring