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Home My WebLink Aboutwell info ,t .-i _ WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. CountyName WELL AND BORING RECORD ( /; �� Minnesota Statutes,Chapter f037 I' � ��+ � � Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed 4cono 117 23 10 ,� �� 318 ,` 5-24-05 GPS DRILLING METHOD LOCATION: Latitude degrees minutes seconds Longitude degrees minutes seconds L�Cable Tool !�Driven ' Dug � Auger �Rotary ❑Jetted House Number,Street Name,Ciry,and Zip Code o(Well Location or Fire Number i �� . 214E3 North Shore Dr �C�� 55391 DRILLING FLUID WELL HYDROFRACTURED? ❑Yes o Show ezact location of well in section grid with"X". Sket h map o well loca�ion. �t��. FROM ft.TO tt. howing roper y i es, N road and buii ngs USE - Monitorin �l L� 9 ❑Heating/Cooling � __j_____j___ __�___ �_ u, �'Domestic [�_'Environ.Bore Hole ❑Industry/Commercial � �� _....,.._ �'.Noncommunity PWS U Irrigation ❑Remedial �� ; ; ; ; p y �I Community PWS []Dewatering :��'�. � --'-----�-----`-- -- -- � ` W ; i ; ; E� + ASING Drive Shoe? �Yes �J No OLE DIAM. � C I H • � ______ � � } �Steel ,�Threaded _'�.Welded ; 7 Mile t I^]Plastic ❑ �, ' ' � � 1 CASING DIAMETER WEIGHT ' � � S � � �—i M��e� :f./ .� 3- __�.�_._--�� ±.��.��.. . —�in.to _..�ft ZZ IbsJR �in.to�. in.ro .._—__ fc _.__ IbsJft _�in.to�,�y. � PROPERTY OWNER'S NAME/COMPANY NAME in.to ft. Ibs./ft. ��p to�y�p. Arter/Cheri Kr�er SCREEN OPEN HOLEs�n� o Propert�owner's mailing address if different than well location address indicated above. Make —' " ��o FROM ft. TO ft. � 88 g��s Type Diam. _ SIoUGauze Length - Set between ft.and it. FITTINGS - STATIC WATER LEVEL 7� ft,�below �above land surface Date measured_��2�}�5 PUMPING LEVEL(below land surface) � WELL OWNER'S NAME/COMPANY NAME _�__ft.after � hrs.pumping__. _g.p.m. WEL��16�D COMPLETION :'iA E Well owner's mailing address if different than property owners address indicated above. ��v �,,Pitless adapter manufacturer �1�1� �� {�1ode1 ��Casing Protection `yd''12 in.above grade ��At-grade(Environmental Wells and Boring ONLY) r GROUTING INFORMATION Well grouted ,S�Yes �No Grout material :,J Neat cement [�Bentonite .Concrete�High Solids Bentonite from�to_�ft �_ ❑yds. �bags from�__to��ft. �,�j[�,1 ��.��bags GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO from to ft. _yds. �bags } MATERIAL NEAREST KNOWN SOURCE OF CONTAMINATION J �.. �� .�[A! bt�,l �C� p �u feet �" direction '-._ '�-�-�'"�J'l'yp i f7 � Well disinfected upon completion .�Yes [__ No ��„�.,,f.,. � PUMP ` : cl �c zio `� t Not installed Date installed � "'�`v� - �V� ��' �1 �1 Q.�,�f �� .}h Manufacturer's name_yr�J�.rYV��,.'�-'`�-i�""' ._ 1 1 LCli ,��1 ,� Model number HP__�Volts :�� j„`�,$ � � 'l z� Length of drop pipe ��V ft. Capacity g.p.m. gravellsl�leJ �«/ Type: ubmersible []LS Turbine `�Reciprocating ]Jet ;� .��SCOIIe �UJ.iCtt f)COM�] � yt � � ABANdONED WELLS € Does property have any not in use and not sealed well(s) �]Yes [.�,'No �31D�.�tOI� � � !L �� VARIANCE Was a variance granted from the MDH for this well? L]Yes�No TN# WELL CONTRACTOR CERTIFICATION This well was drilled under my supervision and in acwrdance with Minnesota Rules,Chapter 4725. The information contained in this report is true to the best of my knowledge. " Use a second sheet,il needed " " REMARKS,ELEVATION,SOURCE OF DATA,etc. �j� ,,St,�ol�, W��.1 Drillinsa W�� 111C� �Z�7L Licensee Busin ss me Lic.or Reg.No. / � � /, � /j, t�JV E�✓ o'e epresentative�'i ature � � Date ... '��`�� LOCAL COPY 7 2 6 4 0 3 Name ol Driller -- HE-01205-OB(Rev.5/02) : IC 140-0020 ^ '� .�� rw� c�y w�-� c � � , r�,� 617 13th Ave So - Hopkins, Minnesota 55343 � (612) 935 - 3556 05/27/2005 Stodola Well Drilling 3841 Norrh Main St. Boni facius MN 55375 938-21 1 1 REPORT OF WATER ANALYSIS Lab #: 2886N Our Laborarory reports these analytical results, determined on a sample taken by CLIENT on OS/25/2005 from the following location: Pete Kraemer 2140 North Shore Dr. Orono,Mn Well #726403 Coliform Bacteria <1/100 ml Nitrates Nitrogen <1.0 mg/1 The results of these tests indicate that this well is producing warer that meets the standards for F.H.A., V.A., or conventional loans. This report is an analysis for coliform and nirrate only and does noi include analysis of Lead and orher conraminanrs. (Unless as specifed by client). `Twin City Water Clinic, Inc. �� .. Bill rsdale Lab Cert�cation#027-053-119 � _ - ' wELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Seai ng No. ell and Boring '„' � % CountyName WELL AND BORING SEALING RECORD Minnesota Unique Well No. �� i� Minnesota Statutes,Chapter 1031 or W-series No. (Leeve Menk�not kiwwn) Township Name Township No. Range No. Section No. Fraction(sm->Ig) Date Sealed Date Well or Boring Constructed f�ra� I17 23 10 '�� '�� c , GPS LatRude degrees minutes seconds LOCATION: Depth Before Sealing �� ft. Original Depth ft. Longitude degrees minutes seconds ppU1FER(S) STATIC WATER LEVEL Numencai Street Address or Fire Number and City of Welt or Boring Location Single Aquifer ❑Multlaquifer ELLBORING �Measured ❑Estimated Water Supply Well ❑Monit.Well �� ` Show exact location of well or bonng Sketch map of well or bo'ng ' in section gnd wdh"X" location,showing prope ❑Env.Bore Hole ❑Other ft. �below ❑above land surface N lines,roads,and buildin CASING TYPE(S) � Steel ❑Plastic ❑Tile ❑Other W -�- - -- - -- -- - E f �\ WELLHEAD COMPLETION � , � J Outside: ❑Well House Inside: ❑Basement Offset _Y_ _1__ _l__ __�__ �� 1��b �p Pitless Adapter/Unit ❑Well Pit --;- -�-- -i-- --i- I ��n � ❑Well Pit ❑Buried S �—�"'�°—�' . ❑Buried _ ._.,a-�. � .� . ��.. PROt�PER�TY OWNt�E�R.'S NAME/COMPANY qN�AMLE��.�y CASING(S) �.� zi�C�� M�� 4�ft�#"'77�� Diamgtar , � � Dep�� Set in oversize hole? Annular space initially grouted? � Property owner's mailing address if diHerent than well location address indicated above /t�" /� � �_Z in.f�om t./ to ft. ❑Yes �Na ❑Yes ❑No ❑Unknown in.f�om to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown in.f�om to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown ; WELL OWNER'S NAMEICOMPANY NAME SCREEWOPEN HOLE ��, .^yf � ! Well owner's mailing address if different than properry owners address indicated above Screen from�[O��ft. Open Hole fron __, _tQ' _ft. oesTaucnoNs Rods/Drop Pipe ❑Check Valve(s) ❑ Debris ❑ Fill ❑ No Obstruction Type of Obstructions(Describe) �/I�1N�� .� � ��,iJ � GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? ❑Yes ❑ No Describe FORMATION If not known,indicate estimated formation log from nearby well or boring PUMP CJ ;t`J TYPe ��,.)�-� Ql. p"� j�Removed ❑ Not Present ❑Other ;�J 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 Type of perforator ❑ Other GROUTING MATERIAL(S) (One bag of cement=94 Ibs.,one bag of bentonite=50 Ibs.) v' �^ ��r�- � /�J�l / Grouting Material ��/�! ��,�// from � 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 with Minnesota Rules,Chapter 4725.The information contained in this report is true to the best of my knowledge. Don Stc�dola Well Dri2lir� CQ, Inc. ;27172 Contractor Busines Name _._. License or Registration No. //'��'' _=%-- e epresentative Signature ` Date \,., i_" H 2�5 911 ` �--, _�._,��,.� LOCAL COPY f �� ,�--� Name of Person Sealing Well or Boring