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Home My WebLink Aboutwell info WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring H 2 31 Counry Name WELL AND BORING SEALING RECORD Minne oNa Unique Well No. Minnesota Statutes,Chapter 103/ or W-series No. (Leeve blenk X M Ivqwn) ?' Town ip a Township No. Range No. Section No. Fraction(sm->Ig) Date Sealed Date Well or Boring Construded '1 i�� V �i� v. v. I � � f y GPS �� degrees minutes seconds -(1 � � �oDS LOCATION: Depth Before Sealing_?b ft. Original Depth Longftude degrees minutes seconds pQUIFER(S) STATIC WATER LEVEL op Numerical Street Address or Fire Number and City oi Well or Boring Location Single Aquifer ❑Multiaquifer ��oN� 25�5 Narth Shoce 1� OtOtiO ELUBORING YYMeasured ❑Estimated �ater Supply Well ❑Monit.Well J`" / / Slww exact location of well or boring Sketch map of well or boring !�,/f'} in section grid wi[h"X" location,sho ' property ❑Env.Bore Hole ❑Other �ft. �below ❑above land suAace I' s,roads,a�d ildings. N , �.:,., ;; � CASING TYPE(S) - - - - - -- -i-- Steel ❑Plastic ❑Tile ❑Other �' W —�- -i-- -;-- --;-- E `:y. � WELLHEAD COMPLE110N � , � �J � � � Outside: ❑Well House Inside: ❑Basement Oftset � ; -'r- -�-- -f- --�— ° �/ � �mib � p�Pitless AdaptedUnit ❑Well Pit --�- /� -�- -�-- --�-- � ❑Well Pit ❑Buried S �--""'"� ❑Buried PROPERTY OWNER'S NAME/COMPANY NAME CASING(S) Diamet�rt Depth l Set in oversize hole? Annular space initlally grouted? ; Prope er s ailing ad re s ifferent than well loca dr s n ica /� � in.ffom `�'� t0��ft. ❑Yes bhJo ❑Yes ❑No ❑Unknown BC8tj .TOt2�8 �\ J� ��ld Jt J+ Ste 42(X) in.ffom t0 ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown - ��8t^��1g! S-�` +�4� in.from t0 ft. ❑Yes ❑Na ❑Yes ❑No ❑Unknown i WELL OWNER'S NAME/COMPANY NAME SCREEWOPEN HOLE � f � Weli owner's mailing address'rf diHerent 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)�,fS(/S�.f�/"� �� I��. r GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? Y2S ❑ NO Describe FORMATION -' H not known,indicate estimated formation log from nearby well or boring PUMP ._ � /�f+� � 'v� t/� Type ✓ 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 PerforatioNRemoval 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.,o/ne'�bag of�entonite-50 Ibs.) / - Grouting Matenal�� Q to�..L 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 Scodola �7eI1 �3c3.ilin� Co,. Icic. 27172 Contractor Business Name License or Registration No. „"",--" �,��,�—i.f J A 'e . n -Signature". Date �OCAL COPY H ��.�5 5 c:�mck Moore Name ol Person Sealing Well or Boring t - WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH M/NNESOTA UN/c]UE WELL NO. coU�cyName WELL AND BORING RECORD � in Minnesota Statutes, Chapter 103I �� $ Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed ft. {�coc�a I17 23 I4 �, �, ,,, GPS Latitude degrees minutes seconds DRILLING METHOD � LOCATION: — �� Cable Tool ��Driven � ,Dug Longitude '� _ degrees minutes seconds = r � Auger �Rotary ;Jetted House Number.Street Name,�iry,and Zip Code of Well Location or Fire Number -� -� Zl�f� LR7CLii �� ViOTIO 55391 DRILLING�FLUID WELL HYDROFRACTURED? ❑Yes �No d Show exact location of well in section grid with"X".� � Sketch map of we!I location. �j'�t'O(�„Ce FROM ft.TO ft. N '--��;.�'f? Sho oladsPand buYld ngs USE - ; 7� []Monitoring �Ji Heating/Cooling ' � � � � �,_ � �Domestic ❑Environ.Bore Hole i.j Industry/Commercial - �,d.4 ±� LI Noncommunity PWS ��Irrigation Lj Remedial ` I i i � '" ,�Community PWS r�Dewatering ❑ . / h CASING HOLE DIAM. � w e T � / Drive Shoe? '�es [�No Ii �.Steel �Threaded �, �Welded � , , , r" Mile - - — — �� ! \� I�Plastic (��] ,� ----- ------ --�----.- 1 �r � I ; ; ; CASING DIAMETER WEIGHT E �(� t F—1 Mile� ��j„�� in.to f1d� ft. �+ ___ Ibs./ft. �y�-in.t � ft. • in.to ft. Ibs./ft. '�in.��ft. PROPEATY OWNER'S NAME/COMPANY NAME in.to ft. IbsJfc �7��.�n. S�OI�Od �S� �ld IalJ1,r SCREEN OPEN HOLE `� _._ Property owner's mailing address if different than well location address indicated above. Make J4MS� FROM �ft. TO ft. 7�V7 ev�y�.$�S B�� TYPe 8�$i�e.� �tl Diam._ ��]Q�f$� t�A1 55426 SIoUGauze ,��_. Length ��___�_�_ Set between_. ft.and it. FITTINGS � � STATIC WATER LEV L � � / 7_p_AL s-14{J5-II4b — �s n�below ,J above land surface Date measured �T�� PUMPING LEVEL(below land surface) �� WELL OVJNER'S NAME/CUMPANY NAME � +� A�^ �� ft.after G hrs.pumping G*� g.p.m. - WELL HEAD COMPLETION � ,{ � Well owner's mailing address if dif(erent than property owners address indicated above. ��PiUess adapter manufacturer ��. _ T•-»�-�,- � �..�el ��Casing Protection '�'12 in.above grade ' ��At-grade(Ernironmental Wells and Boring ONLY) GROUTING INFORMATION i� Well grouted �Yes �� No Grout material '�Neat cement f�Bentonite ��;;Concrete�'1-1igh Solids Bentonite from +��/� to 'M-^� ft. � � I yds. �ags from .7V to �l ft. �� y�. !�bags GEOLOGICAL MATERIALS COLOR H MATERIALOF FROM TO from to }t. ❑yds. ��.bags NEAREST KNOWN SOURCE OF CONTAMINATION b��iil7 �j,11�t1 � �.� :.f� teet �.?�..� direction �.� r - � , �:t � Well disinfected upon completion es ❑No �..�.�,,,�.,,. '� �„..r,i,.�.._... �rt *O �� PUMP 1 1 ..� _. /'�/ }i,�. '��Not installed Date installed t r8 �l`� 4 SA qM Manufacturer's name �� ----> � !"�i � .�J� `��_ ; 1 3CRJ 6i/V � ^ " Model number HP ��✓�. Vclts ��-%�`��J b�l � ��,�t, '",�1�} Length of drop pipe �� ft. Capacity g.p.m. Type:�. Submersible ❑LS.Turbine ❑Reciprocating ❑Jet j� ABANDONED WELLS Does properry have any not in use and not sealed well(s) ❑Yes o VARIANCE i: Was a variance granted from the MDH for this well? �_�Yes . o 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,i/needed � StocioLa Weli fl�ti.11ing ca, 1�s �71!i(. �. REMARKS,ELEVATION,SOURCE OF DATA,etc. Licensee Business Name Lic.or Reg.No. /� 1,.:- �� o epr tative Sig ure Date Jim Kahls LOCAL COPY �] �� Q Name of Driller I � H601205-OB(Rev.5/02) �� IC 140-0020 � / ' rw� c�-y w�-� c � � � r� 617 13th Ave So � Hopkins, Minnesota 55343 � (612) 935 - 3556 03/10/2006 Stodola Well Drilling 3841 North Main St. Bonifacius MN 55375 938-21 1 1 REPORT OF WATER ANALYSIS Lab #: 124BN Our Laborarory reports rhese analyrical resulrs, derermined on a sample taken by CLIENT on 03/OS/2006 from rhe following location: 2545 Northshore Dr. Orono,Mn Well#726438 Coliform Bacteria <1/100 ml Nitrates Nirrogen <1.0 mg/1 The resulrs of ihese tests indicate that this well is producing water thai meets 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 contaminants. (Unless as specified by clier�t). �Twin City Waier Clinic, Inc. Bil�. dale � I.ab Cert�cation#027-053-119