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Home My WebLink Aboutwell info MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring � �� WELL Oii BORING LOCATION �yELL AND BORING SEALING RECORD Sealing No. �H_ Counry Name Minnesota Unique Well No. — Minnesota Statutes,Chapter 1031 or W-series No. � I Henne p in M1.�.�„�k��, —, Township Name Township No. Range No Sec�o o. F t n(sm.-►Ig.) Date Sealed Date Well or Bormg Constructec7 4toao 117 23 � -0004 ',�`� /_�� G '� Numencal Street-Atltlress or Rre Number and Ctly oi Well or Boring Location ��'�^ / � 2 V U 5 N Shore Dr, OL 011� 5 5 391 Depth eetore Seaimg�__it Orig�nal Depth �� n Show exact loc n of well or boring Sketch map of well or boring qOUIFER(S) STATIC WATER LEVEL m�seetiongriQwith"X'. location, showing propeny �OlSingle Ayuifer ❑ Multiaquder lines,roads,and buildings. N WELUBORING Measured ❑ Estimated � � � � � � Water Supply Well ❑MonA.Weil �/ / ❑ Ern.Bore Hole ❑Other _ � h. �elow ❑ above land surtace W --�- -i-- -i— --i— E �� CASING TYPE(S) � ' ` � � as � � —�- ---- -i-- --�- � �� Steel ❑ Plastic ❑Tile �Other Ytmik � y —�- -�-- -�-- --i-- � \� CASING(S) �s��' Diamete�� Depth Set in oversize hoie7 Annular space initiaily grouted7 �`� i miie ,�" ,,j�t' � in.from� to: f �J ft. ❑ Yes ❑No ❑ Yes ❑ No ❑ Unknown �' �— —�" ,�,j�,=�4 f PROPERTY OWNER'S NAME in.from to ft. ❑ Yes ❑ No ❑ Yes ❑No ❑ Unknown Property own r s mailing a ress i i ere an we I on address indlcated above. in.from to ft. ❑ Yes ❑ No ❑ Yes ❑No ❑ Unknown 2193Q Minnetonka B�Qd SCREEWOPENHOLE � , ,;_� . f E��$l a t� i71� 5 5 3 3I Screen from ro ft Open Hole from -'✓ � to� R. OBSTRUCTtONS WELL OWNER'S NAME Rods/Drop Pipe ❑ Check Valve(s) ❑ Debris ❑ Fill ❑ No Obshudi Well ownels mailin addresa if OiHerent Man r owner's address indicated above. —j✓"��/'^ �� 4� �� g p oPeny Type of Obstructions(Describe) Obstructions removed? �Yes ❑ No Describe PUMP �j � TY� �,'�C,, �l)� 1' OEOLOOICAL MATERIAL COLOR HARDNESS OF FROM TO �Removed ❑ Not Present ❑ Other FORMATION N rat krawn,inOicete eatimated tormabon bg from nearby well or bonng. METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: �lo Annular Space Exists �- � ('-- � - ,—� ❑Annular space grouted with tremie pipe �. � ❑Casing Perforation/Removal � in.trom to fl. ❑ PeAorated ❑ Hemoved in.from �o h, ❑ Perforated ❑ Removed Type of peAorator ❑ omer GROUTING MATERIAL(S) (One bag of cement=94 Ibs.,one bag of bentonite=50 Ibs.) f i_ Grouting Material ��//�`� � to� it. yards �S begs irom to ft. yards bags from to fl. yards begs hom to__ ft. yards bags REMARKS.SOURCE OF DATA,DIFFICULTIES IN SEALING OTHER WELLS AND BORINGS 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 conteined in this report is true to the best of my knowledge. �.,,�;�.,, . I3on Stodola tdell Driling Co. , Inc. 27172 Contracror Business N e �,- /,� License or Registration lio. `) � �i �--`c"` --'� �- ..1 '.aV �-- � ----�'� �-� �<o.J ,�..a,. �'� ,„ �ai-' �t��. .` A tative ignafure . Date t- _ �. r'"„e'� (� �� ✓ ._._..v � /'--'r.�--�"-"'i-'�"d1'd�w-�- � �� "� 18 5$5 5 Neme o�Person Seali�W Bonng _� !� . WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. County Name WELL AND BORING RECORD 6 6 8 0 2 6 Rennepin Minnesota Statutes Chapter f03/ Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed Orono lI7 23 09 ,, „ 245 n 8-28-Di House Number,Street Name.City,and Zip Code of Well Location or Fire Number DRILLING METHOD 26$5 N Shore Dr, Orono, MN 5391 C7 CableTool ❑ Driven ❑ Dug ❑ Auger �Rotary �1 Jetted �: Show exact location of well in section grid witn"X'. �SkBJch map of weil location. ❑ ,_ _ � ___ �howing property lines, - �� ;� % . �lrpads and bwldings. DRILLING FLUID WELL HYDROFRACTURED? :-.]YES O N - � .._�, —� . + �a t�r FROM __k.to ft. i -i- -i- -� USE 'f ❑ Monitoring [7 Heating/Cooling i i i i L'J Domestic ❑ Communit PWS ❑ Irrigation Y f7 Industry/Commercial i i y i -��--- ❑ Noncommunit PWS w E T � ❑ Environ.Bore Hole Y ❑ Remedial i i i i .,,� ,/ ❑ Dewatering n i , i r �/zIM1e ____"_'_ CASING Drive Shoe? Yes ❑ No HOLE DIAM. _i_ _i_ _i_ _i_ � � � ��, �Steel �Threaded — ❑ Welded - � � � ' ❑ Plastic ❑ �1 M�ile� _, �...� CASING`DIAMETER WEIGHT PROPERTY OWNER'S NAME `� in.to 233 ry. 1.� Ibs./ft. 8 in.to 3 Erotas Building Corp• __in.to ft. Ibs/R �in to.�f� Property owner's mailing address if different than well location address indicated above. _ in.to R _. ______Ibs./ft. ��__,''� g 2193� H3nnetonka B1Fd SCREEN OPEN Excelsior, MN 55331 Make._- f,om � ,,.,0 245 � ; Type Diam. ___ SIoVGauze Length . Set between ft.and ft. FITTINGS: � STATIC��R LEVEL WELL OWNER'S NAME _._ __ _ ft. �below ❑ above land surface Date measured_ ��0� PU�Ij�C�L�//�L�(�pjow land surtace)�f� j'� Well owner's mailing address if different than property owner's address indicated above. L�• L�� fl. after ` ______hrs.pumping �`+�� g.p.m. W�LL HEAD COMPLETION ��Pitless adapter manufacturer whi t ewa t� Model �."7 Casing Protection _ __ ____�12 in.above grade L� At-grade(Environmental Wells and Borings ONLY) GROUTING INFORMATION Well grouted? �2�Yes ❑ No HARDNESS OF Grout Material ❑ Neat cemery,� f� Bento��❑ Concrete�L�High Solids Bentonite GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO from__ �j to�i ft. -4 Q❑tyds t�bags from � to L 31 ft. n8��.�$�_ Sl.y�.l� bags el8y yellov �tf��t2tA 1 r�om_ �o n. ❑ yds ❑ bags NEARE��NSOURCEOFCONT9�fy11NFyTl �+ ` /j � , � c2ay/aand gray soft 1 22 feet �S%�"'� f direction ` � type re Well disinfected upon completion? C�Yes ❑ No S�[�J `�� —v shale/sandston yello mediu 22 24 PUMP Cl Not instalied Date installed ._______ �, ��1t�Q1 Manufacturer'sname lle=�.�Q�_.____._ _ _ Model number HP 1 s S Volts fr�� Length of drop pipe_. ._�� _.__ ft. Capacity g.p.m. Type: �Submersible G LS.Turbine ❑ Reciprocating ❑ Jet ❑ _ ABANDONED WELLS Does property have any not in use and not sealed well(s)? G Yes �No VARIANCE Was a variance granted from the MDH for this well? ❑ Yes �No TN#. WELL CONTRACTOR CERTIFICATION Use a second sheet,i/needed This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. .. REMARKS,ELEVATION,SOURCE OF DATA,eta The information contained in this report is true to the best of my knowledge. Don Stodola W�11Drillin�o, . Inc.__2 172 ------- - DroQe cas ing 2' ice ee Business Name �Lic or Reg No. .,�- :�� - ..-. _ � �2-20-0 Authorized RepresenjStive Signature Date ehuck Moore �-2$-01 Name of Driller � Date _ LOCAL COPY � 6 6 8 0 2 6 HE-01205-07(Rev.2/99) IC#140-0020 � - rw� c�-y w�� c � � , r�,�. 617 13th Ave So � Hopkins, Minnesota 55343 • (612) 935 - 3556 �<'S OS/31/2001 Stodola Well Drilling 3841 North Main St. Bonifacius MN 55375 938-21 1 1 REPORT OF WATER ANALYSIS Lab #: 950 r Our Laborarory reports rhese analytical resulrs, deiermined on a sample taken by CLIENT on OS/29/2001 from ihe following locarion: 2685 N.Shore Dr. Orono,Mn Unique Well #668026 Coliform Bacteria <1/100 ml Niirates Nitrogen <1.0 mg/! The results of rhese tests indicare chac this well is producing water thac meers 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). icy ater Clinic, Inc. , �.o,. eill le Lnb Certification N 027-053-I 19