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Home My WebLink Aboutwell data�' __ A � MINNESOTA UNIQUE WELL WELL/BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. Counry Name WELL AND BORING RECORD �7 4 3 4 4� � - i Minnesota Statutes,Chapter 103I Township Name Township No. Range No. Section No. Fraction WELL/BORING DEPTH(completed) DATE WORK COMPLETED 17 23 09 �a ��a ��a 219 n 1-k-fl7 GPS DRILLING METHOD LOCATION: Latitude degrees minutes seconds _ C I Cable Tool � 'Driven �.Dug _ Longitude degrees minutes seconds "��"IAu er g .�Rotary ❑Jetted House Number,Street Name,City,and Zip Code of Well Location or Fire Number — � Cti1 � � �COIIQ 5539 DRILLING FLUID WELL HYDROFRACTURED? G Yes �.. o Show exact location of well/boring in section grid with"X." / Sketch map of well location. �teC Showing property lines, From ft.To ft. N // roads,buildings, USE �_.Domestic �-I Monitoring �.-.:Heating/Cooling . and direction. ❑Noncommunity PWS .�.Environ.Bore Hole I.1 Industry/Commercial i ,f �� ,-Community PWS I.J Irrigation '. '.Remedial . '--- ' ` -`-- -� � f �� ❑Elevator r'Dewatering I.; � �� ' ' ' � CASING MATERIAL Drive Shoe? �. I Yes I I No HOLE DIAM. Y `� W ' � � � E� • eel hreaded Welded , �.� l_ISt ❑T , , , , , , , r --,--- --•--- --�----�— �'" �Plastic =_ ,� i i ; i Mtle ��.;�� C�ASING � yz " ------ ------ --•-- ---�- '' 1 --� iameter Weight Specitications , , S , , �� 4 212 ft 2 l/llbs./ft. a$t� 8 JV tt. �1 Mile� �.:y�... in.to • ___,._ in.to n _____in.to _ _ ft. Ibslft. �in.to��7 ft. :: PROPERTY OWNER'S NAME/COMPANY NAME in.to ft. Ibslft. in.to ft. �� 4 ROberts R@SidEtitial RemOCI@lit� TnC. - - oPeN Ho�e SCREEN_� Property owner's mailing address if different than well lo/c�a�tion address indicated above. Make `�U�Zl�t'� i � From fL To tt. t 2999 W Cty Rd 42s �� 1W TYPe �ta�ltl�$s $t�l Diam. L L 1 '' �${T�iZe'�t71� 5>� Slot/Gauze. __. .�e�� _____ _ Length_�t� f' '�i� i Set between_.�1 ft.and�1�____ft. FITTINGS�_jT STATIC�WAATER LEVEL _.._�+ __ (t.�Below I �,Above land surface Date measured__� '*�� __ PUMPING LEVEL(below land surface) WELUBORING OWNER'S NAME/COMPANY NAME ^� __�7 R.after 2 hrs.pumping, 25 g.p.m. - WELL HEAD COMPLETION �}� - � `�_�;_ � Well/boring owner's mailing address if different than property owner's address indicated above. j�pitless Adapter Manufacturer�„^�"�'�^^'�'�'"'l�fodel ..J Casing Protection __�12 in.above grade CIAt-grade(Environmental Well and Boring ONLY) - " GROUTING INFORMATION/ Well grouted? j4Yes i �.No - Grout materials Neat cement�Bentonite i Concrete ! I Other__ From � To �ft. � y u. �.Y�ds. �Bags From�___To�R �$El][$i y�� :�Bags GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO From_ To ft. ! 'Yds. �. �:Bags MATERIAL NEAREST KNOWN SOURCE OF CONTAMINATION clsy gcay sc�ft 0 90 __ � -�•..s.�.-- ry� , 1� /' ;<..� '- feet �� diredion � Well disinfected upon completion? Yes L�L No ,-�,.(y,�� +�' � s�arui gray soft 90 135 PUMP '�. I Not installed Date installed /� !� �G � � (,"I��T �r�$5j .�Q�t �,J� 21Q Manufacturer'sname `�S'�Y I1 ��Model Number HP , `� Volts � �� lo �l� Length of drop pipe � ft. Capacity g.p.m. Type: ubmersible i-�LS.Turbine �:Reciprocating , I Jet L ABANDONED WELLS Does property have any not in use and not sealed well(s)? i �.Yes V'No VARIANCE Was a variance granted from Ihe MDH for this well? ._.Yes�No TN/1 WELL CONTRACTOR CERTIFICATION This well was drilled under my supervision and in accordance with Minneso[a Rules,Chapter 4725. The information contained in this report is true to the best of my knowledge. Use a second sheet,il needed. tL. T �= REMARKS,ELEVATION,SOURCE OF DATA,eta uVn Stodola Well 13rilling Co��ll�. 169I n _ _ - _-- — - ; Licensee Business Name 1 Lic.or Reg.No. � � - �� 7 i epresentative Sign� re Date � Chuck Moore , — - - -- ° LOCAL COPY 7 4 3 4 41 Name of Driller HE-01205-09(Rev.9/OS) IC 140-0020 r- 1� rw� c�-y w�-� c � � � .r�,�. 617 13th Ave So � Hopkins, Minnesota 55343 � (612) 935 - 3556 O1/09/2007 Stodola Well Drilling 3841 Norrh Main St. Boni facius MN 55375 938-21 1 1 REPORT OF WATER ANALYSIS Lab #: 12BN Our Laboratory reports these analytical results, determined on a sample raken by CLIENT on 01/04/2007 from the following location: 3080 NORTH SHORE DR ORONO,MN WELL 743441 Coliform Bacteria <1/100 ml Nitrates Nitrogen <1.0 mg/1 The resulis of ihese rests indicate that this well 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 incfude analysis of Lead and other contaminants. (Unless as specified by client). Twin City ,pter Clinic, Inc. �� Bill Va'n Arsdale Lab Certification#027-053-I 19 MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring H 2 5 4�91 WELl�AN6�BORING SEALING RECORD Mennle9oa�Unique Well No. Minnesota Statutes,Cha ter 103i or W-series No. in p c�ae�e e�a�k��o�k�aw�i Township Name Township No.Range No. Section No. Fraction(sm.�Ig.) Date Sealed Date Well or Boring Constructed ocmo 117 23 09 2�00'�9 '' f� �v U'7 , : Latitude de rees minutes seconds GPS 9 Depth Before Sealing 2� ft. Original Depth_ ft. LOCATION: Longitude degrees minutes seconds �FER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location �ingle Aquifer [;Multiaquifer �f�.r�L � 3 0$0 N o c t h S h o r e D r, n r� 5 S 3 9 I WEIUBORING �Measured ❑Estimated Date Measured ��' t+• 'Water-Supply Well ❑Monit Well � Show exact location of well or boring Sketch map of well or boring ? � in section grid with"X° location,showing property ❑Env.Bore Hole ❑Other _ ft. �below (]above land surface N lines,roads,and buildings. CASING TYPE(S) � � � � �.�,— � --'-----'--- '—"'--'- " Steel ❑Plastic ❑Tile []Other .'� --'--- --'--- ---`-- ---`-- '� WELLHEAD COMPLETION ' � w : : ; ; ET � - � � � � � Outside: �i Well House f]At Grade Inside: �asement Offset '� - '�4 Mile ❑Buried i,Well Pit .. --,--- --1--- ---=-- ----- _ itless A p dUnd ` Buried 1 �]P da te �, S U Well Pit ' , , ' :�1- ❑Other �--1 Mile—� - (� ❑Other ....,-_•�"+�.�.. PPOPERTY OWNER'S NAME/COMPANY NAME T CASING(S) Roberts Resiciential Re�nodeli 1(Z(,.'• Di� te�� ' Depth /' ' Set in oversize hole? Annular space initially grouted? Property owner's mailing address if di�terent than well location address indicated above �in.ffom c-Y to v�. ft. ❑Yes �No ❑Yes ❑No [�Unknown 2'999 W Cty Rd 42, Ste It� in.from to ft. ❑Yes ❑No ❑Yes ❑No �]Unknown Burnsville, A4�T 55306 in.from_ to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown WELL OWNER'S NAME/COMPANY NAME SCREEN/OPEN HOLE � 4 Well owner's mailing address if diflerent than property owner's address indicated above SCfeen ffom �`� to�� ft. Open Hole from to ft. �O/BSTRUCTIONS ' y�,Rods/Drop Pipe ❑Check Valve(s) ❑Debris [��Fill ❑No Obstruction i Type of Obstructions(Describe) r/U.lJ�r�-- �.L�� 9�"_� GEOLOGICAL MATERIAL COLOR HnaDNEss oR FROM TO Obstructions removed? �Yes ❑No Describe FORMATION PUMP � If not known,indicate estimated formation log from nearby well or boring. � I TyPe ..: CJ� i CJ i-; !`^�� Q "� � �Removed ❑Not Prese t ❑Other METHOD USEDTO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: .No Annular Space Exisls ❑Annular Space Grouted with Tremie Pipe ❑Casing Perforation/Removal ; in.from to____ __fl. ❑Perforated ❑Removed i in.from _to _ft. ❑Perforated ❑Removed Type of Perforator n Other _ _ ____ 1 GROUTING MATERIAL(S) (One bag of cement=94 Ibs.,one bag of bentonite=50 Ibs.) /� � �7 � GroutingMaterial ��~� ��f��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 property7 []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 Stodola t+�ell Drillic�g Co,. Ine. 1fi91 Contractor Business Name License or Registration No. �..� � /��" y � �„ /� d: � I Certified R prese�t2}iira' ignature Certilied Rep.No. Date LOCAL COPY H 2 5�9 91 �'W~ ��:�:/""`-j�``•—J Name of Person Sealing Well or Boring � HE-07434-09 ICn 140-0423 s/osR