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Home My WebLink Aboutwell info .. .: .. .. .,.. �..:',�'. �'sno"�� :-.�: -,�r -<,:,-�-�^-*�:�M,._ . . _ . . . -s __ ..�-x- ..,,� . ,_. . . .. . . . .. ..� . _... .., ;.r_. ---�....�.�,.. _ w"y4. ... . :�.tl:r; .f ~ R MINNESOTA DEPARTMENT OF HEALTH MIN AND BOR/NQG NO. ELL . WELL OR BORING LOCIATION . CountyName WELL AND ��V..G RECORD � �� ,�-�. � �� Minnesota St s,Chapter 1037 � ...s - Township Name Township No. Range No. Section No. Fraction WELIJBORING DEPTH(completed) DATE WORK COMPLETED � �- �D�fO �3� � � v< v< y R. GPS DRILLING METH "? LOCATION: Latitude degrees minutes seconds Longitude degrees minutes seconds [.__�Cable Tool r 'Driven _-Dug -- L,'�.Auger �Flotary j ]Jetted . - House Number,SUeet Name,City,and Zip Code of Well Location or Fire Number �� - �� ' t� � �'� �'� g� DRILLFNG FLUID WELL HYDROFRACTURED? . .Yes ' o .� e✓ Show exact location of well/boring in section grid with"X" Sketch map of well/boring location.� �� $t�� From ft To Showing property line � � N roads,buildings,and directi . USE �- omestic ❑Monitoring LJ Heating/Cooling �� ' ' L____1_ .�oncommunity PWS ❑Environ.Bore Hole ❑Indushy/Commercial '�� '--- ' ,4 . 'Community PWS I]Irrigation n Remedial 1----i- --`-----`-- . - '- � �. � ,Elevator �]Dewatering � � � — �__. - � ��: '. '�'� , � , ET l.�a � CAStNG�MATERIAL Drive Shoe? ❑Yes �Vo HOLE DIAM. �#,,. � �--- --�-----*- I � � �, . ; ; ; �-___Steel j ]Threaded ❑Welded . /z Mile " I I , , � lasfiC �� --�----�----�-----�- . . . � �./ CASING g � ''�j Diameter Weight Specifications �1 Mile-� `� �in.to_�__ft �IbsJft �__ � in,to�. PROPERTY OWNER'S NAME/COMPANY NAME in.to _.ft. ___.___Ibs./fl. �in.to ��. �<..;:�:! �5 'G.�j T� ��2�..� in.to ft. Ibs./ft. _ in.to ft. � �rany a! �S�tLEI OPEN HOLE �� Property owner's mailing address if different than well location address indicated above. SCREEN _ .______ �' Make_�� From _ ft. To _ fl. :.; � � �� TYPe ��B�Tl�Pl�_�.� Diam. .: ._- -- -- --- SIoVGauze_ !"1�'/1 Length_�_��_�• �va:.r Set between ft.and ft. FITTINGS �!iR STATIC WATER LEVEL �s �A Measured from �/�� .N ft.�_y�Below ,f-.j Above land surface Date measured J�7�'V�7� WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) L�►'°� ft.after �s� hrs.pumping 3J _g.p.m. Well/boring owner's mailing address if ditterent than property owner's address indicated above. WELLHEAD COMPLETION ;.` . � � �itless/adapter manufacWrer ��`-�"__.__*•,S;t�-.�--.s-°�-�-ry�odQh-- __ Casing Protection I,�Q2 in.above grade j_�,,Ahgrade(Environmental Well and Boring ONLY) GROUTING INFORMATION Well grouted �(es _,No Grout materials j�Neat cement ��lentonite 'i�Concrete '�Other From O To_�Q fL �'/ 3�t�Yds. �Bags '� GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO From ��@ _ To_ �q4�+'�` ft.��j �yW�. '�,�;Bags ,k MATERIAL Fro�3t3_ .frii t��[,�ds. �Bags To NEAREST KNOWN SOURCE OF CONTAMINATlION ��}��Z bJ�4:lE �� V 3 i � `...� feet /�✓ �' �. direction �— ��a..,,.r-tq ��g �y �} �pWell disinfected upon completion? es ❑No �, .,.,. �6t�i gL'� �li J fA PUMP �j .�- ❑Not installed Date installed ! � � � "�� J �� Manufacturer's name ��t � �� `� � Model Number HP � (O�.Volts U��0 U� ; �� t Length of drop pipe y ft. Capacity g.p.m. �� 1 �. . �t� 9t'�t �f�t L" Type:�' ubmersible [„_J LS.Turbine (�Reciprocating ❑Jet ❑ �t �i�41 i !V) 4i3 . ABANDONED WELLS Does property have any not in use and not sealed well(s)? []Yes I- o VARIANCE 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,if needed . '� REMARKS,ELEVATION,SOURCE OF DATA,eta � - �� Q11 �LO��.l1�� 1 f� C'��_T--�G.--.��.- - Licensee Business Name Lic.or Reg.No. � f. � ' � L � - - !r � i� d Representative Signatur� Certified Rep.No. Date� LOCAL COPY � � 0 6 3 6 Name of Driller � � � IC 140-0020 HE-01205-11(Rev.3/07) � . • � rl�u i�vV C i�" 1NG�.tP�' C � � , I v�►�'i. y 617 13th Ave So � Hopkins, Minnesota 55343 � (612) 935 - 3556 07/1 1/2008 Stodola Well Drilling 3841 North Main St. Boni facius MN 55375 938-21 1 1 REPORT OF WATER ANALYSIS Lab #: 292BN Our Laboratory reporrs ihese analytical results, determined on a sample t-aken by CUENT on 07/09/2008 from the following location: � � Jon Heodon 3180 North Shore Dr. Orono,Mn Well 760636 Coliform Bactevia Absent Nitrates Nitrogen <1.0 mg/1 The results of these t-ests 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 nit-rai-e only and does not include analysis of Lead and other coniaminanis. (Unless as specified by client). Twin Ci�fWater Clinic, lnc. � ; �, eill VarrArsdale Lab Certification#027-053-I 19 WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring I„I ��](1�Q� WELL AND BORING SEALING RECORD Sealing No. / �.� v C�ty Nam�, Minnesota Unique Well No. r��x�e.�1■[i Minnesota Statutes,Chapter f031 or W-series No. (Leave blenk�rl nol known) Tc..._. ,. "ownship No. Range No. Section No. Fraction(sm.�Ig.) Date Sealed Date Well or Boring Consiructed OtOI]O iZ7 �� } �� E3 r' � �� / ^g � GPS Latitude degrees minutes seconds Depth Before Sealing ! /� ft. Original Depth ft. LOCATION: Longitude degrees minutes__ seconds A �FER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location � ingle Aquifer ❑Multiaquifer �/ ,,... . /� �L/BORING ,�l Measured ❑Estimated Date Measured --•'��f�� 'fr WaterSupply 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 �iasc�� ❑T�ie ❑Other _ �� --'-----�-----�-- ---`-- � WELLHEAD COMPLETION �` � W ; ; : � ET ,�,t � � � _;__ __r__ Outside: [_I Well House �yrnt Grade Inside: I��Basement Offset �� --�-----�-- - T� �- :. , , , , Mile � � itless A p dUnit ❑Buried f]Well Pit v 1 . 'h til''••� ['P' da te ��- --;--- --,--- ---�-----:- 1 ❑Well Pit L�Buried S ❑Other {--i M�ie-� - � ❑Other _ ' '�-��ti -_.�:_.��-a-�a.. P�PER y/Y WNER'S NAp{��/C ANY NAME CASING(S) j ""•"�� '�"�� Diame �� r Dept/h /_ F Set in oversize hole? Annular space initially grouted? �:, Property owne�'s mailing address it diflerent than well location address indicated above ��n.from� to f r�(C' ft. ❑Yes [�Vo ❑Yes �]No ❑UnknOWn .5 in.from ro ft. [�Yes ❑No ❑Yes ❑No ❑Unknown ___in.from to ft. CJ Yes �]No ❑Yes ❑No ❑Unknown WELL OWNER'S NAME/COMPANY NAME SCREEWOPEN HOLE � Well owner's mailing address if different than properry owner's address indicated above SCreen ffom �"vc'tL� to ��Q ft. Open Hole irom to ft. � OBSTRUCTIONS �]Rods/Drop Pipe �Check Valve(s) []Oebris �Fill �o Obstruction Type of Obstructions(Describe) GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? ❑Yes ❑No Describe - FORMATION If not known,indicate estimated formation log trom nearby well or boring. PUMP Type �' � � � ❑Removed �Jot Present _ ❑Other ; METHOD USEDTO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: [�o Annular Space Exists ❑Annular Space Grouted with Tremie Pipe �J Casing Perforation/Removal in.from to___ R �]Perforated ❑Removed in.from to .___ft. f]perforated ��]Removed Type of Perforator _ U Other GROUTING MATERIAL(S) (One bag ot cement=94 Ibs.,one bag of bentonite=50 Ibs.) � � f /�t / ,ft ,t�/ Grouting Material��/`�T��/r��/�'Trom�_ to_�._� ft. yards� bags _ from to ft. yards bags ._._ from ro ft. yards bags OTHER WELLS AND BORINGS REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING Other unsealed and unused well or boring on property? r]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. Uon Stc�dol8 Well Dcilling Co,. Inc. 2691 Licensee Business Name License or Registration No. / �-a� Q i jT'-,�'" �f �> � .� �J�" ,��' / tif(�F I�d Representative Signature. ( Certified Rep.No. Date LqC�.t.COPY H Z�O Z V Z /�"•��.. r.�=t', ..��-�,.�1,,,F-t'�-- %t Name ol Person Sealing Well or Boring 1 : HE-01434-10 IC#140-0423 ' sio�a �