The URL can be used to link to this page

Home My WebLink Aboutwell info wELL Of1 BORN�G LOCATiON MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Bonng �H �41518 � , WELL AND BORING SEALING RECORD Sea6ng No. �� - - H�nne lIl Minnesota Statutes,Cha ter 1031 Minneso;a Unique No. F p or w-senes No. I ILeave blank�I nu�known) J TowrWiq Name Townshlp No. Range No Section No. Fracnon�sm.-i Ig.) Date Seaied Date Well or Boring Constructetl Ix'c�CRCiNG ? i 7 11 t1$ ,. , �f�? � Nixnencal Street Address a Ffre Number and Clry of Well or Bonng Locatlon � / �`i C%� Alarthshc:�I'�P_ QZ 1.4'E L+r�I20� MI QeDtFr�C°�'��i�"9 �,,,"'�,o�j N Original Depth �� n Show exatt bca6on d�rell or boring , Sketch map of well or bor�ng UIFER(S) STATIC WATER LEVEL in section grid whh'X'- locahon, showmg property Single Aywfer � Multiaqui}er _ lines,raads,and bulldings. N � WELUBORING Measured ❑ Es6mated . ! Water Supply Well ❑Monit Well r —'�_�.� ��r, ' , ❑ Env.Bore Hole ❑Other _ _�tt. �bebw ❑ above Wnd surtace W 'T' 'T' 'Y' 'l" E 1 � .� ; CASING TVPE(S) . � � � ! � �� -�'- -r- -i-- -�-- � F j .,.. � �Steel � Plasfic �Tile �Other � � i i u m�le � �._.�__ _... _�_ _'_ ' ' � I CASING + -i-- -�— c_ _..___. Diameter Depth � Set m oversize hole9 Annualar space inrtially grouted7 ll�� ..._.�...... .._._._._..__._ ___ _.__ / �/ � �(�—imis� . � ,,,�1' �/ in.from � to 5�+� tt. ❑ Yes �No ❑ Yes ❑No ❑ Unknown I �`. PFiOPERTV OYIMER'S NAME in.from to fl. ❑ Yes ❑No ❑Yes ❑No ❑ Unkrrown �{�.� �.'.1��.�'�i�� Prape'ry ownel's mairg adOress if AiNerent than well location adtlress indlcated above. in.from to tt. �❑ �es ❑No ❑Y� ❑No ❑ Unknown SCREEWOPEN HOLE 1 / r Screen from �� to� ft. Open Hole from to k. OBSTRUCTIONS ��'��E Rods/Dro Pi p pe ❑ Check Valve(s) ❑ Debris ❑ Fill ❑ No Obstructbn YYM ow�els meip address if difterent than propeAy owner's address irWicated above. Type of ObsVuctions(Describe)i//l��-f f�� `'_ � �j �� Obstructions removed?�Yes ❑ No Describe PUMP TYPQ J�� /7vrr�� (iEOL.OQIC�L YATFJMAL COLOR HARDNESS OF FROM TO Removed ❑ Not Present ❑ Other FORMATION M nol b�,ndce`esEmabd fom�a6on log from nearby well or boring. METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING ANO BORE HOLE: ; �No Annular Space Ezits - ❑ Annular space grouted with tremie pipe ❑ Casing Pertoration/Removal in.from to ft. ❑ PeAaated ❑ Renaved in.from to ft. ❑ Perforated ❑ Rertioved Type of peAorator ❑ omer GROUTING MATERIAL(S) �`` y GroutingMaterial �.-+f"�'�'�`^`��'°-�from '�� ro�r� (t. yards � begs from to tt. yards bags from to fl. yerds begs from ro__ It. ysrds baps Ii�ANLS,901MICE OF DATA,dFFICULTIES IN SEALING OTHER WELLS AND BORINGS Olher unsealed and unused well or boring on property? ❑Yes No How man� LICENSEO OR REGISTERED CONTRACTOR CERTIFICATION This well or boting was sealed in accordance with Minnesota Rules,Chapter 4725. The iMamation oontained in Mis repoR is true to the best of my knawledge. L`C;N S'i'UI?U� k'�;LI., DRI:.LI�i� Ct?. , 1NC. �:71"12 Confrector Business Name ;!=��+� licw�se a Repisha0on�:o. ,�`'/ � t orized epre ntative Signeiure Drps ,:-- �. H �� Name ol Persan Seqling Well a Bori� - LOCALCOPY FE-01�34-03 2/97 q WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. CountyName �FI� WELL AND BORING RECORD 615 5 61 Minnesota Statutes Chapter103/ Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) � Date Work Completed fl. flRa�o i 1� �3 c�s ,. �,. �,. z a� • House Number,Street Name,City,and Zip Code of Well�ocation or Fire Number DRILLING METHOD 3498 iVarthshnr� Drive Orona MRI. 553�1 O qubeeTool ❑ Driven ❑ Dug g �] Rotary ❑ Jetted Show exact location of well in section grid with"X". Sketch map of well location. ❑ Showing property lines, roads and buildings. DRILLING FLUID WELL HYDROFRACTURED? ❑YES �NO N W�ter. , , , , FROM n.to n. -_ -_- — USE ❑ Monitoring ❑ Heating/Cooling i i i i ��Domestic _�_ _� � i ❑ Community PWS ❑ Industry/Commercial i i i i ❑ Irrigation ❑ Noncommunit PWS w E T ❑ Test Well Y ❑ Remedial i i i i ❑ Dewatering ❑ i i i i �/zIM_1e CASING Drive Shoe? �1 Yes ❑ No HOLE DIAM. _i i � i_ � w�,�� Steel ❑ Threaded ❑ Welded — i _ i_ _i_ _i � ❑ Plastic ❑ S 1� �/�� —,M,�e—� /��jf��'1►��-tll�.f` QK. CASING DIAMETER WEIGHT PROPERTYOWNER'SNAME +4 in.to2��3 _ft. � • � IbsJft. ?�n�fo �� ;{�� A.RI1SO�i in.to ft. Ibs./R. ' �n��i"s�fl. Property owner's mailing address if different than well location address indicated above. in.to ft. Ibs./ft. ��^�,,�_'�g. SCREEN � OPEN HOLE Make from ft.to ft. Types+S;��.�.� �Z��_Diam. SIoVGauze Length_ Set between � ft.and it. FITTINGS: ��'� STATIC WATER LEVEL WELL OWNER'S NAME __ �� t ft.� below ❑ above land surface Date measured t��„ y� , PUMPING LEVEI(below land surface) Well owner's mailing address if different than property owner's address indicated above. 2�� ft. after 1 hrs.pumping � g.p.m. WELL HEAD COMPLETION C�Pitless adapter manufacturer I,PIi 4 i��s r,:n�a r Model , ❑ Casing Protection �1 12 in.above grade ❑ At-grade(Emironmental Wells and Borings ONLY) GROUTING INFOFMASTION Well grouted? L�+Yes ❑ No � GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO Grout Material ❑ Neat cement�(7 Bentonite ❑ Concrete �High Solids Bentonite t, MATERIAL from�__to�_ft. 2� ❑ yds.�7 bags .�` from_ to ft. ❑ yds. ❑ bags � ��,r� a n?� � f from to_ ft. ❑ yds. ❑ bags NEAR�NO�N SOURCE OF CONTAMINATION� /� j�(J C��_ � � feet ��S ��_� _direction�`��"'c''��_rype � Well disinfected upon completion? ❑ Yes ❑ No -^-� � u+4�� '' f` rJ' C 1 fPUMP ❑ Not installed Date installed Z 1—24—9 8 r'' t �Manufacturer'sname +��C� Jacket Model number �1�7��r3 HP 3 4 vai�s 2 3 0 � k Q � �Length of drop pipe �� ft. Capacity �� g.p.m. Type: �ubmersible ❑ L.S.Turbine ❑ Reciprocating ❑ Jet ❑ � ABANDONED WELLS y Does property have any not in use and not sealed well(s)? ❑ Yes 'lJ No VARIANCE Was a variance granted from the MDH for this well? ❑ Yes Oxlo � _ WELL CONTRACTOR CERTIFICATION j 4 Use a second sheet,ilneeded This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. � REMARKS,ELEVATION,SOURCE OF DATA,etc. 7he information contained in this report is true to the best of my knowledge. DO1V ST�bCL�1 ��dELL DRIL.LING INC. �7172 License Business N me -� Lic.or Reg�N�.�� ,.�.—t;,s .r' 1 uthorized Repres' ve Signature Date Fred Lei.�y IO-29-98 _—__ -_— Name ol Driller Date LOCAL COPY � ,�� S�, HE-01205-06(Rev.9/97) ^ Jcuin �it 1/Vater ��`'nic, J�izc. � t� ac 617 13th Ave So • Hopkins, Minnesota 55343 • (612) 935 - 3556 11/03/1998 Stodola Well Drilling � 3841 North Main St. Bonifacius MN 55375 938-2111 REPORT OF WATER ANALYSIS Lab#: 36066 Our Laboratory reports these analytical results, determined on a sample taken by CLIENT on 10/29/1998 from the following location: Ken Carison 3498 N. Shore Dr. Orono�Mn Unique IMell�615561 Coliform Bacteria <1/100 ml Nitrates Nitrogen <1 .0 mg/1 The results of these tests indicate that this w�ell 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 include analysis of Lead and other contaminants. (Unless as specified by Gient). � . 't ater Clinic, Inc. �, \ Bill ale an�q�a�4bo�awry coo.�B� w.cm a�.�y��x��r, soa�wu�c�.r Lab Cort�ioation�Y 027-033-119