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Home My WebLink Aboutwell info r � . WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. �o��tY Name WELL AND BORING RECORD 6 6 H O 3 O Minnesofa Statutes Chapter103/ Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed Orono 317 23 8 ,. ,. ,. 125 " 8-29—01 House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLWG METHOD 3510 N Shore Dr, �r�A�} 55391 ❑ CableTool f7 Driven ❑ Dug ` �"' Auger �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 HYDROFRACTURED7 ❑YES " Water i i � i FROM ft.to_ ft. -i -i- -�- -i- -- USE Cl Monitoring ❑ Heating/Cooling i � i i �Domestic ❑ Communiry PWS ❑ Indust /Commercial � � � i � � Irrigation ❑ Noncommunity PWS G Remed al w I I I I e� �`�.��,1\ . ❑ Emiron.Bore Hole ❑ Dewatering �_:, _ i _, -T r '/zMie _.. . CASING DriveShoe? ❑ Yes No HOLEDIAM. i _i_ _i_ _i_ � ❑ Steel. ❑ Threaded ❑ Welded '� � � � 1 �J . �.. .... �� Plastic ❑ S .t,'.._ .._r_. � _ /� . �-1 Mile--{ CASING DIAMETER WEIGHT PROPERTY OWNER'S NAME � in.to !j'8 ft. 2'01 Ibs./ft. 8 in.to '��ft Raleidoscope D�sfgn LLP �� o _.__�. __ __�bs.�tt. S<;�.�ol�,,. Property owner's mailing address it different than well location address indicated above. __—_-- ___in.to _____ft. Ibs./ft. in.to____ft. 26890 Noble Ad SCREEN_._�y�sO�_ OPEN HOLE Shorevaod, MN 5533T `'�''�` _ Make from ft.to_ R. Type� _�� _..____Diam. ' � SIoVGauze_._ •il�� Length , �� Set between _��____ft.and___�.��__ft. FITTINGS��__ STATIC WATER LEVEL WELL OWNER'S NAME _�__________ft. �below ❑ above land surtace Date measured�—?_9 Q� PUMPING LEVEL(below land surface) Well owner's mailing address if different than property owner's address indicated above. __ _1_1_�_ tt. after 1 hrs.pumping�.�__ g.p.m. WELL NEAD COMPLETION ,,�y j �PiNess adapter manufacturer �111 L ep$t e��vl,ordel ❑ Casing Protec�ion_ _ I]y 12 in.above grade C At-grade(Environmental Wells and Borings ONLY) � GROUTING INFORMATION Well grouted? �Yes ❑ No GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO Grout Material ❑ Neat cement ❑ eentonite ❑ Concrete ['�I+�High Solids Bentonite MATERIAL � �Q __�j� Y � 9 from to ft. ds. ba s tp +� trom_�__.._.to._��fl. �8,�_$,�_$� C��d��1 bags t0�1g�1� b�BC� ��it Q J trom _ _ to_ fl. ❑ yds. ❑ bags NEA/R��S/T�)$NC,WN SOURCE OF CONTAMINATION �� +C (�"1$� gr8'�/ �(�f t ,7 �Q ___1S,L ._ feet _��.� �direction � t _type Well disinfected upon completion? C�'es ❑ No sand/�ravel gray soft 90 12b PUMP CJ Not installed Date installed Q�[7�n1� Manufacturer's name [1et�Q�� _ Modelnumber __.______.____ _._ HP�9 Volts L�� Length of drop pipe.__ ��._..__ __ ft. Capacity g.p.m. Type: ubmersible G LS.Turbine ❑ Reciproca6ng ❑ Jet ❑ ABANDONED WELLS � Does property have any not in use and not sealed well(s)? ❑ Yes �No VARIANCE Was a variance granted from the MDH for this well7 ❑ Yes CJ�No TN# _ ! WELL CONTRACTOR CERTIFICATION Use a second sheet,il needed This well was drilled under my supervision and in accordance with Minneso[a Rules,Chapter 4725. REMARKS,ELEVATION,SOURCE OF DATA,eta The information contained in this report is true to Ihe best of my knowledge. �_�flri 7 t inrr (`.n_ T�n�T9 I�'� Lice ee Business Name � ic.or eg. o. .f,:,� / � ��=� `�` ` �--�" 9-2A�n� Authorized Representative Signature Date Chuck Moote 8-29—OI Name of Driller Date LOCAL COPY 6 6 8 0 3 0 HE-01205-07(Rev.2/99) IC#140-0020 I .. rw� c�- w�� c , , , r�,� y 617 13th Ave So • Hopkins, Minnesota 55343 � (612) 935 - 3556 OS/31/2001 Stodola Well Drilling 3841 North Main St. Bonifacius MN 55375 938-21 1 1 REPORT OF WATER ANALYSIS Lab #: 949 Our Laborarory reports these analytical results, determined on a sample taken by CLIENT on OS/29/2001 from the following location: 3510 N. Shore Dr Orono,Mn Unique Well #668030 Coliform Bacteria <1/100 ml Nitrates Nitrogen <1.0 mg/1 The results of these tests indicate that this well is producing waier that meets the standards for F.H.A., V.A., or conventional loans. This reporr is an analysis for coliform and nitrate only and does nor include analysis of Lead and other contaminants. (Unless as specified by clien[). �,, 'n Ci Water Clinic, Inc. �\ Bill ale � Lab Certification#027-053-119 � WELL OH BORING LOCATION MINNESOTA DEPARTMENT OF HFALTH Minnesota Well and Boring I ��n a"� � Counry Name WELL AND BORING SEALING RECORD Sea�ing No. �H O L Minnesota Unique Well No. � � Aennspin Minnesota Statutes.Chapter 703/ o�W-series No. w�c n na w�w�� Township Name Township No. Range No. Section No. Fracuon(sm.-►Ig.) Date Sealed Date Well or Bonng Consiructed 4rona 117 23 8 . ,. Zt � � C� Numencal Street Address or Fire Number and Ciry of Well or Bonng Location � t 353.0 At Sho�e Br, flrono 553�l1 � — Depth Betore Sealmg �� R Onginal Depth �� n� Show exact locatwn of N�ell or bonng ��Sketch map ot well or bo�ng AO IFER(S) STATIC WATER LEVEL in section grid wdh"X'. 1�'�"�ylocahon, showing prop y Single Aywter � MWhaquifer '-Y lines,roads,and building . � N - WELUBORING Measured ❑ Estimated � �1Nater Supply Well ❑Monit.Well — — � .�'� ❑ Em.Bore Hole ❑Other , � R �j below ❑ above land surface W -- - - '- - -- -- -- E � CASING 7YPE(S) I I � � � � -�-- -;-- -;-- --i-- �Steel ❑ Plastic �Tile � Other yimile > -�-- -i-- -i-- --�— � CASING(S) S ' Diamete%' Depth � / Set in oversize hole7 Annular space initially grouted7 �1�—t mae� -�' � in.from C.-/ to /��-� ft. ❑ Ves �No ❑ Yes ❑No ❑ Unknown � -y�-,. .� � g_ ��,__,,. . PROPERTV OWNER'S NAME m.trom to fl. ❑ Yes ❑No ❑ �es ❑ No ❑ Unknown �,,,. i i Ine n tio ss indicated above. in.from to tt. ❑ Yes ❑No ❑ Yes ❑No ❑Unknown 2689� Rlob2e Rd SCREEWOPEN HOLE r �f�` i Shore�►ood� MN 5 5331 Screen from �d� ro� R Open Hole from to tt. OBSTRUCTIONS WELL OWNER'S NAME �Rods/Dro Pi ( ) ❑Debris ❑ Fill ❑No Obstruction p pe ❑Check Valve s ..-- �- /� / �'^ Well owners mailing address it diflerent Man property ownars address mdicated above. Type ot Obslructions(Describe) �/uN�� r/� �"- �/ � � Obstructions removed? �Yes ❑ No Describe PUMP Type (iEOLO(31CAL MATERIAL COLOR HARDNESS OF FROM TO � Removed [�C Not Present ❑ Other FORMATION It not krawn,indicete eatimated fortnatbn log from nearby well or bonng. �METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: r ,LS.No Annular Space Exists v Q ❑Annular space grouted with tremie pipe ❑Casing Perforation/Removal in.from to R. ❑ PeAoreted ❑ Rertroved in.fiom �p ry, ❑ PeAorated ❑ Removed Type of perforator ❑ Omer GROUTING MATERIAL(S) (One bag of cement=94 Ibs.,one bag of bentonite=50 Ibs.) �^' / Grouting Material �� F'�Kom � to� ft. yards � bags from to R. yards bags from to ft. yards bags from to__ ft. yards bags REMARKS,SOURCE OF DATA,DIFFICUlT1ES IN SEALING OTHER WELLS AND BORINGS Other unsealed and unused well or boring on property? ❑Yes No How many? LICENSED OR REGISTERED CONTRACTOR CERTFICATION This well or boring was sealed in accordance with Minnesota Rules,Chapter 4725. The infortnation confained in Mis report is true to the best of my knowledge. Don Stodola ide21 Drilling Co., Inc. 27272 Contractor Business N e - � f License o�Regishafion/io. `� �'� r � ,�� :�� mo •nr , srgnerure Dere _ .----� -....�. �`:, J ;� � . . �}Y��,Q�S Y � l.�DCAL CO�PY H ��p� Neme o/Person Sealing Al/or Bonng V `J