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Home My WebLink Aboutwell info � ' - ' RECEIVED WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH M/NNESOTA UNIQUEWELL NO. County Name WELL AND BORING RECORD SEP �2�� g�7 z @flnep�n Minnesota Statutes Chapter 1031 � �� , a Township Name Township No. Range No. Seclion No. Fraction WELL DEPTH(completed) C� e�c��O rono I37 23 8 �, ,,, ,, 152 3-14-�3 GPS DRILLING METHOD LOCATION: Latitude degrees minutes seconds Longitude degrees minutes seconds ��Cable Tool riven �Dug , �Auger �Rotary _ _Jetted House Number,Street Name,City,and Zip Code of Well Location or Fire Number � �. 3b25 N Shore DC� OCOAO DRILLING FLUID WELL HYDROFRACTURED? I�I Yes No Shop exact location of well in section g'n�i with"X". /� Sketch map of ation. Wg t C r FROM ft.TO fl. �"1y��M Showi roperty lines, _ -- ---- N '-`�" , ads and buildings USE ]Monitoring ❑Heating/Cooling � � , � ��No co�mmunity PWS � ��Irrigation ��Industry/Commercial ` J �,__Community PWS [�)DewateriBgre Hole � � � I Remedial '� --'---"-�"'""'"`'- ---`-- ASWG OLE DIAM W - --- -- E� C Drive Shoe? ._��.Yes o H . ;- - -, � F � [ I teel �Threaded �d � : ; �1M��e �--,� P�ast�� — — : : : ..� , ------ ------ - �-- --.— --� CASING DIAMETER WEIGHT ; ; S ; � � �4� __��0_i_ � 15�. � in.to fL IbsJfl in.to �--i nn�ie—; . ___ in.to__.. ___ft. Ibs./ft, in.to ft. PFOPERTY OWNER'S NAME/COMPANY NAME in.to ft. Ibs./ft. in.to ft. ack Welch SCREEN OPENHOLE Property owner's mailing address if different than well location address indicated above. Make��j,i1$D.�--_ FROM ft. TO ft. `' 1$430 Cty xd 4 TyPe—��t[2��.��_a*�Diam.�—A � t��Ou�y' � �S/ `� SIoUGauze__.��_ _ Length�... . .. t� 1 k t `f Y Set between ft.and it FITTWGS STATIC WATE L ___3�____ft.,�below above land surface Date measured____��,_4}��— _ PUMPING LEVEL(below land surface) �� WELL OWNER'S NAME/COMPANY NAME . . x --l�- �--- - hrs.pumping—�}Q_ ft.after__ ___ g.p.m. WELL HEAD COMPLETION Well owner's mailing address if different than property owners address indicated above. , pltless adapter manutacturer_ �t�te� Model ___ _.._ �- ❑Casing Protection_ ___________ " _�12 in.above grade 4 ❑At-grade(Environmental Wells and Boring ONLY) GROUTING INFORMATIO� Well grouted Yes ❑No Grout material �-��Neat cement �_,Bentonite i .��Concrete�High Solids Bentonite ; from_. _.Sl_to__�oat. �_y-- - �.--�.Yds. �bags �� from_�Q.to 152rt Qg.t.U,t$I, � ��.J,I�;bags . GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO from___. to ft. _ _yda �__]bags MATERIA� `" NEAREST KNOWN SOURCE OF CONTAMINATION , ) - ' . ��._.J feet ��--"D._.Uirection ' . ��-.. �u--_tYP �.:� a soil lack soft Q 4 _, Well disinfected upon completion Yes No and ra soft � 12 PUMP -- � '�.Not installed Date installed ��—U'3 `� �� +8 aof t j 2 �,5 Manufacturer's name Asw..w�w.. Model number__ .__ __.HP�Volts_Z3Q. _. ___ and Ea �of r Z 5 1{Q Length of drop pipe _____��___ ft. Capaciry_ _____________g.p.m. Type: Submersible '��''�..LS.Turbine [j Reciprocating [J Jet I._�_. .� � � �A CH ��,{.�j�'� I}Q �I� ABANDONEDWELLS � � Does property have any not in use and not sealed well(s) ��Yes No and cs of t 115 1 S 2 VARIANCE � Was a variance granted from the MDH for this well? Yes '�, �No 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,etc. DQn �_a��1�_��1 1. .n..3 1 1 /��. _T�C._�� f tuu�l �l 112.-s-i-i u _4 L Licensee Businesa Name ic.or Reg.No. i _. , ; ' 7-24-(33 , -:� :_� -- =--- ' ---- ----- u nzed Representative Sign�ture Date Chuck Mooce 7t-14-03 ___ -- _-- - � � �� Name ol Driller Date LOCAL COPY He-oizas-oe�Ra�-sroz� IC 140-0020 rw� c�-y w�-� c � � , r�,� 617 13th Ave So • Hopkins, Minnesota 55343 � (612) 935 - 3556 03/18/2003 Stodola Well Drilling 3841 North Main Si. Bonifacius MN 55375 938-21 1 1 REPORT OF WATER ANALY5IS Lab #: 181 Our Laboratory reports these analytical results, determined on a sample taken by CLIENT on 03/17/2003 from the following location: , Mark Welch 3625 N. Shore Dr. Orono,Mn Unique Well #688967 Coliform Bacreria <1/100 ml Nitrates Nitrogen <1.0 mg/1 The results of rhese tests indicate thai ihis well is producing water that meets the standards for F.H.A., V.A., or conveniional loans. This reporr is an analysis for coliform and nitrate only and does not include analysis of Lead and other contaminants. (Unless as specified by client). �.f ' City Water Clinic, Inc. ��, " �\ . . •�.. . �� BiII V.,' �� ild�e ' ``� Lab Certification#027-053-119 WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HFALTH Minnesota Well and Boring i ��O�� WELL AND BORING SEALING RECORD Minnlesota Unique Well No. H County Name -- Aenn�pin Minnesota Stalutes,Chaptei�03� o�W-�eri�sNa �_ � Township Name Township No. Range No Section No. Fracuon�sm.�Ig.) Date Seaied Date Weu or Bonr�g Constructed - Orono 117 23 0$ �� Numerical Street Atldress or Fire Numbei and Ciry of Well or 8oring�ocation � , 3fi25 t�� Sh�tB Lr • Orano, �. Depth Before Sealing �� __R Oriqinal Depth __��___ h Show exad locah n of K�ell or boring Sketch map of well or bonng ApUIFER�S) STATIC WATER LEVEL � in section�ri it�"X'. IocaUon, showing property Single Aywfer � Multiaqwfer ( I�ne�,roads,and buildmgs. ry J��! � '+ ,J WELUBORING �vleasured ❑ Estimated � r ater Supply Well ❑Monit.Well /� i � ❑ Em.Bore Hole ❑Other _ Gr_�R �below ❑ above land surtace W -�- -i-' -i- --i- E CASING TYPE(S) � -�-- -�- --i-- --�- � �Steel ❑ Plastic �Tile � Other }�e milB �� `- -�-- -�-- --�-- � CASING(S) .,�� Diame er�` Depth � Set in oversize hole9 Annular space initially qrouted7 � S � l'�' � �l Ves �Jo ❑ Yes No Unknown t mae� q`�'" in.irom to R. ❑ ❑ � PROPERTY OWNER'S NAME in.irom �o R. ❑ Yes ❑No ❑ Yes ❑No ❑ Unknown ' 1 �•x 3 Property owner's mailing address ilmun�nrn man wen iocauun nuuinae mw�am�a..�.a,..�+,��' in.frOm t0 ft. ❑ �0S ❑NO ❑ �'e5 ❑NO ❑ UnknOwn ,•�� ?.� SCREEWOPEN HOLE =3fiP'��` £t!S �; � r Screen trom_�_to�� ft. Open Hole irom to ft. OBSTRUCTIONS WELL OWNER'S NAME �Rods/Dro Pi e p p ❑ Check Valve(s) ❑ Debris ❑ Fill ❑ No Obstruction Well owner's mailing aAAress if tliMerent than properry ownar's atltlress indicalad above. Typ6 Of Obstrudions(DeSCribe) -fA.//V�J� � /�a� � ��e'/l/- Obsiructions removed? �Yes ❑ No Describe . ._ - -- --- .. _.. PUMP "�} TYPQ a�C.l.�'� r+ IJ<-LJ! GEOLO(31CAL MATERIAL COLOR HARDNESS OF FROM TO �Removed ❑ Not Present ❑ Other FORMATION If rat krawn,indicate estimateA tormatbn loq hom nearby well or bonng. METHOD USED TO SEAL ANNULAR SPACE BE7WEEN 2 CASINGS,OR CASING AND BORE HOLE: �o Annular Space Exists Annular space grouted with tremie pipe ❑Casing PeAoration/Removal in.from ro tt. ❑ Perforated ❑ Removed in.irom to tt. ❑ Perforated ❑ Removed - Type of perforaror ❑ Other GROUTING MATERIAL(S) (One bag of cement=94 Ibs.,one bag of bentonite=50 Ibs.) ,t.l�/�` C'�`,'��L ' Grouting Material - to.�,�Z R. yards � bags from to fl. yards bags irom ro R. yards bags from to__ ft. yaids bags REMARKS,SOURCE Of DATA,DIFFlCULTIES IN SEALING OTHER WELLS AND BORINGS Other unsealed and unused well or boring on property? ❑Yes o 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. '„ _ _ . .:; t80N STOl?QLA WBLL DRILLING Ct?. , INC. 271'72 Confracror Busine eme A . Cicense or Registretion I'Jo. '3` � .} -'. � jy-! d �' ii"�f��'�� / th0`r!i epresentative Signeture' Dete ;�:',� t�r tJF30i"�'C� �7in� A�ttonsoQ A^�� Name al Person Sealing Well or Bonng LOCAL COPY H G S�