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Home My WebLink AboutWell info t:. ..,�_... .. � r�. ,�.-�,.. ._ ,F�.I ..r.. � . . i'� ri t"f;�"fa� !R'9ET' �dv 6..J��9�' _ . ' .. _.. �. :.�. �t-F:.. , , . ,� . .�._ �. � ,. . . .._. _,... . .� . .�J. �v'+$�'":.k':..iw � . . ... . .r. . �'".�r �,.� . . . .... .-... ., .,,.. .' WEL�OCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. � Counry Name WELL AND BORING RECORD 7 � � �� Minnesota Statutes, Chapter f037 Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed n. v, y �i GPS DRILLING METHOD LOCATION: Latitude ___ degrees minutes seconds _ Longitude degrees minutes seconds i J Cable Tool I�'Driven � ��.Dug � — �Auger �Rotary ��Jetted House Number,Street Name,City,and Zip Code of Well Location or Fire Number �� DRILLING FLUID WELL HYDROFRACTURED? ❑Yes No ; - - Show ezact location of well in section grid with"X". Sketch map of well location. �t��e FROM ft.TO R. Showing property lines, ' N roads and buildings USE . Noncommurnt PWg I`�I Mo ation 9 ��Heating/Cooling J `� � � �Domestic Y � � 9' L J Industry/Commercial �� . .___ , ___�__ _._ _ . I Environ.Bore Hole � -� � Remedial ' ' ' ' ❑Community PWS L_�Dewatering r�� , � _ �r ' � � 1� CASING HOLE DIAM. - w eT � .G,� Drive Shoe? �Yes �No � : --;--- --;-_ __�_____�,_ I � . [,Steel ❑Threaded ❑Welded '� 'h Miie � Plastic � P� ; ; ; ; � -� - � � � � CASING DIAMETER WEIGHT . � � S � � F---iMile—� /, ,�� '-`_�,.�x„ :j� � , —� in.to �"!� _ft. ��0� Ibs./ft � in.to �Q��. I "-'�"�`�J in.to__ ft. IbsJfL �in.to �"��ft. �� PROPERTY OWNER'S NAME/COMPANY NAME in.to ft. Ibs./tt. in.to ft. SCREEN 2nJ...�w... OPEN HOLE Property owner's mailing address if different than well location address indicated above. Make _ FROM ft. TO ft. � � a1..,�.� Type Diam__�_ _ [7V�C �� SIoVGauze "'-" ��Length�� }�f �.�� Set between � ft.and �l ft. FITTINGS R N � ' STATIC WATER LEVEL � - , ... _ �+ ft� .below ❑above land surtace Date measured V J v5 PUMPING LEVEL(below land surface) � WELL OWNER'S NAME/COMPANY NAME �� q /� � ft.after_ �+ hrs.pumping �v � g.p.m. WELL HEAD COMPLETION Well owner's mailing address if different than property owners address indicated above. �,pitless adapter manufacturer u�.�u�+��'h�Mo el [,Casing Protection �2 in.above grade �'�.Abgrade(Environmental Wells and Boring ONLY) � GROUTING INFORMATION Well grouted �Yes ';J No �^ Grout material �,�Neat cement ❑Bentonite�[�ConcretQe,rc�High Solids Bentonite from O to �"'_ft. ^✓ ]yds �Fiags from -^✓ to `�7 ft. �� Z ❑bags GEOLOGICAL MATERIALS COLOR H MATERIALOF FROM � TO from to ft � g ❑yds. �ba s NEAREST KNOWN SOURCE OF CONTAMINATION ��" �+. ��..a feet y,,,}.� direction Well disinfected upon completion ''Yes �J No �.;,1 � PUMP !Not installed Date installed "3� ' f Y/ � rJ'`J Manufacturer's name ..,��r.�� <��-- Model number HP '"��'�J Volts i.J�-'� / .� Lenyth of drop pipe /� .�v` ft Capacity g.p.m. Typ Submersible �.j L.S.Turbine r1 Reciprocating jJ Jet [j ABA DONED WELLS Does property have any not in use and not sealed well(s) ;]Yes - o VARIANCE Was a variance granted from the MDH for this well? Lj 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,il needed }�,�� -�� REMARKS,ELEVATION,SOURCE OF DATA,etc. LVi! SL�OI� ��I��1� W�• iT�C• G�7Z 1`� �r�� n�.+��1 � �t t� 20�� Licensee Business Name Lic or Reg.No. 1 ....-""" .r /�_ .� c:,�� h ze epresentative Si Date t Chvck �crre - < �OCAL COPY �� +} � Name of Driller L HE-01205-08(Rev.5/02) ` IC 140-0020 f � / ^ � � T,�i Tw wv C i,ty 1Na�t�' � , ;. r�12 935 - 3556 617 13th Ave So Hopkins, Minnesota 55343 � . ) — 08/09/2005 Stodola Wel1 Drrlling 3841 North Main St. Bonifacius MN 55375 938-21 l 1 REPORT OF WATER ANALYSIS Lab#: 4546N Our Laborarory reporrs these analytica! results, determined on a sample taken by CLIENT on OS/OS/2005 from the following location: Tim Zwarts 3970 N.Shore Dr. Orono,Mn Well#719825 Coliform 8acteria <)/J 00 m! Nitrates Nitrogen <1.0 mg/1 The results of these tests indicate that rhis wel! is producing water rhat meets the standards for F.H.A., V.A., or conventiona! loans. Thrs report is an analysis for colifarm and nitrare only and does not include analysis of Lead and other contaminants. (Unless as specified by client). ' City Water Ginic, fnc. gi�l rsdale Lab Certificetion ii 027-053-119 WELL Op BORING�OCanON MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring I„I � CountyWame WELL AND BORING SEALING RECORD M nnfesoNa Unique Well No. Minnesota Statutes,Chapter f031 or W-series No. H�I1T!@ �II �'-°�"�°"""""°"`"�"� Township Name Township No. Range No. Section No. Frection(sm->Ig) Date Sealed Date Well or Bo�ng Constructed Oconc� 117 23 R 33-�fl06�i ''� GPS Latitude degrees minu[es seconds � Q C" � LOCATION: Depth Before Sealing ft. Original DepthSl..Z—ft. Longitude degrees minu[es seconds pU1FER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location ingle Aqu'rfer ❑Multiaqu'rfer �,,{' ,; E ORING lymeasured ❑Estimated Water Supply Well ❑Monit.Well �� , Show exact location of well or boring Sketch map of well ory ring in section grid with"X" location,showi ❑Env.Bore Hole ❑Other �ft. �ielow ❑above land suAace N lines,roads� uddings. CASING TYPE(S) � lY Steel ❑Plastic ❑Tile ❑Other � � � �.� W -- - -i-- -;-- --;-- E t WELLHEAD COMPLETION � � � � �{ Outside: ❑Well House Inside: ❑Basement Offset --�- ---- -;-- --i— � � 1��b �❑r'Pitless AdaptedUnit ❑Well Pit �� —�- -�-- -i-- --�— I a'� Z ❑Well Pit ❑Buried �� .: ��...�.��-..;. �'� _ ❑Buried r.__.�,/�. PROPERTY OWNER'S NAME/COMPANY NAME CASING(S) .`� " ��11 �.�rt8 Diameter Depth � Set in oversize hole? Annular space initialty grouted? Properry owner's mailing address it difterent than well loca6on address indicated above '�� r/ � �_ in.ffom� t0�.�ft. ❑Yes �No ❑Yes ❑No ❑Unknown + in.from to ft. ❑ves ❑No ❑ves ❑No ❑uMcrwwn - in.ffom t0 ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown WELL OWNER'S NAME/COMPANY NAME SCREEWOPEN HOLE � r Well owner's mailing address if difterent Man properry owners address indicated above Screen from�,.�t0��ft. Open Hole from t0 ft. OBS UCTIONS ' �Rods/Drop Pipe ❑Check Valve(s) ❑ Debris ❑ Fill ❑ No Obstruction Type of Obstructions(Describe) ,��ct/•v�.�' y�� ¢ E"� GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM ro Obstructions removed? ❑YBS ❑ NO DeSCfibB FORMATiON If not known,indicate estimated fortnation log from nearby well or boring PUMP dtt�'t 0 85 T'�e -' � �Removed ❑ Not Prese t ❑Other METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: No Annular Space Exists ❑ Annular space grouted with tremie pipe ❑ Casing Perforation/Removal in.from to ft. ❑ Perforated ❑ Removed in.from to ft. ❑ Perforated ❑ Removed Type of perforator ❑ Other >, GROUTING MATERIAL(S) (One bag of cement=94 Ibs.,one bag of bentonite=50 Ibs.) /� i Grouting Material�(�,L�'��/��T�from�£,�to�ft. yards � bags from to ft. yards bags from to R. yards bags OTHER WELLS AND BORINGS REMARKS,SOURCE OF DATA,DIFFlCULTIES IN SEALING pther unsealed and unused well or boring on property? ❑ Yes No How many? LICENSED OR REGISTERED CONTRACTOR CERTIFICATIO 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. llari stodoia WeII Drixlin�; Co,. rr�. ;2n72 Conhactor Business Name License or Registratlon No. ��// ��f �presen�t e ' �' Date H ��1�8� Ji�n Antonson LOCAL COPY Name o/Person Sealing Well or Boring n .