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Home My WebLink Aboutwell info . , � WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. � co��ri Name WELL AND BORING RECORD + �i![i2 in Minnesota Statutes,Chapter 1037 �� Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed t)ca� 12 i 23 07 �, ,, ,, " GPS DRIL I METHOD LOCATION: Latitude degrees minutes seconds . _ . Longitude degrees minutes seconds �Cable Tool r�Driven .�Dug � — ❑Auger �iotary _Jetted House Number,Street Name,City,and Zip Code of Well Location or Fire Number � �[} N f,'"�� ► � gQ� DRILLING FLUID WELL HYDROFRACTURED? n Yes . o J Show exact location of well in section grid with"X". _,�� Sketch map of we!I location. ��r FROM ft.TO � ft. � r� Showing property lines, — � N � !f 9 Noncommunity PWS �Manitorin � # roads and buildin s USE ., �/ g ❑Heating/Cooling �-- � � � � j�.Domestic ,Environ.Bore Hole ❑Industry/Commercial '� t ��"�'—""""—^-- f] Irrigation ❑Remedial �< ; I ; ; �( �]Dewatering !L� � .I Community PWS : � � -� � �� `-� CASING HOLE DIAM. �� '� w ; ; ; ; e�- � Drive Shoe? [j]Yes�o � ' ' ' ' I I�l'Steel ��Threaded � n Ided �` � --�----�--- --F-- � '/Mile �Plastic �� ❑ ; ; ; ; 1 � -- - : --------------�-- ---.-- CASING DIAMETER WEIGHT � � � S � � � ,�P � in.to 11� ft. Z*� Ibs./ft. �+ in.ro� ft. �--i M�ie� {'' � ��'�r Q - - � ""� in.to it. Ibs./ft. �in.�`✓� ft. PROPERTY OWNER'S NAME/COMPANY NAME in.to ft. Ibs./it. in.to ft. - � rfll S9 SCREEN OPEN HOLE s Property owner's mailing address if different than well location address indicated above. Make__�(y�'[j![AR__ FROM ft. TO ft. Type et�e{wt�rsae st� Diam. � � � SlotlGauze •�li� Length �___,� ��__ Set between ft.and it. FITTINGS STATIC WAT EL OU tt�' below �J above land surface Date measured TZ�"t�! PUMPING LEVEL(bel land surface) WELL OWNER'S NAME/COMPANY NAME �H �,^ " �I1 ft.after 2 hrs.pumping '�iV g.p.m. WELL HEAD COMPLETION 1 Well owner's mailing address if different than properry owners address indicated above. ��i�less adapter manufacturer � ;,)�'�3 T w ;,,t��+��v_r�Model_ ��Casing Protection `�12 in.above grade ❑At-grade(Environmental Wells and Boring ONLY) GROUTING INFORMATION Well grouted 't Yes ❑No Grout material �Neat cement [�Bentonite �:Concrete�High Solids Bentonite from�to�ft. �_ [j yds. I�.kSags from�to__��ft ��,��, 7^,bags GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO from ro R. J yds. ��.bags MATERIAL NEAREST KNOWN SOURCE OF CONTAMINATION O �� &Cx ��t O � _ feet '�� direction � type _ Well disin(ected upon completion Yes ❑No PUMP �� 0 � �Not installed Date installed J � �-' ��/4 � w.�,�' r y�,�, ��,t y/� �� Manufacturer's name �� l�%"� /' - " lisitiVR i. 1J 9iJ Model number HP � � Volts t � �,� 1�' Length ot drop pipe �% ft. Capacity g.p.m. Type: - Submersible ❑LS.Turbine ❑Reciprocating ,��,�.Jet '�J V� CO1O� �O� 1VL3 �g� AB DONED WELLS Does property have any not in use and not sealed well(s) ❑Yes No VARIANCE f Was a variance granted from the MDH for this well? jJ 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,il needed - REMARKS,ELEVATION,SOURCE OF DATA,eta �, �'�, I� s IIIC• 27�� Licensee Business Name Lic. eg.No. / ..1 ^ �- �l- c:* or' e at e Sign ure � Date - �2C�[ MOOt@ �1�`�i 7 �� Name of Driller LOCAL COPY HE-01205-08(Rev.S/02) � ' IC 140-0020 Tw%vv Ci,t'y l�t�a�t�e�' C ' � ' , � I vtic� 617 13th Ave So • Hopkins, Minnesota 55343 • (612) 935 - 3556 03/16/2004 Stoclola Well Drilling 3841 Norrh Main St. Bonifacius MN 55375 938-211 1 REPORT OF WATER ANALYSIS Lab#: 153 Our Laborato�y reports these analytical results, derermined on a sample taken by CLIENT on 03/15/2004 frorn the following locaiion: Dan Phipps 4064 N.Shore Dr. Orono,MN Unique Well#705930 Coliforyn Bacteria <1/100 ml Nitvates Nitrogen <1.0 mg/1 The results of these tests indicare that this well is producing waier that vneets the standards for F.H.A., V.A., or conventional loans. This report is an analysis for coliforrr► ancl nitrate only ancl does not include analysis of Lead and other contarninants. (Unless as speci�ed by client). .., � i Citi Water Clinic, Inc. �\•�� `� . eil ale Lab Cartificetion#027-053-119 �_ r _ ► WELL OR BoaiNG�oCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring I„I � � County Name WELL AND BORING SEALING RECORD MennlesoNa Unique Well No. � i� Minnesota Statutes,Chapter 103i or W-series No. _ (Leeve blenk il na�k��own) Township Name Township No. Range No. Section No. Fraction(sm�Ig) Date Sealed Date Well or Boring Constructed - �rono t17 23 a 44 5 ', ' ;�21�, GPS Latitude degrees minutes seconds R(w� /y�'� � LOCATION: Depth Before Sealing `—^'v ft. Original Depth v� ft. Longitude degrees minutes seconds �FER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location ingle Aquiter ❑Multiaquifer WE L/BORING Measured ❑ Estimated _ � � �VJater Supply Well ❑Monit.Well � Show exact location of well or boring � SkePch map of well or boring '� in section grid with"X" location,showing property ❑ Env.Bore Hole ❑Other ti:� ft �below ❑above land surface � _`�^�,�lines,roads,and buildings. N � CASING TYPE(S) a � � � � � --�-- —� '. teel ❑Plastic ❑Tile ❑Other W -- - - -- - — -- — E WELLHEAD COMPLETION i, � � � r , , , Outside: ❑Well House Inside: �Basement Offset -�-- -�-- -;— --,— � """"�'� . � �^'�� lJ�3Q.�1 ❑ Pitless AdaptedUnit ❑Well Pit -r- -i-- -�-- —�— I 1 ❑Well Pit ❑Buried � S r''`� r mee� ,��` ;��a.:s"•-�,.��_�e�. . ❑Buried PRTO.P.ERTYnOt�WtNER'S NAME/COMPANY NAME CASING(S) fRt� �[il s 952-472�'�7 Diameter Depth^ t Set in oversize hole? Annular space initially grouted? Property owner's mailing address if different than well location address indicated above �� y►�� in.frOfll� to�ft. ❑Yes [�No ❑Yes ❑No ❑Unknown in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown in.ffOm t0 ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown WELL OWNER'S NAME/COMPANY NAME SCREEN/OPEN HOLE � �� t Well owner's mailing address if different Ihan property owner's address indicated above Screen from i, to�ft. Op@n Hole frOm t0 ft. OBSTFUCTIONS �Rods/Drop Pipe ❑ Check Valve(s) ❑ Debris ❑ Fill ❑ No Obstruction Type of Obstructions(Describe) �.LNI�..�� '� 9"' �� GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? 2S ❑ No DeSC�ib2 FORMATION It not known,indicate estimated formation log from nearby well or boring PUMP . r^� J�_T �v�p J� ;�.J � TyPe t'�� Removed ❑ Not Present ❑Other � METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: �o 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 o�bentonite=50 Ibs.) Grouting Material �"/��r `�-��'�'�?rom � to � ft. yards � bags from to ft. yards bags from to ft. yards bags OTHER WELLS AND BORINGS � c' REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING Other unsealed and unused well or boring on property? ❑ Yes No How many� LICENSED OR REGISTERED CONTRACTOR CERTIFICATION This well or boring was sealed in accordance with Minnesota Rules,Chapter 4725.The information coniained in this report is Irue to the bes[ot my knowledge. Don Sti�d�a �tell Dcillir� Co,. Inc. 27172 Contractor Bus�ess arrrc License or Registration No. �."' � �� /�,� �7 q tho�ed epresentative tur � Date �4\ .' 218145 ` ' �"`` LOCALCOPY H �� Name ol Person Sealing Well or�