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HomeMy WebLinkAboutwell info WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. County Name WELL AND BORING RECORD 688976 Minnesota Statutes Chapter 1031 Township Name Township No. Range No. Section No.Taction WELL DEPTH(completed) Date Work Completed 1117 23 07 % v. 1% n. 9-23-04 GPS DRILLING METHOD LOCATION: Latitude degrees minutes seconds Longitude degrees minutes seconds [:]Cable Tool ❑Driven Dug ❑Auger Rotary ❑Jetted House Number,Street Name,City,and Zip Code of Well Locationor Fire Number ❑ DRILLING FLUID WELL HYDROFRACTURED? ❑Yes No Shop exact location of well in section grid with"X". Sketch map of well location. Water FROM ft.TO ft. ��,` Showing property lines, ds and bwldings USE N "- ❑Monitoring ❑Heating/Cooling Domestic ❑Environ.Bore Hole ❑Industry/Commercial !!!"`❑Noncommunity PWS ❑Irrigation ❑Remedial •�3fl ❑Community PWS ❑Dewatering ❑ t CASING c� HOLE DIAM. w e J� Drive Shoe? _]Yes ,p No ' T (� ❑Steel ❑Threaded ❑Welded h mile Plastic El ---- ---------- -- 1 CASING DIAMETER f }�WEIGHT 8 4 in.to 186 ft. 2 lbs./ft. V in.to 30ft. F--1 Mile y in.to ft. lbs./ft. in.to I% 194ft. PROPERTY OWNER'S NAME/COMPANY NAME in.to ft. Ibs./ft. in.to ft. Stonewwd DWiM %ild SCREEN OPEN HOLE Property owner's mailing address if different than well location address indicated above. Make � FROM ft. TO ft. "2Q Shoreline Tar Type stainlew stl Diam. r— — ��wn P*rkq M 553% Slot/Gauze Length LL9 4 Lt �'Ys'��,$o Set between19V ft.and ft. FITTINGS 27XW Wlkp STATIC WATER LEVEL +f��ht W ft.X below ❑above land surface Date measured 9 L'23"(A PUMPINGLEVEL(below land surface) WELL OWNER'S NAME/COMPANY NAME 184 ft.after__ 1.5 firs.pumping pit} gp.M. WELL HEAD COMPLETION Well owner's mailing address if different than property owners address indicated above. Pitless adapter manufacturer itr Model ❑Casing Protection f 12 in.above grade ❑At-grade(Environmental Wells and Boring ONLY) GROUTING INFORMATION Well grouted Yes ❑No Grout material FLJ Neat cement ❑Bentonite ❑Concret.XHHigh Solids Bentonite from_ © to 4 30 ft. 2.5 [_]yds. bags a from 30 to 8 ft. =tUCS1 JUU ❑bags GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO from to ft. ❑yds. ❑bags NEAREST KNOWN SOURCE OF CONTAMINATION a� clay brown Soft 0 20 feet direction _I p Well disinfected upon completion es ❑No Clay/swo ray soft 20 182 PUMP • ❑Not installed Date installed WaterSand ay soft 182 1% Manufacturer's name Aermtor Model number HP 1.5 Volts 230 Length of drop pipe ft. Capacity g.p.m. Type,.,y Submersible ❑L.S.Turbine ❑Reciprocating ❑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 well? ❑Ye No TN# WELL CONTRACTOR CERTIFICATION ir 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 se sheet,if needed on St�1a Well uLll� co,,. ,T.N. 2nn REMARKS,ELEVATION,SOURCE DATAeLicensee Business Name Lic.or Reg.No. 2-9-05 - A homed Rese ative Sigm ure Date 0** Moore LOCAL COPY F6889716 Nameo/Driller Daterle-olzos-oa(aev.5102) IC 140-0020 riv L-'*V C icy W at-a-r- C U*t4c/., I vw-1- 617 13th Ave So Hopkins, Minnesota 55343 (612) 935 - 3556 09/29/2004 Stodola Well Drilling 3841 North Main St. Boni facius MN 55375 938-2111 REPORT OF WATER ANALYSIS Lab #: 752 Our Laboratory reports these analytical results, determined on a sample taken by CLIENT on 09/27/2004 from the following location: 4516 N.Shore Dr. Orono,MN Unique Well#688976 Coliform Bacteria <1/100 ml Nitrates Nitrogen <1.0 mg/1 The results of these tests indicate that this well 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 client); win City Water Clinic, Inc. Bill ' Arsdale Lab Certification#027-053-119 WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring o. H 206523 County Name WELL AND BORING SEALING RECORD Minnesota Unique Well No. Hennepin Minnesota Statutes,Chapter 1031 or W-series No. (LeO bt.nk it nod known) Township Name Township No. Range No. Section No. Fraction(sm-)-Ig) Date Sealed Date Well or Boring Constructed Orono 117 23 07 10006 X1J 03 GPS Latitude degrees minutes seconds F LOCATION: Depth Before Sealing l�K ft. Original Depth J ft. Longitude degrees minutes seconds AQUIFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location ingle Aquifer ❑Multiaquifer WELL/BORING Measured ❑Estimated 4515 Northshore Dr.• Orono♦ Mn• Show exact location of well or boring Sketch map of well or boring )(Water Supply Well ❑Monit.Well r in section grid with"X' Coca bn,showin erty ❑ Env.Bore Hole E]Other15—Z ft. (below ❑above land surface N � ineroMs e uil gs. CASING TYPE(S) " feel ❑ Plastic ❑Tile ❑Other W- - ` ' ';" ";-- E WELLHEAD COMPLETION Outside: ,❑]LLWell House Inside: ❑Basement Offset kmile Ivi.44 41(1, i L�itess Adapter/Unit ❑Well Pit 1 ❑Well Pit ❑Buried r mae ❑Buried PROPERTY OWNER'S NAME/COMPANY NAME CASINGS) Diametek' Depth / Set in oversize hole? Annular space initially grouted? Property owners mai Ing address it di erent than well Location address indicated above kv in.from—0 to � / ft. ❑Yes dQvo ❑Yes ❑No ❑Unknown 4420 Shoreline Drive Spring Park, MN. 55384 n.from to ft. ❑Yes 0 No ❑Yes F1 No E] Unknown in.from to ft. ❑Yes ❑ No ❑Yes ❑ No ❑Unknown WELL OWNER'S NAME/COMPANY NAME SCREEN/OPEN HOLE r / Welt owner's mailing address if different than property owner's address indicated above Screen from t0 ft. Open Hole from to 1e—s—, ft. OBSTRUCTIONS "A Rods/Drop Pipe ❑ Check Valve(s) ❑ Debris ❑ Fill ❑ No Obstruction Type of Obstructions(Describe) _ ZA 444640 Tpe ¢ J�OMP GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? es ElNo Describe FORMATION If not known.indicate estimated formation log from nearby well or boring PUMP n Type— f CJ/�'i� f [!�Iemoved ❑ Not Present ❑Other 4MEETHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: E)ko Annular Space Exists El Annular space grouted with tremie pipe El Casing Perforation/Removal ,,`` in.from to ft. ❑ Perforated ❑ Removed in.from to ft. ❑ Perforated ❑ Removed Type of perforator ❑ Other GROUTING MATERIAL(S) (One bag ofcement=94 lbs.,one bag of bentpnite=50 lbs.) Grouting Material / G�f�r�// -/"!from 0 to ��� yards � bags from to ft. yards bags from to ft yards bags OTHER WELLS AND BORINGS 'EMARKS,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 contained in this report is true to the best of my knowledge. DON STODOLA WELL DRILLING CO. , INC. 27172 Contractor Business N e License or Registration No. A ri R pres ntative Signature Date 'AL COPY H 2065231 Name of Person Sealing Well or Boring