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HomeMy WebLinkAboutwell info UNIQUE WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH MIN ASSOTA ND BORING NO.WELL County Name WELL AND BORING RECORD 760625 Minnesota Statutes,Chapter 1031 Township Name Township No. Range No. Section No. Fraction WELUBORING DEPTH(completed) DATE WORK COMPLETED 7 23 07 GPS DRILLING METHOD LOCATION: Latitude degrees minutes seconds Longitude degrees minutes seconds E]Cable Tool El Driven Dug E]Auger ?Ootary E]Jetted House Number,Street Name,City,and Zip Coop of Well Location �or Fire Number ❑ 0. SW North Milwe ft. Qqm SQL DRILLING FLUID - E1: HYDROFRACTURED? ❑Yes o Show exact location of well/boring in section grid wit "X" •7Skkettcchh map of well/boring location. �,"` From, ft.To ft. She property lines, N 1I ro ,buil s,and directi SE [ omeslic ❑Monitoring ❑Heating/Cooling -----------------=-- ❑Noncommunity PWS ❑Environ.Bore Hole ❑Industry/Commercial ❑Community PWS ❑Irrigation ❑Remedial �� ❑Elevator ❑Dewatering ❑ w E T Shoev LWo HOLE, � CjASING MATERIAL Drive ❑Yes E DIAM -n steel ❑Threaded ❑Welde7"""" "." 'h Mile aslic ❑ CASING S Diameter Weight Specifications 11 1 Mile 4 in.to ft. 1LAIbs./ft. a in.to 3011. PROPERTY OWNER'S NAME/COMPANY NAME in.to ft. lbs./ft. in.toll"ft. n.to ft. lbs./ft. in.to ft. Property owner's mailing address if different than well location address indicated above. SCREEN_ OPEN HOLE jojo� Make From ft. To ft. Type Diam. Slot/Gauze Length Set between ft.and ft. FITTINGS + STATIC WATERML Measured from 53 ft. elow ❑Above land surface Date measured WEL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) ft.after 10hrs.pumping 25 g.p.m. Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION �{� �itless/adapter manufacturer t.,t..l't. del Casing Protection (in.above grade ❑At-grade(Environmental Well and Boring ONLY) GROUTING INFORMATION Well grouted [_-*s ❑No Grout materials ❑Neat cementntonite ❑Concrete ❑Other From To 30 ft. Yds. IFBags GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO From ��3t© To�ft. Wt — Ej Bags MATERIAL From W To 108ft. Yds?[Xags NEAREST KNOWN SOURCE OF CONTAMINATION r'7 v J feet —direction -�'• a ti O� soft 3 9 Well disinfected upon completion? es ❑No NJ CbW PUMP . J soft _, _,40 El Not installed Date installed Manufacturer's name Model Number ../ HP J Volts 0 Length of drop pipe �` ft. Capacity g.p.m. Type:❑Submersible ❑L.S.Turbine ❑Reciprocating ❑Jet ❑ ABANDONED WELLS Does property have any not in use and not sealed well(s)? ❑Yes AO VARIANCE Was a variance granted from the MDH for this well? ❑Yes Pgo 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. -. xw. ton Licensee Business Name Lic.or Reg.No. o Cer pr at Certified Rep.No. Date LOCAL COPY ---F760625 Name of Driller IC 140-0020 HE-01205-11(Rev.3/07) riv i vv C Xy W abef- CU*UCI I ncl. 617 13th Ave So Hopkins, Minnesota 55343 (612) 935 - 3556 06/03/2008 Stodola Well Drilling 3841 North Main St. Boni facius MN 55375 938-2111 REPORT OF WATER ANALYSIS Lab #: 208BN Our Laboratory reports these analytical results, determined on a sample taken by CLIENT on 06/02/2008 from the following location: Rex Rewerts 820 North Shore Dr. Orono,Mn Well 760625 Coliform Bacteria Absent 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). Twin C �Water Clinic, Inc. Bill a; 1'rsdale s Lab Certification#027-053-119 WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring H 0")/{ Seal County Name WELL AND BORING SEALING RECORD Minnleso aoUnique Well No. JJ `t Minnesota Statutes,Chapter 1031 or W-series No. Hmrwpin (Leave blank if not known) Township Name Township No. Range No. Section No. Fraction(sm.—Ig.) Date Sealed Date Well or Boring Constructed Or 117 23 0-1 NO',W ZZ- GPS Latitude degrees minutes_ seconds Depth Before Sealing ft. Original Depth ft. LOCATION: Longitude degrees minutes seconds IFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location ingle Aquifer ❑Multiaquifer 8�}(� 1L�s. raw �j'�( W L/BORING Measured ❑Estimated Date Measured S 1�mG /-'►' 2 lw th �m fts 5I_! ' Water-Supply Well ❑Monit.Well Show exact location of well or boring Sketch map of well or boring in section grid with"X" location,showing property ❑Env.Bore Hole ❑Other J ft. )pelow ❑above land surface lines,roads,and buildings. N CASING TYPE(S) c Steel ❑Plastic ❑Tile ❑Other '-''-'" j WELLHEAD COMPLETION w Y�� Outside: ❑Well House ❑At Grade Inside: ❑Basement Offset '"itless Adapter/Unit ❑Buried ❑Well Pit --r---- ❑Buried 3 ❑Well Pit ❑Other 1 Mile F-1 Other PROPERTY OWNER'S NAME/COMPANY NAME CASING(S) Raverts Diam> f r Depth t Set in oversize hole? Annular space initially grouted? Property owner's mailing address if different than well location address indicated above 6.e f ❑ ❑ ❑ ❑Unknown in.from �` to �✓ ft. Yes No Yes No in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown WELL OWNER'S NAME/COMPANY NAME SCREEWOPEN HOLE r If Well owner's mailing address if different than property owners address indicated above Screen from to-- 7—ft. Open Hole from to ft. OBSTRUCTIONS ,�/ ❑Rods/Drop Pipe ❑Check Valve(s) ❑Debris ❑Fill I/ c Obstruction Type of Obstructions(Describe) r GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? L]Yes ❑No Describe FORMATION PUMP If nol known,indicate estimated formation log from nearby well or boring. Type ❑Removed lot Present ❑Other W0ODUSED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: 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 beptonite=50 Ibs.) Grouting Material V,�4 6-zl�?,:5"Trdtn 10--'777—If ft. yards bags from to ft. yards bags from to ft. yards bags OTHER WELLS AND BORINGS REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING Other unsealed and unused well or boring on property? ❑Yes Mo 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. Dan Stodola Well Dri111ng Co,. Inc. 16% Licensee Business Name License or Registration No. d<9 CiWifieR6#resenffive Signature' C"""ertified Rep.No. Date LOCAL COPY H 270242 Name of Person Sealing Well or Boring HE-01434-10 IC#140-0423 5/07R MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring /� W@LL OR BORING LOCATION Sealing No. H `7 County Name WELL AND BORING SEALING RECORD Minnesota Unique Well No. Minnesota Statutes,Chapter 1031 or W-series No. (Leave sunk if not known) Township Name Township No. I Range No.Section No. Fraction(sm.—Ig.) Date Sealed Date Well or Boring Constructed Ornnn 117 23 07 1 AJ JW/. 31400 Q f GPS Latitude degrees minutes seconds Depth Before Sealing ft. Original Depth ft. LOCATION: Longitude degrees minutes seconds AQ U ER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location gle Aquifer ❑Multiaquifer ,�/ 8�fA �a 11.. q'j WE BORING L�Ipeasured E]Estimated Date Measured 20 fbc" Shore DL Orow 55%4 ter-Supply Well ❑Monit.Well Show exact location of well or boring Sketch map of well or boring in section grid with"X." location,showing property ❑Env.Bore Hole ❑Other v� ft. Xelow ❑above land surface N lines,roads,and buildings. CASING TYPE(S) .4� Steel ❑Plastic ❑Tile ❑Other --'------L -- WELLHEAD COMPLETION W E �\ TOutside: Well House ElAt Grade Inside: [ asement Offset 'h MilePitless Adapter/Unit E)Buried El well Pit , s , ❑Well Pit ❑Buried 1 Mile ❑Other ❑Other PROPERTY OWNER'S NAME/COMPANY NAME CASING(S) vavoDismay, t Depth(j/�/.��( Set in oversize hole? Annular space initially grouted? Property owner's maili address if different than well location address indicated above � in.from 4 to q— ft. ❑Yes >(NNo ❑Yes ❑No ❑Unknown in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown 2 of 2 in.from to ft. ❑Yes ❑No E]Yes ❑No L]Unknown WELL OWNER'S NAMEICOMPANY NAME SCREEN/OPEN HOLE Well owner's mailing address if different than property owner's address indicated above Screen from---0$04!+ rom+ to---! � ft. Open Hole from to ft. OBSTRUCTIONS [ {ods/Drop Pipe ❑Check Valve(s) ❑Debris ❑Fill ❑No Obstruction Type of Obstructions(Describe) -LyAlo . -Z GEOLOGICAL MATERIAL COLOR HARDNESS OR FORMATION FROM TO Obstructions removed? (es E]No Describe If not known,indicate estimated formation log from nearby well or boring. PUMP Iftift © s Type ❑Removed ^ot Present ❑Other _ METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: 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 lbs.,one bag of bentonite=50 lbs.) Grouting Material tV164 ft. yards bags from to ft. yards bags from to ft. yards bags OTHER WELLS AND BORINGS REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING Other unsealed and unused well or boring on property? ❑Yes Xo 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 frilling Cos. Inc. 16% Licensee Busine a e License or Registration No. 9-S-M e epresentative Sig ure Certified Rep.No. Date H 274376 'lu Anton"Lw•::CL COPY Name of Person Sealing Well or Boring HE-01434-11 ICk 140-0423 2/08R