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Home My WebLink Aboutwell info 4 MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring 253342 WELL OR BORING LOCATION WELL AND BORING SEALING RECORD S aliiesotaoUnique Well No. H County Name Minnesota Statutes,Chapter 1031 or W-series No. 4.....01.101m1...0 Towns tPFP ownship No. Range No. Section No. Fraction(sm.-.Ig.) Date Sealed Date Well or Boring Constructed Orono 118 23 35 134/003. 3 GCT £ GPS Latitude degrees minutes seconds Depth Before Sealing / 2 f 2 tft. Original Depth ft. LOCATION: Longitude degrees minutes seconds AGUIFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location Single Aquifer ❑Multiaquifer WfLL/BORING X Measured ❑Estimated Date Measured Water-Supply Well ❑Monit.Well f Show exact location of well or bo getch map of of well or boring in section grid with"X" location,showing property ❑Env. Bore Hole ❑Other ?i ft. below ❑above land surface lines,roads,and buildins. N CASING TYPE(S) y ,� ❑Steel E Plastic ❑Tile ❑Other WELLHEAD ❑Well COMPLETION t t w E tL ___.__ __,__; Outside: House ❑At Grade Inside: ❑Basement Offset k Mile XPitless Adapter/Unit El Buried ❑Well Pit - ----T---- -- - 1 n ❑Well Pit El Buried S '°' l ❑Other ❑Other 1 Mile l../ PROPS TY OWNER' NAME/ MPANY NAME j CASING(S) "�+" Onsttoct3on Dig.Iv /^y f Depth J Set in oversize hole? Annular space initially grouted? Property owner's mailing address if different than well location address Indicated above in.from / to / ft. ❑Yes No ❑Yes 6583 158th St W, Ste 116C ❑No ❑Unknown Apjle Val1 ,i 55124 in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown WELL OWNER'S NAME/COMPANY NAME SCREEN/OPEN HOLE Well owner's mailing address if different than property owner's address indicated above Screen from 43 to /4/19 ft. Open Hole from to ft. OBSTRUCTIONS WRods/Drop Pipe ❑Check Valve(s) ❑Debris ❑Fill ❑No Obstruction Type of Obstructions(Describe) _f /1f ..n rd :. it tJme HARDNESS OR GEOLOGICAL MATERIAL COLOR FORMATION FROM TO Obstructions removed? Xes ❑No Describe If not known,indicate estimated formation log from nearby well or boring. PUMP �} dt,�] Type Sue Pom r U 1 7+y Removed ❑Not Pre ant El 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. E Perforated ❑Removed Type of Perforator ❑Other GROUTING MATERIAL(S),�/�L (One beg �of�cement=94 Ibs.,one bag of benftpnite=50 lbs.) I .terry Grouting Materiale'"'r19/ <C�`tff ° f to /S"ft. yards ! G. 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? E 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 m-, Inc- 1691 Contractor Business Name License or Registration No. 419 (00$(' ;,�►�.• /d-1. a 4 ative Signe,e Certified Rep.No. Date p H253342 s. LOCAL COPY Name of Person Sealing Well or Boring f HE-01434-09 IC#140-0423 6/O6R • Tw£ n' C(ty W cter C LI,vtI,c', I v / 617 13th Ave So • Hopkins, Minnesota 55343 • (612) 935 - 3556 10/17/2006 Stodola Well Drilling 3841 North Main St. Bonifacius MN 55375 938-2111 REPORT OF WATER ANALYSIS Lab#: 693BN Our Laboratory reports these analytical results, determined on a sample taken by CLIENT on 10/16/2006 from the following location: 1000 Old Long Lake Rd Orono,Mn Well #743419 Coliform Bacteria <1/100 ml Nitrates Nitrogen <1.0 mg/I 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 City Water Clinic, Inc. Bill`,V` rsdale Lab Certification#027-053-119 • MINNESOTA UNIQUE WELL WEJBORIf. LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. County Name WELL AND BORING RECORD 743419 � � Minnesota Statutes,Chapter 1031 Township Name Township No. Range No. Section No. Fraction WELLBORING DEPTH(completed) DATE WORK COMPLETED Orow 118 23 35 'i '/. '/. 150 ft. 1013-06 GPS DRILLING METHOD LOCATION: Latitude degrees minutes seconds ❑Cable Tool Driven ❑Dug Longitude degree§" minutes_ seconds_ ❑Auger *riven ❑Jetted House Number,Street Name,City,and Zip Code of Well Location or Fire Number ❑ ,; 1000 Old Long 'lake Rd, Orono 55391DRILLING LUI t5 WELL HYDROFRACTURED? ❑Yes to Show exact location of well/boring in section grid with"X." Sketch map of well location. From ft.To ft. Showing property lines, USEmestic ❑Monitoring ❑Heating/Cooling N t { .ads,buildings, 9/ 9 ; ; i '' and direction. ❑Noncommunity PWS ❑Environ.Bore Hole 0 Industry/Commercial j --' ❑Community PWS ❑Irrigation Remedial ❑Elevator ❑Dewatering ❑ T ill CASING MATERIAL Drive Shoe? ❑Yes ;o HOLE DIAM. W 1 1 E T ❑Steel ❑Threaded ❑Welded Plastic ❑ I i '/:Mile CASING 1 Diameter Weight Specifications I--1 Mile--I ,s, ' , 4 (_" 4 in.to• i � ft. 2�' lbs./ft. Mat 8 in.to ft. in.to ft. lbs/ft in.to lig)ft. PROPERTY OWNER'S NAME/COMPANY NAME in.to ft. lbs./ft. in.to ft. Strong Arm Constrzustion SCREEN juhneen OPEN HOLE Pro%rty owner's mailing address if different than well location address indicated above. Make From ft.To ft. 6583 15hStX11, ! 1160 sal mi Type Diam. 1e VSt 1 0 55124 Slot/Gauze •O O �a� Length 4� *- t l� ii�l J ,i►�3 f ri Set between 150 ,fL and 141 ft. FITTINGS rem. witp STATI ATER LEVEL 14)6 ft.Xelow ❑Above land surface Date measured lT' ' PUN=LEVEL(below land surface . WELLBORING OWNER'S NAME/COMPANY NAME170 +� ft.after 1,-a5 hrs.pumping '30 g.p.m. W LL HEAD COMPLETION Well/boring owner's mailing address if different than property owner's address indicated above. Xpitless Adapter Manufacturer -"�"�* o✓del ❑Casing:protection-: ' X2 in,attove grade ❑At-grade(Environmental Well and Boring ONLY) .„_•"' - GROUTING INFORMATION Well grouted? Yes ❑No oar[ , Grout materials ❑ V Neat cement plenton Concrete ❑Ot From To +� ft. ❑Y s fags From To I#2 ft.' ❑Bags HARDNESS OF GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO From To ft. ❑Yds. ❑Bags �4// NEAREST KNOWN SOURCE OF CONTAMINATION f Ili�,�,,,y,,,�` brow moth= 0 6 ' feet direction 0....444- Well disinfected upon completion?X/es ❑No fi +9 PUMP f claysoft 6 18 ❑Not installed Date installed / - 18"<34 /,�,�li brown y Manufacturer's name '-'. grewel/ii7LsModel Number HP Volts a clay gray medium 48 90 Length of drop pipe` ic) ft. Capacity g.p.m. # Type 6ubmersible ❑L.S.Turbine ❑Reciprocating ❑Jet ❑ ;tf l soft 900 1 ABANDONED 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? ❑Yes TN# WELL CONTRACTOR CERTIFICATION !� This well was drilled under my supervision ant;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,DECEIVED Dort Std Well Drilling Co. Inc. 1691 Licensee Business Name Lic.or Reg.No. J DEC 312007 `, 3-/m c7 Aut ''ed ,.. .sen••,eSI.na iiir Date CITY OF ORONO On& Mere LOCAL COPY 7 4 3 419 Name of Driller HE-01205-09(Rev.9/05) IC 140-0020