The URL can be used to link to this page

Home My WebLink Aboutwell info WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. County Name WELL AND BORING RECORD 7 a 5 9 Minnesota Statutes,Chapter 1031 Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed 118 23 35 GPS197 R. 6-17-04 Latitude degrees minutes seconds DRILLING METHOD LOCATION: ❑Cable Tool ❑ ri Longitude degrees minutes seconds ven ❑Dug ❑Auger Rotary ❑Jetted House Number,Street Name,City,and Zip Code of Well Location or Fire Number 1005 Old lam Ti Rd 55391 DRILLING FLUID . WELL HYDROFRACTURED? ❑Yes,'No Show exact location of well In section grid with"X". Sketch )Sketch map of well owino pr ,,tion. FROM ft.TO ft. N :..j ICL L c v't L 'c�h ideljngs USE ❑MonitoringHeating/Cooling • ❑ w Domestic ❑Environ.Bore Hole ❑Industry/Commercial ; Noncommunity PWS ❑Irrigation ❑Remedial ---i-----'--- ------h--• - ❑'Community PWS ❑Dewatering ❑ w ; ,E v' CASING Drive Shoe? ❑YesNo HOLE DIAM. r ------i--• ❑Steel ❑Threaded Ided % - ,blas ❑ Mile ` ,h tic - , --t----t— -. 1 t:rCASING DIAMETER WEIGHT S „ 4 189 I---1 Mile---Iin.to ft. + Ibs./ft.: in.to in.to It. lbs./ft. in.to Z7ift. PROPERTY OWNER'S NAME/COMPANY NAME in.to ft. IbsJft. in.to ft. Standmee OvoistrectionSCREEN OPEN HOLE Property owner's mailing address if different than well location address indicated above. Make JohnsonFROM TO ft. 420 It Rice St Type injitaidil iit Diam. MN 55+J 9 Slot/Gauzei Length •9i Set between Iftnf ft.and ft., FITTINGS 2,4~ grAftra. STATIC WATER LEVEL '�,., 85 ft' below ❑above land surface Date measured +'"-"'O4 (belowPUMPING LEVEL land surface) WELL OWNER'S NAME/COMPANY NAME ft.after hrs.pumping q.p.m. WELL HEAD COMPLETION Well owner's mailing address if different than property owners address indicated above. Pitless adapter manufacturer t v 4 4 r Model Casing Protection [(2 in.above grade ❑At-grade(Environmental Wells and Boring ONLY) GROUTING INFORMATION Well grouted Yes ❑No Grout material Neat cement El Bentonite ❑Concreted/ Iigh Solids Bentonite from to_ ft. ❑yds.rags from_to_! fts. ❑bags GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO from to ft. MATERIAL ❑yds. ❑bags: NEAREST KNOWN SOURCE OF CONTAMINA ION 6. feet direction ..7 R .,,I' Well disinfected upon completion yes ❑No PUMP Soadicocke brown soft 6 10 ❑Not installed Date Installed ! - Ips GM clay smy sati g Manufacturers name Model number 111.111 HP It 1 Volts r mend way soft 60 No Length of drop pipe {6 ft. Capacity g.p.m. Type:; ,, ubmersibte ❑L.S.Turbine ❑Reciprocating ❑Jet ❑ • CillyittititilSSW to no ABA, ONED WELLS Does property have any net In use and not sealed well(s) p Yes 0000 garret -colored1 Imo 1' VARIANCE �1/ Was a variance granted from the MDH for this well? 0 Yes Flo TN# WELL CONTRACTOR CERTIFICATION 'This well was drilled under my supervision and•i0.accordance with`Minnesota Rules,Chapter 4725. The information contained in this report is true to th'e.bestof my knowledge. Use a second sheet,if needed REMARKS,ELEVATION,SOURCE OF DATA,etc. Dan St 040441i Ocilliag I, Itloo 27172 Licensee Business > Lic.or:eg.No. .' - A7../..., ..,,, ..,,,, A •Piz==rep'j eri alive Slgnatu ifir - 1.r— Date LOCAL COPY 705912 Name of Driller HE-01205-08(Rev.5/02) IC 140-0020 A - Tw ifli C CtW atts CUvtI,c,, I vices 617 13th Ave So • Hopkins, Minnesota 55343 • (612) 935 - 3556 06/22/2004 Stodola Well Drilling 3841 North Main St. Bonifacius MN 55375 938-2111 REPORT OF WATER ANALYSIS Lab#: 477 Our Laboratory reports these analytical results, determined on a sample taken by CLIENT on 06/17/2004 from the following location: Stonehouse Construction 1005 Old Long Lake Rd. Orono,Mn Unique Well#705912 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). i City Water Clinic, Inc. Bill`• , Arsdale Lab Certification#027-053-119 MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring 1 WELL OR BORING LOCATION Sealing No. H 218161 County Name WELL AND BORING SEALING RECORD Hennepin Minnesota Unique Well No. Minnesota Statutes,Chapter 1031 or W-series No. heave aaak n flm knownl Township Name Township No. Range No. Section No. Fraction(sm-*Ig) Date Sealed Date Well or Boring Constructed Orono 118N 23W 35 ''' ''' ''' leo Jit) DV • GPS Latitude degrees minutes seconds f LOCATION: Depth Before Sealing /2(49 ft. Original Depth 126 ft. Longitude degrees minutes secondsFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location Single Aquifer 0 Multiaquifer 1005 Old Long Lake Rd Orono, mcW�E`WBORING Measured 0 Estimated (][Water Supply Well ❑Monit.Well r Show exact location of well or boring Sketch map of well or boring rTTT«�- in section grid with"X" location,s,•wing property 0 Env.Bore Hole 0 Other ft. below 0 above land surface lines,r.-' bui N / ,.. . .,--,. y, * CASING TYPE(S) 0 Steel t'lastic 0 Tile 0 Other W - E _—....« WELLHEAD COMPLETION r _ _ ��( Outside: 0 Well House Inside: 0 Basement Offset I I f I i kr 111[[[ j pitless Adapter/Unit 0 Well Pit 116S 0 Well Pit 0 Buried L' ~r""I°-+ 0 Buried l PROPERTY OWNER'S NAME/COMPANY NAME CASING(S) Stonehouse Constr. Dia rt.# oDepth/.� { Set in oversize hole? Annular space initially grouted? Property owner's mailing address if different than well location address indicated above in.from to/i jj��rr.��. 0 Yes No 0 Yes 0 No 0 Unknown 420 B. Rice St. Wayzata, Mn. 55391in.from to ft. 0 Yes 0 No 0 Yes 0 No 0 Unknown in.from to ft. 0 Yes 0 No 0 Yes 0 No 0 Unknown WELL OWNER'S NAME/COMPANY NAME SCREEWOPEN HOLLEE� t Well owner's mailing address if different than property owner's address indicated above Screen from ZiZeto rS'ft. Open Hole from to- ft. OBSTRUCTIONS Rods/Drop Pipe 0 Check Valve(s) 0 Debris 0 Fill 0 No Obstruction Type of Obstructions(Describe). 4 /A1(/ F ¢ /04.417/0 HARDNESS OR GEOLOGICAL MATERIAL COLOR FORMATION FROM TO Obstructions removed? Xes 0 No Describe If noun,indicate estimated formation log from nearby well or boring +�/_PUMP !� (� '7.5) 0 Irs sPTYpe Vu11 XRemoved 0 Not Prese 0 Other METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: Vo Annular Space Exists 0 Annular space grouted with tremie pipe 0 Casing Perforation/Removal in.from to ft. 0 Perforated ❑ Removed in.from to ft. 0 Perforated 0 Removed Type of perforator ❑ Other GROUTING MATERIAL(S) //!'^ (O,nee bagbaoff�crye+ment=94 lbs.,one bag of bentonite=50 lbs.) /i Grouting Material y'Ci / rtL�Tj.1 f�r•+�to/2R,f yards ,# bags 9 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? 0 Yes NrNo 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 Name License or Registration No. e erfrettative Sig azure Date LOCAL COPY H 218161 Name of Person Sealing Well or B 'n Minnesota 44813Welland Boring WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Sealing No. H County Name WELL AND BORING SEALING RECORD Minnesota Unique No. BenneMinnesota Statutes.Chapter 1031 or W-series No. pin0,........ Township Name Township No. Range No. Section No. Fraction(sm. .lg.) Date Sealed Approximate Date Well Orono 44�p 8g� 2.3 35 pp� /4 /5 CCT c3 or Boring Constructed L�;7 �f Numerical Street Address or Fire Number and City of Well or Boring Location � 1005 Old �tgLake Depth Before Sealing dra ft. Original Depth /[iy ft Show exact location of well or boring Sketch map of well or boring Static Water Level Fi.e1iccurate in section grid with"X-. location.showing property lines. y roads.and buil in s. ❑Approximate ` Single Aquifer 0 Multiaquifer !`' R. below above land surface t ` "t L W I E t ‘_ -i • CASING TYPE S ra: r-' h mile feel 0 Plastic 0 Tile 0 Other ...q....1 e t g't Screen from ` to ft. Open Hole from to ft. S ,t ' ,../J4 N--1 mile-awl OBSTRUCTION/DEBRIS/FILL PROPERTY OWNER'S NAME ❑Obstruction Xpebris 0 Fill Nancy Samuels-Hoyt 2 of 2 dyne df A R4e- Type of debris/obstruction +r Mailing Address if different than properly address indicated above. Obstruction/Debris/Fill removed?likes 0 No 72 niversid® AVe PUMP } vers de, CT 06878 0 Removed lot Present 0 Other ate. ilkC CASING GEOLOGICAL MATERIAL COLOR HARDNESS OF FROM TO FORMATION Diameter Depth Set in oversize hole? Annular space initially grouted? If not known,indicate estimated formation log from nearby well or boring. , i / l�i.i ^ `� in.from C> to ft. 0 Yes ,/Jo 0 Yes 0 No 0 Unknown ll�i. �j W in.from to _ ft. 0 Yes 0 No 0 Yes 0 No 0 Unknown in.from to ft. ❑Yes 0 No 0 Yes 0 No 0 Unknown METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE pArlo Annular Space Exists ❑Annular space grouted with tremie pipe 0 Casing Perforation/Removal r AN 3 1994 in.from to ft. 0 Perforated 0 Removed in.from to ft. 0 Perforated 0 Removed _.. Type of perforator I` _. l'' ❑Other GROUTING MATERIAL A y Grouting material A/CA` cx -fel 0 to &te ft. yards _bags from to ft. yards bags REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING from to ft. yards bags Grouted 2" well 68' deep from to ft. yards bags ,..abs4L cement UNSEALED WELLS AND BORINGS Jbentonite Other unsealed well or boring on property? 0 Yes o 2men orf rig & cement grout pump 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 tothe best of my knowledge. Drilling �+� Inc. e� �{ Don S _. a Well Co., 27172 Contractor Business me License or Registration No... � 10-] 3 Authorized Representative Signature Date Jim Antonson LOCAL COPY H 4 4 813 •~ Name of Person Sealing Well or Boring WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Sealing No. .. H 4 4 81 2 County Name WELL AND BORING SEALING RECORD Minnesota Unique No. Minnesota Statutes,Chapter 103/ or W-series No. Hennepin (Leave blank if not known) Township Name Township No. Range No. Section No. Fraction(sm. •1g.) Date Sealed Approximate Date Well or Boring Constructed Orono IIB 21 15 42.4xxim /'9 OCT c3 Numerical Street Address or Fire Number and City of Well or Boring Location / f ' 1005 old e / eke, R t Depth Before Sealing //0 ft. Original Depth + !O ft. _ Show exact location of well or boring Sketch map of well or boring Static Water Level "Accurate in section grid with"X. location.showing property lines. N ........,,,,..... 1.-., . .;r.ads.aruf t tildlngss. 0 Approximate 1 \ t 1 .r/ I lJt6ingle Aquifer ❑Multiaquifer �tt. �` below above land surface • I t/ I t CASING TYPE W E �T r 1 , V mile . r • 1 ' feel 0 Plastic 0 Tile 0 Other ,' al S Hg--- Screen from f �' to " ft. Open Hole from to ft. r""le OBSTRUCTION/DEBRIS/FILL PROPERTY OWNER'S NAME 7bstruction 0 Debris 0 Fill ♦ er Cyt �g� ��/y of Type of debris/obstruction /AJ --I , tPL I- (G/i / ki /1' Mailing Address if different than property address indicated above. 3K es Riverside Ave Obstruction/Debris/Fill removed? ytTes ❑No riverside, CT 06878 PUMP f X.Fiemoved 0 Not Present 0 Other StA5 Po,7e CASING GEOLOGICAL MATERIAL COLOR HARDNESS OF FROM TO FORMATION Diameter Depth Set in oversize hole? Annular space initially grouted? If not known,indicate estimated formation log from nearby well or boring. t f drift 110 all in.from to F ft. ❑Yes to 0 Yes 0 No 0 Unknown 0 1 i(Y in.from to ft. 0 Yes 0 No 0 Yes 0 No 0 Unknown in.from to ft. 0 Yes 0 No 0 Yes 0 No 0 Unknown 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 'j�9 in.from to ft. 0 Perforated 0 Removed .. in.from to ft. 0 Perforated 0 Removed 4�W4 Type of perforator ❑Other ' GROUTING MATERIAL DECt .LVW Grouting material,IV(/J/ CA Ill1rom o to fl c ft. yards 1 bags: from to ft. yards bags. REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING from to ft. yards _ bags Grouted 4" well 110* deep from to ft. yards bags 9 bags cement UNSEALED WELLS AND BORINGS tom/ 10 lbs � Other unsealed well or boring on property? 0 Yes So 2 labor, ri ,� LICENSED OR REGISTERED CONTRACTOR CERTIFICATION' ` L.L 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 st a-• .le Well Drilling Co. I' Contractor Business Name 4 dense or R j rgNo. '`✓. _.._. i•---til" 17-83 Ae presentative Signature 63- Date LOCAL COPY H 4 4812Jim Antonson Name of Person Sealing Well or Boring HE-01434-01