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HomeMy WebLinkAboutwell info MINNESOTA UNIQUE WELL WELL OR RARING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. WELL AND BRING RECORD County Name 7 0'6 2 yam" Minnesota Sues,Chapter 1031 6Ohl hV Township am Township No. Range No. Section No. Fraction WEI/BORING DEPTH(cgmpleted) DATE WORK COMPLETED Orono 117 23 01 v i28 " b-3-€' GPS LOCATION: Latitude degrees minutes seconds DRIl7NG METHOD �",:❑Cable Tool r ❑Driven L]Dug Longitude degrees minutes seconds rotary r ry ❑Jetted House Number,Street Name,City,and Zip Code +oof,,Well,Location or FireeNumber .- 'C Auger , oto 1555 rd Flex, 55364 DRILLING FLUID` WELL HYDROFRACTURED? 11 Yes to Show exact location of well/boring in section grid with"X." Sketch map of well/boring location. bentonite From ft.To ft. Showing property lines, roa buildings; d direction. USE N � y` ti- � , omestic ❑Monitoring []Heating/Cooling ----__ --_--______.-- ! .r. _ - - ❑Noncommunity PWS ❑Environ.Bore Hole ❑Industry/Commercial Community PWS ❑Irrigation ❑Remedial �+C! ❑Elevator ❑Dewatering ❑ w E �, 7 ) CASG MATERIAL u T Drive Shoe Yes '(Jo Dtk b❑'Steel ❑Threaded ❑Welded h Mile ❑ I APlastic CASING0 S Diameter Weight Specifications 10. I 1 Mile— I /'�...�'^' ___14,_in.to la ft. t 9 lbs./ft. __in.tot. PROPERTY OWNER'S NAME/COMPANY NAMF>f _,,,1--"` LY_ in.to ft. TiT-lbs./ft. - - _$ in.toft. Pat Wysocky , in.to ft. lbs./ft. in.to ft. Property owner's mailing address if different than well location address indicated above. SCREE OPEN HOLE s as Make + �* From .�ft. To_ ft. Type stalanleMss� steel. Diam. t� Slot/Gauze IAA Length 4t + 40 Set between_An_ft.and 1 ft. FITTINGS 2114X241. w STATIC WATER LEVEL Measured from _ 60 ft.LI, elow ❑Above land surface Date measured 6..3,.08 WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) _ 118 ft.after 1r5 hrs.pumping g.p.m. Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION 1 itless/adapter manufacturer, _I.y yje..i. li odel ❑Casing Protection 102 in.above grade ❑At-grade(Environmental Well and Boring ONLY) j GROUTING INFORMATION Well grouted ?hes ❑No Grout materials (i Neat cement [ entonite ❑Concrete ❑Other From )To _ft. 3 ❑Yds. Lags GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO From, To110 ft. �_nu ❑Bags MATERIAL From It© To 28travelli ]fs. IL-tags NEAREST KNOWN SOURCE OF CONTAMINATION clay yellow soft 0 is -2, feet �. direction ,.l =--'-s- 1e Well disinfected upon completion? I? 'es ❑No gray clay ft 18 90 PUMP j' f_ rfine sand Q� soft 90 128❑Not installed Date installed (.O" k( 0 8 ,r `�`--� i Manufacturer's name }7� Model Number HP -1"1, Volts C7G7 Length of drop pipe 8 / r 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 [ lo '•_••04,7 ',' VARIANCE Was a variance granted from the MDH for this well? ❑Yes [(Vo TN# WELL CONTRACTOR CERTIFICATION )11f 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. DISI Stodola Well Drilling Co., Inc. 1691 Licensee Business Name Lic.or Reg.No. ....AK:/-‘...r -/ .. / i"�!' 1 8R 7o8 Cer -d'•:"es: tative Si.nature ' i Certified Rep.No. Date LOCAL COPY 7 6 0 6 2 6 /borne ' Name of Driller Cheek IC 140-0020 HE-01205-11(Rev.3/07) Tw(,n' cry W atex C , I vu/. 617 13th Ave So - Hopkins, Minnesota 55343 • (612) 935 - 3556 06/05/2008 Stodola Well Drilling 3841 North Main St. Bonifacius MN 55375 938-2111 REPORT OF WATER ANALYSIS Lab #: 218BN Our Laboratory reports these analytical results, determined on a sample taken by CLIENT on 06/03/2008 from the following location: Pat Wysocky 1555 Orchrard Beach Pl. Orono,Mn Well 760626 Coliform Bacteria Absent 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 CiViater Clinic, Inc. Bill V dale Lab Certification#027-053-119 MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring 270245 WELL QR BORING LOCATION Sealing No. H County Name WELL AND BORING SEALING RECORD Minnesota Unique Well No. Hennepin (Leave Statutes,Chapter 1031 or W-series No. (Leave blank if not known) Township Name Township No. Range No. Section No. Fraction(sm.—.Ig.) Date Sealed Date Well or Boring Constructed Orono 117 23 07 42-0025 2 f �J eJ L O 8 GPS Latitude degrees minutes seconds Depth Before Sealing 40 ft. Original Depth ft. LOCATION: Longitude degrees minutes seconds $OUIFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location "Single Aquifer ❑Multiaquifer /� 1555 orchard, Beach Place, once 55 ELUBORING Measured ❑Estimated Date Measured 5Ivy OAP ater-Supply Well ❑Monit.Well l t Show exact location of well or boring Sketch map of well of bo g ~/ in section grid with"X." location,showing pro e Env.Bore Hole ❑Other ft. Xbelow ❑above land surface N lines,roads,and builvng. CASING TYPE(S) % )it Steel ❑Plastic ❑Tile ❑Other -- -- r „,,` WELLHEAD COMPLETION w ET _I__,_ I � Outside: CI Well House ❑At Grade Inside: ❑Basement Offset %Miletless Adapter/Unit ❑Buried ❑Well Pit Pi Buried S ❑Well Pit 1 t Mile—� ❑Other ❑Other PROPERTY OWNER'S NAME/COMPANY NAME CASING(S) Pat Wysocky Diam , / Depth r Set in oversize hole? Annular space initially grouted? Property owner's mailing address if different than well location address indicated above (� in.from Q y to `L tt. ❑Yes %No ❑Yes ❑No ❑Unknown 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 49'2Q t Well owner's mailing address if different than property owner's address indicated above Screen from to )� ft. Open Hole from to ft. OBSTRUCTIONS ❑Rods/Drop Pipe ❑Check Valve(s) ❑Debris ❑Fill XNo Obstruction Type of Obstructions(Describe) GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? ❑Yes ❑No Describe FORMATION PUMP Ifnotnown,indicate estimated formation log from nearby well or bo/ring. / (1 i.� V •4 Type jJt- ❑Removed XrNot Present ❑Other I' METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: fkiNo 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 A/4 Ce/P'C /,j/ i om © to 96J 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 ; to 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 Veil Drilling Co., Inc. 1691 Licensee Business Name License or Registration No. d ative aura Certified Rep.No. Date LOCAL COPY H ^/7 ^/ 5 Z” : � *~� i. I 0 2 4 5 Name of Person Sealing Well or Boring HE-01434-10 IC#140-0423 �.i 5/07R