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Home My WebLink Aboutwell info MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring WELL OR BORING LOCATION ali9 H 268214 CtAxriy Name•' 1NELL AND BORING SEALING RECORD Mi peso a Unique Well No. Minnesota Statutes,Chapter 1031 or W-series No. O..dank x not known) Township.Name Township No. Range No.Section No. Fractior(sm.-.Ig.) Date Sealed Date Well or Boring Constructed fteno 117 23 7 3200021'A at Ff. 0 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 0 Mukiaquifer WMeasured oRING ZI}Measured ❑Estimated Date Measured 5 /� 1 Show exact location of well or boring Sketch map of well or boring 7star-Supply Well 0 Mont.Well ‘/ in section grid with"X." location,showing property ❑Env.Bore Hole 0 Other Y n. 'elow ❑above land surface N ,�i islines and Ings., CASING TYPE(S) )(Steel ❑Plastic ❑The 0 Other i f WELLHEAD COMPLETION w ET I__• I fr Outside: 0 Well House 0 At Grade Inside: 111(lasement Offset.. 1 Mile ❑Mess Adapter/Unit ❑Buried ❑Well Pit ❑;Well Pit ❑Buried 1 me-� 111 Other ❑Other P PERTYNA COMP AME CASING(S) Dier7�etpre t Depth (� a Set in oversize hole? Annular space initially grouted? Property owner's mailing address If different than well location address indicated above y in.from ' to/2 t7.:. ft. 0 Yes No ❑Yes ❑No ❑Unknown in.from to ft. ❑Yes ❑No ❑Yes 0 No 0 Unknown in.from to ft. ❑Yes ❑No ❑Yes 0 No ❑Unknown WELL OWNER'S NAME/COMPANY NAME SCREEN/OPEN HOLE Well owners mailing address If different than properly owner's address indicated above Screen from-f r. to r ft.' Open Hole from to ft. OBSTRUCTIONS ❑Rods/Drop Pipe ❑Check Valve(s) ❑Debris 0 Fill AI No Obstruction Type of Obstructions(Describe) HARDNESS OR GEOLOGICAL MATERIAL COLOR FORMATION PROM I TO Obstructions removed? ❑Yes 0 No Describe If not known,indicate estimated formation log from nearby well or boring. PUMP Type LI ❑Removed ANot 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 0 Casing Perforation/Removal- it from to ft. ❑Perfdrated 0 Removed in.from to ft. ❑Perforated 0 Removed Type of Perforator ❑Other GROUTING MATERIALS) (One bag of`cement ee 94 lbs.,one bag of bentonite Jet)lbs.) /ZZs r V Grouting Material i.e'�rC/1t')7 om 69 to/13Z ft. yards bags from to ft. yards bags frofn to ft. yards: bags OTHER WELLS AND BORINGS REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING Other unsealed 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. • pan ala WealCe., Inc- 1491 Licensee Business Name License or Registration No. •epresentative Signatu'-' Certified Rep.No. Date LOCAL COPY H 268214 Name of Person Sealing Well or Boring HE-01434-10 IC#140-0423 5/078 WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH 1 MINNESOTA UNIQUE WELL AND BORING NO County Name WELL AND BARING RECORD {� Minnesota StgtUtes,Chapter 1031 ,7 6-L 610 ' - Township Name Township No. Range No. Section No. Fraction WELL/BORING DEPTH(completed)- DATE WORK COMPLETED orate 117 23 7 ` 'A 'A 'A 135 ft' 24548 GPS Latitude degrees minutes ;seconds DRILLING METHOD LOCATION: ❑Cable Tool ❑_Driven D Dug Longitude degrees minutes seconds ❑Auger l ❑Jetted House Number,Street Name,City,and Zip Code of Well Location or Fire Number ❑ 4755 llartit Shore Deo Gram DRILLING FLUID pDJIOFRACTURED ]Yes o Show exact location of welVboring in section grid ith"X." Sketch ap of welVboring location. ft.To ft. Showing property lines, N roa ,buildings,and direction. USE omestic ❑'Monitorin g ❑Heating/Cooling ---f- I- --- -------- ❑Noncommunity PWS ❑Environ.Bore Hole ❑Industry/Commercial .,"., . . `. ❑Community PWS ❑Irrigation ❑Remedial ;' r -- - -❑.Elevator ❑Dewatering ❑ a W E 4 i f T r CA ^". .,, Drive Shoe? ❑Yes [ o HOLE DIAM Y inSteel ❑Threaded ❑Welded. %Mile .E d� [Mastic 0 iCASING S tt` Diameter Weight Specifications I1 Mile _I in.to�ft. ri_Ibs./ft. 1 _ ---- in.to PROPERTY OWNER'S NAME/COMPANY NAME in.to ft. lbs./ft. n.to in.to ft. lbs/ft. in.to ft. litarillen HOLE Property owner's mailing address if different than well location address indicrted above. SCREEN Make From ft.-To ft. Type a__ Diam. 311 SIot/Gauze . Length Set between and ft- FITTINGS__4"301)._STATIC WATER Measured from '•_ ft.(slow❑Above land surface Date measured 1145111438 WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) ` ' - ts ft.after j hrs.pumping 108 q.p.m. Well/boring owner's mailing address if different than property owner's address indicated above.` WELLHEAD COMPLETION ?Clew/adapter manufacturer I Casing Protection. [2 in.above grade ❑At-grade(Environmen 0l Fand Boring ONLY) GROUTING INFORMATIDPI Well groutedes ❑No Grout materials ❑Neat cement[ entonite ❑,Concrete❑Other f_To ft. ..______,,,j___ ❑Yds. f agsmags HARDNESS OF From To I a,,ft. ' 0 Bags, GEOLOGICAL MATERIALS COLOR FROM TO —y MATERIAL From s To i ft gs a. NEAREST KNOWN SOURCE OF CONTAMINATION t "11111011100111 area alret 0 0 (00 feet direction _ 11,46. iiiiiir Well disinfected upon completion? es ❑No ` ebKr ow sett amp Asro PUMP ,: ❑Not installed Date installed 3, .3"- Manufacturer's name +"+ 1 .Model Number HP Volts '. Length of drop pipe #05 ft. Capacity g.p.m. Type:[dubmersible ❑L.S.Turbine ❑Reciprocating ❑Jet ❑ ABANDONED WELLS Does property have any not in use and not sealed well(s)? ❑Yes VARIANCE ! Was a variance granted from the MDH for this well? ❑Yes ^[ lo TN# WELL CONTRACTOR CERTIFICATION r 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. ailleStedellaVal Thant* . lee* Licensee Business Name Lic.or Reg.No. 3 a C r . . n,:cr, gna: Certified Rep.No. Date LOCAL COPY e+e 1 760610 Name of Driller IC 140-0020 HE-01205-11(Rev.3/07) Tw%vv C it W a to r CLI,nLc', I vtc. y 617 13th Ave So • Hopkins, Minnesota 55343 • (612) 935 - 3556 02/27/2008 Stodola Well Drilling 3841 North Main St. Bonifacius MN 55375 938-2111 REPORT OF WATER ANALYSIS Lab #: 61 BN Our Laboratory reports these analytical results, determined on a sample taken by CLIENT on 02/25/2008 from the following location: Gary Everson 4755 North Shore Dr. Orono,Mn Well 760610 • 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 an41 does not include analysis of Lead and other contaminants. (Unless as sp cified by client). Twin City Water Clinic, Inc. Bill ICan Arsdale Lab Certification#027-053-119