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HomeMy WebLinkAboutwell info WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Mi a Well n g County Name WELL AND BORING SEALING RECORD Seal No. ' N . H 12 7 9 9 3 lenneizi Minnesota Statutes,Chapter 1031 or W- �->� ue „,,tO% (leave tel" k if not know Township Name Township No. Range No. Section No. Fraction(sm.i Ig.) Date Sealed Date Wel Qr'ring Constructed Orono 117 23 02 >6 >6 u 24 c:fe 57 ,d• Numerical Street Address or Fire Number and City of Well or_Boring Location / / 15 Orono Orchard Road .N.)Orono, N'-j pth Before Sealing z ft. Original Depth z ft. Show exact location of well or boring etch map of well or boring AQUIFER(S) STATIC WATER LEVEL in section grid with'X'. I tion, showing property Jp�j`["ingle Aquifer 0 Multiaquifer lines, ,and buildings. N ,;? WELUBORINGeasured 90 . CI Estimated Water Supply Well ❑Montt.Well e --t---+---1----+—I : 1 \\, l ❑ Env.Bore Hole ❑Other fl ft. <beiow 0 above land surface W- Iiiii I I I E CASING TYPE(S) --1----t----1----i--- I + / i I t I ! u mem Steel ❑Plastic ❑Tile 0 Other --+---1---4----1-- 1 i CASING S L. ,-,1,` ;. L. ,,s Diameter Depth 254 j�/ , Set in oversize hole? Annualar space initially grouted? �—i^' 11in.from to G T 0 ft. 0 Yes No 0 Yes ❑No ❑Unknown PROPERTY OWNER'SNAME James Farley in.from to ft. ❑Yes ❑No 0 Yes 0 No ❑Unknown Property owner's mailing address if different than well location address indicated above. - in.from to ft. ❑Yes 0 No El Yes ❑No ❑Unknown %Jerry Ahlstrom / SCREEWOPEN HOLE w/Roger Fazkddlin �/� / / - Realty Screen from to ft. Open Hole from 25/P: to 2 ft. 473-7000 OBSTRUCROWDEBRIS/FILL WELL OWNER'S NAME >f Obstruction 0 Debris 0 Fill 0 No Obstruction Well owner's mailing address If different than property owner's address indicated above. - Type of Obstruction/Debris/Fill 1 n/A,t�/t r f . U/•-7 f� Obstructlon/Debris/Fiil removed? ,(Yes 0 No PUMP Type SUI' Pump HARDNESS OFFROM TO '`Removed 0 Not Present ElOther GEOLOGICAL MATERIAL COLOR FORMATION If not known,indicate estimated formation log from nearby well or boring. )(No USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: - - ciir ) No Annular Space Exits (( �� �CJ' ❑ Annulerspace grouted with tremae pipe i -1...:— �`—� .-J'J 0 Casing Perforation/Removal /Rem oval t in.from W, ft. 0 Perforated 0 Removed in.from to ft. 0 Perforated 0 Removed Type of perforator ❑ Other GROUTING MATERIAL(S) e Grouting Material A//-.LST .141 a/I'_ m ✓ to21?---2ft. yards bags from to ft. yards bags . from to ft. yards bags from to ft. yards bags REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEAUNG UNSEALED WELLS AND BORINGS Other unsealed well or boring on property? 0 Yes LICENSED OR REGISTERED CONTRACTOR CERTIFICATION This well or boring was sealed in accordance with Minnesota Rules,Chapter 4725. The information contained M this report is true to the best of my knowledge. DON STODOLA WELL DRILLING CO. , INC. 27172 Contractor Business NameLicense or Registration No. —Afl-6;----ei5c:AtIP//ee '!17:°;11PPP'4 Data LOCAL COPY H 12 7 9 9 3 Name of Person dealing well orBoring HE-01434-02 WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. County Name WELL AND BORING RECORD Bennepin Minnesota Statutes Chapter 1031 643190 Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) • Date Work Completed Orono 117 23 02 185' 8-1-00 v. House Number,Street Name,City, City,and Zip Code of Well Location or Fire Number DRILLING METHOD 15 Orme Orcrdd Orono, .55391 0 Cable Tool 0 Driven ❑ Dug 0 Auger _ 2 Rotary 0 Jetted Show exact location of well in section grid with"X'. Sketch owinngg map of well lo ' 0 Sh roads and bu DRILLING FLUID WELL HYDROFRACTURED? DYES NO N j � - --i" i --- i �ep>•+1 FROM ftto ft. i I USE X 0 Monitoring 0 Heating/Cooling L---`- Domestic 0 Community PWS 0 Industry/Commercial O Irrigation W i i E ❑ Environ.Bore Hole -0 Noncommunity PWS 0 Remedial i i T - ❑ Dewatering ❑ --r--ti---r---r- i 1 ,ham • telt "- CASING Drive Shoe? j Yes 0 No HOLE DIAM. j I O, X Steel jig Threaded 0 Welded 0 Plastic 0 S —,mii,,_I • re) CASING DIAMETER WEIGHT _ PROPERTY OWNER'S NAME •*.�,����, �si� Inc4 in.to 169 tt. 11 Ibs./ft. 7 7-n _Q. /i��its roup Inin.to ft lbs./ft.lilt_in.tots*. Property owners mailing address if different than well locationoctiaddress indicated above. in.to N: 'befit. 3-4l11 14151 20303 Lakevisur allure SCREEN OPEN HOLE laior, I . 53331 Make link from 9 tt.to_ ft. Type Diam. Slot/Gauze Length Set between ft.and ft. FITTINGS: STATIC WATER LEVEL WELL OWNER'S NAME 50 ft.igbelow 0 above land surface Date measured 1111-1-00 1 PUMPING LEVEL(below land aUrface)+� Well"owners mailing address if different than property owners address indicated above. 165 ft. after 23 hrs.pumping 30 g.p.m. WELL HEAD COMPLETION �yy,,g • O Pitless adapter manufacturer wuzit.*.ratter Model✓Inc - - 0 Casing Protection 12 in.above grade 0 At-grade(Environmental Wells and Borings ONLY) GROUTING INFORMATION Well grouted? ip Yes ❑ No HARDNESS OF Grout Material 0 Neat cement- High Solids Bentoni)e GEOLOGICAL MATERIALS COLOR FROM TO 0 Bentonite 0 Concre 0 MATERIAL' from_to 30 ft. 21 0 yds."; bags from to_Amt. atitteria 0 yds.0 bags Clay _ Yellow 9 a" 10, from to ft 0 yds.0 bags 8 NEAUFA�T KNOWN SOURCE OF CONTAMINATION Clay/Gravel Gray1 d' 1 , 13 feet north direction sept l e type ar y� K O Well disinfected upon completion? lig Yes 0 No Sandstone 9ro�Gira2 160'1*51 PUMP 0 Not installed Date installed 1 11 6I Manufacturers name !! Model number HP 1 a 5- Volts 230 Length of drop pipe 84 ft. Capacity g.p.m.• Type:XSubmersible ❑ LS.Turbine 0 Reciprocating 0 Jet ❑ ABANDONED WELLS Does property have any not in use and not sealed well(s)? 0 Yes MgNo VARIANCE Was a variance granted from the MDH for this well? ❑Yes SW TNM WELL CONTRACTOR CERTIFICATION Use a second sheet,if needed This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. REMARKS,ELEVATION,SOURCE OF DATA;etc The information contained in this report is true to the best of my knowledge. DON STODOLi1 WELL DULLING CO., INC. Licen Business meLic.or Reg.Na '�--' - 27172 12-5.-00 Autho ed Represtl Ve Signature Date Doane PUltheirs 8- 1-00 Name of Driller Date LOCAL COPY 643190 HE-111205-07(Rev.2/99) > WELL OR BORING LOCATION Count'Name 7--- MINNESOTA DEPARTMENT OF HEALTH Minnesota Well erx)Boring rH WELL AND BORING SEALING RECORD Sealing No. — Minnesota Unique Well Hennepin ... Minnesota Statutes,Chapter 1031 or W-series No. s.m era II not known) Township Name Township No. Range No. Section No. Fraction-(sur.i Ig.) Date Sealed Date Well or Boring Constructed Orme 117 13 02 22-4002. to NII) Numerical Street Address or Fire Number and City of Well or Boring Location g�yf� r 15 0bard M � S pth Before Sealing Age) ft. /Original Depth 7 ft Show exact location of well or boring Sketch map of well or lx npg IFER(S) STATIC WATER LEVEL in section grid with le. location, showing proptell' Sin le Aquifer lines,roads,and buildin g q ❑ Multiaquiter N WELLIBORING %Measured 0 Estimated ' ) - 4aJ' /Water Supply Well ❑Monis.Well f --T --T---l-- -1-_- Env.Bore Hole 0 Other _ Itfig k Oielow . 0 above land surface --+---4----+----1--- ... yy . . E i„54i CASING TYPES) Ff1 -I-"-'T teel ❑Plastic ❑Tile ❑Other I Smile i�r'' --+---+---4.----1--- 1 CASING(S) Diameter Depth Set in oversize hole? S Ili-- J' 'f ,y't (Ir Annular space initially grouted? r roe { in.from /J to h, 0 Yes No 0 Yes 0 No 0 Unknown PROPERTY OWNER'S NAME I in.from to ft. ❑Yes ❑No 0 Yes 0 No 0 Unknown Property:owner's mailing address if different the I location address indicated above. in.from to ft. 0 Yes 0 No ❑Yes 0 No ❑Unknown 20305 Lalartiev &v B SCREEN/OPEN HOLE set lir Mir 53331 . Screen from ICA.E r to _ft. Open Hole from to ft. OBSTRUCTIONS WELL OWNER'S NAME .... 0 Rods/Drop Pipe 0 Check Valve(s) ❑Debris 0 Fill No Obstruction Welowner's mailing address if different than properly owner's address indicated above. Type of Obstructions(Describe) - Obstructions removed? 0 Yes 0 No . Describe PUMP Type HARDNESS OF 0 Removed )(Not Present 0 Other OIEOLO0IK AL MATERIAL COLOR FROM TO FORMATION METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND'BORE'HOLE: a not known.Indicate estimeted"fomudiori log from nearby wellor boring. } to Annular Space Exists d1 © r 0 Annular space grouted with uremia pipe 0 Casing Perforation//Removal in.from to ft. 0 Perforated 0 Removed in.from to ft. 0 Perforated 0 Removed Type of perforator 0 Other • • GROUTING MATERIAL(S) (One bbaa�g;�offc�cement..94 lbs.,one bag of bentonite.60 lbs.)-. Grouting Material,4ii ! //1T".R�from rG { to ISO ft. yards bags from to ft. yards bags from to ft. yards bags from to__ ft yards bags REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING OTHER WELLS AND BORINGS • Other unsealed and unused well or boring on property? 0 Yes No How many? LICENSED OR REGISTERED CONTRACTOR CERTIFICATION This well or boring was sealed M accordance with Minnesota Rules,Chapter 4725. The information contained in this report Ii true to the best of my knowledge. DOS Stella* Well Drilling CO** Ins 21172 Contractor Business Name License or Registration No. ..S— 0 CO VirreRepr sentathro Sig ramie Date LOCAL COPY H 1 S ■ 5 S O Name of Person or Bourg • • r a . Tw i/vv C£ty Water C , I vtc. 617 13th Ave :; ) • Hopkins, Minnesota 55343 • (612) 935 - 3556 08/10/2000 Stodola Well Drilliti j 3841 North Main St. Bonifacius MN 55375 938-2111 REPORT OF WATER ANALYSIS Lab #: 39651 Our Laboratory reports these analytical results, determined on a sample taken by CLIENT on 08/07/2000 from the following location: Landschute 15 Orono Orchard Rd. Orono,Mn Unique Well#643190 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, ater Clinic, Inc. Bill i ' s le Analyical laboratory Consulting Engineer Water Analysis Reagents Boiler Water Chemicals Lab Certification#027-053-119