HomeMy WebLinkAboutwell info WELL LuCATION� MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO.
County Name WELL RECORD 5 4� 5 6 0
i.�,-��„,,�� Minnesota Statutes Chapter 1031
Township Name Township No. � Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed
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C�T"UI1C1 G..� I �'tS t:.i .L% :S,Gw-lt(i�.'��; ��. � ..,p;
Numerical Street Address and City of Well Location or Fire Number DRILLING METHOD
❑ Cable Tool ❑ Oriven ❑ Dug
��'4�' ��t'����X� �1VC' �C7�1(/ �'1 �JS,.. � ❑ Auger ,p Rotary ❑ Jetted
Show exact location of well in section grid with"X". Sketch map of well location. ❑
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Showing property lines,
N roads and buildings. DRILLING FLUID
i � � i i
--r---I— —1 —1_ �"I'......_�._�
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i � � i �� __ ,USE ❑ Heating/Cooling
._�_ ___ _ �_ �Domestic ❑ Monitoring
W � � � � E �� ❑ Irrigation ❑ Public ❑ Industry/Commercial
° ' T j�- ❑ Test Well ❑ Dewatering O Remedial
_1_ _1_ ' ' I
i _� __ �
� � ' f•mi. ��r � CASING Drive Shoe? ❑ Yes ❑ No HOLE DIAM.
";- �' � -�' I x' ❑ Steel ❑ Threaded ❑ Welded
1 ,A Plastic ❑
�—1 milr� �
r(,�� �) �
•--�/�'I*�t/l./�I.lOCl1�l .
� - CASING DIAMETER WEIGHT
PROPERTY OWNER'S NAME Ea 1 1+� �—,�1 ". ���� �( �
'�,,�„,. in.to ft. Ibs./ft. �
�U ���^�-� I�• in.to ft. Ibs./tt.
Mailin address if different than ro ert address indicated above. in.to ft. Ibs./tt. -�-��4�
9 P P Y in.to ft.
J���� '���� A�. �w�• SCREEN��� OPEN HOLE
�.E..l Make _.,,,,,�t from ft.to ft.
C,CY.?n iZ::�.�?]..f.�r� ��„ v_ �4L TYPe •C.�ZLl �'Sb .�C7C1 Diam� -
SIoVGauze��l�_�� Length "
Set between tt.and ft. FITTINGS: '
STATIC WATER LEVEL
HARDNESS OF �_��t�.�
GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO ��1� tt. C��below ❑ above land surface Date measured ''
i PUMPING LEVEL(below land suriace)
elcy YE=13. .�3 �.'� !�{.j� 1 p� ft. after � hrs.pumping �4 g.p.m.
t WELL HEAD COMPLETION �����r
�.�lt�y ��� `;, ��:j� ��tl j,E] Pitless adapter manufacturer Model
❑ Casing Protection C}5.12 in.above grade
Ci<7�7 B�C.'�WIl � i ic�� ��:{} GROUTING INFORMATION
Well grouted? �L7 Yes ❑ No
��'y" � � �-�w -- Grout Material ❑ Neat cement C�[Bentonite
�`�� '� �`"t' ��� from 0 �o .`��[; n. `� ❑ yds. C}`bags
from to R. ❑ yds. ❑ baqs
S�I�Y� C1G:y r G�' ��3 Br- � 1:3'�` 17C� r�om �o e. ❑ vds. ❑ eags
NEAREST KNOWN SOURCE OF CONTAMINATION .
��i.�bC� �1C;�.' � ► /!i� ����; ..,�-.�� l�,L.�;�a ;,'�� direction ^-.:>,'�` "" �/. type
feet �.%�•��
Well disinfected upon completion? C]�Nes ❑ No
PUMP
2—r9—y�
❑ Not installed Date installed [
Manufacturer's name E�T.Y(xJ�(Jr' �.
Model number �_T__ HP ✓� � Volts ��
Length of drop pipe � ft. Capacity 4 g.p.m.
Pressure Tank Capacity ���r�c��i��
Type: C�5°.Submersible ❑ L.S.Turbine ❑ Reciprocating ❑ Jet ❑
ABANDONED WELLS
Does property have any not in use and not sealed well(s)? ❑ Yes O;(Vo
WELL CONTRACTOR CERTIFICATION
This well was drilled under my supervision and in acwrdance with Minnesota Rules,Chapter 4725.
The information contained in this report is true to the best of my knowledge.
Use a second sheet,ilneeded �� ='�1r�J�� ��+ ��.��s �L�}.� T�. l�� l t
REMARKS,ELEVATION,��f�.E OF�TA���� Licens eusiness Name Lic.or Reg.No.
K 1 _�'/�=�_�wL��� t-�-5�
� £
� Authonzed Represenfative Signature Date
'r°re�: I�ihy 2-8-9�
� � NameolOriller Date
LOCAL COPY 5 4 8 5 6 0 HE•01205-04(Rev.S/92)
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� ` �!�"�trin City �Nater Clinic, Inc.
61713th Ave So • Hopkins,Minnesota 55343 • (612)935-3556
02/10/1995
Stodola Weil D�illing
15306 Hwy 7
Minnetonka MN 55345
938-2111
REPORT OF WATFR ANALYSLS
Lab�: 25106
Our Laboratory �eports these analytical results, determined on a sample taken �
by CLIENT on 02/08/1995 from the following location:
RKO Builders Inc •
2320 3hadowwood Dr
Oro�o.Mn
Unique N 648560
Coliform BacteNa <1/100 ml
Nftrates Nftroge� 1.81 mg/1
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).
�v ity Water Clinic, Inc.
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Bill V �' s�ale
Brlan ��\
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w,tx nody.i�Aw�ea1� Bun.r w.ar c�emiod.
L�b Certd'w�tioa/027-033-119