HomeMy WebLinkAboutwell info WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO.
CountyName WELL RECORD - 5 3 6 2 � 8
_�, ,�,�, �j,� Minnesota Statutes Chapter 1031
To�Snship Name' Township No. - Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed
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Numerical Street Address and City of Well Location or Fire Number DRILLING METHOD
`�t, t C ❑ Cable Tool ❑ Driven ❑ Dug
�r3Lt.` a�ixt��G117I� �:t]�.VL �t�3 ��i'1. ✓� �� ❑ Auger �Rotary ❑ Jetted
Show exact location of well in section grid with"X". Sketch map of well location. C
Showing property lines,
N roads and buildings. DRILLING FLUID
� � _i _i_ `�' �'C:.3"<1��„��.T.E'.
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i � i �� ,USE ❑ Heating/Cooling
p Domestic ❑ Monitoring
yy � ; i � E �„}� '`�C] Irrigation ❑ Public ❑ Industry/Commercial
� ❑ Remedial
� �- ❑ TestWell ❑ Dewatering
-;- -?- -; =- T ��� �, �
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� F'^"� CASING Drive Shoe? ❑ Yes ❑ No HOLE DIAM.
--�- �- ; —r- I '� � ❑ Steel ❑ Threaded ❑ Welded
� 1
}� Plastic ❑
�I mile�
"+' CASING DIAMETER WEIGHT /
PROPERTY OWNER'S NAME `i in.to ��r� R. '�''����� Ibs./ft. t rjirt'to ��='ft.
£ri_tu� h'�c�;�.l� Lc,rayti�ci.c;r� ,�.�o n. �b5.�n.6 ���,.,01 iC:n.
Mailing address if different than property address indicated above. in.to ft. Ibs./ft. in.to ft.
���� ,� i �y�� �il�,� SCREEN OPEN HOLE
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Make � � � from ftto ft.
�`s�'' .�c.t'i �.�� TYPe ` ' 't �.��z_Diam ,u
��a=ci¢r:�:� �c
SIoUGauze Length � £�`
Set between �" P�'�i;�, ft.and ��{'; ft. FITTINGS:
STATIC WATER LEVEL
GEOLOGICAL MATERIALS COLOR H MATERIAL�F FROM TO ,3�;° ft. ,�below ❑ above�and surtace Date measuredl�__�_,i.�;._Zg�;.
PUMPING LEVEL(below land surface)
�..�ct�+` bt >Je3.r`a11. „�'j ���� �{�,li,:'e ft. after hrs.pumping g.p.m.
WELL HEAD COMPLETION
i��p. ��a ���tZ x '�'�(,!�Pitless adapter manufacturer �����:,1-� Model
❑ Casing Protection �12 in.above grade
GROUTING INFORMATION
Well grouted? �Yes O No
Grout Material ❑ Neat cement �Bentonite
from ��' b -�% ft. � ❑ yds!lO bags
from to ft. ❑ yds. ❑ bags
from to fl. ❑ yds. ❑ bags
NEAREST KNOWN SOURCE OF CONTAMINATION
��,1.�� feet /�["�J6C t � direction ���type .
Well disinfected upon completion? �7 Yes C No :�/�#►J�'
PUMP
❑ Not installed Date in^�stalled �3����`�u�� r
Manufacturer's name .��ly�i i?. bc �r.�3.tli�� 1
Model number Li,�'i�'�3(,+�'��j j HP ����a Volts ����
Length of drop pipe �� tt. Capacity g.p.m.
Pressure Tank Capacity �L��.} �--'�.�i� ric
�� Type:;1(7 Subme�sible ❑ LS.Turbine ❑ Reciprocating ❑ Jet ❑
ABANDONED WELLS
Does property have any not in use and not sealed well(s)? ❑ Yes � No
WELL CONTRACTOR CEfiTIFICATION
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,ilneeded ��� U��-�� ���+ ��-1�� ���1 i�• i�� L
REMARKS,ELEVATION,SOURCE OF DATA,etc. �icenseeeusinessName Lic.orReg.No.
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_F,.. ��--�i�)--��i
, Ati horized F�BpreS ntative Signature � Date
�'.�'. �1:�hr<�3 i C`����--94
Name of Driller Date
LOC;4L COF'Y ��6 ��$ HE-01205-04(Rev.5/92)
.
� �I'zvin City �Nater Clinic, Inc.
, . .
61713th Ave So • Hopkins,Minnesota 55343 • (612)935-3556
10/12/1994
Stodola Well Drilling
15306 Hwy 7
Minnetonka MN 55345
938-21 1 1
:4';.
REPORT OF WATER ANALYSLS
Lab�: 24099
Our Laboratory reports these analytical results, determined on a sample taken
by YOU on 10/10/1994 f�om the following location:
8rian Metcalf Const
1�20 Shoreline Drive
Orono�Mn
L!niqur.� 536288
Collfo�m Bacteria <1/100 ml
Nltrates Nftrogen <1.0 mg/)
The results of these tests indicate that this well ls producing water that meets the
���� standards fo� F.H.A., V.A., or conventional loans. Thls report is an analysis for coliform
and nitrate only and does not include analysis of Lead and other contaminants. (Unless �
as specified by client).
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alter Clinfc, Inc.
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Bill � I
Brian �
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a�.ywd�.�«.ary ��
Wuar AroIY��R�� Hoiler WaMr(�miwb
LabCmtifioa�ion/027-0SY119