HomeMy WebLinkAboutwell info STATE OF MINNESOTA DEPARTMENT OF HEALTH
�� WATER WELL RECORD M/NNESOTA UNIpUE WELL NO. ������
County Name Jor Wafer SaMplr
F�i1f�k�£.i� Mihnesofa Slafrfes 156A.01-.08
Township Name� ownship Number Range Number Section No. Fraction 4.WELL DEPTH(compktedl Date of Completion
i N E y, '/� '/�
� ��.T.'`v'.'_i.:� �.1�.5 � ~..� W �..t,t � l;i tt. ' t'+'�
�-�1°<-.�
tiumerical Stree[Addtess and City of Well Loca[ion or Distance from Road In[ersection. 5.DRILLING METHOD
O CableTool O Reverse ❑Driven ❑p�g
G'��i1.,� {?�1Z r'�ZT�'33Ik? IVC?�C..�T t ��'OT1G� M1Y2T1.
ow ncaa Ixation d well in section grid with"X." Sketch map d well laatan. ❑HollowNod ❑Air O Bored O
N
� � _i i_ Addi[ion Name �L7 Rotary ❑Je[ted ❑Power'Auger
-� � � � 6.DR[LLING FLUID
� � � Icek Number
•-+- --- �- �- 7.USE
W � i � E
_1_ _1_ _'_ __ �Domestic ❑Monitoring ❑Heat Pump
I '. � � r Lot Number ❑Irrigatan {]Public ❑Industry
h mr.
' � i ❑Test Well C]Municipal ❑Commercial
-i- �- - -r- j ❑AirConditioning ❑
�-���e'—� 8.CASING HOLE DIAM.
HEIGHT:Above/Below
2.PROPERTY OWNER'S NAME Mailing Address if differen[[han property address (�81ack
�Threadcd
indicated above. Surtace (t.
�iil2 +�$Gk.l�itAfi: U.:sTI:=`�.t'. I�"all�. t'�2�.�i1i�; OGalv. ❑Weldea
Drive Shce? Yes�� No—
!t3111. ��11Z3.Z� 1.3�3ilfV 4:� • - _ O Plastic p If 4 t�
�:X ::.'; � ,q
���; z:i.= ;ir�, - �."?=- 1= in.to��[t. Weight�IbsJ(t. —�n. t���ft.
3. FORMATION LOG COLOR HARDNESS OF FROM� TO in.to fL Weight IbsJft. �n. to_lt.
FORMATION
in.to ft. Weight Ibs./ft. �n. to�t.
�;���y t; ��-: 9.SCREEN Or�openhole
Make ���1��1 from ft.to. ft.
_ ^ f� Tyce �''i�:�1]"1� _ C: :i -. .� Dlam. ;,'r��
,'
`, SIoVGauze �-� Length ���
1�t FITTINGS:
Set between 1#1 ft.an�J-4� tt.
10.STATIC WATER LE�BL
,6=�-' ft.�'3 below ❑above Date Measured 1-�-==i r-�i
land surface
ll.PUMP[NG LEVEL(below land surtace)
��'-�'� ft.after +- hrs.pumping -�+' g.p.m.
- (l.after hrs.pumping g.p.m.
12.HEAD WELI,COMPLET[ON
-' w��Pi[less adapter manufacturer'�1����F ��f-Fr Model
❑Basement o(tset ,�At least 12"above ground
❑Plastic casing protection
13.WELLGROUTED? �Q'es ❑No
� :
�,.,�� ❑Neat Cement O Bentonite � ��ui`i.�1 t���C:1L s;L
'r'
Grout material from to tt.cu.yds.
i :
o-".'
r: �.
14. NEAREST SOURCES OF POSSIBLE CONTAM(NATION
�� feet direction �ype
Well disinfec[ed upon mmpletion? f,�Yes ❑No
15. PIJMP �-�
�-1..'���1 ;
Da[e installed ❑Not installed � �
Manufacturer's name ��F'-'p'�
� " Model number HP �- Volts��� -
E
I,ength ot drop pipe "� fL Capacity �� g.p.m.
Material of drop pipe �p�,��,\7�
Type��O Submersible ❑L.S.Turbine L]Reciproca[ing
❑Jet ❑Centrifugal ❑
I6. ABANDONED WELLS
Unused well on Vroperty? ❑Yes .lL7 No
Use a second aheel,ij needed �ed ❑ Permanent ❑ Temporary ❑ Not sealed
17. REMARKS,EIEVATION,SOURCE OF DATA,etc.
18.WATER WELL CONTRACTOR CERTIFICATION
This well was drilled under my jurisdiction and[his report is true lo the hest of my
knowledge and belief.
lli;Fv Si(.��i,¢<�, Vv�;1+L: F�Fti'ILLING UG.. ii�K:. ;r.�17�
Licensee Brsineu Narae License No.
Address ��-=,?'i:) �3..:.'ii�%+�,:.�':�' ?i ���t:3 i !`iT3. ,��;.�tt'�
�.�._. /
Si nt4f`"'� ,�.:...,,..�.�f-��./��at: . f Datr �_.'�a?.r��
8 �
Au[horized Idepresenfntlue
j'�• - y''C.-`TivY.'._... 9—�.._.�i1
DatP -
Name of Dril(er
5/74 30M
LOCAL COPY � 6 g� � 7 ���s�
�,�8 30M
HE-01205-03(Rev.9/88) p�82�p�„�
c
• ?u�li�c �� �/at��i ���'�1G, �ir�,
617 13TH AVE.SO. • HOPKINS,MINNESOTA 55343 • 935-3556
� Stoc]ola Well Drilling January 18, 1991
15306 Highway 7
Minnetonka, Mn. 55345
REPORT OF WATER ANALYSIS
Croceived trom you 1 Januaty 15� 1991
Our Iaboratory reporta tMs�analytical nsults,det�rmined on s sampl• J o�
M�wiy.us
well water
Van Eechout Builders
2130 6th Ave. N.
Orono, Mn. .
Unique Well � 469537 �
Bacteria (Coliform group) less than 1/100 ml
Nitrate nitrogen less than 0.1 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.
ity Water Clinic� Inc.
��
Bill Van Arsdale
Analytiul I�baatory Consull�ng englneer
Water snalytis roaqeMs Bo�ler water chem�cals
17.t parlslmdlron equals t.0 gra�nigallon