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Home My WebLink Aboutwell info � `'''_i_�OCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. , �untyName WELL AND BORING RECORD �^y � -, Hcr�nG�l�': Minnesota Statutes Chapter 1031 `�✓ �-J�� Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed C�r_cna 11'3 L;; t:4 5 y K. � ; . . `._�__ �. �. �< _ > House Number,Street Name,City and Zip Code of Well Location or Fire Number DRILLING METHOD L�t'�.i .Ci.,vXil��'.�'r:.�} �,c1,;1� (}j:'C'?jji7 t MYl 'J�%:?t:�� ❑ Cable Tool CI Driven ❑ Dug ❑ Auger C%7�.Rotary ❑ Jetted Show exact location of well in section grid with"X". Sketch map of weil location. ❑ Showing property lines, roads and buildings. DfiILLING FLUID WELL HYDROFRACTURED? ❑YES O " ��ntc�t;i��e � � � � Faonn n.ro n. -,- -;- -;- -,- USE ❑ Monitoring ❑ Heating/Cooling i i i i �Domestic ❑ Communi PWS -�- -�- -�- -�' ❑ Irri ation �' ❑ Industry/Commercial � � � � <Ll. 9 ❑ NoncommunityPWS ❑ Remedial �( ❑ Test Well W i i i i E T ❑ Dewatering ❑ -r -�- -r- -r � � � i i y2Mi1e k CASING Drive Shoe? ❑ Yes No HOLE DIAM. _i _i_ _i_ _i_ � � � q_Steel ❑ Threaded ❑ Welded ' ' ' ' as�Plastic ❑ s . �-1 M�ile-� � CASING IAMETER WEIGHT � PROPERTY OWNER'S NAME � in.to ��H. i �U ibs.in. 'fi' i t f �et�r �Anctr4� Cc�n�t.�tny ---��.to h. �bs.�n. �;�.�a`� £s Property owner's mailing address if different than well location address indicated above. in.to ft. Ibs./R. in.to ft. � � ��;�i i�f�,� �r j:� �!� SCREEN 4., OPEN HOLE R.a j ., � � -,�; Make QLF21 Cil'1 from ft.to ft. �;c�.,n � r:��.rif, M.n. .,�.�_;f .�._� . � 5tee1 Type Diam. SIoUGauze • 11 L� Length � Set between !��t ft.and � �� ft. FITTINGS:_t'u � ��%p '{P7/ g �,:.._�,. STAT�f��IPPfER LEVEL A .��l!��' � - WELL OWNER'S NAME tt. ❑ below ❑ above land surtace Date measured PUMPrVQ I[€VEL(below land surface) r�- �� r3 2 r c: Well owner's mailing address if different than property owner's address indicated above. ft. after hrs.pumping g.p.m. �LL HEAD COMPLETION �tit��W.tE.'1' Pitless adapter manufacturer Model ❑ Casing Protection_ �.12 in.above grade ❑ At-grade(Environmental Wells and Borings ONLY) GROUTING INFORMAT10N Well grouted7 ❑oes ❑ No GEOLOGICAL MATERIALS COLOR H MATERIAL�F FROM TO Grout Material ❑ Neat cem�}i ❑ eentor�te� ❑ Concrete y��'iiigh So�ids Bentc�ite from to ft. ❑ yds. ❑ bags l from to ft. ❑ yds. ❑ bags 1'C?� J�1� �+1�c(:�C :i �i � � � from to ft. ❑ yds. ❑ bags NEAR OWN SOURCE OF CONTA ATION� S� T1C �-'�-`-��r Br�3�%�1 C � ' �l' = feet �C7�-� � direction rype � Well disinfected upon completion? p Yes ❑ No Cli'�� t7r�1' � S J�' ' G r-� PUMP � ❑ Not installed Date installed �`✓`�� :1:y Gr::�%�:l Grey �!i �'i x ' 1 i '� ' AermQ�:ar Manufacturer's name C97KG[.7769 7 • 23C Model number HP Volts �:tTlt� `X':331 tl � �;i ' �� ` r,' - � 1�i Length of drop pipe ft. Capacity g.p.m. Type: Cj:Submersible ❑ L.S.Turbine ❑ Reciprocating ❑Jet ❑ ABANDONED WELLS Does property have any not in use and not sealed well(s)? ❑ Yes b�No VARIANCE Was a variance granted from the MDH for this well? ❑ Yes C'�No 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 oi my knowledge. DC�A! S'i`C?Df�L.�z WEI,� U'RZI,LTivG C�,, , INC. Licensee siness N�me Lic.or67eg.No. /� . �•_--+-•-- :�i'' . � „ �`'� :� . ; <%'� ' �i?—�8-9_ ` _ - .r'. Authorized Representative Signature �� Date i'htic3c f�Ic:c��'� 1 �;-�.8--�4% Name ol Dril/er Date LOCAL CC��Y � �� HE-01205-06(Rev.9/96) _ ` + Jwin �ity 1/Vater ��`'nic, J�nc. 61713th Ave So • Hopkins, Minnesota 55343 • (612) 935 - 3556 1�ro�r�es7 Stodola Well Drilling 15306 Hwy 7 Minnetonka MN 55345 938-2111 REPORT OF WATER ANALY5L5 Lab#: 33873 Our Laboratory reports these analytical results, detertnined on a sam�e taken by CLIENT on 10/28/1997 from the following location: Peter Andrea Co. 2850 Somerset Lane Orono,Mn Unique 1Mall#5�6678 Colifam Bacteria <1/100 ml Nitrates Nitropen <1.0 mg/t 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 far coliform and nitrate only and does not include analysis of Lead and other contaminants. (Unless as speci�ed by client). � \ te Clinic, Inc. Bill rsdale nmlyiw�Vboe�o�r �g� W+�r�Yor� BOibr W�ter Chamiah L�b Cartd'oatioo/027-033-119