HomeMy WebLinkAboutwell info WELL L�'CP,T!ON+r MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO.
County Name WELL RECORD 5 4 8 5 3 2
�tIY��J3.n Minnesota Statutes Chapter 1031
Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed
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t�rc�r�, �' ?3�`
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Numerical Street Address and City of Well Location � DRILLING METHOD
M. G Cable Tool ❑ Driven ❑ Dug
.����.1: :�C7Fi1Q1'SEt ��.`I�i1� �. vL�Gl'�CJ �1. �?�?� ❑ Auger O Rotary ❑ Jetled
Show exact location of well in section grid with"X". Sketch map of well location. ❑ r•
Showing property lines,
N roads and buildings. DRILLING FLUID
I � _i _i_ ` F3E'Y�`:
-r--7- � i
� � i i .USE ❑ Heating/Cooling
._+_ ___ �_ �_ �Domestic ❑ Monitoring
yy i i E ❑ Irrigation ❑ Public ❑ Industry/Commercial
' T . ./1 ❑ Test Well ❑ Dewatering O Remedial
_1_ _1_ _'_ _' I . t�
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I � �""° *�r�� CASING Drive Shoe? ❑ Yes ❑ No HOLE DIAM.
--�- � -� � 1 ;
- � �- —�' � ❑ Steel ❑ Threaded ❑ Welded
� I milr'—� �j;(�,�' [3�Plastic ❑
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U� CASINC�,DIAMETER WEIGHT
!= 1�y i (�(� i(,
PROPERTY OWNER'S NAME in.to ft. Ibs./h. i to R. -
�tVc.�te�w; & A.��aC3.c"ite5� .LI1C. in.ro tt. ibs./ft. ��.to�.
Mailing address if different than property address indicated above. in.to ft. Ibs./ft. in.to ft.
��.!{�C� V3.Jt1.I� I���I,V�' S�.� 1{� SCFEEN OPEN HOLE
��1 Prs�irie, �. 5�:i�� Make �r'3Y'Cj .�ix1]_f;.� from ft.to tt.
TYPe �a'�����yo-�t-c.cae..�,a„�Diam. �R
� � Slot/Gauze Length �'
Set between �z(2�tt.and_}_�'�__ft. FITTINGS:
HARDNESS OF STATIC WATER LEVEL
GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO yf�F ft. �be�ow ❑ above land surface Date measured $1—:'—gt�
PUMPING LEVEL(below land surface) -
�.�.,rZV .�5 (i� �('� ft. after_ hrs.pumping g.p.m.
� WELL HEAD COMPLETION
�a'1'1Cy �. �(,.'� ��,�� ��itless adapter manufacturer ���+��� Model
O Casing Protection (�72 in.above grade
GROUTING INFORMATION
Well grouted? �Yes ❑ No
Grout Material ❑ Neat ceme i ❑�entonite� ., r
�rom �'� to ''{� ft. �", ❑ yds.t�? bags
from to R. ❑ yds. ❑ bags
from to ft. ❑ yds. ❑ bags
NEAREST KNOWN SOURCE OF CONTAMINATION x
�,, feet �•L/���r direction .�c.�/�'/� type
Well disinfected upon completion? C�Yes ❑ No
PUMP
O Notinstalled t r�sta�lp(�� . 11—i��—��G
Manufacturer's name ��'t"�������
Model number J HP V L$-�=
Length of drop pipe y ft. Capaci� � g.p.m.
Pressure Tank Capacitv _ UL e.��.'L'!]"�"�' 1'c3 C
Type:�] Submersible ❑ L.S.Turbine ❑ Reciprocating ❑ Jet ❑
ABANDONED WELLS
Does property have any not in use and not sealed well(s)? ❑ Yes �QVo
WELL CONTRACTOR CERTIFICATION
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,i/needed �� �'������ ��� �I�1� �"1 x�• l�t r L
'
REMARKS,ELEVATION,SOURCE OF DATA,etc. Licensee Business Name Lic.orReg.No.
_____
APR 4 1995 ��``"`� .. 11—�—y4
..--. �,�`=--.
_ Authorized Representative Signature Date
I�.F. I'�"�iC?1'1 3�—L'—��
Name ol Driller Date
0
M1
LOCAL CO�Y 5 4 8 5 3 2 HE-01205-04(Rev.5/92)
,
� � � �I'zvin City 7Nater Clinic, Inc.
61713th Ave So • Hopkins,NNnnesota 55343 • (612�935-3556
11/04/1994
Stodola Well Drilling
15306 Hwy 7
Minnetonka MN 55345
938-2111
REPORT OF WATER ANALYSTS
Lab�: 24369
Our Laboratory reports these analytical resuits, determined on a sample taken
by YOU on 11/02/1994 from the following location:
Waters 8 Associates .
3020 Somerset Trail 8
Orono�Mn
Ll niqu�i#� 548532
Coliform Bacteria <1/100 ml
Nitrates Nitrogen <1.0 mg/I
The results of these tests Indlcate that this well is producing water that meets the
standards for F.H.A., V.A., or conventional loans. This �eport is an analysis for coliform
and nitrate only and does not include analysis of Lead and other contaminants. (Unless
as specified by client).
Twin 'ty W te linic, Inc.
�
Bill rsdale
Brian Blair
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w,�a�y.:x�r sou�r wwr c�a.
Lb CoAd'�oNioo/027-053-119