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Home My WebLink Aboutwell info WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. �;,��.. WELL RECORD 5 3 6 2 5 0 �-��-Y� Minnesota Statutes Chapter 1031 Township Name Township No. � Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed tt. t°�t4-�nc: 11"/ :��? i:'�; 3��,.{qt��,�, �. t�:% �:_•�C � Numerical Street Address and City of Well Location or Fire Number DRILLING METHOD ❑ Cable Tool ❑ Driven ❑ Dug �'F11i .ci11S�'�X RC3�?L� l�lrnli+fi �• ❑ Auger `�C] Rotary ❑ Jetted Show exact location of well in section grid with"X". �� Sketch map of well location. ❑ Showing property lines, s roads and buildin s. DRILLING FLUID B. �l I i N i i J�+�-y�X 9 --r---r -1 -1- 5r ,r i � � i ,.l�� ,USE �Domestic ❑ Monitoring � Heating/Cooling yy � ; I � E �Ni ❑ Irrigation ❑ Public ❑ Industry/Commercial � T ❑ Test Well ❑ Dewatering �� Remedial _1_ ___ __ 1_ I ❑ I ; ' �''"'� CASING Drive Shoe? ❑ Yes ❑ No HOLE DIAM. --�- � � ' 1 , �' - -�' ❑ Steel ❑ Threaded ❑ Welded � � Plastic ❑ �—I mile—� CASING DIAMETER WEIGHT PROPERTY OWNER'S NAME � f� ", in.to_�.�yt. Ibs./ft � ,?� in.to�� ft. �� r�� in.to ft. Ibs./fl. : �r�� in.to.�[�.ft. Mailing address if different than property address indicated above. in.to ft. Ibs./ft. in.to ft. '��,� '�� SCREEN OPEN HOLE ��,�„�X' �. �r.��;- Make a�C��1�1SC�J1�1•^� from ft.to ft. '-.i TYPe r�?'�#i��`cs r�i-m� Diam. �M Slot/Gauze Length Set between ft.and �4� ft. FITTINGS:�{Z�� . STATIC WATER LEVEL GEOLOGICAL MATERIALS COLOF HARDNESS OF FROM TO t^; ft.� below ❑ above land surface Date measured 1��~ � MATERIAL - PUMPIN��EVEL(below land surface) 1 '�C LZ��' Y��.C7�r� S �" y;i;' i'��• ft. after hrs.pumping E•Yj g.p.m. , WELL HEAD COMPLETION �.��,�x, �,x� (�jr��s� �L�t �i(y� �7 Pitless adapter manufacturer Model ❑ Casing Protection �] 12 in.above grade .+ �t �I�K.� �I'ari �{�� i e.�i°� GROUTING INFORMATION Well grouted? �I Yes ❑ No � t` x �-�C� t Grout Material ❑ Neat cement � Benronif,e Cl�.y G7C� i._;(; 1.�.> from �' to ��` a. � ❑ yds.� bags „ 1 from to ft. ❑ yds. ❑ bags `�"�� Tc�l� � t 4j� �t:e; from to ft. ❑ yds. ❑ bags NEAREST KNOWN SOURCE OF CONTAMINATION ��feet '��v_�� direction��,. a� type Well disinfected upon completion? �Yes ❑ No PUMP ❑ Not installed Date installed �� '�'�"f� Manufacturer's name �� Model number - HP_��__ Volis L]�e Length of drop pipe °"t R. Capacity �l. g.p.m. Pressure Tank Capacity �.� h"�Y�%�- Type: � Submersible f7 LS.Turbine ❑ Reciprocating ❑ Jet ❑ ABANDONED WELLS Does property have any not in use and not sealed well(s)? ❑ Yes �] No 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,il need�V � � �y �� I�� •� �'��` �/j� � REMARKS,ELEVATION,SOURCE OF DATA,etc. Licensee eusiness Name Lic.or Reg.No. .+'� . j �'','�� ,�'` � � ;c—�`�--�� - Authorized Repres2ntative Signature Date �� I�'l�'Jy �—�`;��'e Name of Driller Date LOCAL C�PY "1 �h / 'A O HE-01205-04(Rev.5/92) �J V L�d ° • 2'7.vin Cit 7Nate� Clinic, Inc. . . .. y 61713th Ave So • Hopkins,Minnesota 55343 • (612)935-3556 03/02/1994 Stodola Well Drilling 15306 Hwy 7 Minnetonka MN 55345 938-2111 REPORT OF WATER ANALYSIS lab�: 22215 Our Laboratory reports these analytical results, determined on a sampie taken by YOU on 02/28/1994 from the following location: Charles Cudd 560 Sussex Crl Orono�Mn ilni,qu�i� 536250 Coliform Bacteria <1/100 ml Nitrates Nltrogen <1.0 mg/I 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. . �\� �n Wat�r Clinic, Inc. `.\ � � \ Bill A s Brian ir �� watar nodry.i�xe.�em Boi1R w.rer C6emiaM ,