HomeMy WebLinkAboutwell info N'�LL LOCPTION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO.
Countv Nas,�` WELL RECORD 5 4 8 5 5 6
f�"����'n Minnesota Statutes Chapter 1031
Township Name Township No. � Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed
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�-f��� �1� �:� cs� ��s� �—��}—y�a
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Numerical Street Address and City of Well Location or Fire Number DRILLING METHOD
L Su��� �,�� ��,����i ��• i_�Jg.� ❑ CableTool ❑ Driven ❑ Dug
�Vt' � ❑ Auger C�Rotary ❑ Jetted
Show exact location of well in section grid with"X". Sketch map of well location. ❑
� Showing property lines,
ry roads and buildings. DRILLING FLUID
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i � i i �y�"' .USE ❑ Heating/Cooling
._+_ ___ _ �_ � 4�1 Domestic ❑ Monitoring ❑ Industry/Commercial
W � i � � E ❑ Irrigation ❑ Public
' j ❑ Test Well ❑ Dewatering ❑ Remedial
_1_ _1_ __ 1_ �
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f-mi. CASING Drive Shoe? ❑ Yes ❑ No HOLE DIAM.
'-i- �- � -�' j ❑ Steel ❑ Threaded ❑ Welded
�-1 milr'—� x�LK�� LI,�Plastic ❑
CASING DIAMETER WEIGHT
PROPERTYOWNER'SNAME E� in.to_��ft. 4T'u?r.�i Ibs./ft. _���(�t f�;;
Jl.t:i ►7E?I1ziC:ll �fC.�1G.".;' in.to ft Ibs./ft.
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Mailing address if different than property address indicated above. in.to ft. Ibs./ft. in.to ft.
L�,�,,.,i. SCREEN 4,..,,., OPEN HOLE
�L�� '�f+:�y1�3r� �j4"�5i�cly Make �C�iut:a�Il from ft.to ft.
�i17"lI1E.'�C)f�Ct3� MCI. rJr3.3�iJ TYPe ����I3�'���,--��� Diam. �p
SIoVGauze Lenqth �i
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Set between �_�,F.�^ft.and �L�ifl. FITTINGS:
STATIC WATERLEVEL
GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO �t�i `�L�`��Y
MATERIAL ft. f�Cbelow ❑ above land surface Date measured
PUMPING LEVEL(below land surface)
L-ld� �SC `��'TKj. .�'�' �� ��.l � ft. after hrs.pumping g.p.m.
c��,.,,..Y WELL HEAD COMPLETION r�..�,���,��,
.�catat � ��;;�`:� �G y��itless adapter manufacturer �vl Model
❑ Casing Protection ;�12 in.above grade
GROUTING INFORMATION
Wellgrouted? QYes ❑ No
Grout Material ❑ Neat cemeW �Bentor»►�: �
from �� ro 3 ft. O yds. I$.bags
from to ft.
from to fl. ❑ yds. ❑ bags
NEAREST KNOWN SOURCE OF CONTAMINATION ,�,,,
�l f)' feet 1����" direction `^�'��+� rype
Well disinfected upon completion? C�Yes ❑ No `�
PUMP
❑ Not installed Date installed �
- Manufacturer'sname ����-���,�
Model number HP _�_ Volts
_ Length of drop pipe ft. Capacity � g.p.m.
� Pressure Tank Capacity ��� � �:��,- �'
Type:.❑ Submersible ❑ LS.Turbine ❑ Reciprocating ❑ Jet ❑
ABANDONED WELLS
Does property have any not in use and not sealed well(s)7 ❑ Yes LTNo
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.
D()Pd S��Lt=3 WE:I.I, I�,L.TNG C:U. 271 1�r. �
Use a second sheef,if needed I
REMARKS,ELEVATION,SOURCE OF DATA,etc. Licens e eusiness Name Lic.or Reg.No.
---_..---- ..
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./ .�"7`~— r �—L�x—g.`�
;./�- `�-"� _
� Authorized Representative Signature Date
�''.P. Nic�ia.lxxl 2-2�—�`_�
� Name ol Driller Date
x LOCAL COPY � q,�� �6 HE-01205-04(qev.5/92)
� ' � - �I'Zvin City �Nater Clinic, Inc.
61713th Ave So • Hopkins,Minnesota 55343 • (612)935-3556
• 02/27/1995
Stodola Well Drilling
15306 Hwy 7
Minnetonka MN 55345
938-21 1 1
REPORT OF WATER ANALYSLS
Lab#f: 25228
. Our Laboratory reports these analyticai results, determined on a sample taken �
by CLIENT on 02/24/1995 f�om the following location:
Jlm Jenson Homes
460 Sussex Lane
Orono,Mn
Unique M 6485b6
.
Coliform Bacterla <1/100 m)
Nitrates Nitrogen <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. This report is an analysis for coliform
and nitrate only and does not include analysis of Lead and other contaminants. (Unless
as specified by client).
� \
ate�Clinlc, Inc.
Bill
Brian 'r
Analyial l�borawry �W��
W�ter Analysu Iteagenu Boiler Wster C6emio�4
L,�b Cettitic�tion!027-033-119