HomeMy WebLinkAboutwell info N'jLL L ' TION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO.
County Name — WELL AND BORING RECORD - 696480
Hennepin Minnesota Statutes Chapter 1031
Township Name --jTownship No. I Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed
ocom 118 23 26 y. 'h 246 10-7-03 DRILLING METHOD
LOCATION: Latitude degrees minutes seconds
Longitude degrees minutes seconds ❑Cable Tool rrr❑r,-00000�����Dotar ❑Dug
❑Auger otary ❑Jetted
House Number,Street Name,City,and Zip Code of Well Location or Fire Number El1085 Tse arack Dr, Orono DRILLING FLUID WELL HYDROFRACTURED? ❑Yes
o
Shop exact location of well in section grid with"X". Sketch map of well location. bmtodte FROM ft.TO ft.
Showing property lines,
N roads and buildings USE ❑Monitoring ❑Heating/Cooling
omestic ❑Environ.Bore Hole ❑Industry/Commercial
--- - -
u Noncommunity PWS E]irrigation Remedial
❑Community PWS ❑Dewatering ❑
"""""`------
i ` CASING OLE DIAM.
w � � � � E� ` �� Shoe? ,�/ ❑No
- C Dnve fires H
feel hreaded 1 El Welded
'h Mile O J� Plastic
"" ----------...... I ASI DIAMETER WEIGHT
' 111 CASING D g�
S
^'" �. . . 4 in.to 219 ft. 11 lbs./ft. _�in.to—
J in.to ft. lbs./ft. in.to�'1.a'
PROPERTY OWNER'S NAME/COMPANY NAME - in.to ft. lbs./ft. to
JIM FAXWS SCREEN OPEN HOLE
Property owner's
mailing address if different than well location address indicated above. Make FROM 219 ft. TO 245 ft.
CriterW 78th alt Type Diam.
Chanhassen, M 55317 Slot/Gauze Length _
Set between ft.and ft. FITTINGS
STATITER LEVEL �
ft. elow ❑above land surface Date measured 10-7-03
PUMPING LEVEL(belA land surface)
WELL OWNER'S NAME/COMPANY NAME
210 ft.after 4 hrs.pumping g.p.m.
WELL HEAD COMPLETION y
Well owner's mailing address if different than property owners address indicated above. ❑Pitless adapter manufacturer Mteater Model_
s ❑Casing Protection ❑12 in.above grade
❑At-grade(Environmental Wells and Boring ONLY)
GROUTING INFORMATION
I
Well grouted L es ❑No
Grout material /'r]Neat cement ❑Bentonite ❑Concrete ;Xigh Solids Bentonite
from__to 0 ft. ' _ ❑yds. [Kags
from 0 to2112 ft. A ❑yds. >'lags
GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO from to ft. ❑yds.. ❑bags
MATERIAL
NEAREST KNOWN SOURCE OF CONTAMINATION
clay ` ltlCliJ. 0 ZZ J --� feet - ' direction type
D meii J. Well disinfected upon completion X Yes ❑No
11
clay gray soft 33 103 PUMP y���
❑Not installed Date installed 10-24-03
sand brawn soft 103 i30 Manufacturer's name Aecwtor
it Model number �, HP I Volts 230
n
clay brown soft 130 193 Length of drop pipe 126 ft. Capacity g.p.m.
Type:❑Submersible ❑L.S.Turbine ❑Reciprocating ❑Jet ❑
sed (fins) brain soft 193 2M ABANDONED WELLS
—j Does property have any not in use and not sealed well(s) Ll Yes- o
Clay red .soft W5 219 VARIANCE
J 7 Was a variance granted from the MDH for this well? ❑Yes c TNk
lfmetone red bard 219 Z4 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,it needed Don Sto&la Well Drilling Co., Inc. 27172
REMARKS,ELEVATION,SOURCE OF DATA,etc.
Licensee Business Name Lic.or Reg.No.
—1IwM
4�,.-entative Signeture1 Date
Chuck PToore 10-7-03
LOCAL COPY � 696480 Name of Driller Date
HE-01205-08(Rev.5/02)
IC 140-0020
rim" CXyWabeorC lncl.
617 13th Ave So Hopkins, Minnesota 55343 - (61.2) 935 - 3556
12/22/2003
Stodola Well Drilling
3841 North Main
St. Bonifacius MN 55375
938-2111
REPORT OF WATER ANALYSIS
Lab #: 1139
Our Laboratory reports these analytical results, determined on a sample taken
by CLIENT on 12/18/2003 from the following location:
JMS Homes
1085 Tamarack Dr
Orono,Mn
Unique Well#696480
Coliform Bacteria <1/100 ml
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).
4inCity Water Clinic, Inc.
Birsdale
Lab Certification#027-053-119