HomeMy WebLinkAboutwell info WEf LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO.
County Name WELL AND BORING RECORD pn� ^h 1
F1 7tt2e�� n Minnesota Statutes Chapter 103/ 8✓ v 2 1
Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed
C;'zc/I?C', 1
7-18-97
House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD
!i,J1(i Zlrzcr uet l�Lreu L%,rie Drone tin. 5
L1 JiV. ❑ Cable Tool [I Driven
[_1 Dug
❑ Auger ❑ Rotary ❑ Jetted
Show exact location of w tion rid wi r, .,,-^j SkQtdh map of well location. ❑
howing property lines,
-Toads and buildings. DRILLING FLUID BE'n l
N }.
�(1111 ,.
USE ❑ Monitoring ❑ Heating/Cooling
y IXDomestic ❑ Communit PWS
71 Irrigation y ❑ Industry/Commercial
❑ Noncommunity PWS ❑ Remedial
W I E T ❑ Test Well ❑ Dewatering ❑
CASING Drive Shoe? ❑ Yes A No HOLE DIAM.
zMile
❑ Steel ❑ Threaded ❑ Welded
IA.Plastic ❑
s Xv�L�cr
I Mlle
CASING DIAMETER WEIGHT
PROPERTY OWNER'S NAME in.to t` - ft. 1 . 9 Ibs./ft. 3 i .
in.to
'font, Eifien Cai:ip<�ny in.to ft. Ibs.ft. �.�� 5:
Property owner's mailing address if different than well location address indicated above. in.to ft. lbs./ft. in.to ft.
'l 1100 Berkshire Leine
SCREEN, _ OPEN HOLE
Plymouth, Mn. 55356? Make t Johnson from ft.to ft.
1'J 4t 46 Type Ista n es Steel Diam.
Slot/Gauze Length
Set between _ 4 ft.and r_t: ft. FITTINGS: ° X (1 fr ;^ KP
STATI ATER LEVEL
WELL OWNER'S NAME el ft. f3.�)elow ❑ above land surface Date measured
PUMPING LEVEL(below land surface)
t�4? «;fin_;
Well owner's mailing address if different than property owner's address indicated above. ft. after < hrs.pumping 1 g.p.m.
WELL HEAD COMPLETION
4-Pitless adapter manufacturer Wh i t E?LV a t:e r Model
❑ Casing Protection CZ 12 in.above grade
❑ At-grade(Environmental Wells and Borings ONLY)
GROUTING INFORMATION
Well grouted? ❑Aes ❑ No
HARDNESS OF Grout Material ❑ Neat cement (X Bentonite ❑ Concrete ❑,High Solids Bentonite
MATERIAL
GEOLOGICAL MATERIALS COLOR FROM TO 3
from to ft. ❑ yds.13 bags
from__ to ft. ❑ yds. ❑ bags
ifl Jo;,.l Black from to ft. ❑ yds. ❑ bags
NEAREST KNOWN SOURCE OF CONTAMINATION
Clay Brownf _ + feet direction type
Well disinfected upon completion? 2-Yes ❑ No
Cl&y Grey I S, [PUMP _
r
ElO Not installed Date installed w�` ' C4 7
ce nG/Grcl.Z'4..3.�. C ,1'.1^ ({ i '� T '� (:
Manufacturer's name Reel Jacket
Model number y'-.7 9 S 8 I HP I Volts
Length of drop pipe 14 Cpactty � g.p.m
.1<y Grey `5 ,�O .
Pressure Tank Capacity
Clay
4,Submersible ElL.S.Turbine ❑ Reciprocating ❑ Jet ❑
Clay Brown M 15 V I ABANDONED WELLS
Does property have any not in use and not sealed well(s)? ❑ Yes X No
Clci. /Boulders Brown B. ` �.
VARIANCE
Was a variance granted from the MDH for this well? ❑ Yes [XNo
Z. Yellow 2 M 235 1' '
WELL CONTRACTOR CERTIFICATION
Use a second sheet,i/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 of my knowledge.
)ON STODCLA WELL DRILLING CO. , INC. 2-11-12
Licensee Businneas Name Lic.or Reg.No.
Authorized Representative Signature Date
Chuck Moore 7-11D-97
Name of Driller Date
1... � .�._ f^(�PU 5 ; ? 1 HE-01205-05(Rev.1/95)
i
s Juin City W.I., cJnc.
617 13th Ave So • Hopkins, Minnesota 55343 • (612) 935 - 3556
07/22/1997
Stodola Well Drilling
15306 Hwy 7
Minnetonka MN 55345
938-2111
REPORT OF WATER ANALYSIS
Lab#: 33080
Our Laboratory reports these analytical results, determined on a sample taken
by CLIENT on 07/21/1997 from the following location:
Tony Eiden
2430 Thoroughbred
Unique Well#580621
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).
ter Clinic, Inc.
Bill V e
nodyiod t-may CO-Uki%E
W&W Anabvis Reegmft Hoaw wdw Cbmtia4
Lb Catd"iediau 0 027-053-119