HomeMy WebLinkAboutwell info WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE W LL NO.
County Name .,,Hennepin WELL AND BORING RECORD Jc 9 6 7 0 0
J Minnesota Statutes Chapter 1031
Ttynns8nNa�me Towns Fyp plp J Range Go,Z Section o. Fraction WELL DEPTH(co, feted) Date Work Completed
1111 ((JJ 1 ! �'4 i� f'77" 12- 19-97
'/.
Ho je plu bey,%el Name,Ci a(d Zi Cgde of Well Location or Fire Number ILLING METHOD
L_LL1 11tC}rCi{1L 1�}Y'eCi Lc�Zle Orono MN. Cable Tool ❑ Driven ❑ Dug
or
❑ Jetted
Show exact location of well in section grid with"X". Sketch map of well location. r
Showing property lines,
roads and buildings. I
L 'IILUID WELL HYDROFRACTURED? ❑YES it NO
N7.
FROMft.to ft.
gg�� ❑ Monitoring ❑ Heating/Cooling
J-_>_- _i_ X �CSromeon ❑ Community PWS ❑ Industry/Commercial
W E ❑ Test Well -
D Irrigation ❑ Noncommunity PWS ❑ Remedial
-
T"'
❑ Dewatering ❑
CASING Drive Shoe? ❑ Yes ET No HOLE DIA .
HJ_i i L I; Steel El Threaded ❑ Welded
- i- _ Plastic.. [},
3 f
GASI DIAMETER- WEIGHT
PROPERTY OWNER'S NAME in to_,___ft _ �.: � __Ibs.fft. tn.to _ ft.
�'rart�. E'�der�«'�Corrtpany
- in-to— _ft. �- lbs/ft, inl td._—_ I
Property owner's mailing address if different than well location address indicated above, in.to— __ ft_ _._._ _ lbs/ft, _ _in.to _ ft.
4 's UO BvekshiSe !.sane SCREEN OPEN HOLE
��yrnata th;
MN. 55446` ohns°n
Make from - ft.to ii ft.
Type Stainless Steel ' Diam.
Slot/Gauze Length g7 L
Set between ft.and � ft!FITTINGS: / P
STATIC�1'Fl�l� A
LEVEL Y
WELL OWNER'S NAME' ft. elow ❑ above land surface Date measured 12-19-97
PUMP�Ic)
L)VSEL(below land surface)
Well owner's mailing address If different than property owner's address indicated above. ft. after -S hrs.pumping 60 a Y- .p.m.
�LLHEAD COMPLETION WhitewaterPitless adapter manufacturer Model
❑ Casing Protection 12 in.above grade
❑ At-grade(Environmental Wells and Borings ONLY)
GROUTING INFORMATION
Well grouted? ❑Yes ETNo }�
GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO Grout Material ❑ Neat cement F Bentonite ❑ Concrete ❑ High Solids Bentonite
MATERIAL
from •fo ft. -3 ❑ yds. A6 bags
from to _ft. ❑ yds. ❑ bags
from to ft ❑ yds. [ bags
_ NEARE RCE OF
( `� CON NATION
",l �. t' r
-Y Grey � 1 feet r! direction' r/� type
Well disinfected upon completion? ❑ Yes ❑ No
Sana '' :ne
Grey c} 7 e3
PUMP
v r - ❑ Not installed Da a Insta�lets
C_l 6* 'kti c't_4 i7
Brown
-1 160 It 2151 a d
Manufacturer's name Y fi
*
Gravel
, Ccry G7 ev H 215= 2 3 C, t Model number HP fes1135s
Length of drop pipe ft. Capacity g.p.m.
Clay, Gravel. , BoUldera 60 Type: 1�6ubmersible ElL.S.Turbine ❑ Reciprocating ❑Jet ❑
t`� ABANDONED WELLS Xy
tt Does property have any not in use and not sealed well(s)? ❑ Yes 4 No
Sand Brown 5 280 7 VARIANCE yy
Was a variance granted from the MDH for this well? 11 Yes [3CNo
WELL CONTRACTOR CERTIFICATION
Use a second sheet,i/needed This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 725.
REMARKS,ELEVATION,SOURCE OF DATA,etc. The information contained in this report is true to the best of my knowledge.
DON STODOLA WELL DRILLING CO. , INC. ;717Z
Licensee Business NaL' Reg.No.
_ ,._ f
`. 12-19- 7
,0.
Authorized RepresentatiVe Signature Date
CHuck Moore 12-19-97
1596700 , Name of Driller DateLOCAL COPYHE-01205.06(Rev. )
. , .
Jwin City Water Clinic, Jnc.
617 13th Ave So a Hopkins, Minnesota 55343 • (612) 935 - 3556
12/24/1997
Stodola Well Drilling
15306 Hwy 7
Minnetonka MN 55345
938-2111
I
REPORT OF WATER ANALYSIS
Lab#: 34254
Our Laboratory reports these analytical results, determined on a sample taken
by CLIENT on 12/22/1997 from the following location:
Tony Eiden
2520 Thoroughbred Lane
Orono,Mn
Unique Wall#596700
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).
Vi Water Clinic, Inc.
I
Bi A ale
Analyiml M"Mory C—Wti%
Water Analysis Reagents Boiler Water Chemical
Lab Certification 9 027-053-119