HomeMy WebLinkAboutwell info WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESqEelQUE WELL NO.
County Name WELL AND BORING RECORDJ H Q.J 9 S
Hennepin Minnesota Statutes Chapter 103/ C
Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed
l TL;II f; 1 17 L iii. 2-14 '
House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD
'521-
Thoroughbred Lane Orono ❑ Cable Tool ❑ Driven ❑ Dug
❑ Auger ❑Aotary ❑ Jetted
Show exact location of well in section grid with"X'. N• t3 rO' JSkV map of well location. 11/ �"SShowing property lines,
roads a
N _1 j"fG' G E1(,7 and buildings. DRILLING FLUID
BeTltuTTltB
USE ❑ Monitoring ❑ Heating/Cooling
y,/ L X 1( Domestic ❑ Community PWS ❑ Indust /Commercial
-� - - -i- -i- ❑ Irrigation
[I Noncommunity PWS di
w E T L] Test Well y ❑ Remedial
I ❑ Dewatering ❑
CASING Drive Shoe? ❑h(es ❑ No HOLE DIAM.
lct Steel IN Threaded
Threaded ❑ Welded
-� ❑ Plastic ❑
S
1 Mile-�
CASING DIAMETER WEIG T /
PROPERTY OWNER'S NAME n.to t 6�ft. _ bs.ttt. /? 8 3i,
LeGran Hones in.to ft. _--_—_ Ibs./ft. � eft.
Property owner's mailing address if different than well location address indicated above. in.to ft. tbs./ft.
i. SCREEN OPEN HOLE
115021 9"t h +ane N.Y;. Make Jc-tf T::cin from ft.to ft.
Blaine, Mri. 5544 Type-- �''t az nlr! s Ste( t Diam. ^,tt
Slot/Gauze Length
Set between ft.and 2 f:4 ft. FITTINGS:
STATIC WATER LEVEL
WELL OWNER'S NAME 12 S ft. EXbelow ❑ above land surface Date measured
PUMPING LEVEL(below land surface)
Well owner's mailing address if different than property owner's address indicated above. ;.�9 ft. after r hrs.pumping !j g.p.m.
WELL HEAD COMPLETION
5Pitless adapter manufacturer Sz3h i + i.: +-. n r-Model
El Casing Protection 4 IX 12 in.above grade
❑ At-grade(Environmental Wells and Borings ONLY)
GROUTING INFORMATION
Well grouted? [-];.Yes ❑ No
HARDNESS OF Grout Material ❑ Neat cement ❑ Bentonite ❑ Concrete ❑ High Solids Bentonite
MATERIAL FROM TO
GEOLOGICAL MATERIALS COLOR i
from �� to .jL'r ft, L.�� ❑ yds. ❑}bags
from to ft. ❑ yds. ❑ bags
lay Bl41G .) ti from
NEARES�T-1 NOWN SOURCE OF CONTAMINATION
Clay Yell ,W S 3 feet direction � +~f c type
Well disinfected upon completion? IX Yes ❑ No
Clay Gree rJ it. 1 b ` PUMP 7---28-97❑ Not installed Date Zrlled
cane r�`ctl2 f)j ` 91mot' Manufacturer's name � Qr
Model number HIP 1 Volts _
1 � 9 p pipe Capacity -g.p.m.
l,l"ly Grev � nth of dro i e 1�=7 t ft. Ca aci i
�t 14 1
Pressure Tank Capacity 1, (oc4 l
'L� 1 > t 1 :
Type: 1.4 Submersible ❑ L.S.Turbine El Reciprocating El Jet ❑
Sand w/C:la\- b :cl. J Very SC)§ .
ABANDONED WELLS
'--i a.n Gravel Clay Br tJ n snit 2091 'does property have any not in use and not sealed well(s)? ❑ Yes LI jyo
VARIANCE
Clay Gre S [,i t� 121,10 Was a variance granted from the MDH for this well? ❑ Yes 4 No
1.`' WELL CONTRACTOR CERTIFICATION
�� Tl d Use a second sheet,if ne�dbbl Cur J .i.(?k i ! / 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.
DON STODOLA WELL DRILLING CO. , INC.
Licensee BusineserName Lic.or Reg.No.
_71 1...
Authorized Representative Signature Date
F, ec LeiiDy 4-2.8-97
Name of Driller Date
!.00AL COPY1580598 HE-01205-05(Rev.1/95)
J.i. City W.&' C J..
617 13th Ave So Hopkins, Minnesota 55343 • (612) 935 - 3556
05/06/1997
Stodola Well Drilling
15306 Hwy 7
Minnetonka MN 55345
938-2111
REPORT OF WATER ANALYSIS
Lab#: 32497
Our Laboratory reports these analytical results, determined on a sample taken
by CLIENT on 04/28/1997 from the following location:
2525 Troughbred Lane
Orono,Mn
Unique Well#580598
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).
f\
:Ie
er Clinic, Inc.
Bill
Analyical laboratory Co-ttitirg Engineer
Water Analysis Reagents - Boiler Wow Chemicals
Lab Certification 0 027-013-119