HomeMy WebLinkAboutwell info WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO.
County Name WELL AND BORING RECORD 3
Hennepin Minnesota Statutes Chapter 1031
578
Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) ft. Date Work Completed
Orono 117 221 04 A h V, 271 ' 2- 13-9fi
House Number,Street Name.City,and Zip Cc Qe of Well Location or Fire Number DRILLING METHOD
l„ line orono, _N' ❑ Cable Tool 11 Driven ❑ Dug
is a. 'I: >llc+ 1' C;: . ❑ Auger EARotary ❑ Jetted
Show exact location of well in section grid with"X'. S IS:1,6 Sketch map of well location. ❑
Showing property lines,
roads and buildings. DRILLING FLUID Bentonite
USE ❑ Monitoring ❑ Heating/Cooling
J.Domestic ❑ Community PWS
Y O�.r t /Commercial
EI Irrigation ❑ N 1r ity � I
w e ❑ Test Well
I _, -r -r CASING Drive Shoe? ❑ Ygs•,C,] No,, r -- -HOLE DIAM.
_i_ 41 Steel F] Threaded — El Welded
El Plastic ❑
��Mi1e� / [.�+✓<`/.✓ SING DIAMETER WEIGHT
PROPERTY OWNER'S NAME r• in.to 2-5 8 ft. Ibs./ft. 7 i7 8
moony Eiden Company
in.to ft. Ibs./ft. "itg �.
Property owner's mailing address if different than well location address indicated above. in.to ft. Ibs./ft. in.to ft.
SCREEN OPEN HOLE
Make Johnsen from ft.to ft.
Type 5tai nIt-5--, C;�'f-4PI Diam. 2
Slot/Gauze 1�) 10 1,1 0 _ Length i. 1+4 '+Z '
Set between 2 5'8 ft.and 27 1 ft. FITTINGS:
STATIC WATER LEVEL
WELL OWNER'S NAME 1 ft 7 below ❑ above land surface Date measured —1 i-9
PUMPING LEVEL(below land surface)
Well.owner's mailing address if different than property owner's address indicated above. ft. after 115 hrs.pumping 35 g.p.m.
WELL HEAD COMPLETION �11i eSdi{ 1:k r
3t Pitless adapter manufacturer Model
❑ Casing Protection Ix 12 in.above grade
❑ At-grade(Environmental Wells and Borings ONLY)
GROUTING INFORMATION
Well grouted? XI Yes q No
GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO Grout Material ❑ Neat c ent I4 Bentonite ❑ Concrete ❑ High Solids Bentonite
MATERIAL from (I to �_ _ft. i'is ❑ yds.R bags
Zi
Clay Black .5
from to ft. C1 yds. ❑ bags
� t �
7 from to ft. ❑ yds. L1 bags
Cloy Yellow �j J t NEA •KDIOt�NSOURee OFCON /{RAIR f T�N7 direction
Clay
disinfected upon completion? K Yes S/❑ No
Clay Grey S10 PUMP �� �y
El Not installed Date installed 2-23—%
Cloy, Grovel Grey L` j(: r Manufacturer's name QXII.dgg _ _ ? 7r�
Model number / HP • �'VoltQlts 430
Length of drop pipe 147 ft. Capacity� g.p.m.
Clay, Sand, ravel Brown S 16 i5 75t
Pressure Tank Capacity S� 01
Type: 0 Submersible C3L.S.Turbine El Reciprocating E1 Jet 1:1Gravel, Sant' a'ello�� �7 _i8 27i
ABANDONED WELLS
Does property have any not in use and not sealed well(s)? ❑ Yes -� No
VARIANCE
Was a variance granted from the MDH for this well? ❑ Yes X No
WELL CONTRACTOR CERTIFICATION
Use a second sheet,if 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.
DON S` UDOLA WELL DRILLING CO. ,
LicenseeBusines Name � _ Lic.or Reg.No.
Authorized Representative Signature Date
Fred Leiby 2-13--96
Name of Driller Date
LOCAL COPY 573578 HE-01205-05(Rev.1/95)
� Jwin
Water
Jnc.city C'unic, .
617 13th Ave So • Hopkins, Minnesota 55343 • (612) 935 - 3556
02/17/1996
Stodola Well Drilling
15306 Hwy 7
Minnetonka MN 55345
938-2111
REPORT OF WATER ANALYSIS
Lab 8: 28784
Our Laboratory reports these analytical results, determined on a sample taken
by CLIENT on 02/14/1996 from the following location:
Tony Eiden
2670 Thoroughbred Lane
Long Lake,Mn
Unique Wall 8673678
Coliform Bacteria <1/100 ml
Nitrates Nitrogen <1.0 mg/l
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).
t \
wilt Qty, Ater Clinic, Inc.
Bills�le
Anslyial W-at y
Wawr Aodysis Ro%=k soil«Wswr Momio.h
Lab Ceffifm ion i 027-053-119