HomeMy WebLinkAboutwell info WELL LGM4 MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO.
County Nam WELL AND BORING RECORD 580432
` z Minnesota Statutes Chapter 103/
Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed
t2rmt 01 11-/ 23 04 7-22-9E
House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD
z.:643 `l'I1C.iY.ougi1i)X'E'...[1 Dili_ 6ronc, rPtl ` !)31510 ❑ Cable Tool ❑ Driven ❑ Dug
❑ Auger $1 Rotary ❑ Jetted
Show exact location of well in se grid with"X'. Sketch map of-well location. ❑
.§jpwirf j'property lines,
„^,.•—��"' ads and buildings. DRILLING FLUID
uta v� E D walle
I I I I
XWf USE ❑ Monitoring ❑ Heating/Cooling
®;Domestic ❑ Community PWS ❑ Industry/Commercial
❑ Irrigation ❑ NoncommunityPWS
w E El Test Well ❑ Remedial
I I I I ❑ Dewatering ❑
r r ,/ZM1e CASING Drive Shoe? ElYes ❑ No HOLE DIAM.
1
❑ Steel ❑ Threaded ❑ Welded
O-Plastic ❑
s
1 Mile
CASING DIAMETER WEIGHT
PROPERTY OWNER'S NAME 19 SDMZ.�1 t -V8
7 bny Esi den Cki CJc ny n.to ft. lbs./ft. _ _�t.
in.to ft. lbs./ft. Irk to ;1�,
Property owner's mailing address if different than well location address indicated above. in.to ft. lbs./ft. _in.to ft.
41 G-u berkshdre T.,ane SCREEN OPEN HOLE
Pl � Mn. 446 Make jC111r1:;0,21 from ft.to ft.
vr� i" a
yiT 3U Type S+--a i Diam.
Slot/Gauze t r t Length _ v
Set between 6 ft.and 2f ft. FITTINGS: } t —6
STATIC WATER LEVEL
WELL OWNER'S NAME 11! ft. ❑jaelow, ❑ above land surface Date measured —L(—
PUMPING LEVEL(below land surface)
Well owner's mailing address if different than property owner's address indicated above. t�.J ft. after 1 hrs.pumping ! 9-p M.
WELL HEAD COMPLETION
Pitless adapter manufacturer &,,;!T er Model
❑ Casing Protection 1 12 in.above grade
❑ At-grade(Environmental Wells and Borings ONLY)
GROUTING INFORMATION
Well grouted? El-?Yes ❑ No
GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO Grout Material ❑ Neat cement Ell
s¢entonite El Concrete El High Solids Bentonite
MATERIAL from 0 to =il ft. E ❑ yds.N bags
Bl
ad
§ from to ft. ❑ yds. ❑ bags
Bla
Clay from to ft. ❑ yds. ❑ bags
NEAREST KNOWN SOURCE OF CONTAMINN
ATIO /
Clay Yell `W 5, z['t /�(5�) 1 feet er'S'"(�+.J 1J direction 'S�—type
Well disinfected upon completion? [ .Yes ❑ No G
Clay Grey S 20 SS PUMP
❑ Not installed Date`1,-nstal d
r S : t• Manufacturer's name "'' CLGray;el htlii S t
Model number 181,S15 4 1 t.L HP 11 Volts 2_340
Length of drop pipe 1 l` r ft. Capacity 1 g.p.m.
Chy y ift 1 4" t Pressure Tank Capacity `25T' X-
Length
Type: C1-.Submersible ❑ L.S.Turbine ❑ Reciprocating ❑ Jet ❑
ABANDONED WELLS
Does property have any not in use and not sealed well(s)? ❑ Yes LI Allo
VARIANCE
Was a variance granted from the MDH for this well? ❑ Yes El-No
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.
DON V&LL EVULLING CO., 1W. 2?1
Licensee Business ame �Lic.or Reg.No.
Authorized Representative Signature Date
k're,6. IAA iby j-21.-9£
5 $ 4 3 2 Name of Driller Date
n0A1 00PY
HE-01205-05(Rev.1/95)
5.i. city Wert., cli.i" J..
617 13th Ave So • Hopkins, Minnesota 55343 • (612) 935 - 3556
10/01/1996
Don Stodola Well Drilling
15306 Highway 7
Minnetonka Mn 55345
REPORT OF WATER ANALYSIS
Lab#: 31039
Our Laboratory reports these analytical results, determined on a sample taken
by CLIENT on 09/27/1996 from the following location:
Tony Eiden
2643 Thoroughbred Lane
Plymouth,Mn
Unique Wall#580432]
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).
oitter Iinic, Inc.
Bill V
Anslyical laboratory C-111tirs weer
Water i4oan"Reagents Boiler water Chemicals
Lab Certification/027-033-119