HomeMy WebLinkAboutwell info MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO.
WELL AND BORING RECORD 591098
Rennet In Minnesota Statutes Chapter 1031
Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed
n
Orono 117 285 ' _16,-9
House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD
❑ Cable Tool ❑ Driven ❑ Dug
4750 Northshore Dr. Orono, Mn. rJ564 ❑ Auger Rotary ❑ Jetted
Show exact location of well in section grid with"X". Sketch map of well location. ❑
Showing property lines,
DRILLING FLUID
N tl✓6y� Bentonite
USE ❑ Monitoring ❑ Heating/Cooling
Domestic
Irrigation EI Community PWS ❑ Industry/Commercial
❑ Noncommunity PWS ❑ Remedial
WET ❑ Test Well
[I Dewatering ❑
,/2M1e CASING Drive Shoe? ❑ Yes ❑ No HOLE DIAM.
❑ Steel ❑ Threaded 17 Welded
:C Plastic ❑
-1 Mile
CASING DIAMETER WEIGHT /
PROPERTY OWNER'S NAME _ C n.to G 7 6 n. SDR•2 1 lbs./ft. z�7;R.
mes Thornson in.to t§�t 1.
JAff. lbs./ft. V tidtb 2$f
Property owner's mailing address if different than well location address indicated above. - __ in.to ft. lbs./ft. in.to _ft.
SCREEN OPEN HOLE
Make Johnson from ft.to ff.
Type Stainless Steel Diam.
Slot/Gauze Length 2" _
Set between ff.and 2 R ft. FITTINGS:
STATIC WATER LEVEL
WELL OWNER'S NAME 12,Ci ft.X below ❑ above land surface Date measured i� 1--E _9 '
PUMPTtl,,LEVEL(below land surfaeM,
Well owner's mailing address if different than property owner's address indicated aboveft. after d hrs.pumping 19 g.p.m.
ELL HEAD COMPLETION Whitewater
m..,
adapter manufacturer Model
❑ Casing Protection 5{❑ 12 in.above grade
❑ At-grade(Environmental Wells and Borings ONLY)
GROUTING INFORMATION
Well grouted? X Yes ❑ No
GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO Grout Material El Neat cement XU Bentonite ❑ Concrete Exigh Solids Bentonite
MATERIAL
fromf�r to 3 0 ft. ❑ yds. R bags
VellGi from to f. ❑ yds. El bagsL y �
from to ft. _ ❑ yds. ❑ bags
-1 NEAREST KN ANN SOURCE OF CONTAMINATION �f
Clay Grey S '30 1 115 0 feet �e�c1 j N direction � (, type
7r �c C Well disinfected upon completion? '[I Yes ❑ No
Sand TFn �� 115 ' 148 PUMP
l_1 J_ '
El Not installed Date,inst ed
Clay Grey `3 146 Manufacturer's name Rei �.acyat- -
Model number 0 b 9 7 5 i 6 HP 3/4 Volts 2 31?,
F'I ne SdriU n 1801 1 9 61 Length of drop pipe 146 ft. Capacity 1 0! c.p.m.
Pressure Tank Capacity PC 12 L
Type: submersible ❑ L.S.Turbine ❑ Reciprocating ❑ Jet [Igilt Grey S �3C) ' 2t�t'+ '
ABANDONED WELLS
Course Sand Tan $ 4,1$0 ' 2S5
Does property have any not in use and not sealed well(s)? ❑ Yes X❑ No
VARIANCE
Was a variance granted from the MDH for this well? ❑ Yes IXNo
WELL CONTRACTOR CERTIFICATION
Use a second sheet,i/needed This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725.
ELEVATION,SOURCE OF DATA,etc. The information contained in this report is true to the best of my knowledge.
REMARKS,
DON STODOLA WELL DRILLING CO. , INC.
Licensee Business Name Lic.or Reg.No. 2 7T-72
�f
1-16-98
fid''Authorized Represents iv�nature Date
Fred Leiby 2-16-9i3 f
Name of Driller Date
LOCAL COPY 591098 HE-01205-05(Rev.1/95)
3-i. City W.t.' cJ..
617 13th Ave So • Hopkins, Minnesota 55343 (612) 935 - 3556
02/18/1998
Stodola Well Drilling
15306 Hwy 7
Minnetonka MN 55345
938-2111
REPORT OF WATER ANALYSIS
Lab#: 34467
Our Laboratory reports these analytical results, determined on a sample taken
by CLIENT on 02/16/1998 from the following location:
James Thomson
4750 Northshore Dr.
Orono,Mn
Unique Well#591098
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).
III ater Clinic, Inc.
Anslyioal laboratory Consulting Etgimer
Wata Analysis agents Boiler Water Cbentioals
Lab Cettifwation M 027-053-119
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