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HomeMy WebLinkAboutwell info MINNESOTA UNIQUE WELL WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. County Name WELL AND BORING RECORD 7 6 O 619 Minnesota Statutes,Chapter 1037 Towns i Township No. RangMe}No. Section��Nyyo. Fraction WELL/BORING DEPTH(completed) DATE WORK COMPLETED DRI LOCATION: Latitude degrees minutes seconds DRILLING M D Longitude degrees minutes seconds ❑Cable Tool ❑Drive{t E]Dug ❑Auger ❑Jetted House Number,Street Name,City,and Zip Code of Well Location or Fire Number 11 IM5 Y Rd �� 15356. DRILLING FLUID J; -HYDROFRACTURED? E]Yes o Show exact location of well/boring in section grid with"X" Sketch map wel oring location. to From ft.To ft. S win roperty lines, N roads,buil d direction. USE omestic ❑monitoring ❑Heating/Cooling ------ ❑Noncommunity PWS ❑Environ.Bore Hole E]Industry/Commercial ❑Community PWS ❑Irrigation ❑Remedial --'-----'------`-- --`-- E]Elevator ❑Dewatering ❑ '-:.;# w ET CASING MATERIAL Drive Shoe? ❑Yeso HOLE DIAM -- ❑Steel ❑Threaded Welded h Mile lactic ❑ ----- --------- ---= I CASING s Diameter may' Weight ' n Specifications s +�{� —1 Mile 4 in.to�(ft. �l1b./ft. 49ft O in.to 30 t. PROPERTY OWNER'S NAME/COMPANY NAME in.to ft. lbs./ft. in.to 215ft. St t.T/S in.to ft. lbs./ft. in.to ft. ++77RC idress SCREEN _19bapW OPEN HOLE Property owner's mailing address if different than well location address indicated above. 7407 tt Blvd. St/O Make From p ft. To ft. St i W_ M 5%26 Type LengtDamh 1G ii�iiia � Slot/Gauze +�© Length bs + 4# Set between ft.and ft. FITTINGS w STATIC WATER LEVEL Measured from ft. -low [:]Above land surface Date measured WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) �{'� AAJI :.'< ft.after 1.5 hrs.pumping 50 g.p.m. Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION (} }-_ [Witless/adapter manufacturer l.3-T'ti�---t w `�+1�tfdel ❑Casing Protection [4IIIIIf2 in.above grade ❑At-grade(Environmental Well and Boring ONLY) GROUTING INFORMAjION Well grouted es [:]No Grout materials ❑Neat cement ntonite 7 Concrete ❑Other From To 30 ft. Yd . L—(— GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO From To ft. an � ❑Bags MATERIAL From To ft. ❑Yds. ❑Bags NEAREST KNOWN SOURCE OF CONTAMINATION cow soft 0 feet ...r direction --- softWell disinfected upon completion? es ❑No 23 601 PUMP ❑Not installed Date installed fp MA " "`1m �i 60 180 Manufacturer's name -Iry ZA ` _ soft 110 Model Number HP fts btam � iii ` Length of drop pipe � ft. Capacity g.p.m. 90/ti 2w 21 Type:[IjOubmersible ❑L.S.Turbine ❑Reciprocating ❑Jet ❑ �! 1 li L.IN bi ABANDONED WELLS Does property have any not in use and not sealed well(s)? ❑Yes o VARIANCE Was a variance granted from the MDH for this well? '_]Yes o TN# WELL CONTRACTOR CERTIFICATION This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. Use a second sheet,it needed. The information contained in this report is true to the best of my knowledge. REMARKS,ELEVATION,SOURCE OF DATA,etc. Dan StallIDla WeU DrUILIng ce.0 I=. 16 Licensee Business Name Lic.or Reg.No. 17 l Gc Ce d nta a Signat Certified Rep.No. Date Noom 760619 Name of Drillerk LOCAL COPY -- IC 140-0020 HE-01205-11(Rev.3/07) rw4CXy waberc � , InCl. 617 13th Ave So Hopkins, Minnesota 55343 (612) 935 - 3556 06/02/2008 Stodola Well Drilling 3841 North Main St. Bonifacius MN 55375 938-2111 REPORT OF WATER ANALYSIS Lab #: 206BN Our Laboratory reports these analytical results, determined on a sample taken by CLIENT on 05/29/2008 from the following location: 1075 Tonkawa Rd Orono,Mn Well 760619 Coliform Bacteria Absent Nitrates Nitrogen <1.0 mg/1 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). Twin Cityr nic, Inc. Bill Vah'A dale Lab Certification#027-053-119