HomeMy WebLinkAboutwell info STATE OF MINNESOTA DEPARTMENT OF HEALTH
1.LOCATION OF WEL WATER WELL RECORD MINNESOTA UNIQUE WELL NO. A 4���I
GCounty Name ... for Water Sample
- Minnesota Statutes 156A.01.08
Township Neje Township Number I Range Number Section No. Fraction 4.WELL DEPTH(completed) Date of Completion
�# ,ttcj 117 23 or 03 NE 'IN '/ 148' ft 5--22-91
Numerical Street Address and City of Well Location or Distance from Road Intersection. 5.DRILLING METHOD
Jyj
2165 Water-tow Pond' �y w r Nn• ❑Cable'fool ❑Reverse 11 Dug -1
Show exact location of well in section grid with"X.- Sketch m of well location. ❑Hollow Rod ❑Air UlIQ� •j�
-N - u
t t UU
Addition Name rotary ❑Jetted ❑Power Auger
j 6.DRILLING FLUID
•-i_ _ _ '_ .�_ Block Number _ F 7. USE
W E
Winneslic ❑Monitoring ��� �np
Lot Number ❑Irrigation ❑Public ❑Indusy
1991
mi.
t � � ❑Test Well 47 Municipal � ❑Commercial
r-
--�- �- - - ❑Air Conditioning ❑ -
r
mile 8.CASING HOLE DIAM.
2.PROPERTY OWNER'S NAME Mailing Address if different than property address ❑Black ❑Threaded HEIGHT:Above/Below
%!L1* J.,y1.C.tfiAn it.
. ❑Galy. ❑Welded
Surface
Pbbert Kantor Hemetwnpx 2165 Watert` n Road Drive Shoe? Yes No—
w
in.to 144 it. Weight lbs,/ft. in. [o4lSdt.
3. FORMATION LOG COLOR HARDNESS OF
FORMATION FROM TO in.to Wi
it. Weight lbs./it. n. tort.
in.to ft. Weight lbs./ft. in. to---Jt.
Uav (} s 9.SCREEN Or open hole
Make Johoson
from ft.to. ft.
Sand 140 . 148 Type Stasi nless, Steel Dfam. 4"
Slot/Gauze Length
FI INGS:
Set between 1 Qd ft.and 148 ft.
10.STA WATER LEVEL
ft.X.I. ❑above Date Measured -•"' `��'��
land surface
11.PUMPING LEVEL(below land surface)
70 ft.after 4 hrs.pumping *" 9-P in.
ft.after hrs.pumping g.p.m.
12.HEAD WELL COMPLETION
*itless adapter manufacturer kbite WaterModel
'❑Basement,offset IXAt least 12"above ground
❑Plastic casing protection
133..WELL GROUTED? )D Yes ❑No
XNeat Cement ❑Bentonite ❑ 30Grout material from 30 to 6 ft.cu.yds.
14. NEAREST SOURCES OF POSSIBLE CONTAMINATION •
feet direction type
Well disinfected upon completion? JKYes ❑No
15. PUMP
Date installed 6-11-91 ❑Not installed
Manufacturer's name (;nlndfCS
Model number HP 14 Volts ..1)
Length of drop pipe 105 .., fl. Capacity 20 g.p.m.
Material of drop pipe I" �+Vq�y
•
Type: XSubmersible ❑L.S.Turbine ❑Reciprocating
❑Jet ❑Centrifugal ❑
16. ABANDONED WELLS
Unused well on property? ❑Yes [Ao
Use a second sheet,if needed Sealed ❑ Permanent ❑ Temporary ❑ Not sealed
17. REMARKS,ELEVATION,SOURCE OF DATA,etc.
18.WATER WELL CONTRACTOR CERTIFICATION
This well was drilled under my jurisdiction and this report is true to the best of my
knowledge and belief. yyyy i�my++..
LlA� b� !�TT ER�t'M CO.,t 1W. L 7r�p
172.:
�Licensee Business Name License No.
Addressr
Si Date 5-22-01
Authorized Repr fal
�t ftie
I F, P. Xcfthm Date 5-•22--91
Name of Di ler
5/74 30M
LOCAL COPY 1475726 7/76�I
HE-01205-03(Rev.9/88) 2/82 10M
7u�l�c C W4Ce4 79C,
617 13TH AVE.SO. HOPKINS,MINNESOTA 55343 935-3556
Stodola Well Drilling June 11, 1991
15306 Higghway 7
Minnetonka, Mn: 55345
REPORT OF WATER ANALYSIS
/ \
Our laboratory reports these analytical results,determined on a sample 1 received from you J on May'22, 1991
taKt�s
• e
well water
from
Mark Johnson Const.
2165 Watertown Road
Orono, ?Mn.
Unique Well # 475726
Bacteria (Coliform group) less than 1/100 ml
Nitrate nitrogen less than 0.1 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.
Wakrtteric, Inc.
Bill V
Analytical laboratory Consulting engineer
Water analysis reagents Boder water chemicals
11.1 partslmilbon equals 1 0 grarnigallon