HomeMy WebLinkAboutwell info WELL L(ACATION10 MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO.
County Name WELL AND BORING RECORD 4
Minnesota Statutes Chapter 1031
Township Name Towpship.No. Range-No. Section No. Fraction WELL DEPTH(completed) Date Work Completed
ft.
House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD
f.
T.
F1 Cable Tool El Driven ❑ Dug'Et 'iatt-i :tow. f oacj Orono, i . ❑ Auger F7 Rotary ❑ Jetted
Show exact location of well in section grid with"X". Sketch map of well location. ❑
Showing property lines,
roads and buildings. DRILLING FLUID
N
I I I I
USE ❑ MonitoringEI
C),Domestic Heating/Cooling
❑ Community PWS ❑ Indust /Commercial
❑ Irrigation
El El
PWS Industry/Commercial
w e El Test Well y El I I I I ❑ Dewatering El
-r YZMae CASING Drive Shoe? ElYes EINo HOLE DIAM.
❑ Steel ❑ Threaded ❑ Welded
Plastic ❑
FI Mile
CASING DIAMETER WEIGHT
PROPERTY OWNER'S NAME ( i ty'" 1 '
in.to ft. lbs./ft.
—In.to_ft,
in.to ft. tbs./ft. t ihl.io'_ift.
Property owner's mailing address if different than well location address indicated above. in.to ft. _ lbs./ft. in.to ft.
u C; -S'kiwid*`cai'i a R oac SCREEN OPEN HOLE
Corcoran, MND 55314 Make „ from ft.to ft.
Type Diam.
Slot/Gauze I f I Length
Set between + •' ft.and i ! ft. FITTINGS:
STATIC WATER LEVEL
WELL OWNER'S NAME ft. below ❑ above land surface Date measured
PUMPING LEVEL(below land surface)
Well owner's mailing address if different than property owner's address indicated above. - ft. after hrs.pumping g.p.m.
WELL HEAD COMPLETION it•:�:t�.ii-F I.E?3:'
R Pitless adapter manufacturer Model
❑ Casing Protection E3 12 in.above grade
❑ At-grade(Environmental Wells and Borings ONLY)
GROUTING INFORMATION
Well grouted? ❑ Yes ❑ No
HARDNESS OF Grout Material 11 Neat cement Bentonite ❑ Concrete [I High Solids Bentonite
GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO
from to ft. e ❑ yds. bags
from to ft. ❑ yds. ❑ bags
from to ft. ❑ yds. ❑ bags
NEAREST KNOWN))SOURCE OF CONT� ,/vtpTION_ - }
<•-I i f,; .. ,. I, feetr�•• /J> direction , type
Well disinfected upon completion? ❑YBs ❑ No
C .V-'Gr avkal 1;.'Cey;°t": PUMP
❑ Not installed Date installed -'L
Manufacturer's name Red Jacket
Modelnumber " tC '°(` HP Volts 136
Length of drop pipe 10 BC Capacity 1(1 g.p.m.
Pressure Tank Capacity #L fi —T r o l
Type: [),Submersible ❑ L.S.Turbine ❑ Reciprocating ❑ Jet ❑
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 El'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.
1r`Tcf! Ct.i.. 1..i
ILicenee Business Name Lic.or Reg.No.
Authorized Representative Signature Date
Name of DrillerDate
LOCAL COPY 15889il HE 01205-05(Rev.1/95)
� cc77
Jahn City W.t.,
C .
617 13th Ave So Hopkins, Minnesota 55343 • (612) 935 - 3556
01/25/1997
Stodola Well Drilling
15306 Hwy 7
Minnetonka MN 55345
938-2111
REPORT OF WATER ANALYSIS
Lab#: 31923
Our Laboratory reports these analytical results, determined on a sample taken
by CLIENT on 01/21/1997 from the following location:
Jim Harris
3065 Watertown Rd
Orono,Mn
Unique Wall 4588949
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).
� C tT linic, Inc.
Bill 1(a e
Analyiod laboratory conoultivaB,ai�,
WaterAmlysis Reagents Boiler Water chami"
Lab Certigoatiou/027-033-119