HomeMy WebLinkAboutwell info WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO.
County Name WELL AND BORING RECORD
Minnesota Statutes, Chapter 1031 705916
Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) It Date Work Completed
O 'k /. /. 184
GPS DRILLING METHOD
LOCATIONLatitude degrees minutes seconds
Longitude degrees minutes seconds ❑Cable Tool Driven ❑Dug
❑Auger �]Aiofary ❑Jetted
House Number,Street Name,City,and Zip Code of Well Location �or Fire Number 171
3310 Ikertmn Rd, Orma 55356 DRILLING FLUID WELL HYDROFRACTURED? [IYes
o
Show exact location of well in secti rid with"X". Sketch map of well location. bentonite FROM ft.TO ft.
Showing property lines,
N J•, roads and buildings USE ❑monitoring ❑Heating/Cooling
omestic ❑Environ.Bore Hole ❑Industry/Commercial
Noncommunity PWS ❑Irrigati6n ❑Remedial
! ❑Community PWS ❑Dewatering ❑
w --------- E T CASING Drive Shoe? El Yes *No HOLE DAM.
[-I El Threaded Ll welded
Ile
fa
' Miie �\
-lastic cEl
` 1 ? � CASING DIAMETER WEIGHT
t Mile f 40—in.to 176 ft. 2.01 lbs./ft. 8—in.to-3aft.
in.to ft. lbs./ft. I in.toll QL ft.
PROPERTY OWNER'S NAME/COMPANY NAME in.to ft. lbs./ft. in.to ft.
Boyer And Him SCREEN OPEN HOLE
Propwttyowner's mailing address if diffrent than well location address indicated aboveJ�n. Make FROM ft. TO ft.
3435 Cty Rd 101,9 Type stainL`go al Diam.
I it�1�t �� � SIoUGauze -0 0 Length « 0
Set between ft.and ft. FITTINGS
STATIC WATER LEVEL ! �t
__ - -•� 78 ft. elow ❑above land surface Date measured 5-17-04
PUMPING LEVEL(below land surface)
WELL OWNER'S NAME/COMPANY NAME "' Q
I73 ft.after 2 hrs.pumping 60 g.p m.
WELL HEAD COMPLETION
Well owner's mailing address if different than property owners address indicated above. Witless adapter manufacturer( �- U °t"t1�l� Abde1
Casing Protection ❑12 in.above grade
❑At-grade(Environmental Wells and Boring ONLY)
GROUTING INFORMATION
Well grouted Yes ❑No
Grout material Neat cement ❑Bentonite ❑Concrete Xigh Solids Bentonite
from to 30 ft. 3 E]yds. �eags
t �lt�t �,{,
from 3'0 to 176 ft.1U1X1 f=. ❑bags
GEOLOGICAL MATERIALS COLOR HARDNESS OF
MATERIAL FROM TO from to ft. [:1 yds. El bags
NEAREST KNOWN SOURCE OF CONTAMINATION
j feet — E. direction .'type
Well disinfected upon completion YYes ❑No
PUMP
clay grAy soft 16 4
❑Not installed Date installed _ �/V
Manufacturer's name _ 7 v
Model number HP e" Volts
clay Qn i yr Length of drop pipe /,;)G ft. Capacity 9-P m.
Type:K.bmersible ❑L.S.Turbine ❑Reciprocating ❑Jet ❑
ABAADONED 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 X0 TN#
WELL CONTRACTOR CERTIFICATION
This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725.
The information contained in this report is true to the best of my knowledge.
Use a second sheet,if needed q +�
REMARKS,ELEVATION,SOURCE OF DATA,etc. &M SCOdols Well Drilling Co., Inc. 27172
Licensee Business Name Lic.or Reg.No.
r' a esentative Signature.. Date
Gnirk-lb-nre
LOCAL COPY 14
Q 5 91 6 Name of Driller
HE-01205-0e(Rev.5/02)
IC 140-0020
1 _ r
riv% C Xy W abs' C ' , I nAcl.
617 13th Ave So Hopkins, Minnesota 55343 (612) 935 - 3556
05/20/2004
Stodola Well Drilling
3841 North Main
St. Boni facius MN 55375
938-2111
REPORT OF WATER ANALYSIS
Lab #: 375
Our Laboratory reports these analytical results, determined on a sample taken
by CLIENT on 05/18/2004 from the following location:
3310 Watetown Rd
Orono,Mn
Unique Well#705816
Coliform Bacteria <1/100 ml
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).
City Water Clinic, Inc.
Bill dale
Lab Certification#027-053-119