HomeMy WebLinkAboutWell and Boring Report VG _LL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO.
County Name WELL AND BORING RECORD --7
1 - 475
Ekweidn Minnesota Statutes, Chapter 1031 ( i
Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed
orlow 128 23 32 41-M 188 9-31-04
GPS DRILLING METHOD
LOCATION: Latitude degrees minutes seconds
Longitude degrees minutes seconds ❑Cable Tool ❑Driven ❑Dug
❑Auger )eotary ❑Jetted
House Number,Street Name,City,and Zip Code of Well Location �or Fire Number ElN� � Rd Orono 55'35 DRILLING FLUID WELL HYDROFRACTURED? ❑Yes No
3330
Show exact location of well in se n grid with"X". Sketch map of well location. =bwFROM ft.TO ft.
Showing property lines,
N roads and buildings USE
.Domestic EnvirEl Monitoring
nBore Hole Industry/Commercial
---f-
❑Noncommunity PWS ❑Irrigation ❑Remedial
L ❑Community PWS E]Dewatering ❑
CASING HOLE DIAM.
w E T Drive Shoe? ❑Yes No
[_1 Steel LlThreaded elded
Mile
'/z (aStiC ❑
1 CASING�DIAMETER WEIGHT �{
s 4 in.to�ft. 2.M 8 ft.
�--t Miley �y`� tf lbs./ft. in.to
in.to ft. lbs./ft. �in.to 288ft.
PROPERTY OWNER'S NAME/COMPANY NAME in.to ft. lbs./ft. in.to ft.
SCREEN OPEN HOLE
Proapeerrttjoowner's mailing address1ffdifferent than well location address indicated above. Make .]L'4brA9011 FROM ft. TO ft.
3435 Cty Rd 101 Type a�srWegig M♦ Diam. 77
Mmetotit m, MN 55343 SIoUGauze 0
010 Length 1 +41
�Li1A� Set between ft.and ft. FITTINGS
STAT,CWATEI
an ft.- elow ❑above land surface Date measured &-32-114
WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(bel w land surface)
178 ft.after 1.5 hrs.pumping g.p.m.
WELL HEAD COMPLETION o
Well owner's mailing address if different than property owners address indicated above. Pitless adapter manufacturer )._r'^
❑Casing Protection )<112 in.above grade
❑At=grade(Environmental Wells and Boring ONLY)
> ' GROUTING INFORMATION
Well grouted �Yes ❑No
Grout material U Neat cement❑Bentonite
Concretq,,e�igh Solids Bentonite
from,to 30 ft. 2♦5❑yds. Fags
from to ft. I!M ❑bags
GEOLOGICAL MATERIALSCOLOR HARDNESS OF t
FROM TO from o .
MATERIAL ft ❑yds. ❑bags
NEAREST KNOWN SOURCE OF CONTAMINATION
cla yellow
"ft q® 1 � feet C-0 direction K-A— type
"ft i+� Well disinfected upon completion ❑Yes ❑No
Mid ra soft PUMP 12 18
Not installed Date installed
soft is
Eli/ Manufacturer's name
37L/1{. Model number // HP Volts
sand (fine) r soft 120 IM Length of drop pipe /fir lGf ft. Capacity g.p.m.
Type: ubmersible E]L.S.Turbine ❑Reciprocating ❑Jet
watersand 1 ❑
t) Soft i" ABAN ONED 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 XNo 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,it needed
REMARKS,ELEVATION,SOURCE OF DATA,etc. DIM Stodola % l �*li dao.• *=. 2n72
Licensee Business Name 1fRyJ. 1 1i/ j *WLi r Reg.
No.
.: ,/6
ri
G Y
d e he`senIiv&Signat Date
Chuck Mwre
IC 140-0020 LOCAL COPY -7711475 Name of Driller
HE-01205-08(Rev.5/02)
T w%vv C Xy W abw' C li , I ncl-
617 13th Ave So Hopkins, Minnesota 55343 (612) 935 - 3556
09/02/2004
Stodola Well Drilling
3841 North Main
St. Bonifacius MN 55375
938-2111
REPORT OF WATER ANALYSIS
Lab #: 681
Our Laboratory reports these analytical results, determined on a sample taken
by CLIENT on 08/31/2004 from the following location:
3330 Watertown Rd
Orono,Mn ,
Unique Well#711475
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).
Win City Water Clinic, Inc.
*Bifisdale
Lab Certification#027-053-119