HomeMy WebLinkAbout1991 - water well record STATE OF MINNESOTA DEPARTMENT OF HEALTH
1.LOCATION OF_WELL I„srl,
WATER WELL RECORD MINNESOTA UNIQUE WELL NO. C o
County Name t for Water Sample J
�, Hen Minnesota Statutes 156A.01-.08
4. T--ship Namei Township Number Range Number Section No. Fraction 4.WELL DEPTH(completed) Date of Completion
oCu� 117 S 23 W 07 SE 'Am'/MW 83 I ft. 8-13-91
Numerical Street Address and City of Well Location or Distance from Road Intersection. 5.DRILLING METHOD
1003 Wi].b rst Trail, r * 66364 ❑Cable I'ooI ❑Reverse ❑Driven 13 Dug
L
Show exact location of well in section grid with"X.” ,...to . • Sketch map of well location. CI Hollow Rod 0 Air 0 Bored O
N X"
t 1 - Addition Name j-^ �1
tprcotary 0 Jetted 0 Power Auger
__r-- _ _i__1_ 6.DRILLING FLUID
I
I
i 1 I Block Number 'Y; 7. USE
XDomestic 0 Monitoring ❑Heat Pump
, i I Lot Number 0 Irrigation 0Public 0 Industry
• F•mi. ❑Test Well 0 Municipal 0 Commercial
--1- --i- i--r- 1 I I LI Air Conditioning 0
1—I mile 8.CASING HOLE DIAM.
2.PROPERTY OWNER'S NAME MailingAddress if different thanpropertyaddressHEIGHT:Above/Below
0Black 0 Threaded
indicated above. Surface ft.
Harriet V t 0 Galv. 0 Welded
J. �tDrive Shoe? YesX No__ 6
IXPlastic ❑ 1/4N
4 in.to 79 ft. Weight 1.90 lbs./ft. to 8a
3. FORMATION LOG COLOR HARDNESS OF FROM TO in.to ft. Weight lbs./ft. Win. tort.
FORMATION
in.to _ ft. Weight lbs./ft. Win. to_ft.
Clay Q 70 9.SCREEN Or open hole
�'otnson , from _ ft.to. ft.
�+.,�� Make Stainless�.,,1 �y���
Sand 70 83 Type Stri inle s Steel Dram. a»
Slot/Gauze 10 Length
_Al__ FITgNGS:
Set betweenft.and 3ft.
10.STATIC WATER LEVELq45 p _
ft.D�elow 0 above Date Measured E)"'13-91
land surface
11.PUMPING LEVEL(below land surface)
ft.after hrs.pumping g.p.m.
ft.after hrs.pumping g.p.m.
12.HEAD WELL COMPLETION �,2
APitless adapter manufacturer y *j..t a litter Model
0 Basement,offset 1b At least 12"above ground
0 Plastic casing protection
13.WELL GROUTED? Wes 0 No
XI Neat Cement 0 Bentonite 0
Grout material from 30 to___O____ft.cu.yds. _
14. NEAREST SOURCES OF POSSIBLE CONTAMINATION
feet direction type
Well disinfected upon completion? CMes 0 No
15. PUMP
Date installed 8"-30.91 0 Not installed
Manufacturer's name
Model number HP 3/4 Volts 230
Length of drop pipe 60 ft. Capacity 12 g.p.m.
Material of drop pipe 1" Galli.
Type:XI Submersible 0 L.S.Turbine 0 Reciprocating
❑Jet 0 Centrifugal 0
16. ABANDONED WELLS �,/
Unused well on property? 0 Yes )(lo
Use a second sheet,if needed Sealed 0 Permanent / 0 Temporary 0 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.
. DON &IMOLA MEL DRILLING CO., INC. 27172
Licenseel�eBusinessBu� Name License No. C
Address
115306 Highway #7, Mtka, W. 55345
Signeh - ' -'! .._ ,1!;i :L� /' Dare 8-13-91
Authorized Representative
F. F. McMahon Date 8-13 91
Name of Driller
LOCAL COPY 475750 5/7430M
7/76 aoM
7/ 8 30M
HE-01205-03(Rev.9/88)
2/82 1OMM
?uric ere, Water F__ � •
617 13TH AVE.SO. HOPKINS,M SQ TA 55343 • 935-3556
r,
Stodola Well Drilling August 22, 1991
15306 Highway 7
Minnetonka, Mn. 55345 kOV 1. '4 1991
REPORT OF WATER ANALYSIS
(received from you August 14, 1991
Our laboratory reports these analytical results,determined on a sample on g
talre us
well water
from
Harriet Mogart
1003 Wildhurst Trail
Mound, Mn.
Unique Well It 475750
Bacteria (Coliform group) less than 1/100 ml
Nitrate nitrogen less than 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.
+ ^ s •_\ linic, Inc.
Bil -
Analytical laboratory Consulting engineer
Water analysis reagents Boiler water chemicals
17.1 partslmillion equals 1 0 grain/gallon