HomeMy WebLinkAboutWell Info WELL LOCATI�N MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNI�UE WELL NO.
Count;�Name �„����� WELL AND BORING RECORD 5�6 4 9 4
Minnesota Statutes Chapter103/
Tawnship Nas�e Township No. Range No. Section No. Fraction WELL DEPTFf(compteted) � Date Wor7c Completed �_
�r���l'�td? 1 1�F �J� 6�-'� y� Y. Y. �VL7 f �/z'.i����
House Number,Street Name,City,and T�p Code of Well La:ation or Fire Number DRILLING METHOD
�GJ� L�..}.}�].T4.L�rJil �''k�$ #�7.'+:113� ��I3. ��.�'!�+ ❑CableTool �_Driven ❑ Du9
.1' ♦ ❑Auger �ftotary ❑Jetted
Show enact I�atlon af well In sectlon grid with°X°. Sketch map of well locatlon. ❑
howing property hnea,
x�y�L roads and butldirtgs. DRILLING FLUID
N ��'I�C�F'�t�.�?
� � � �
—,— --�— —,-- —,—
I I 1 ' USE �Domesdc ❑� m�9 P� ❑ HeaUng/Caoting
-�- -a- -�- -� ❑ Irrigation � ❑ IndustrylCommercial
� i i � ❑ Nmicommuniry PWS ❑ Remedial
yy E T ❑Test Well ❑ pewatering ❑
i i i i
i i i -r yl� CASING Drive Shae4 ❑Yes O:�lo HOIE DIAM.
I_ _i_ _L_ ,_ � ❑ Steel ❑Thread� ❑Wetded
` � �,+►�' j�.� ❑g.�astic ❑
� r+e
F-,�-� �,���t �
CASING DIAMEfER WEIGHT
PROPERTY OWNER'S NAME `��� ��� ���`����r `� in.to ���+ it �.'� IbsJR. �i�d,'���. '
In.to ft. IbsJff. �t��j����•
Property ownePs mailing address N different than well locatlon address indicated above. in.to ft. IbsJft. _in.to_R
SCREEN OPEN HOLE
���!�«s3 �iI'�L`�.T'� �t'. �e w-:"gea�c:,F3, rrom Rco n.
�'�.�I�'c�ttl'r�'�"Lp r�l::.��:.'�!/'�„-. ryPe�'c".�1�3��.�� «�`��� Diam. c, F.,,
SIoUGauze Length
�:�
Setbetween N.arM r-��R FfITINGS: G� +�S .a� 4v �`i`�,``,.
STATIC W�jT�F�LEVEL
WELL OWNER'S NAME `� ri�below ❑above land surtace Dete measured �"��'��'
PUMPING�{,�EVEI(6elow lar�d sur(ace)� �
Well owner's mailing address ff diifereM than propeAy ovmer's eddress indicated above. •Y f i ft. aTter � hre.pumpNg �'�� ��-�a.p.m.
WELL HEAD COMPLEfION
❑:i'fUesa adapter menufacturer �tV�_L�4^.�"�_€�i' Model
❑Casing Protection � 12 In.above grade
O At-grade(Enwonmentel Wells and Borings ONLY)
�ROUTING INFORMATION
WeII grouted? �3 Yea ❑ No
HARDNESS OF Grout Materlal ❑Neat cemeM ❑ BeMonite ❑Concrete ��iAigh Solids Berrtonfte
GEOLOGICAL MATERIALS COLOR ��R�� FROM TO �m �° to ��+ ft. 3•�" ❑ yda. O�ibags
q trom ':f'� to��t �;;�i�:.C.2M.�s'�71ds. ❑ ba�
���..�.L.�� {.�i3�7 ��� .�'., �i 1 F3 'F
trom to ft. ❑ yds. ❑ bags
��l� ����� � � �� � �� j NEAREST I OWN SOURCE OF CONTAMINATION r
! � a s ° feet �.+���� dlrectlon °'��'�+�/�type
Weli disinfect�upon completion7 ❑�es ❑No
5�;��:� �.�/fC�f t..7. ���,�/�` ,�.�;. �3 �i� �° �'c�.-s PUMP ��_z�1 f-�'tu
❑ Not Insfelled Date installed
MenutBCturer'8 nemB 'o
Model number � a$= �^" HP � Voits ��t7
Length of dmp pipe ��i�� ' ft. Capacity ��i a.p.m.
Pressure Tank Cepacfty ���+�� ������
Tqpe: f�Submereible � LS.Turbine ❑ Recipr�ating O Jet ❑
ABANDONED WELLS
Does property have arry nat in use and rrot sealed well{s)? ❑Yes �No
VARIANCE
Was a varian�grented from the MDH for this well? ❑Y� ❑�No
WELL CONTRACTOR CERTIFICATION
Use a seaond sheet,H needed Thla well was drilled under my�rvision erM in acxordence with Minnesota Rul�,Chapter 4725.
REMARKS,ELEVATION,SOURCE OF DATA,etc. The infortnetlon conteined tn thla report is true to the hest ot my Imowledge.
��'� i�`.��>�ll'�tt-'� ��'�°i� ���.t�a.d.�`++'�i ��+'r r �L�.
Llce e Busineas Name �; Ltc.or Reg.No. �f c.-
�,r.�� ;.�� -k �'_L^+'�-^JM'^
Autlio�ized Reprasml Nve S/grtature Date
t�tF.3i�"l: �-���? �--����La
Name of Odlrer Date
LOCAL COPY 5� 6 4 9 4 HE-01205-05(Rev.1/95)
. 4 Jwi� citc� UVa�ep ���r�ic, J��cc.
617 13th Ave So • Hopkins, Minnesota 55343 • (612) 935 - 3556
� �oro�ns�
Stodola Well Drilling
153�Hwy 7
Minnetonka MN 55345
938-2111
REPORT OF WATER ANALYSIS
Lab#: 31041
Our Laboratory re�rts these analytical results, determined on a sample taken
by CLIENT on 09/24/1996 from the following la;ation:
Tony Eiden
2255 Abbington Way
Orono�Mn
Unique Wfell#b86494
I
Coliform Bactena <1/1�mi
Nitrates Nitrogen <1.0 mg/I
The results of these tests indicate that this well is pr�ucing 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 Gierrt).
at r Clinic, Inc.
Bill n
�
a�ty�°.t�.u°�°ry c�aas�
w.ser.Aaatyeia Reas� soiler weWr c�mioale
Leb Cert�oation�027-033-119