HomeMy WebLinkAboutWell info _� � STATE OF MINNESOTA DEPARTMENT OF HEALTH �pL,l_;�
- �_� ^ATION WATER WELL RECORD �N/NNESOTA UN/QUE WELL NO. ���Q O ^
� County Name �1
Jor Wate�Sample ''
�.� Minnesota SNtules 156A.01�.08 L�
Township Name� ���� ownship Number Range Number Section No. Fraction 4.WELL DEPTH(mmpleted) Date of Completion
LUIM� I�C.}�. 11�/ ° �� �y �)s ,�� � ;=I�✓ 1 V� ��.�� ft. $"'l�T"�}
Nu treet Add�ess and�' o ocation or Distance from Road Intersec[ion. 5. DRILLING METHOD
3�ui, �y;i� �Ggd� �}(�r �j,j��j� ��i3jb ❑Cable'lool ❑Reverse ❑Driven ❑Dug
exact location of well in section i . Sketch map of well location. ❑Hollow Kod ❑Air ❑Bored p
� � r i Addition Name s�Rotary OJetttd ❑Power�Auger
-r -~ _1 _1 ���`���� 6. DRILLING FLUID
i �
1 '
'-�- -=- i- �- Block Number ���
W ' � E 7. USE
i
_1_ _1_ _'_ S_ T ���.�T �mestic ❑Monitormg ❑Heal Pump
� � i � . Lot Number O Irngation O Public ❑Industry
f�m�.
' � � � � . ,- �� O Test Well {]Municipal ❑Commercial
--�- �- - -r- � � �
� � O Air Conditioning O
�—1 mile� 8.CASING HOLE DIAM.
2.PROPERTY OWNER'S NAME HEIGHT:Above/Below
Mailing Address if different[han property address ❑glack ❑Threaded
indicated above. Surface ft.
� �yr�r� �`�,� ❑Galv. ❑Welded .n+
Drive Shce? Yes_ No—
.�1 pPlastic ❑ , J �
`� in.to �'1+� (L Weight�Z�IbsJfL ��l�n. to%t.
3. FORMATION LOG COLOR HARDNESS OF FROM TO in.to tt. Weight Ibslft. �n. [o-1t.
FORMATION
in.to ft. Weight IbsJft. �n. to�t.
��� �' ^t 9.SCREEN Or�open hole
Make ��� (rom (t.to. ft.
TYPe ��C�1111�.1�J J`t�i Dlam. (�fi
SbVGauze �� Length
�x
FITTINGS: _
Set between�ft.and�tt.
10. STATIC WATER LEVEL
�� f�below ❑above Da[e Measured �^"'��-'�9
land surface
I I. PUMPIrNG LEVEL(below.land sur(ace)
�`; tt.a(ter '' hrs.pumping �t' g. m.
P
(t.after hrs.pumping g.p.m.
12.yy�AD WELL COMPLETION
�f'illess adapter manu(ast rer �� ���.'�.� Model
'O Basement o((set �t leasl 12"above ground
❑Plastic casing protection
13.WELL GROUTED? ,�Q Yes ❑No
13 Neat Cement ❑Bentonite L]
Grou[material from,.LL�[o��tt.cu.yds.
L7 \J t� CJ
' 14. NEAREST SOURCES OF POSSIBLE CONTAMINATION
/ � � �
, f., j (eet direction i
YPQ
� � I Well disinfected upon completion? �Yes ❑No
15. PUMP
Date installed�`����7 ❑Not ins[alled
ManufacWrer's name `�
Model number HP � � Volts �'1�
Length o(drop pipe ��, fL Capacity �2 g.p.m.
p (�'� �
Material of drop pipe � �'+�•
Type: �ubmersible ❑L.S.Turbine L7 Reciprocating
�OJet ❑Centrifugal C]
16. ABANDONED WELLS
Unused well on property? f}Yes O No
Use a semnd shee(,i/needed Sealed !�J''Permanent ❑ Temporary ❑ No[sealed
17. REMARKS,ELEVATION.SOURCE OF DATA,etc.
• 18.WATER WELL CONTRACTOR CERTIFICATION
This well was drilled under my jurisdic[ion and this report is true to[he best ot my
knowledge and belief.
..�.�A�.9.A/1.�['► 1��i37.1L1 �iri3 W.r 1iR.. �7L
LirenseeL�B'usineys,s,..N�.a�me y, 7 t,,ta..7�.., t�L,icense No.
Address��•S�" liLQ119NG'.� W !t t'AL3'M,T� P2il• J�1J'F�
Ci tW��"`'`r ;%�� ��..... ,F�' Date d�-�!�7-O J
Authortzed Repre nse�tattue
j11�.1�3c�i`2 Hltfi}l Date���''ag '.
p Name oJ Drlller
LOCAL COPY O O 5� O O 5/74 30M
�i�s ao�n
HE-01205-03 Rev.9/88) ��78�
� 2ie2�oM
� DAT TIME
CITY OF ORONO CALLED IN '
INSPECTION NOTICE� � scHE�u�Eo � ' �
PERMIT NO. � COMPLETED '� V``C�
ADDRESS �
OWNER ���S CONTR. c�����_
TELEPHONE NO. �J�'o�,�� I
� FOOTING C PLUMBING RI ❑ FIRE PREV.
�
{� �= FRAMING ❑ PLUMBING FINAL C FIRESUPRESSION SYS.
� C; INSULATION C MECHANICAL RI ❑ EXCAVIGRADINGIFILLING
y ❑WALL BD. _; MECHANICAL FINAL ❑ LAKESHORFJWETLANDS
� ❑ FINAL ❑ FIREPLACEIWOOD BURNER ❑TREE REMOVAL
Q ❑ DEMO—SITE C WATER HOOK-UP ❑ KENNEL LICENSE
� C DEMO—FINAL ❑ METER SETITURN ON ❑SITE INSPECTION
v C',SEWER HOOK-UP ❑ PROGRESS
_ ❑ SEPTIC MAINT. ❑COMPLAINT
J C SEPTIC INSTALL. ❑ FOLLOW-UP
� ❑ SEPTIC FINAL
O ❑SITE WELL
� �WELLTEST PUMP
� COMMENTS:
� ���" N�' lS�
0
� �;�ic, �� � ��r
0 /+
�` �-�'i"�L� vT ��E-S�A.C..� l a�
W
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Q S C.�( �'1�. �—�'� G d �C.�t
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d
q�-rCj�/ORKSATISFACTORY:PROCEED C PHOTOTAKEN
�W C CORRECT WORK&PROCEED ❑ CITATION ISSUED
C CORRECT WORK,CALL FOR REINSPECTION ❑ ISSUE CERTIFICATE OF OCCUPANCY
V BEFORECOVERING TEMPORARY
C CORRECT UNSAFE CONDITION WITHIN HOURS. PERMANENT
INSPECTOR WILL RETURN
�STOP ORDER POSTED.CALL INSPECTOR
S INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance.473-7357
OwnerlContrac n '
Inspector.
White Copyllnspector's File Canary Copy/Site Notice
7u�l� L?�y ?��rt� L��cCc. �Kc.
617 13th AVE. SO. • HOPKINS,MINNESOTA 55343 • 935-3556
Stodola Well Drilling August 28� 1989
15306 Highway 7
Minnetonka� Mn.
REPORT OF WATER ANALYSIS
/r�c�fv�d Irom you August 19� 1989
Our laboratory reports th�s�analytical nsulta,determined on a sampls ( ���us � �
\ _ __ ..,. :-__. ..�:,._..�, ,�_.
.. ,..�,,_. _
Well water
fran
Dan Esters
3400 Bayside Road
Long Lake, Mn.
Unique Well � 505008
Bacteria (Coliform group) less than 1/100 ml �
Nitrate nitrogen less than 0.1 mg/1
Conductivity, Specific 480. micromhos
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.
Tw' i Water Clinic, Inc.
�
\
Bill 1�'a� Arsdale
Ana�y�kd�.eo..t«y • co�.u�Uny.nQU..�
W�iN�Mlyll�r�ap�nt� Boll��wat�r cMmlcals
17.1 paAslmilllon�qu�is t.0 pnfnlpallon
STATE Of MIMNESOTA OEPARTlENY OF lIEALTM
' ABANDOIIE� M�].L RECOItO '
1. ►ONTIM M 1411 MIMMESOTA 1►N1alE MELL M0.��
t«.oy w� (�ua►lw� v rt w.)
Hennipen
?M�111��N 1w���1�/yy�� M1� rW�I f1stlM M. Ir�C11M •. Y[ll 0[�iN (LM�1�{N) O�N N�11�
N � � ��f �
���o+��' ii� s 23 � 05 E sw r� �� ,�. � I (a� g`�
IM�H��1 ftr�et Ayn►� W C11�N W11 lu�tlw �r Ylit��c� IrM yN f. Il ri ML1�Wp (fI ►eo.w)
►�Nrw�t1M �a�l• iMl Q VMry�
3400 Bayside Rd. , Orono �w►,..w Q,►,. ,�pM,.� i,�p__
SY��4�1 IK�{IM�/Mi► ��ru•r t�d.tur �r�w•�.w.
(1��11M�►11�IN•l•) �tt\�y�/MII 1K�t1r �
�. astwct�as.� _
wn a.c.,auf�r � N.
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M _ � � � •� n...r. cwuct�a
•. E � �ttaa...iiM.
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t. /�QTi O��'i MR IUIH�� 1Nry�� 11�1lhnnt tMe �. U31Mclt)
MM�ty Wn« 1Mit�l�� �Mv� 10�IKL �� �
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�41�. �]141Mr
Dan Esters SAME �p nu�+� �iy�.�.�, zti1
�. ro�r�a �a w�u.css a
COlO� IOYMTIOM /�OM TO 1�. 4�tt.
Ir rc Y�. twlu4 hnrctM lh rrM�w�wll •r rMy r�tl. b. q
,��,tt.
�%(1�1— 1 � u�cu
� ��.«w o�t rr..��c. al,[�n.
Itt w.)
D o�.. wi• tn._n. w_rs.
u. sunc w►tu
l�� tt. Mlwr ��Mw
� w wM 11t��rrN �1
». K�uuo co�una
10 Htlqt AM�4t _(]��y y�«
�b�wt Nfwt � `�'��.��
. . �]1411 Ht
1. �IYRf. LLIIMTIO�. 0/MT�.C4{1Mi �LJID�[0. GSlOii ►qiDYTtC� [Tt.
11r WTIIK IMIOIIMilOM
Grout 2" Wel l Approx. 40' ��" `""'`• �~"""' a ,
2 Bags Cement • «••��4M�1__r,..�.Li �t. w. ,,�
2 Bag Bentonite ----- -- —
2 Men, Rig, and Cement Grqut Pump i�• "�"'�s�N�s a coirtrw��na // �
. �IrK{IM ld•l//�.vnW^/ �
Yell �ttlNKt�/MfM N�HMf ❑�M
l�. ►MI M�rN (�IY�t rnwt
1,�»: ,p sw..n�u• ��.:. iw�+.. p ro�.,.ut�y
�,+.t Q c..v��.�.i (�
-____.__
' 11. [113i1M 1[L�i (Il��w �Mt�� l�sat/wi �I�N�rw�W
KN�N Mll� 1� ��yrL� Mi!M M Mt�.�
OtMr wwN/w11I�I M �nM►t�T �]T�� M
AMrw�t �hn��wt �T�r�ry [� f��lN
� 1�. WTU Y[ll COM1�AClORS C[�TlfIG114
TM� MII M� w�IN wMr� J�HNtitIM M/YI� /�
t� try t� ty M�t N�W�1NM MN MI►�f.
DON STODOLA 4JELL DKILLING CO. , INC
NcMw�Iw1Nu M� ►Ic�.b M.
4N►��t
fl�r�,,�--��_-• _- - - N 1
Mar Sto o a �,. 1 4
i1cWt AYMo0M1 rtll �tW�o (M�7 M wN r« ►�.ty t..e.r.r) rw N a�ll�r .
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