HomeMy WebLinkAboutWell info MINNE
MINNE TA
SOTA UNIQUE WELL NO.
' WELL LOCATION SO DEPART ENT OF HEALTH
- CountyName WELL AND ¢O ING RECORD 6 2� 9� 5 �
Heanepin Minnesota$tatute Chapter 103/
Township Name Township No. Range No. Section No. Fraction W�LL DE TH(completed) Date Work Completed
�rono 217 23 06 ,,, ,, ,. , 26S' tt 7-1 g--
House Number,Street Name,City,and Zip Code of Well Location or Fire Number RILLIN METHOD
4461 Ba 81de �038 O�Cocio. Mri. 5356 CableTool t❑G Driven ❑ Dug
Y Auger ai Rotary ❑ Jetted
Show exact location of well in section grid with"X". Sketch map of well location. �
Showing property lines,
� ro s and,buildings. ILLIN FLUID WELL HYDROFRACTURED? ❑YES �NO
N �
�, _i_ _ i_ _I _ _I_ f tOIIf L@ FROM __ft.to n.
i i i i �---'`
U E ❑ Monitoring CI Heating/Cooling
i i i i � . Domestic
_i_ _�_ _�_ _i_ � ❑ Community PWS ❑ Industry/Commercial
i i i i Irrigation ❑ Noncommunity PWS ❑ Remedial
w e � �����Environ.Bore Hole
� i i i X ❑ Dewatering ❑
-r -�- -r- -r T
i i i ' +/zMie ��t(� C SING � Drive Shoe? ❑ Yes ❑ No HOLE DIAM.
_� i i i_ � Steel ❑ Threaded ❑ Welded
_ _i_ _ _ _i
Plastic ❑
S
�-1 Mile-� .
CASING ��IAMETER WEIGHT
PROPERTY OWNER'S NAME in.to 252 n. SI}��Z1 IbsJft. �.�0 h.
Gabriel Jabbous �n.to_ ft. Ibs/ft. in.to2fiSft�
Property owner's mailing address if different than well location address indicated above. in.to ft. Ibs./ft. in.to ft.
� SCREEN OPEN HOLE
M ke Jothason from R.to ft.
p�r- T�pe e$igleg� st.�ne.1 Dia p
SI�VGau 0�8 0�8 OZ V Length ��' �+ �
Set betw n ��_�'�ft.andZ��f ft. FITTINGS:
� S ATIC ATER LEVEL -
WELL OWNER'S NAME � ft. �below ❑ above land surface Date measured �7 �
PWM�PfIN LEVEL(below land surface)
'Well owner's mailing address if different than property owner's address indicated above. 6� f ft. aRer 3 hrs.pumping ZQ g.p.m.
�..
a� `~ � LL HE D COMPLETION �y�.
Pitless daptermanufacturer �u�te�at�� Model
❑ Casing Protection �12 in.above grade
❑ At-gra (Environmental Wells and Borings ONLY)
G OUTI INFORMATION
Well routed? �1 Yes ❑ No
HARDNESS OF Grou Material ❑ Neat cement ❑ eentonite ❑ Concrete X] gh So�ids Bentoynite
GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO /� �_ ❑ yds.4 bags
from � to 3 V ft.
Ciay Gr�y S O� iQo from to_ ft. ❑ yds. ❑ bags
from to fl. ❑ yds. ❑ bags
�s 1 N AR �yN SOURCE OF CO I/��pT ION y,v✓: `
: Sand a�� ..5 �0� 1�O feet �y `-� direction��• f r� type
WBII disinf cted upon completion? Ia.Yes ❑ No
Siit Grey S 180 252 P 'MP
❑ Not in alled Date installed 1�19�'�
Sand-Gravel Tan S 252 265 Gcsulds �'
M�nufactu r's name
Madel nu er SJF2021 L HP 2 Volts 2�0
t �f
Le gth of op pipe Z 6 B ft. Capacity `� g.p.m.
Ty e: t? ubmersible ❑ L.S.Turbine ❑ Reciprocating ❑ Jet ❑
ABpNDO ED WELLS
Dogs prop�rty have any not in use and not sealed well(s)? ❑ Yes �No
VA IANC '
Was a vari ce granted from the MDH for this well? ❑ Yes �No TN#
5
W�LL CO TRACTOR CERTIFICATION
Use a second sheet,if needed ThiS well w s drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725.
REMARKS,ELEVATION,SOURCE OF DATA,etc. The inform tion contained in this report is true to the best oi my knowledge.
DON TODOI�A wIELL DRILLING C0. , INC.
Licensee Business N el� Lic.or Reg.No. �f^/i 9 2
i! !
1-3
Author¢ed Repr ative Signature Date
Fred Leiby 7-16-00
I Name of Driller HE 01205-06(Rev.7/98)
LOCAL COPY 6�Q.9 4 5
, �
7rl�u i�V C i.t" 1 N a� C � � , .I ��.
y
617 13th Ave So � Ho kins, Minnesota 55343 � 612 935 - 3556
07/20/1999
Stodola Well Drilling
3841 North Main
St. Boni facius MN 55375
938-21 1 1
REPORT OF WATER NALYSIS
Lab #: 374
Our Laboratory reports rhese analytical resulis, erermined on a sample taken
by CUENT on 07/1 S/1999 from rhe following loc rion:
Gabriel Jabb ur
4461 Bayside d.
Orono,Mn
Unique Well #6 4945
Coliform Bacteria <1/100 ml
Nitrates Nitrogen <1.0 mg/1
The results of these tests indicare that this well i producing water that meets rhe
srandards for F.H.A., V.A., or conventiona!loans. This report is an analysis for
coliform and nitrate only and does not include a alysis of Lead and orher
contaminants. (Unless as specified by client).
`�
T i 't W e Clinic, Inc.
\
Bill d 'le\
Analy�c,jl laboratorv Consultmg Engmcer
Water Analys�s Reagents Bo�b�r Water('hem�cals
Lab Certificauon#027-0 3-119
I I