HomeMy WebLinkAbout2000 Well & Boring WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO.
' �o���YName WELL AND BORING RECORD � 5 5 0 3 8
Henne pin ,� Minnesota Statutes Chapte�1031
Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed
tt.
Orono I17 23 10 ,. �. ,. I78 I1-6-00
House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD
q ❑ Cable Tool ❑ Driven Cl Dug
2125 Carria e Lane �r��Q SJ56 7 Auger �.Rotary ❑ Jetted
Show exact location of well in section grid with"X". Sketch rr1ap�(well location. ❑ _ _.
�krdwing p perty lines,
{F� roads an�buildings. DRILLING FLUID � � � WELL HYDROFRACTURED? ❑�YES�10
_ N _ '�l �
, , , , ., su er el—g FROM • ft.to h.
; -,- -;- -� � ,
�--^' \ USE f:] Monitoring ❑ Heating/Cooling
i � i i �+ omestic
"`., �-•�� s�� ❑ Community PWS [] Industry/Commercial
_i_ _a_ _x_ _i_ '^' 9 �\'� , ❑ Irrigation
yy � � � � E T � �.����� �� ❑ Environ.Bore Hole � Noncommunity PWS ❑ Remedial
i i i i ❑ Dewatering ❑
-� -,- -r- -� ��ZIM.1e � CASING Drive Shoe? ❑ Yes �No HOLE DIAM.
_i i � i_ � ,� ❑ Steel ❑ Threaded ❑ Welded
i _ i_ _i _ _i
),�Plastic ❑
S
�--1 Mile�
CASING DIAMETER WEIGHT
PROPERTY OWNER'S NAME _��_in.to�_�_�n. �r�r 71 Ibs./n. ���g__�
JOri Roh s Cons t ruc t f on _—�n.to __ft. _ __ IbsJfl. j 1 {n.to�y
Q�
Property owner's mailing address if different than well location address indicated above. in.to__.. ft. ___IbsJft. in.to tt.
600 Rwy 169 S, �1 S S SCREEN OPEN HOLE
St Louis Park, F�T 55�+26 Make_Johnson ��om h.�o h. `
�
Type �FA �e�� atoe� Diam. �
SIoVGauze Orl�t A ...__.._—Length /�T�.L___ __ ��
iva�
Set between tt.and ft. FITTINGS:
STATIC WLA'TER LEVEL
WELL OWNER'S NAME ____._57�ft.�below ❑ above land surface Date measured_1.1.���Q
PUMyPING LEVEL(below land surface) _
Well owner's mailing address if different than property owner's address indicated above. 1 60 ft. after ___�__ hrs.pumping__3_� g.p.m.
� �W LL HEAD COMPLETION
Pitlessadaptermanufacturer����_��$_�_�� Model _ :.
� ❑ Casing Protec[ion___.. __ ._____. l�'�12 in.above grade �i.
❑ At-grade(Environmental Wells and Borings ONLY) j�`
GROUTING INFORMATION
Well grouted? �Yes ❑ No �'��4:.
HARDNESS OF Grout Material ❑ Neat cement f7 Bentonite ❑ Concrete i h Solids Bentonite
GEOLOGICAL MATERIALS COLOR FROM TO '�9 I.
MATERIAL � to_ �h ___�_ ❑ yds.�bags
from_
v * from—�V—to_i_-f-73__ft. na t_�_r�t-_t'lyis3O bags �.�
C�By J��1�� a��t 0 � from to ft. ❑ yds. ❑ bags -
— }_
NEAREST KNOWN SOURCE OF CONTAMINATION
C183► gr8�7 SofC 2� 5 _� ��__ _feet ' 7 � direction ��l [j�.C:._ _type
�
Well disinfected upon campletion? �Yes ❑ No ,
clay/�ravel gray soft 58 9 PUMP
❑ Notinstalled Dateinstalled 2�23��1
clay gray soft 90 11.4
Manufacturer's name __ A e..�.,.�.... ___.._. '�
.r[cLmV{�V�-_
gravel/clay gray soft it� 138 "'�de���mbe� _ HP��� �o�ts_ .��_
Length of drop pipe_ _�,.26 ft. Capacity _.__g.p.m.
clap/ssnd broWn .40�� 138 lb3 Type �Submersible f� LS Turbine ❑ Reciprocating ❑ Jet ❑
ABANDONED WELLS
sand/grsve 1 col ored S�f t �,63 16$ Does property have any not in use and not sealed well(s)? ❑ Yes ;�'No
VARIANCE
sand broWn $�t C 1 68 1�8 Was a variance granted from the MDH tor this well? ❑ Yes �'No TN#_
E
WELL CONTRACTOR CERTIFICATION
Use a second sheet if needed This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725.
REMARKS,ELEVATION,SOURCE OF DATA,eta The information contained in this report is true to ihe best of my knowledge.
Ql1 S C A(�A 1 A L�TP� � �}��.]����.�,,�,,,--�V+ �b� 2 -
Licensee 8usiness Name — L�c.or Re .No.
�,//�_�� ,i,.-r � 'r --- ��`26�'V�.
. Authorized Representahve Signature Date .
Duane Mathews 11-6-00
Name of Driller Date
LOCAL COPY 6 5 5 0 3 8 HE-01205-07(Rev.?J99)
FROM ,:, , FAX N0. : Feb. 09 2001 11:40AM P1
T"w%w C i.ty 1�Ua•�"e�►�' C ' ' , .�v�c'i.
617 13th Ave So - Hopkins, Minnssota 55343 • (612) 935 - 3556 _
�09/a00�
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Stodola Wel/ Drilling
3841 North MAin
Si. BonifAcius MN 55375
938-711 1
R�PORT O�'WATER ANALYST,S
Lab#: 589
Our Laboratory reports these analyt�ica!results, determined on a sample tqken
by CLIENT on 1 1/06/Z000 from the following location:
2125 Carriage L,ane
Orono,Mn
Unique WQH#655038
Coli form Bacteria <i/100 ml
Nitrates Nitrogen <1.0 mg/I
The results of these Yests indicate rhat this wel!is producing water thot meets the
standards for F_H_A_, V.A., or conventional Ioans. This ►'eport is an analysis for
collform and nirrare only and does not indude analysis of Lec7d A»d other
c�ntaminants. (Un!¢ss �s spacfTed by clien�},
it Warer Clinic, Mc.
Bil/ s le
Lob Ca4i6cetian Y OZ7-O5�119