HomeMy WebLinkAbout2001 -Well & boring record , �..
WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO.
County Name WELL AND BORING RECORD 6 6 0 5 51
xenne in Minnesota Statutes Chapter 103/
Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed
OCono 117 23 10 �� �� ��� 181 n 11-29-01
House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD
❑ Cable Tool ❑ Driven ❑ Dug
2155 Cacria e Lane � ❑ Auger �{Rotary ❑ Jetted
Show exact location of well in section grid wi�h�'X". Sketch map of well location. ❑ _ _____ �
Showing property lines, e
..i',.? .�oads and buildings. DRILLING FLUID WELL HYDROFRACTURED? ❑YES � O +
" j� ,�� water
i i � i � FROM r ft.to R.
-i -i- -�- -i- p �
USE .1 ❑ Monitoring ❑ Heating/Cooling
i i i i A�Domestic
_i_ _�_ _i_ _i_ ❑ Irrigation ❑ Community PWS ❑ Industry/Commercial
i i i i ❑ Noncommunity PWS ❑ Remedial
w i ' I e T _ ❑ Environ.Bore Hole ❑ Dewatering n .
i i i r +2IM.1e � � �� CASING Drive Shoe7 ❑ Yes No HOLE DIAM. �
i i i i . ❑ Steel ❑ Threaded ❑ Welded
_i_ _ i_ _i _ _i .
l�... � � �Plastic ❑
S ,,
�1Mile-� ....
' CASING DIAMETER WEIGHT
r PROPERTY OWNER'S NAME k in.to1 73 ft. �O1 Ibs./ft. in.to 3�.
JOn ��h3 C�n$t ruC in.to ft. Ibs1ft �in.to�,_$_�,ft.
Property owner's mailing address if different than well loca�ion address indicated above. _ _in.to ft. ,_.._ Ibs./fl. in.to R.
SCREE OPEN HOLE
600 HWy 269 S, Ste 155 ,��ga�
Make from ft.to ft.
St Louis Park, Mri 5542b TYPe s sin ss steei Diam.
SIoUGauze •OZ o Length��� }���
Setbetween �7'� fLand__�a�_R. FITTINGS: 9M�4A« �Il_
STAp�LVATER LEVEL 1 7
WELL OWNER'S NAME �� ft.�,below ❑ above land suAace Date measured 1 Z�29 i
PUAAPIIyCa{EVEL(below land surtace) - Q
Well owner's mailin address if different than ro ert owner's address indicated above. 1��j ft. after � hrs. um in +O m.
9 P P Y — _ P P 9 9P
VyELL HEAD COMPLETION
�6 Pitless adapter manufacturer whi t ewa��� Mo el
❑ Casing Pro[ection_ �2 in.above grade
❑ At-grade(Environmental Wells and Borings ONLY)
GROUTING INFORMATION
r Well grouted? �Yes ❑ No
HARDNESS OF Grout Material ❑ Neat ce�'�j nt ❑ Benton ❑ Concrete� igh Solids Bentonite
GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO trom " to �� ft. F-`..•,w�' ❑ yds.�bags
from 3� to i 73 tt. n$�si� ��c�.�] bags
topsoil black oft 0 3 from to h. o yds. ❑ bags �
sand/gravel broWn pf't 3 �$ "EA'K�WaSOURCEOFCor sw rS f S-�-. J j'4
G-� feet � direction ype
Well disinfected upon completion? Yes ❑ No
clay bco�n oft 1$ 40 PUMP
❑ Notinstalled Dateinstalled Z2�12���
cla OraV oft 40 165 Aermotor
� O ! Manufacturer's name
e s Model number HP ��� Volts �3�
.. ssnd/grsvei bro�n oft 165 i81 Lengthofdroppipe I05 ft. Capacity g.pm.
Type��Submersible ❑ L.S.Turbine ❑ Reciprocating ❑ Jet ❑
ABANDONED WELLS
Does property have any not in use and not sealed well(s)? ❑ Yes �I No
VARIANCE
Was a variance granted from the MDH for ihis well? ❑ Yes �No TNM
WELL CONTRACTOR CERTIFICATION
Use a second sheet,il needed This well was drilled under my supervision and in accordance with Minneso[a Rules,Chapter 4725.
REMARKS,ELEVATION,SOURCE OF DATA,etc. The information contained in this report is true to the best of my knowledge.
on Stodola �eII Drilling Co.� INc. 27 72
Licensee Business aaae • �� �'l� Lic.or Reg.No.
. r� ,;�. s f� ��__
� ZZ�Z1�'��
Authorized Representative Signature Date
C / - - �<=T-��1 1-� n
Name ol Driller ate���
�oc�,�.coP,r 6 6 0 5 51 HE-0120507(Rev.2/99)
��#,40-0020
♦ '
rw� c:�-y w�-� c � � , r�.
617 13th Ave So � Hopkins, Minnesota 55343 � (612) 935 - 3556
12/03/2001
Stodola Well Drilling
3841 North Main
St. Boni facius MN 55375
938-21 1 1
REPORT OF WATER ANALYSIS
Lab #: 1326
Our Laboratory repvrts these analytical results, determined on a sample raken
by CLIENT on 1 1/29/2001 from the following location:
Jon Rohs Construction
2155 Carriage Lane
Orono,Mn
Unique Well #660551
Coliform Bacteria <1/100 ml
Nitrates Nitrogen <1.0 mg/1
The results of thesc resrs indicare rhar rhis well is producing warer that meets rhe
standards for F.H.A., V.A., or conventianal loans. T�iis report is an analysis fov
coliform and niirate only and does nor include analysis of Lead and other
concaminants. (Unless as speci fied by client).
Tw" ity ater Clinic, Inc.
, � �
���
8i11 dale
�
Lab Certification#027-053-I 19