HomeMy WebLinkAboutwell info WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO.
�. Count`Name -_� ��������rj WELL AND BORING RECORD 5 � 0 5 71
� Minnesota Statutes Chapter f03/
Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed
R.
(iI:tTIl� � � i .l� l.�, 1� �i °
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House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRiLLING METHOD
,''�i'?�" t.::l'tRi:l_y'�57.t�e �Z�].V�,' {h�. �.'r��ili�'� F�jl, ❑ CableTool ❑ Driven ❑ Dug
❑ Auger f�Rotary ❑ Jetted
Show exact location of well in section grid with"X". �r� - Sketch map of well location. ❑
- J���7 Showing property lines, .
V roads and buildings. DRILLING FLUID �
N �V ��.:1t.(.:ii�.L_G
_i i i i_ 1}�V
i _i' _i_ _ �_
USE ❑ Monitoring ❑ Heating/Cooling
� i i i � � CXDomestic
❑ Communiry PWS ❑ Indust /Commercial
i -� i i ❑ Irrigation ❑ Noncommunit PWS ry
w E � Test Well Y ❑ Remedial
i � � i ❑ Dewatering ❑
i i i r � CASING Drive Shce? ❑ Ves [};No HOLE DIAM.
'/2 Mae
_i_ _ i_ _i_ _�_ � ❑ Steel ❑ Threaded ❑ Welded
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dSPtastic ❑
s
�.-,M��a-� CuUN,j!�� /'�
�/.� CASING DIAMETER WEIGHT
PROPERTY OWNER'S NAME �1 Lf � in.to �=�� n. � •� Ibs.ttt. 7 i�{.�Z .�.
`k�!�rl� �1L�E..''Zl CC)I::TJct27�� in.to ft. Ibs.ttt. �i�.)6�N !#
Property owner's mailing address if different than well location address indicated above. in.to tt. Ibs./tt. in.to ft.
�a ��JI: BG3^1C�i�llX� Lc2.T�lf:' SCREEN OPENHOLE
I I�ISIC�LI C.�'1� �i11. �J`-`'r�3 i) Make �" J� n`���'� from ft.to ft.
7yPe �`�c��11 �a'�:: wl�E��1 Diam. •���
SIoVGauze ��:�F�}I i Length � � ;
'�---7�
Set between � �� ft.and 1�+� ft. Fll'TING�5�� �� •�'�
STATI��y/�FtiH LEVEL
C.
WELL OWNER'S NAME + i tt. 6�tielow ❑ above�and surface Date measured "—��'�=
PUMPING LEVEL(below land surface)
Well owner's mailing address if different than property owner's address indicated above. � ��� ft. after r • ��� hrs.pumping S�� c�7.I� g.p.m.
WELL HEAD COMPLETION
C'�Pitlessadaptermanufacturer �Y�ilt,..,�°Wi:�P�Model
❑ Casing Protection �i1 12 in.above grade
❑ At-grade(Environmental Wells and Borings ONLY)
GROUTING INFORMATION
Well grouted? j�Yes ❑ No
HARDNESS OF Grout Material ❑ Neat cement ❑ Bentonite ❑ Concrete �;}ligh Solids Bentonite
GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO �,
from to -'{'R. ❑ yds.� bags
�' `i (`1- � c� � + ' � from ro ft. � yds. ❑ bags
il(.i.t..- rZ 3E.�ZC.i �'? �� L.1+
from to ft. ❑ yds. ❑ bags
Ci.. t (� . NEAREST KNOWN SOURCE OF CONTA,M`INATION �! e�^�
,,1�.1 l.Y �,1rE�1 �JI @� :? �;C,� � G{:i � �t,'�-' feet fVClFt• ! F+ direction �~"'��t� -f� tYPe
�
Well disinfected upon completion? C�Yes ❑ No
L�.:i� Cir:1?rE�. �5�'G.til"t ;i �S�i ' ry4t c
PUMP
❑ Not installed Date installed ��� ��� �
�c�I1C; �'.C�irS� �Z�f�tiT1 � �r ii y �(.'t� S Manufacturer's name K('.C; a1 c3(:K�l:.
Model number � 5(;j,���(k j HP��Volts �����_
Length of drop pipe 9 '7 t ft. Capacity �r, g.p.m.
�'jrf'T • �r?
Pressure Tank Capacity �G�l.i ��2r'sl+t�?:.C�71
Type: �Submersible ❑ LS.Turbine ❑ Reciprocating � Jet ❑
ABANDONED WELLS
Does property have any not in use and not sealed well(s)? ❑ Yes C�No
VARIANCE
Was a variance granted from the MDH for this well? ❑ Yes ❑ Nb
WELL CONTRACTOR CERTIFICATION
Use a second sheet,il needed This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725.
REMARKS,ELEVATION,SOURCE OF DATA,etc. 7he information contained in this report is irue to the best o(my knowledge.
L�C`�: :,'?°CL'�:I:f: ;�Ik.i�L DRILLI�JG C:t�, , INC.
L�cens�e Busine Name . r Lic.or Reg.No. i��� I L
/ r, ff�
�' .�r' Ji' i� ��,�,'�"'�-, �"�{ �—L'�
rM�-:; �� . I/S� ,
--�j 'Authorized Representafiv'e Signature - Date
LIiL<:r: �+ic}('-Y'c? .;—��—�l
n 7 Name ol Oriller Date
,.,._, ..„, , . � � �s a� 1 � HE-01205-05(Rev.1/95)
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' , Jwirc �itc� UVater �ircic, �rcc.
617 13th Ave So • Hopkins, Minnesota 55343 • (612) 935 - 3556
03/22/1997
Stodola Well Drilling
15306 Hwy 7
Minnetonka MN 55345
938-2111
REPORT OF WATER ANALYSIS
Lab#: 32226
Our Laboratory reports these analytical results, determined on a sample taken
by CLIENT on 03/18/1997 from the following location:
2650 COUNTRYSIDE DR. W.
ORONO,MN
UNIQUE WELL#580571
Coliform Bacteria <1/100 ml
Nitrates Nitrogen <1.0 mg/1
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. This report is an analysis for coliform and nitrate only and
does not inGude anaiysis of Lead and other contaminants. (Unless as specified by client).
?xsr City Water Clini�, Inc.
i
Bill Van Arsdale , /
;
/
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Analyiwl►aboratory C�W���
Water Analy�air Reagenu Boiler Water Chemioa4
Lab Cert�ication M 027-033-119