HomeMy WebLinkAboutwell info WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO.
CounryNa�n1 Hennepin WELL RECORD 5 613 8 8
Minnesota Statutes Chapter f031
Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed
t1 x-��no 1 1% �'� f;r;, 1 �:-t�U i t�: � -;:. r n i � _,- c'�:.
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Numerical Street Address and City of Well Location or Fire Number DRILLING METHOD
[;7�`•l.� Cc:�un�try��1C�� D�. �. �(Ji1� I.r�:1wE±� ❑ CableTool ❑ Driven ❑ Dug
❑ Auger O Rotary ❑ Jetted
Show exact location of well in section grid with"X". M�. J�jSk�tch map of well location. ❑
J�6howing property lines,
N � roads and buildings. DRIL�ING FLUID .
� � � �'vj Ird��. .
"r"-1_ _1 _1_ �
i �
i � � i �� ,USE ❑ Heating/Cooling
._�_ ___ �_ �_ �Domestic ❑ Monitoring �-
W � � � E ❑ Irrigation ❑ Public ❑ Industry/Commercial
' ' ❑ Test Well ❑ Dewatering � Remedial
-1- -1- -- =- T .� o
' � ' f,mr. � .
, � CASING Drive Shce? � Yes ❑ No HOLE DIAM.
'-�- �' ; -r- I ,a ❑ Steel ❑ Threaded ❑ Welded
� ' 1
,� � � I�.Plastic ❑
�'-1 m�lr� .,..lJ 1`�{�-�i
�,J � Ae+
CASING DIAMETER WEIGHT
PROPERTY OWNER'S NAME �> ��F; �DRa�� / ��/ �
in.to tt. Ibs./h. iR to "f�.
i 021Y �,a_C;E333 �.UI!'t�ei Xl� in.to R. Ibs./ft. -Z-iR.��' R. �
Mailing address if different than property address indicated above. in.to R. Ibs./ft. in.to_fl.
SCREEN OPEN HOLE
z�:� 1 +;r; IsEr.k�:hire Larae --i�i-�i�i-btxr�on
Make from ft.to tt.
��1�7ii1C�l?t=i7� �Il. C��;y l:� TYPe .�t_":ZIl e5.�a ..�i�2E'�. Diam. ^no
Slot/Gauze 1�� 'U Length V
Set belween �6 Ej ft.and__U_Lft. FITTINGS: � 1 � f:fs
STATIC WATER LEVEL
GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO 1t t` c: ;r:
MATERIAL � h. CJ}�elow ❑ above land surface Date measured � ,� ,
PUMPW�'a I.�VEL(below land surface)
i - . c � J.; ' �
l.l.%rt y Y e I�.o�} : C' !i ft. after � hrs.pumping -'� g.p.m.
WELL HEAD COMPLETION
�l�ty �.yrE'�; ;,,� �U � � ��� �C'I�Pitlessadaptermanufacturer ���1'�'e'"��'�`'�'�"'r'Model
❑ Casing Protection C�12 in.above grade
Gra�ty�.� L1ci V Brc��yr� �J j t;[. ` �{y` GROUTING INFORMATION
Well grouted? L�1 Yes ❑ No
Grout Matenal ❑ Neat cement �SBentonite
S8
�`..ic:llfi `7�ci Il :� � _;_ � ��'i�- � from �% to �'t�ft. r• ❑ yds C�''bags
from to tt. ❑ yds. O bags
�.�.c'.`T �+r{76YI1 �.r'> � � � ���. p from to ft. ❑ yds. ❑ bags
NEAREST KNOWN SOURCE OF CONTAMINATION
� / diredion
c' �. . ` a r`� ? feet �-
.�a tt r `I�.n � 1�(' i i. .�,�- , � [-��'"r� �.L__�ryae
Well disintected upon completion? �0��+1'es ❑ No
PUMP
❑ Not installed Date installed � `��! � �-��-�
Manufacturer's name,t �. �� C�S ,,.�
�f�_: -����:T�-
Model number HP Vol�sC� b
Lenqth of drop pipe � ft. Capacity � g.p.m.
Pressure Tank Capacity #�L J�: �S-^t.1:�C,.1
Type:y47 Submersible ❑ L.S.Turbine ❑ Reciprxating ❑ Jet ❑
ABANDONED WELLS
Does property have any not in use and not sealed well(s)? ❑ Yes C3kNo
WELL CONTRACTOR CERTIFICATION
This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725.
The information contained in this report is true to the best of my knowledge.
t`�..t�Pv Sri'��D(=!Li"', tivEI,L DRII�IaING t;:l.�. , I JC;. .,
Use a second sheet,il needed
REMARKS,ELEVATION,SOURCE OF DATA,etc. Licensee eusiness Name / Lic.or Reg.No. �;� .;'�
�,:: 11_s; .c�
�
���. _
,. '" � uthonzed Representahve S� af .--�"�� Dafe
`��� ` � ��5b �'r�r� Lei.b�� i L-5-95
Name ol Driller Date
LOCAL COPY 5 613 8 8 HE-01205-04(Rev.5/92)
_ < <I'zvin (�ity 7Natey Clinic, Inc.
617 13th Ave So • Hopkins, Minnesota 55343 • (612)935-3556
12/14/1995
Stodola Well Drilling
15306 Highway 7 �
Minnetonka Mn 55345
938-21 1 1
REPQI�T QF WP_TE�t A.►�dAb.YSLS
Lab#: 28302
Our Laboratory reports these analytical results, determined on a sample taken �
by CLIENT on / / from the following location:
Tony Eiden
2780 Countryside Dr. W.
Orono,Mn
Unique Wieli #561388 �
Coliform Bacteria <1/100 ml
Nitrates Nitrogen <1.0 mg/I
The results of these tests ind�c:ate that this weil is producing water that meets the
standards for F.H.A., V.A., or ;onventional loans. This report Is an analysis for coliform
and nitrate only and does no� include analysis of Lead and other contaminants. (Unless
as spe�ifled by cller.i).
� ` s .
w \, �Nater Clinic, Inc.
. \�\ �
\ l� 1`
Bill V � �I�
�
Aoalyial labonary Conultin6 8c�guaer
Wator/Uuly�u RwgotW tioiler Wuer ClnmiwL
I.ab Ccrtification Y 027-033-I19