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Home My WebLink Aboutwell info . � WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. . ��CountyNanle WELL AND BORING RECORD 5 7 3 �6 8 A�nnepin Minnesota Statutes Chapter 103/ Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed C�r.r,�no 198 ::� �7 ,, ,. ,. i€;� ` " l-1 �:-�� House Number,Street Name,City,and Zip Code ot Well Location or Fire Number DRILLING METHOD C ❑ Cable Tool ❑ Driven ❑ Dug 711 � C�x F�rm Rca Orono,�IN. ❑ Auger � Rotary ❑ Jetted , Show exact location of well in section grid with"X". �- Sketch map of well location. ❑ �?-��6 Showing property lines, roads and buildings. DRILLING FLUID - N - � B�Ilt'.0711}.i: � � � � - ___ _-_ _ � USE ❑ Monitoring ❑ Heating/Cooling i i � i Domestic �y ❑ Indust /Commercial -�- -a- -�- -�- � � ❑ Irrigation � Communi PWS ry i i i i � �/ ❑ Noncommunity PWS ❑ Remedial w E T X ❑ Test Well i i i i ❑ Dewatering ❑ -r -�- -r- -r i i i i +/ZMia.0 CASING Drive Shoe? ❑ Yes ❑ No HOLE DIAM. i i i i ❑ Steel ❑ Threaded ❑ Welded -� -�- -�- -i p Plastic ❑ s �1 Mile� CASING DIAMETER WEIGHT PROPERTY OWNER'S NAME � in.to �� n. �DR'�� Ibs./ft. 1 ,��E 'i{' Fe�ture Builc�erC ,�.,o n. �bs.�n. ��,/�o=�f�4 Property owner's mailing address if different than well location address indicated above. in.to ft. Ibs./ft. in.to ft. ��"1� Cabblestc�ne Ia�ne SCREEN �� OPENHOLE gt]Xj"jS V l,l 1,Q f �I2„ rj J 3�7 Make t from ft.to ft. Type ain �SS .r7�Q�1 Diam. ')n SIoUGauze ��if 1 V Length � ,+4 � Set belween �Z�. ft.and �� ft. FITTINGS: � �—6 STATIC WATER LEVEL WELL OWNER'S NAME 4{-r,�f�O below ❑ above Iand surface Date measured �—�—g(j PUMPINC,.I�EL(below land surface) .� �1' Well owner's mailing address if different than property owner's address indicated above. � ' ft. after hrs.pumping g.p.m. WELL HEAD COMPLETION �y��e��y��, Xl Pitless adapter manufacturer li Model ❑ Casing Protection �2 in.above grade ❑ At-grade(Environmental Wells and Borings ONLY) GROUTING INFORMATION Well grouted? �7 Yes ❑ No GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO Grout Materia� ❑ Neat cement ❑�entonite ❑ Concrete ❑ High Solids Bentonite MATERIAL from��to_�_ft. � O yds.$I bags from to ft. ❑ yds. ❑ bags C1�3y YeIZ� S G ' �U from co a. ❑ yds. ❑ bags NEAREST KNOWN SOURCE OF CO AMINATION / r l.Zc1�7 Grey � �:ti � ��I j ��. teet Y/'C�� direction ��' °' �type Well disinfected upon completion? �T Yes ❑ No Clay-Gravel Brown M 1 1� 13C:� PUMP 3-I2-96 ❑ Not installed Date installed L�nd �3anC� s t��y �f}C� Manufacturer'sname �:ed Jacl�et Model number HP_��Volts ?� Length of drop pipe 1!SC ft. Capacity g.p.m. �.'ryiuI1C� & Grav�:l �1X@t� ..ri—� �4� �8� Pressure Tank Capaciry �}3 X -T'Y'1� Type: �Submersible ❑ L.S.Turbine ❑ Reciprocating ❑ Jet ❑ ABANDONED WELLS Does property have any not in use and not sealed well(s)? ❑ Yes �No � VARIANCE Was a variance granted trom the MDH for this well? ❑ Yes �No WELL CONTRACTOR CERTIFICATION Use a second sheet,il needed This well was drilled under my supervision and in accordance with Minnesota fiules,Chapter 4725. REMARKS,ELEVATION,SOURCE OF DATA,etc. The information contained in this report is true to the best of my knowledge. AON S'I'UUOIIA ��lELL DkILLZNG CO. , II�C. License usiness Name Lic.or Reg.No. , j l �--_ ' 1-i�-96 .-:,. � Authonzed Representative Signatu e Date � �'rec3 Le.i k�y 1-12-96 � Name ol Driller ME 01205-05(Rev.1/95) LOCAL COPY � � � � 6 $ r . Jwirc �it I/Vater ��inic, J�nc. M ' // 0 617 13th Ave So • Hopkins, Minnesota 55343 • (612) 935 - 3556 01/18/1996 Stodola Well Dritling 15306 Hwy 7 Minnetonka MN 55345 938-2111 REPORT OF WATER ANALYSIS Lab#: 28574 Our Laboratory reports these analytical results, determined on a sample taken by CLIENT on 01/15/1996 from the following location: 1115 Cox Farm Rd Orono,Mn Unique 1Mell#573568 Coliform Bacteria <1/100 ml Nitrates Nitrogen 1.10 mg/I 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 include analysis of Lead and other contaminants. (Unless as specified by client). � �� y ter Clinic, Inc. � � Bi Aoalyial labontory Conuh'u�g Engioem Wator Analyeie Resgenu Boiler Water Chemiwb Lab Cert�ication Y Q27-033-119