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Home My WebLink Aboutwell info WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. County Name WELL AND BORING RECORD 615 5 71 Aenne Minnesota Statutes Chapter 703! Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed R. � �� L7 '/� '/. '/� House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD ❑ Cable Tool O Driven ❑ Dug ❑ Auger �otary ❑ Jetted Show exact location of well in section grid with"X". C t O G L Sketch map of well location. � i �J�J� Showing property lines, roads and bu' ings. DRILLING FLUID WELL HYDROFRACTURED? ❑YES ❑�O - N - r�EL�- '� , , , , FROM n.to n. � -�- -�- -� USE ❑ Monitoring ❑ Heating/Cooling i i i i � �Domestic ❑ Community PWS ❑ Indust /Commercial � i i v Irrigation ❑ Noncommunity PWS ❑ Reme al yy E Q ❑ Test Well � � � � ❑ Dewatering ❑ i i i � '/2M.e �� CASING Drive Shoe? ❑ Yes No HOLE DIAM. _i _i_ _i_ _i_ I . ��'�\ _ �� teel ❑ Threaded ❑ Welded i i i i � _",,,►r.�.�...r. � lastic ❑ F-,n�ie-� � CASING DIAMETER WEIGHT PROPERTY OWNER'S NAME k in.ro 2��n. �'g Ibs./n. g in.to ny. �� in.to_ ft. Ibs./ft. �in.to__f!7� Property owner's mailing address if different than well location address indicated above. in.to ft. Ibs./ft. in.to ft. �4�'�iS ir�IIWOOd �LC SCREEN OPENHOLE �den Prgirie, M� 5S3�6 Make Johnson from ftto h. ype��-�xE��e$o_vzn�cc�Diam. '3p SIoUGauze__� ____Length Set behveen � ft.and ft. FITTINGS: STATIC WATER LEVEL WELL OWNER'S NAME _��___ ft. elow ❑ above land surface Date measured ��=�Q� PUMPING LEVEL(below land surface) Well owner's mailing address if different than property owner's address indicated above. �� ft. after � hrs.pumping 3..Q_g.p.m. WELL HEAD COMPLETION whi t e�s t er �Pitless adapter manufacturer Model _ Casing Protection �12 in.above grade ❑ At-grade(Environmental Wells and Borings ONLY) GROUTING INFORMATION Well grouted? �Yes ❑ No GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO Grout Material ❑ Neat cement ❑ Bentonite ❑ Concrete �High Solids Bentonite MATERIAI ) from�to�(L ft. _�_ ❑ yds.�,bags P� C �f from�_to�_�_�ft. n��_��$_� ❑ yds. ❑ bags �+�gy y�11aw s�it 0 G� from to ft. ❑ yds. ❑ bags NEARE �QVOWN SOURCE OF CO TAMINATION � �i.��iy �C$}I $O�t �5 gQ teet �L��l direction ��'/�1�iype Well disinfected upon completion? I�'es ❑ No /� Clayloravel calore� me�lium 9� 13fl PUMP ❑ Notinstalled Dateinstalled 1�`��JU e�ay �t�6'1F1 SOtt Z�Q ��Q Manufacturer'sname �� Jacket Model number l riflf'.NC1��t��y� votts '9ll�A/� sarid cray sofr lso 17� Length of drop pipe 1 2� ft. Capacity g.p.m. Type: �ubmersible ❑ L.S.Turbine ❑ Reciprocating ❑ Jet ❑ ABANDONED WELLS Does property have any not in use and not sealed well(s)? ❑ Yes �lo VARIANCE Was a variance granted from Ihe MDH for this well? ❑ Yes o WELL CONTRACTOR CERTIFICATION Use a second sheet,if needed This well was drilled under my supervision and i�accordance with Minnesota Rules,Chapter 4725. REMARKS,ELEVATION,SOURCE OF DATA,etC. The information contained in this report is true to the best of my knowledge. Uon ��n�iol.a �Tell Dril�in�% C�. ��-.--?.7172 Lic ee Business Na e � ,�r Reg.N� / � i Kr I —� 1��C7�7� � u hori' d epresentative Signature `�� Date Chuck 1�ioore 9-3-gg Name of Driller HE 01205-06(Rev.9/97) LOCAL COPY � �, �� ( �, . Jwir� �itc� �ater C��inic, �n.c. � 617 13th Ave So • Hopkins, Minnesota 55343 • (612) 935 - 3556 09/09/1998 Stodola Well Drilling 15306 Hwy 7 Minnetonka MN 55345 938-2111 r.EroR: �r w��r��.�r�a�.��sis Lab#: 35718 Our Laboratory reports these analytical results, determined on a sample taken by CLIENT on 09/03/1998 from the following location: Charles Richards Inc. 35 Crystal Creek Rd. Orono,Mn Unique Well #615571 Coliform Bacteria <1/100 ml Nitrates Nitrogen <1.0 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 snPcified hy client). � i ter Clinic, Inc. Bi s a Analyicallabontory Coneult' er m6 Fing�ae Water Analyeis Reagente Boiler Water Chemicals Lab Cert�ca[ion N Q27-033-119