HomeMy WebLinkAboutwell info WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO.
CountyNarne Hen31epz.�i WELL AND BORING RECORD � � 72 � �
Minnesota Statutes Chapter f03!
�}o�n��p��me To�n�ip No. Range No.� SectiopyNp. Fraction WELL DEPTH(completed) � Date Work Co leted
1 ! L Lx4 1��i n. �— tl—��
v, l. va
�o�sg�lumhe[�tl,etNaq�„�1Lv,ap�Zip�Code�of WeI1lqGaijoa i � =r Fi��u�tler� DRILLI�Ca le�Tool � Rotary ❑ D n d
tJ �I- ict fi '.L E- 11 tJZ t.lIl
❑ Auger a
Show exact location of well in s ction grid with" p Sketch map of well location. ❑
��f'I.. ��A� / I"`, Showing property lines, �
ads and buildin s. DRILLIA{GFLUI.�`}��i t� WELL HYDROFRACTURED? ❑YES LJ NO
N t�f�jl
i i i i FROM ft.to ft.
_i _i_ _i_ _i_
USE ❑ Monitoring ❑ Heating/Cooling
i i i i s '� Domestic
_i_ _�_ _�_ _i_ �Y�"� ❑ Community PWS ❑ Industry/Commercial
� i � � ❑ Irrigation ❑ Noncommunit PWS
� Y ❑ Remedial
w E ❑ Test Well
i i � i T ❑ Dewatering ❑
-r -�- -r- -r
i � i � yzM�ie CASING Drive Shoe? ❑ Yes No HOLE DIAM.
_i i _i_ _i_ ❑ Steel ❑ Threaded ❑ Welded
� -,- � � 1 Glue
� Plastic ❑
S
�-1 Mile-�
CASING DIAMETER WEIGHT
PROPERTY OWNER'S NAME � � �� in.to 1 7 1 ft. � "� Ibs./ft � -���
trharles C.uaci Ca. ��.t
in.to ft. Ibs./ft. ������7��'
Property owner's mailing address if different than well location address indicated above. in.to ft. Ibs./ft. in.to ft.
SCREEN ,���2� OPEN HOLE
iBG� WQoddale Drive �c�}
Make from ft.to ft.
bd�r?cibury, Mn. �;51 �:� TYPe ._ .a�,n �ss S�eeZ Diam.
Slot/Gauze .V�� Length _
Set between ft.and `�ft. FITTINGS:
STATIC WATE V�L �
WELL OWNER'S NAME � ft. �below ❑ above land surtace Date measured �—j�—'��'
PUMqING,1,F�1EL(below land surfac�
Well owner's mailing address if different than property owner's address indicated above. _j �� ft. after hrs.pumping �� �1'�g.p.m.
�YELL HEAD COMPLETION
�J Pitless adapter manufacturer �rl l t�'�1V t���� Model
❑ Casing Protection �J 12 in.above grade
❑ At-grade(Environmental Welis and Borings ONLY)
GROUTING INFORMVTION
Well grouted? �E] Yes ❑ No
GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO Grout Material ❑ Neat cem t� ❑ Benton �p Concrete -C�laHigh So�ids Bentpnite
MATERIAL from � to �t' ft. " ❑ yds.rb bags
F�ill-C1ay Br'C��:I2 ;� t; ' 3 ' from to n. ❑ yds. ❑ bags
from to ft. ❑ yds. ❑ bags
rL'C.`n :?f:al E�,.t,s�(,k �' j i � ! NEAR KNOWNSOURCEOFCOf�,MINATI�
i /"' .���✓� U /�
feet + ' direction �`�` ��Gtype
Well disinfected upon completion? -�Yes ❑ No
C.�Ci� �S�t3�llr`I� M U � Jt.; PUMP S��'—h�
J
❑ Not installed Date installed
8rat'e�' R'O�"Or Z'1 `' ��` �L C' Manufacturer's name 5'L�"�� 1
Model number �5�'�����=��S �� i ` Volts �4 tF
CI zy Grc.y :7 1 i�W 1 �:U �:6 i 8
Length of drop pipe ft. Capacity g.p.m.
�`1�� �, Type: �Submersible ❑ LS.Turbine ❑ Reciprocating ❑ Jet ❑
Grey �, 1 �t:� 1�i:�
ABANDONED WELLS
Does property have any not in use and not sealed well(s)? ❑ Yes � No
VARIANCE
Was a variance granted from the MDH tor 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 Rules,Chapter 4725.
REMARKS,ELEVATION,SOURCE OF DATA,etC. The information contained in this report is true to the best of my knowledge.
._ IiCti� ��'iUD`vLA WEL,L DhIL�It�G CO. , INC.
__ ;
;,'z-C r _ �.
� Licensee Business Name Lic.or Reg.No. � / j�
E,.�;� 2. 6 ��9? �F,, ,�`;' � ,.�' J i E-9 F,
" � Authorized Representative Signature Date
9 '� .....� {��L1C1C ��(7C�Z'd'-'.'' ��—�s:—��5
v+1y " �'
Name ol Driller HE 01205-06(Rev.9/96)
LOCAL CQPY j � �j � �i �j
_ �,lwin �it� t/Va�er l,.rLL/Z4G� �ru.
617 13th A�e So • Hapkins, Minnesota 55343 • (612) 935 - 3556
1 Q/10/1 S98
Stodola Well Drilling
15306 Hwy 7
Minnetonka, MN �534a
935-2111
REPORT OF WATER ANALYSIS
Lab#: 3�94
� our Laboratary reports these analytical resufts, deterrnined on a sample taken
by CLiENT an 05/12l1998 from the foflowing location:
Charles Cudd Co.
2815 Deer Run Trail
Un�que WefE#597218
Coliform Bacteria �1/140 ml
Nitrates Nitrogen <1.0 mgA
The results of these tests indicate that this well is producing water ihat meets the standards for
F.W.A., V.A., or conventional loans. This report is an analysis for caliform and nitrate only and
does not include analysis of Lead and other contaminants. (Unless as specified by client},
S.
T�\�• ,Flinic, Inc.
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Bill Va�s le
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Ana�yiusl 4bo�atory l:orwultirpt Frpinem
Wr[cr Aoslysiac Rcagcntx Ho�ler Water�.hpuyicpk
I.ab Ccrtiticatint��027-053-1 l�