HomeMy WebLinkAboutwell info WELL LOCAT ON MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO.
�o���,Name WELL AND BORING RECORD 6 5 5 0 5 7
x�nfl� �n Minnesota Statutes Chapter 103!
Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed
tt
Oroao 117 23 OS �. �. ��. 135 1-3-01
House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD
3't 2'�T F Lake J� 0 r�h0 5 S 3 5 6 � Cable Tool ❑ Driven ❑ Dug
� Auger g-'Rotary ❑ Jetted
Show exact location of well in section ri ith"X". Sketc a of well location. ❑ �
9 L��`E ow Pg property lines,
roads and buildings. DRILLING FLUID WELL HYDROFRACTURED? ❑YES �,�'NO
N
�� '� ��`L SLt er —X FROM n.to K.
_� � � �_ � —
� -�- -�- -� USE ❑ Monitoring �j Heating/Cooling
i i � i �Domestic
_i_ _a_ _i_ _i_ � ❑ Community PWS �7 Industry/Commercial
i i i i � ❑ Irrigation ❑ Noncommunit PWS
w e T \, ❑ Environ.Bore Hole Y ❑ Remedial
i i � i .�� ❑ Dewatering ❑
i y r i '2IM.ia q CASING Drive Shoe? ❑ Yes �No HOLE DIAM.
_i i i i_ � � ❑ Steel ❑ Threaded ❑ Welded
i_ _i_ _i _ _i
�Plastic ❑
�1 Mile-� �
CASING DIAMETER WEIGHT
PROPERTY OWNER'S NAME _.f,�_in.to�_"��ft. ��_'�' ,�__Ibs./ft. ���/t�__n, Q
TO� �a in.to h. IbsJfl. ��- in.to � �
v
Property owner's mailing address if different than well location address indicated above. _in.to ft. __ Ibs./ft. in.to__ft.
SSNe IIB above SCREEN OPEN HOLE
Make ____ from tt.to tt.
Type�_ _Diam. 9«
SIoUGauze Leng[h
•
Set between ft.and . FITTINGS:
- er S
STATIC WATER LEVEL 'w
� WELL OWNER'S NAME /� tt. [R'below ❑ above land surface Date measured�_�_���_�
—I.��--------
PUMPING LEVEL(below land surface)
Well owner's mailing address if different than property owner's address indicated above. __1.�Q______ft. after_ 1�5 hrs.pumping__�__g.p.m.
WELL HEAD COMPLETION
�Pitless adapter manufacturer__�.�$�����_ Model ___ __
f7 Casing Protection_._,_ _ ____ ___ �12 in.above grade
❑ Ahgrade(Environmental Wells and Borings ONLY)
GROUTING INFORMATION
Well grouted7 '6X Yes ❑ No
HARDNESS OF �f
GEOLOGICAL MATERIALS COLOR FROM TO Grout Material ❑ Neat cement ❑ Bentonite !1 Concrete J3 High Solids Bentonite
MATERIAL from.__�__ to __�Q_ft. ____�_�� yds.� bags
j Ly r from__�_to_}�_�tt. n�i.�..�1 ❑tVds.tCl bags
t��$DiZ U18CIl +,��Lt 0 from_ . ._ to _.—___h. C�Gj i ❑lydslO bags
NEAREST KNOWN SOURCE OF CONTAMINATION r
peat b��9C� S�1 t 2 2 —��l feet _ �/�L�S��_direction �l/ � type
Well disinfected upon complelion? �L Yes -1 No � !� L r1
�` C. L /G
clay gray soft Z$ H PUMP
, � ❑ Not installed Date installed 1�1�7�01
sandJgravel colored $�ft O'i 9 Manufacturer'sname _ _ �8�_ ______
'^�:. .0 Model number _.__. __.___ HP ��a___ Volts 7�n
� C l�y �jr8y ��t t �� I 15 Length of drop pipe ��� _ _____ _ R. Capacity __��___._ g.p.m.
sand/gravel, cliored $��t 115 12 Type �Submersible ❑ LS Turbine fl Reciprocating C] Jet ❑
ABANDONED WELLS
:``� ` Does property have any not in use and not sealed well(s)? ❑ Yes �No
s8�d tan 30�t �Zv ��� VARIANCE
Was a variance granted from the MDH for ihis well? ❑ Yes �o TN#
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.
icensee usiness� ame c.o g.No.
rTlG�G� 7 2
s
--L-_?.�_�L
!�r���zed Representa(ive Signature � Date
—__ Duane itathews_____1-3-Q1
� � � ^ O� � � NameolDriller Date
LOCAL COPY �'*
`•J HE-01205-07(Rev.2/99)
+ � �� l�wi�w C i,t" 1Na�"e�' C ' ' , .I�u'i.
y
617 13th Ave So � Hopkins, Minnesota 55343 � (612) 935 - 3556
Ol/OS/2001
Stodola Well Drilling
3841 North Main
St. Bonifacius MN 55375
938-21 1 1
REPORT OF WATER ANALYSIS
Lab #: 8
Our Laboratory reports [hese analyiical results, determined on a sample taken
by CLIENT on 01/03/2001 from the following location:
Tom Radke
3424 E Lake St
Orono,Mn
UNique Well #655057
Coliform Bacteria <1/100 ml
Nirrares Nirrocaen <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 nvt include anulysis cf Lead and other
contaminants. (Unless as specified by client).
in City Water Cli►�ic, Inc.
\
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Bill s e
Iab CertificaUon N 027-053-I 19