HomeMy WebLinkAboutWell info � WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO.
CountyName WELL AND BORING RECORD �
��j��g�y�,� Minnesota Statutes Chapter 1031 615 5 8 7
Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed
ft.
Cirono I18 23 3fi �. �. �, 2f�6' 1-29-�9
House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD
7$1 ��rndale �LC�� 1�. �L'OT10� � ;����� n CableTool ❑ Driven ❑ Dug
❑ Auger �J Rotary ❑ Jetted
Show exact location of well in section grid with"X". Sketch map of well location. ❑ _ �
Showing property lines, �
roads and buildings. DRILLING FLUID WELL HYDROFRACTURED? ❑YES ❑NO
N
, , , , �entonit� FROM n.ro_ n.
-; -;- -;- -,-
USE ❑ Monitoring O Heating/Cooling
� � i � �J Domestic ❑ Community PWS ❑ Industry/Commercial
_i_ _�_ _�_ _i_ ❑ Irrigation
i i i i ❑ Noncommunity PWS ❑ Remedial
W E T ❑ Test Well
i i i i ❑ Dewatering ❑
i i i i +2IM_e � CASfNG Drive Shoe? � Yes ❑ No HOLE DIAM.
_�_ _i_ _i_ _i_ � � `�I L � Steel ❑�(hreaded ❑ Welded
' ' � � ` �� w��" ❑ Plastic ❑
S '�t X
�-1 Mile--i ^�'
y CASING DIAMETER WEIGHT �
PROPERTYOWNER'SNAMEL�"y � in.ro__2�_ft. 1 � Ibs./ft. �in.ro��ft.
�t� -� in.to ft. Ibs./ft. 1 in.to�.�t.
�
Property owner's mailing address if erent than well location address indicated above. in.to ft. Ibs./ft. i ,m -7�,�
U��7
3436 'fOt.�1 S�• �v�•�' • SCREEN OPENHOLE
Make �r,t/A from ft.to ft.
811��i��QI �i�i• rJ�J.31 .� TYPe Diam.
SIOUGauze Length
Set beiween ft.and ft. FITTINGS: �
STATIC WATER LEVEL
WELL OWNER'S NAME ft. C�rbelow ❑ above land surface Date measured�_�,_`n� C�
PUMPING LEVEL(below land surface)
Well owner's mailing address if different than property owner's address indicafed above. _��y�_ ft. aRer hrs.pumping �]!�_g.p.m.
WELL HEAD COMPLETION
Model
❑ Casing Protection ❑�in.above grade
❑ At-grade(Environmental Welis and Borings ONLY)
GROUTING INFORMATION
Well grouted? Oj�Yes ❑ No
GEOLOGICAL MATER�ALS COLOR HARDNESS OF FROM TO Grout Material ❑ Neat cement ❑ Bentonite ❑ Concrete C�High So�ids Bentonite
MATERIAL _$_ __�� �_ Y � 9
from to ft. ❑ ds. ba s
from to ft. ❑ yds. ❑ bags
_ t � from to ft. ❑ yds. ❑ bags
NEARES <NOWN SOURCE OF CON,TqAM�INATION -7-J f
� feet /LlQ�T�_direction �� l 1 C rype
Well disinfected upon completion? g(Yes ❑ No
, PUMP
❑ Not installed Date installed `3�2 1�9�
Manufacturer's name MvA t�Q
Model number HP_�_ Volts �3�
Length of drop pipe �.G V� ft. Capacity 1 V g.p.m.
Type: 19Submersible ❑ LS.Turbine ❑ Reciprocating ❑ Jet ❑
ABANDONED WELLS
Does property have any not in use and not sealed well(s)? ❑ Yes L�No
VARIANCE
Was a variance granted from the MDH for this well? ❑ Yes C7'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.
Uvt3 S��IiOLA WELI� DRILLI�tG �O. , IN�C
Licensee 8 siness N e�'� Lic.or Reg.No. Z,'1,�2
t''---'---�,+
xo-z�-gg _ .�
uthorized eqres r tive Signatu Date
Frer� L�iay 1-29-99
Name of Driller Date
LOCAL COPY � �� � 8� HE-01205-06(Rev.9/97)
~ Jcuin �itc� I/Vater ��ircic, J�rac.
617 13th Ave So • Hopkins, Minnesota 55343 • (612) 935 - 3556
02/02/1999
Stodola Weil Drilling
3841 North Main
St. Bonifacius MN 55375
938-2111
REPQRT QF WATER AIYA�.YS[S
Lab#: 36526
Our Laboratory reports these analytical results, determined on a sample taken
by CLIENT on 02/01/1999 from the following location:
Erotas Building Corp.
781 Ferndale Rd.
Orono,Mn
Uniqye Well #615587
Coliform Bacteria <1/100 ml
Nitrates Nitrogen <1 . 0 mg/1
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, � at�r Clinic, Inc.
V�\� � �
Bill V r e�
An�lyiwl laboratory Conultu�F_ogineer
Waler Analyaia RnageNc Boiler WaWr Chemicals
LabC�rtiticationl1027-033-119 '