HomeMy WebLinkAboutwell info a . �
. �
WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO.
CounryName WELL RECORD 5 20 4 6 4
t'f�x;Y.�..'L)1.I': Minnesota Statutes Chapter 1031
Township Name Township No. � Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed
C�rcr2c� 117 2� t:.� , t, ► h. �__,�_<._
. c
�. �. �.
Numerical Street Address and City of Well Location or Fire Number DRILLING METHOD
��j�,� �''�Tk ��i,.�'�'� ���C)r1T•� I`�:. ❑ Cable Tool ❑ Driven ❑ Dug
❑ Auger � Rotary ❑ Jetted
Show exact location of well in section grid with"X". �/J� Sk map of well location. ❑ '
� J j Showing property lines, �
N d roads and buildings. DRILLING FLUID
I � _i _i_ tit�'P.t�C_�'t.Z�:f?
--r- �- � i
i � i ,USE ❑ Heating/Cooling
_+_ _�_ �_ �_ C�`�Domestic ❑ Monitoring ❑ Industry/Commercial
yy i � I E ❑ Irrigation ❑ Public
_1_ _1_ __ __ T ❑ Test Well ❑ Dewatering O Remedial
1 � '
f,m�. CASING Drive Shce? ❑ Yes ❑ No HOLE DIAM.
--�- ' i
� �- - -r- I �;Steel ❑ Threaded ❑ Welded
1 ❑ Plastic ❑
�—1 milr ,�r
�✓�LL CASING DIAMETER WEIGHT ..
PROPERTY OWNER'S NAME �I't'�'; k t .i>t'+ �
in.to ft. Ibs./ft. : `�in.to���%�it.
� �?"f'�l i. �S
y,.,���..;;l.f�:>C:I l�.i,�,f�:' �'- in.to ft. Ibs./ft. in.to ff.
Mailing address if ditferent than property address indicated above. in.to ft. Ibs./ft. in.to ft.
-� - y - - SCREEN '� ;� �� � " OPEN HOLE
�i.,�.. ....:.I..��:`..'-J':' i i�:":r�: C�1..iaT:.�Tz—
, Make �.,�i��4j from R.to tt.
f'+;..,i �,..�,;i r ��:C�-.. . .._ Z ,- .,t ....:� .
- Type Diam.
SIoUGauze �- � Length a��
Set between �+�`�� ft,and ����� ft. FITTINGS:
STATIC,WATER LEVEL '���(l.._L�?
GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO � ft. O;below ❑ above land surface Date measured
MATERIAL
'{ �;t .:.. � PUMPING LEVEL(below land surface)
�..1C.1y' . _. �
ft. aRer hrs.pumping g.p.m.
� 4,(.i�,�, y:✓f ��,.� WELL HEAD COMPLETION
� C`4.Pitless adapter manufacturer �^r^�r�"r��"<l+"..,,i. Model
❑ Casing Protection C�,12 in.above grade
GROUTING INFORMATION
Well grouted? ❑ Yes 1� No
Grout Material ❑ Neat cement ❑ Bentonite
from to ft. ❑ yds. ❑ bags
from to ft. ❑ yds. ❑ bags
from to R. O yds. ❑ bags
NEAREST KNOWN SOURCE OF CONTAMINATION
feet direction type
Weil disinfected upon completion? <F7 Yes O No
PUMP .,,'j,_t.:
❑ Not installed Date irlSiaU
i'�I��.-:
Manufacturers name
Model number HP Volts L"`��
Length of drop pipe ��'=�� ft. Capacity ��� g.p.m.
Pressure Tank Capacity �<< f-',�.�„i�l [�];�y tt
Type: 0}$ubmersible O L.S.Turbine ❑ Reciprocating ❑ Jet ❑
ABANDONED WELLS
Dces property have any not in use and not sealed well(s)? ❑ Yes 2J No
WELL CONTRACTOR CERTIFICATION
This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725.
The information contained in this report is true to the best of my knowledge.
Use a second sheet,ilneeded iA-`iV . .;...'�..X 3 r": v'vi .t(, 1!2�. 1 sta11'ul�� �.. , � .�..',i,,.. s::� :'y.
REMARKS,ELEVATION,SOUR�E OF DATA,etc. Licensee Business Name Lic.orReg.No.
4
Aufhonzed Representative Signature Date
�„ �` y� ' " �- (�';
��y/ �G G�",^��'��-.�-_� � �_-r%�...-_ ...
� �..� � ..
Name ol Dnller Date
�'.. . �•�:,ti�a:z,_.r 3—�:',. _ :.
LOCAL COPY 5 2 0�6 4 HE-01205-04(Rev.5/92)
+" ►
TWIN CITY WATEk CLI�IC, INC.
617 13th Ave. So.
Hopkins, Minnesota 55343
(61? ) 535-3556
02;05!93
Stodola Well Drilling
15306 Hwy 7
Minneton}ca, MN 55345
938-2111
Lab # : 18717
REPORT OF WATER ANALYSIS
�ur laLoratary reports these analytical results, determined on a
sample taken by YQU on 0?;03!�3 fY•G:1� t.he following laeatioi::
Land�chute C,roup, Inc.
tlnique # 520464
1685 Fox �t
Orono, Mn
Coliform Bacteria <1/100 ml
Nitrates Nitrogen <1.0 mg/1
The regults of t.hese te�ts in��icate that this well is producing water
that meets the standard� for F.H.A. , V.A. , or c�oi:vei�tional loan�.
T in �i y Water Clinic , Inc .
�
Bill an Ar�dale
Brian Blair