HomeMy WebLinkAboutwell info � T� ,
WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO.
c����Name WELL AND BORING RECORD 6 g�,��1
�iq Minnesota Statufes Chapter 1031 �..
Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed
Ococ�o I37 23 07 "
,, ,, ,
GPS DRILLING METHOD
LOCATION: Latitude degrees minutes . seconds _ .
r Cable 7001 U Driven Dug
Longitude degrees minutes seconds ,�,�r -��
[,Auger �_�rtotary __Jetted
House pNu/m�be/r+,.S,treet Name,City,and Znip,C.o,�de of Well Loca�tio�rn� or Fire Number �; /
I1W �Xi� CC�� Vi{AR7 SSJV'F DRILLING FLUID WELL HYDROFRACTURED? ❑Yes i o
Shop exact location of well in section grid wiih"X". Sketch map of well iocation. ��er FROM ft.TO ft.
Showing property lines,
N No cosmmunit pyys I`Monitoring ❑Heating/Cooling
1 , ' f roads and buildings USE [] y �,J Environ.Bore Hole i_;Indus�ry/Commercial
--'-- —'-- ---`-- ---F- '�
�Irrigation ❑Remedial
❑Community PWS �'��Dewatering ❑
--'"-"'-"-'--`-----`-- ASING OLE DIAM �
W ; ; ; ; E� ��� - - �
� Drive Shoe� C Yes � : o �
� � � ' \`� � Threaded ❑ elded
--�-----�-----�-----%— �.�Steel _ .
'h Mile �j�; 18S1iC _
""'""---'--- --'--�"-`-- � . ��,. CASWG DIAMETER WEIGHT
S , e� p
' f � in.to��___fl. `�O� Ibs./ft. v in.to L�t.
�1 Mile—� ��:..,` T 2L7Q
in.to ft. Ibs./ft. 4 in.to_i}t.
PROPERTY OWNER'S NAME/COMPANY NAME in.to ft. Ibs./ft. in,to fl.
� `' �S SCREEN OPEN HOLE
Property owner's mailing addrescs if differert than well location address indicated above. Make__�_. _ . -- FROM ft. TO ft.
221 F i�cile r7t Type �A'�1'1�P�RR St; __ _ Diam ______
.Stlll�ter� �iN 55082 SbUGauze_ _ �� ____— — —_ Length__.._�1�,_�!
Set between ft.and it. FITfINGS_ w
STATIC WATER LEVEL
1� ft below �r�above land surface Date measured 11�3
PUMPING LEVEL(be ow land surface) -
WELL OWNER'S NAME/COMPANY NAME l�g � 3 hrs.pumping g.p.m.
ft.after �0
------ -- -- - �
WF�L HEAD COMPLETION �itewatec �
Well owner's mailing address if different than property owners address indicated above. ���Pitless adapter manufacturer _____ �I_ `
-- _.
� 1 Casing Protection .._ _____ 12 in.above grade
��At-grade(Environmental Wells and Boring ONLY)
GROUTING INFORMATION
Well grouted Yes �No ,�/
Grout material �Neat cemem �__Bento'n�it(e��_J Concrete;/�High Solids Bentonite
from O to �+�+ ft. �/.,��* r�- 'I yds. y�,bags
from � _to_ ��.,ft���R.L l�._�ls./�__J bags :
GEOLOGICAL MATEFIALS COLOR HARDNESS OF FROM TO from _to_______ft '__'�,yda �_ I bags
MATERIAL
NEAREST KNOWN SOURCE OF CONTAMINATIO
C1aV 11� �ft Q 18 -- '�" _teet _._ �� direction _`--"�'''ti�•--`"-����4type
l
Well disinfected upon completion Yes ❑No
C� Csy BOlt IS �JIJ PUMP
�.Not installed Date installed 1 s_����
.�j�JC�ay �$y �ft 17V ;W Manufacturer's name _����____ _________
Model number ._HP_ _�Volts__ ._
�..'lay� � r8� �i�il ��41 GJLJ Length of drop pipe 14!____ ft. Capacity ________._g.p.m.
rq� L� Type: Submersible []LS.Turbine ❑Reciprocating ❑Jet J
� L�� SOlC Z!l! ZW �AB DONED WELLS
Does property have any not in use and not sealed well(s) �'��Yes � . o
VARIANCE
Was a variance granted from the MDH for this well? r�'�.Yes No TN#
WELL CONTRACTOR CERTIRCATION
This well was drilled under my supervision and in accordance with Minnesota Rules.Chapter 4725.
The information contained in[his report is true to the best of my knowledge.
Use a second sheet,if needed j�� �s T
REMARKS,ELEVATION,SOURCE OF DATA,etc. l./Vll .7todola Well Dcilling Co�: 1�• 27172
—_ -__. _--- - — ..—_. --� -
Licensee �sin Name Lic.or Reg.No.
� i`
.,�.�.-_. . ,
� �—^ �
�./�,�_ � - - 12-15-0� ;
Aut orized Representative Signatur�' Date
(�ck Pioo� 11-5�-U3
- - -- - -__ __ _ — -- -- _
LOCAL COPY 6�6 4 61 Name ol Drller Date
HE-01205-08(Rev.5/02)
IC 140-0020 �
� �
rw� � :�y w�-� c � � � .r�,�
617 13th Ave So � Hopkins, Minnesota 55343 � (612) 935 - 3556
il/06/2003
Stodola Wel! Drilling
3841 North Main
St. Bonifacius MN 5537'�
938-21 1 1
REPORT OF WATER ANALYSIS
Lab #: 1026
Our Laboratory reports these analytical resulrs, determined on a sample taken
by CLIENT on 1 1/04/2003 from the following location:
Dan Lang
1180 Garden Ct
Orono,Mn
Unique Weii #696461
Coliform Bac ��ria <1/100 ml
Nitrates Nit►�gen <1.0 mg/I
The results uf these tests indicate that this well is producing water tliat meets the
srandards for F.H.A., V.A., or conventional loans. This report is an analysis for
coliform and nitrate ��nly and does not include analysis of Lead and other
contaminants. (Unles s as specified by clienr).
/
�i 'n City Water Clini�, Inc.
��
�. �
Bil �lrsdale
�
� Lab CeAif cation N 027-053-I 19