HomeMy WebLinkAboutwell info WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO.
���-,�q Na� WELL AND BORING RECORD 6 2 4 9 61
� � y Minnesota Statutes Chapter 1031
� Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed
n.
Q I 8 23 3 ��a ��. ��. 237 12-£�-
House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD
❑ Cable Tool ❑ D iven ❑ Dug
� � ❑ Auger �otary ❑ 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 O
N /
' _I I I I_ ! � ���`r water
_� FROM ft.to R.
�t � -l- -�- -� .� USE � ❑ Monitoring ❑ Heating/Cooling
i � i i .,., omestic
_i_ _a_ _i_ _i_ ❑ Irrigation � Community PWS ❑ Industry/Commercial
i i i i � ❑ Noncommunity PWS ❑ Remedial
w E T � ❑ Environ.Bore Hole
i � i i ❑ Dewatering ❑
k i i r i ,2IM_ie c^U� CASING Drive Shoe? ❑ Yes o HOLE DIAM.
E _i_ _ i_ _� _ _i_ y ❑ Steel ❑ Threaded ❑ Welded
i i i i -�.,j
1 � �rPlastic ❑
� s C 1�
�--1 Mile--{ `+,
CASING DIAMETER WEIGHT
�I PROPERTY OWNER'S NAME �_in.ro_�C�t. '��(�� Ibs./ft. �in.to_�Qt.
4 �{�v�� J h� in.to ft. _ Ibs./ft. G�.in.ro�' '�t.
-v;
Property owner's mailing address if different than well location address indicated above. in.to ft. Ibs./ft. in.to ft.
109 Hackberry Tiili SCREEN OPENHOLE
T ,�. t� A ` Make Johnson from ft.to ft.
Lnl22�Zt$A�� M� �:�J�V TYPQ 9t���t,k�,g-�--PP� Diam.
' SIoUGauze A1 A Length ) f ,�, JL,�� -
c�
Set between ft.and ft. FITTINGS:
STATIC WATER LEVEL
WELL OWNER'S NAME 130 R.�elow ❑ above land surface Date measured Z��8'��
PUMPING LEVEL(below land surface)
Well owner's mailing address if different than property owner's address indicated above. 2�� ft. atter Z hrs.pumping �5 g.p.m.
WE�,L HEAD COMPLETION
�Pitless adapter manufacturer tsh# F avm t n r Model
❑ Casing Protection �12 in.above grade
❑ At-grade(Environmental Wells and Borings ONLY)
GROUTING INFORMATION -
Well grouted? ,�4es ❑ No
HARDNESS OF Grout Material ❑ Neat cement ❑ Bentonite ❑ Concrete High Solids Bentonite
GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO
from�to_�Q_ft. ❑ yds.�'bags
C1$v Ve11`�w .g{�Ft � ZS from_-3i�--to�7-ftn8t��-����!t�
� J J from to ft. ❑ yds. ❑ bags -
t NEARESJT KN�(VN SOURCE OF CONT�AM+INATION
Cila�� �r$y s�l t �5 40 �r•� feet L /'�S� direction�� �� ryp
e
Well disinfected upon completion? ,�4es ❑ No
GRav�I, c co2ored mediurs3 90 125 PUMP
n ❑ Notinstalled Dateinstalled II����'77
C1aylGravel �;r�►y �ediu� 25 ZG� Manufacturer'sname �g���$
r Model number HP_� Volts ���
watersand ;ray �QL� 20 ��� Lengthofdroppipe 160 ft. Capacity g.p.m.
�. �/
Type:,i6l Submersible ❑ L.S.Turbine ❑ Reciprocating ❑ Jet ❑
ABANDONED WELLS
Does property have any not in use and not sealed well(s)? ❑ Yes �No
VAR�ANCE `
Was a variance granted from the MDH for this well? ❑ Yes �Jo 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.
Don StQdola ��il Drillin�-= Ca. - Inc. 2 I72
ice e Business me- r-:� � �or Reg.�
i�
�-- .�_ _� 12-30-99
Authorized Repressrftative Signature Date
Chuck Moore II-8-99
Name of Driller Date
; LOCAL COPY 6��4 9 61 HE-01205-06(Rev.7/98)
- � rw� c�-y w�-� c � � , r�,�.
617 13th Ave So � Hopkins, Minnesota 55343 � (612) 935 - 3556
11/12/1999
Stodola Well Drilling
3841 North Main
St. Boni facius MN 55375
938-21 1 1
REPORT OF WATER ANALYSIS
Lab #: 38135
Our Laboratory reports these analytical results, derermined on a sample taken
by CLIENT on 1 1/09/1999 from the following locarion:
Kevin Schmid
160 Goldenview DR
Orono,Mn
Unique Well #624961
Coli form Bacteria <1/100 ml
Niirates Nitrogen <1.0 mg/1
The resulrs of rhese tesrs indicare thai rhis well is producing water thar meers ihe
siandards for F.H.A., V.A., or convenrional loans. This report is an analysis for
coliform and niirare only and does nor include analysis of Lead and other
coniaminants. (Unless as specified by clieni).
i Wdter Clinic, Inc.
,, ,.
Bil! V�� a
Malyical labora[ory Consulting Engineer
Water Analysis Reagents F3oiler Waler Chemicals
Lab Certifica[ion t1 027-053-I 19