HomeMy WebLinkAboutwell info STATE OF MINNESOTA DEPARTMENT OF HEALTH
1. A, WATER WELL RECORD MlNNESOTA UN19UE WELL NO. ������
. � County ame a
���'�. ~ r,�-��i,.>� Mianeso(a Statrtes/56A.0J-.08 /�Wate'Sarn e
Township Name� ownship Number Range Number Section No. Fraction 4.WELL DEPTH(completed) Date ot Completion
�T. �.t�i 31'._; J..�.��k a �.'� W e._•{ J�� ��.W ;�i-;,/ c./l.� ft. �,-'t r _ .
Nu ell Location or Distance from Road Intersection. S.DRILLING METHOD
� � ❑CableTool O Reverse ❑Driven ❑pug
���`.? }'.lf�� 7..e3SIt?� i Ul1C)� I�i:LI1TT.
� ow exact location d well in sectiortgrid wi "X." Sketch map of well locatan. ❑HollowNod ❑Air ❑Bortd ❑
N
i Addi[ion Name a�l Ro[ary ❑Jetttd ❑Power�Auger �
'_r' ti_ _ �.","�-..�-^
�" i � ;� � 6.DRILLING FLUID
� h�' �
I I i 1 �
--�' '�- - �_ Black Number �,".
W � � � E t� 7. USE
� �omestic ❑Monitoring ❑Heat Pump
_1_ _1_ _'_ S' � JP
I � � � Lot Number ' ��- ❑Irrigation �O Public ❑Industry
h mi. �
� � � > �Test Well {7 Municipal ❑Commercial
--�- - - -r'- � ❑AirConditioning ❑
1
��,�1e'—� 8.CASING �(� �HOLE DIAM.
2.PROPERTY OWNER'S NAME Mailing Address if diffe�ent than property address r HEI�:�ove/�lo� ��
�Q Black �'Q'hreaded
indicated above. Surtace (c.
�,�3.C:.� t..'�L'.1.ICla O Galv. O Weldcd
F'�-3 ��"�Z t���� �t"�� ❑plastic Drive Shce? Yes�' No—
f...,.. � ,�j �y 1�c: , �7�
�p '�"'' • �i:?.5 <
�.�^^��t �...�k in.to�__6 St�ft. Weight
�Ibs./fL �n. toi..-t-.1t.
3. FORMATION LOG COLOR HARDNESS OF FROM TO in.ro (t. Weight Ibs./ft. �n. to�t.
FORMATION
in.to tL Weigh[ Ibs./tt. —in. to�t.
L..Z.ii�% �� ��= 9.SCREEN Or�open hole
J�u-y�i� (rom ft.to. tt.
Make
J,
�txl�C.i �:.i �s�U Type .fi`a�"�1" j �_�r' °-itE�E'�� Diam. ,t'�
ry 1
SIoVGauze 1� Length �
` 36� L�.� FITTINGS:
�,yZ1T1' J14'TC7 L{_r c���tr' Set between ft.and it.
� t t 10.,��'ATIC WATER LEVFL t' t,
� j[ L.�LGt[' i� l�rl� /:t S �7-�'�'7�,
j (L O'bebw ❑above Da[e Measured
land surface
��" I t. PUMPING LEVEL(below land surfare)
�.1CIy 'ri i.� ��3 b
��� ft.a(ter '� hrs.pumping "t� g.p.m.
(t.after hrs.pumping g.p.m.
``M31�'`7"'���r`r� '�a '��= 12. HEAD WELL COMPLETION
�]Pitless adapter manufacturer ���1 ��� � �'f��'-'� Model
❑Basement oftxt �lt leas[12"above gruund
❑Plastic casing protection
1�3.WELLGROUTED? ]}SYes ❑No
❑Neat Cement ❑Bentonite � �'���-�43t g=��;'b-�112
Grout material from m tt.cu.yds.
'� 14. NEAREST SOURCES OF POSSIBLE CONTAMINATION
fee[ direc[ion � type _
Well disinfected upon completion? � �es ❑No -
15. P[JMP
Date installed ���j�"�`-s ❑Not installtd
Manufacwrer's name �-�' *���1��-
Model number HP �4 ��iVolts •--%�'
Length of drop pipe �t���• tL Capacity �L g.p.m.
MatEtial of drop pipe -�-H U'>>i V
tr
Type:�]Submersible ❑L.S.Turbine L7 Reciprocating
OJet ❑Centri(ugal L]
16. ABANDONED WELLS ,
Unused well on property? O Yes ❑]�o
Use a serond sheet,iJ needed `.xaled O Permanent ❑ Temporary ❑ Nol sealed
17. REMARKS,ELEVATION,SOURCE OF DATA,etc.
18.WATER WELL CONTRACTOR CERTIFICATION
This well was drilled under my jurisdic[ion and this report is true to the best of my
knowledge and beliet.
't�.i�v ��`��Di;i,r�, tt�'"L,r. �Ili�i CG.� IItiC:. :�11��
7 Lrcensee Business Name License No.
Addressl:�-.'i'-C1 �.'i..C.����:.-�`✓ � i L�L`}S.? �1J_,flt1. :.t;.��.3ltJ
s
�:����'..
Signed9'"��_.�_ �-�� Datr �_'try��`�
Au�ortzed Representattue ��
F'4.,�.���.C'�«i 1�.�� Date Z''fi"�..sy.�t
Name oJDriller
,... :-., .� 5/74 30M
�.. }_ �,... ,; �(' 's� 7/76 30M
LOC<;L_ COPY `r , ;
`J HE•01205-03(Rev.9/88) ziez io�M
r
7�liic �� i�'�/It ���'r1,C� �ir,C.
617 13th AVE. 50. • HOPKINS, MINNESOTA 55343 • 935-3556
Stodola Well Drilling August 13, 1990
15306 Highway 7
Minnetonka, Mn. 55345
REPORT OF WATER ANALYSIS
Creceived irom you 1 August 7� 1990
Our laboratory reports th�s�analytical reaults, determined on a sample �y J on
s
well water
from
Erick Celms
1535 Highwood Lane
Orono, Mn.
Unique Well # 466475
Bacteria (Coliform group) less than 1/100 ml
Nitrate nitrogen less than 0.1 mg/1
conductivity, Specific 480. micromho
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.
a er Clinic, Inc.
Bill Van Ar ale
Analytic�l I�borNory Consul:inp�npin��r
Wal�r�n�lytlt r��p�nl• Boil�r wal�r ch�mlcals
17.1 partslmillion�quals 1.0 pr�inigallon
.��n�� v� n a mw.av�n fA..!M 1 fLn 1 N- ��ur.�n
MW11�WIfLL �LLL I�LCl/��L
� � ' ' 1. LOCATION Of YELI M(..Ei etank NiQnoE Mna,�„�,)N0.
co��cr N..� Herule in
Towns�ip Xaw� Tavns�ip Nwber Rangt Nu�ber S�ction No. Fr�ction �. YELL UEPTN (to�pl�Gd) Dat� s�ai�d
N E 4 4 af M� � �
Orono 117 0� 23 Y� 07 SW SW SE „2� � � +c. (;� �� c���
s
Nwnertc�l Str��t Addnss and Ctty of Ytll Loc�tlon or Dtitanct fro� Ro�d 5. DRILLIN6 METH00 (1f knarn)
Intenectlon 1[]Gbl• tool 1�Wv�rs� 7[�CNvtn 1Ln Duq
1535 Highwood Lane Orono, NIIV. �D�>>�� s0�+� ep e��a ��p
�Rotary 6�JKtW �Ppwr Auy�r
Snor exact locatlon of w�ll
(in s�ctton gNd rttn 'X') Sbtt� yp of rwil loealloe 6. OBSTRUCTIONS
M � INtI oescruct�d Q s (�No
_ � _ _ _ ._ _. � �� Ob:truccloes n�owd�r�s ❑No tt oescruetlon: c�nnoe b�
, . ' � •�e�`' W� r�wov�d. contut !nN
M - • - • -� -�- � - E � �� fc� i��liny.
` �,,�e
` ; : T ' �. �sE
- ' ' ,,.:. 1�oo..:c�� �lbn�coHM ep Huc �000
_' J�
' ' ; � . � 2�IrNgation 5�Public �]Industry
.. . _.�.. ..,
� S 3p r..t wii �w��c�o.i iap w�.n�.i
�---1 .aL�--i 7Q A1�ConHtlonin� 11(]
2. PR07ERTY OMNER'S NAlIE Ma111ng Addr�ss tf dlffannt th�n 8. SIN6(5)
property �ddr�ss tndlut�d abow 1 luk �Thr��dW ]0
�..�
Erick Celms SAME �+'•. SCl w'a.d
3p ri..c�� q]sa��i.:: sa.i
HARONESS OF �_��. � 236 ft.
3. FORMATIOM LOG COLOR FONINTION FROM TO
If not known. tndicate forwatton loy fro� n�w w�ll or n�arpy rell. 1n. W ft.
Drift 0 240' 9.�s��.a .»it rro. 236.t. �, 240 rc.
(f f knrnm)
❑Op�n Nol• f►ro�_ft. W_ ft.
10. STATIC YATEU LEYE
�_ft. b�lor ��pow
l��d ur �t� Dat� p��sund -1 I
11. YELLHEAD COIilETION
l0 Pitt�ss Adapt�r �Fp�ad WH�d
L '�
2Q 8�s�nt olts�t 1c�( � _C�i<:,�,�r -�r t..�1
3p wii P�c T
16. REMARKS, ELEYATION, SOURCE OF DATA - CASINGS REMpYEO. CASIN6S PENFOMTED, ETC.
12.�RO�ITIN6 INFORlNTION
h;�INat Cew�nt 2�Btetpett� �
Grout 4" Well Approx. 240' Deep wo� ..aN�l frwd.�.Qw,� re. ��. ya:
20 Bags Cement •
22 Lbs. Bentonite — —
17. NE1lREST SOURCES Of COMTANINATION
2 Men, Labor, Rig and Cement Grout Ptmlp _ re�e a,��t�� tY,�
IM11 dtsinf�ct�d b�fort s�a11nq7 (]T�s
11. PUlli �q�r�0 Not-PnHnt
TYD�: 1�Sub�nlbl• L.S. Tubine :�Reciproc�tinq
�J�t �GntHfug�l EQ
15. EXISTING IIELLS (Pt�as� sluteh louttan of aMndon�d and
aetiv� w�llf 1n rwrkt 1on or on back.)
Oth�r unufW iwll(t) oe proptrty7 �Y�s No
AWndoned: �/tr�anent �Twporary � t �ltd
17. W1TER MEII COIfTRACTORS CENTIF1GTIpl
This w�ll ws s��1W und�r �y Jurisdtcifon and this report
is tru� W the btst of q knorl�dq� anA b�ll�f.
DON STODOLA WELL DRILLING CO. , INC.
LiC�nsN Su21Mff NaM UCfnff Nq,�l��
L
Addr�ss 15306 . 7 inn tonka MN. 5 345
Sty -- D�t� — —
Mark �tnrjnl a Wt�
FF1CIAl ABANppNED VELL RECOIIO (May be us�d for Vrop�rty Transt�r) Nawe o1 Drill�r
IYP�IT.Yly dlLd MITB D�D