HomeMy WebLinkAboutwell info WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO.
�o«�Y N3�+� WELL RECORD �4 $5 6 2
�����='1�} Minnesota Statutes Chapter 1031
Township Name Township No. � Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed
ft.
�T'OYlt) 1�fi �.� i(; '_+ •
c
v. v. �a �.� 1—G�—�_:
Numerical Street Address and City of Well Location or Fire Number DRILLING METHOD
� ❑ Cable Tool ❑ Driven ❑ Dug
�.3.? ��LL2I�1�: �'c3x1T'i Rt3c�C� C)x'�7I2C%� MTI. J°J �� ❑ Auger �i Rotary ❑ Jetled
Show exact location of well in section grid with"X". Sketch map of well location. ❑
��� .� Showing property lines,
N �� roads and buildings. DRILLING FLUID
I i ' � ��J'�r
__r__�_ _i _1_ ' �S
� , �r�
i � i i ,USE �Domestic ❑ Monitoring � Heating/Cooling
'-a- --- �- �- ❑ Industry/Commercial
yy � ; � E GG! ❑ Irrigation ❑ Public ❑ Remedial
' T ❑ Test Well ❑ Dewatering
_1_ _1_ __ 1_ I ❑
� I �
F•m,. CASING Drive Shoe? ❑ Yes ❑ No HOLE DIAM.
--�- � C Steel ❑ Threaded ❑ Welded
� �- -r- I ,�wG LL
1 C�Plastic �
�1 milr�
CASING DIAMETER WEIGHT
PROPERTY OWNER'S NAME � �� -� -
in.to �. Ibs./ft. _1- ._a�/(p�..-,(r,
'�111t�iSDI'I�� �VuZC�r� --- in.to_ ft. Ibs./ft. _�'i_lryt4�;,_ft.
Mailing address if different than property address indicated above. in.to ft. Ibs./ft. �in.to ft.
F7.j�3 Highpointe Ori��� SCREEN�.����_ OPEN HOLE
8���+�,�,�+ �`����4��. Make '__����_����� from R.to ft.
I K�l. �LC�ll 11
Type Diam.
SIoUGauze �`� Length
Set between ��� ft.and �d�. FITTINGS:
HARDNESS OF STATIC WATER LEVEL
GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO �C� ft. �below ❑ above land surtace Date measured c;—�S— J
���x � C't t 1(;,PUMPING LEVEL(belo�laafterurface) hrs.pumping g.p.m.
WELL HEAD COMPLETION
r�'s1�IIG ri 1��!� }(�T❑ pitless adapter manufacturer__�1�1 Model
❑ Casing Protection ❑ 12 in.above grade
GROUTING INFORMATION
Well grouted? J�,Yes ❑ No
Grout Material ❑ Neat cement �Bentonite
from � to ��� ft. -� ❑ yds. ❑Xbags
from to ft. ❑ yds. ❑ bags
from to tt. ❑ yds. ❑ bags
NEAREST KNOWN SOURCE OF C,OCNTAMINATION �
�U�_� feet t,.. ��_'r,. ! direction ���F�%%C type
Well disinfected upon completion7 C�Yes ❑ No
PUMP
❑ Not installed Date installed �-..�,-�[;.
Manufacturer's name
Modelnumber It�+-S �` HP j•�-%Volts 1���'
Length of drop pipe �4 ft. Capacity LU g.p.m.
Pressure Tank Capacity �y����
Type: L�ubmersible ❑ LS.Turbine ❑ Reciprocating ❑ Jet ❑
ABANDONED WELLS
Does property have any not in use and not sealed well(s)? ❑ Yes �QVo
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,if needed �� �,�'t�}}j,�(:i � �,]'�JI�` �j�, I�'� 2"��j�
REMARKS,ELEVATION,SOUI�i�IOF DAT et . Licensee eusiness Name Lic.or Reg.No.
H���� �
i �"_�- 1.—'l.?-9S
..�.�`"%� � .'; ,
� AuthorizedRepresentabve�8ignature� Date
�Yeca �ii�y %--23-9�
Name ol Driller Date
' ��"'. `'�PY 5 4 8 5 6 2 HE-01205-04(Rev.S/92)
. � • �I'zvin Cit �Nater Clinic, Inc.
y
61713th Ave So • Hopkins,Minnesota 55343 • (612)935-3556
02/24/1995
Stodola Well Driliing
15306 Hwy 7
Minnetonka MN 55345
938-2111
REPORT OF WATER ANALYSLS
Lab�: 25199
Our Laboratory reports these analytical results, determined on a sarriple taken ''
by CLIENT on 02/22/1995 from the following location:
Anthony Vlfeidera
836 Hunt Farm Rd
Orono�Mn
Unique*b48562
Collform Bacteria <1 J100 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
e as spe�ified by client).
\
'ry Water Clinic, Inc.
;,
Bi :� ale
,
Bri
noa�yical ubonwry Cm�Bo�r
Wuer Aodysi�Re�ge�s Boilar Wa/er Chemiwb
L�b Cat�"oati�i 027-033-119