HomeMy WebLinkAboutWell info .t. .
� _ *w�.
x
WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO.
County Name WELL AND BORING RECORD 6 7 3 8 6 3
He�ne in Minnesota Sfatutes Chapter 103i
Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed
R.
Ocano 21$ 23 32 . �. �. 29Q 1-i5-02
House Number,Street Name,City.and Zip Code ot Well Location or Fire Number DRILLING METHOD
❑ Cable Tool ❑ riven '7 Dug
S75 �okesh Rd Qr�'�'1� 55359 ❑ Auger �Rotary i� Jetted
Show exact location of well in section grid with"X". Sketch map of well location. f7
Showing property lines,
roads and buildings. DRILLWG FLUID WELL HYDROFRACTURED? ❑YES NO
N auper gel-x
i , i i FROM_ __ft.to __ ft.
_i_ _i_ _i_ __
USE ❑ Monitoring ❑ Heating/Cooling �
i � � � �l Domestic
_i_ _�_ _a_ _i_ �. ❑ Irrigation � Community PWS ❑ Industry/Commercial
i i i i � ❑ Noncommuniry PWS ❑ Remedial
W E T� �~� - t�' f7 Environ.Bore Hole _ _--
i � � i I '� ❑ Dewatering
i i i -r '/ZM1e � � '`� CASING Drive Shce? es ❑ No HOLE DIAM.
_, i _L_ _i_ � �� � �1 Steel �Threaded — ❑ Welded
i - i- i i �� �
❑ Plastic ' O
�1 Mile� :)i�,�
!�� CASIN�DIAMETER ��� WEIGHT �� � ��� �A
PROPE TY OWNER'S NAME v
Lp� T in.to ,,. Ibs./ft. ��i .to ft.
L$(� SCll�t� G�d�t' ln�'s _ in.to fl. IbsJft `�y�?�in.to ff. ��
Pro erty owner's mailing address if different than well location address indicated above. __in.to ft. Ibs./ft. „) /i��$ _ft. 9 0
2t�305 Lakeeiew Ave SCREEN OPEN HOLE
Eaceisior, MN 55331 Make from 25�i n.to 290 h.
Type .Diam.
SIoUGauze Length
Set between ft.and ft. FITTINGS:
STATIC WAtTER LEVEL '
WELL OWNER'S NAME 12Y ft.l�below ❑ above land sur�ace Date measured__ '�_� 5— 2
PUMPING LEVEL(below land surface)
Well owner's mailing address if different than property owner's address indicated above. �__�,_$Q_ __ft. atter_ ��__hrs.pumping �__g.p.m.
WELL HEAD COMPLETION �hi t ewa L e r
^ ❑ Pitless adapter manufacturer_ ______ ____ Model __ _
� C7 Casing Protection___ ___. _ ❑ 12 in.above grade
❑ At-grade(Environmental Wells and Borings ONLY)
GROUTING WFORMA�N
Well grouted? Yes r7 No
GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO Grout Material [1 Neat cement ❑ Bentonite ❑ Concrete �High Solids Bentonite
MATERIAL
from_ _ �_to__._3_Q_ft. � _�.__ ❑ yds. �bags
from__�_to�_�ft. Q�� O�slq bags
from _ to_ ft. ❑ yds. ❑ bags
NEAREST KNOWN SOURCE OF CONTA�tAINATlO�
�--����� feet �� direction
clay gray �roft � 25 lo '_- ' ' � ' � --n��
Well disinfected upon completion? '�Yes ❑ No �
gravellcl8y gray aoft �00 I55 PUMP
r 4 Cl Not installed Date installed ��J�O�
Cl8yf8j-�t O�gJ "'��lf 15� 2�1 Manufacturer'sname ���ffi����
C� �C� Model number HP � Volis �Q
granel/clay grap �aedium 21I 245 . --!- y?-- --
Length of drop pipe�J�,y l ____. ft. Capacity g.p.m.
sandstone/shsl g[$y�� �en 2�'S �fA� Type ❑ Submersible C7 LS.Turbine ❑ Reciprocating ❑ Jet ❑ ___
G7
�� u� ABANDONED WELLS
Does property have any not in use and not sealed well(s)? ❑ Yes 1�No
VARIANCE
Was a variance granted from Ihe MDH tor this well? ❑ Yes � No TN#
WELL CONTRACTOR CERTIFICATION
Use a secondsheet,i/needed This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725.
REMARKS,ELEVATION,SOURCE OF DATA,eta The intormation comained in this report is true to the best of my knowledge.
Don Stodol$ W�II Drilling Co. , Iuc. 2 172
-- -_ -
�Li�ss Na.......ii%.._. --' :or Reg.No. ----
�"'
�C 9-25-42
Authonzed Represent6tive SignaNre Date
Duan e Mathe�ra 1-15-fl2
� Name ol Driller Date
LOCAL COPY 6 7 3 8 6 3 HE-01205-07(Rev.?J99)
IC#140-0020
� > r..
-rw�. c�-y w�-� c � � , r�,�.
617 13th Ave So • Hopkins, Minnesota 55343 • (612) 935 - 3556
01/17/2002
Siodola Well Drilling
3841 North Main
St. Bonifacius MN 55375
938-211 l
REPORT OF WATER ANALYSIS
Lab #: 57
Our Laboratory reports ihese analytical resulis, deCermined on a sample taken
by CLIENT on O1/15/2002 from the following location:
575 Kokesh Rd
Orono,Mn
Unique Well#673863
Coliform Bacteria <1/100 ml
Nitrates Nitrogen <1.0 mg/1
The resulcs of ihese tesis indicate that this well is producing water that meets rhe
standards for F.H.A., V.A., or conventional loans. This report is an analysis for
coliform anc!nitrate only and does not include analysis of Lead and other
contaminants. (Unless as speci�ed by client).
� 'ry Water Clinic, Inc.
..\\..\
\� .
\�
B�ll dale
' Lab Cratilication H 027A53-119