HomeMy WebLinkAboutwell info WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO.
CountyName WELL AND BORING RECORD 6 4 315 7
Henne�in Minnesota Statutes Chapter f03/
Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) � Date Work Completed
Orono I17 23 09 ,,, ,, ,. 110' tt 2-25-00
House Number,Street Name,City,and Zip Code of Well Location or Fire Number DPILLING METHOD
2865 L�Ltle OtChsrd �iap Ozo1� , Mn 553 6 ❑ AugerTool ❑ Driven ❑ Dug
�Rotary ❑ Jetted
Show exact location of well in section grid with"X". Sketch map of well location. ❑
Showing property li s,
�lopd�and buildia�s. DRILLING FLUID WELL HYDROFRACTURED? p YES ❑NO
- N - L Lt..- ,� BeaLonite
i � i i X FROM fl.to ft.
_ _i_ _i_ _i
USE ❑ Monitoring ❑ HeatingiCooling
i � � i �Domestic ❑ Communi PWS
-�- -a- -�'- -�-
❑ Irrigation ty ❑ Industry/Commercial
i � � i ❑ Noncommunity PWS ❑ Remedial
yy E T ❑ Environ.Bore Hole
� i i i �� ❑ Dewatering ❑
i i i -r '2IMia �'�"^� � CASING Drive Shoe? ❑ Yes ❑ No HOLE DIAM.
_, , _, _ _,_ I I '•-- �� ❑ Steel ❑ Threaded ❑ Welded
i - i- i i �
/� �i Plastic ❑
�-1 M�ile-� �.✓
CASING D�METER �O� WEIGHT
PROPERTY OWNER'S NAME �} ;,,.to K. SD$Z 1 ,bs.,n. 7 ;�,�8 �
PARAGE31►I DBS I GNERS b BLD $���.�o h. ibs.in. ���.�011 t1�.
Property owner's mailing address if different than well location address indicated above. in.to ft. Ibs./ft. in.to ft.
3550 Fainra? I.ane SCREEN __ _ OPENHOLE
Miaaetoaka, I�. 55305 Mak�ohnaaon 1 from f�.�o n.
Type ta A eQa Steei Diam.
SIoUGauz� Length
�
Set between � � ft.and � ft. FITTINGS �
- STATIC WATER LEVEL
WELL OWNER'S NAME �5� ft. C+�below ❑ above land surface Date measured ��1 S�0
PUMPING LE1VEL(below land surface)
Well owner's mailing address if different than property owner's address indicated above. ��1 ft. after � hrs.pumping 30 g.p.m.
WELL HEAD COMPLETION
❑ Pitless adapter manufacturer Model
❑ Casing Protection ❑ 12 in.above grade
❑ At-grade(Environmental Wells and Borings ONLY)
GROUTING INFORMATyION
Well grouted? QRes G No
HARDNESS OF Grout Material ❑ Neat c ent ❑ Bent ❑ Concrete igh Solids Bentonite
GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO �' °�'b ][
from to ft. ❑ yds.a bags
Lakef i 11 ----- S 0' 1� from co n. ❑ Yas. ❑ bags
from to tt. ❑ yds. ❑ bags
1 .y NEARF��y p+�y�/MSOURCE OF CONT�/�v�J/Nyf N .r �J ?"(C,//
Ciay ge110 3 10 y� ✓ !J feet Yf/`��s/ direction ��type
Well disinfected upon completion? LTYes ❑ No�/� �Sr� �.7
Clay Grep S 22 102 PUMP �G �
Sa�� T8n S 102 1 1� ❑ Not installed Date installed �_�O_O4
Manufacturer's name �VA P'Q
--�-T�-=-�
Modelnumber J�QSQ� _ HP�_ Volts 7�n
Length of drop pipe 04 ft. Capacity g.p.m.
Type: ❑ Submersible 17 LS.Turbine ❑ Reciprocating ❑ Jet ❑
ABANDONED 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? ❑ Yes �Tlo 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 reporl is true to the best of my knowledge.
DON STODOLai ie1ELL DRILLING G0. • INC.
� Licensee Bu �ess Nam � d�ia.or�eg.No.'1�'1 j 7 2
� ._�r...._ �_ -
Authorized Representative Signature Date
g-r...�t.pt;b� 2_z s_nn
Name o/ �il/e� a e
LOCAL COPY 6 4 315 7 HE-01205-07(Rev.2/99)
� . . .,
rw� c�y w�� c � � , l�.
617 13th Ave So � Hopkins, Minnesota 55343 � (612) 935 - 3556
02/18/2000
Stodola Well Drilling
3841 North Main
St. Bonifacius MN 55375
938-21 1 1
REPORT OF WATER ANALYSIS
Lab #: 38559
Our Laboraiory reports rhese analytical results, determined on a sample taken
by CLIENT on 02/1 S/2000 from ihe following location:
Paragon Design
2865 Little Orchard Way
Orono,Mn
Unique Well #643157
Coliform Bacreria <1/100 ml
Nitrares Nitrogen <1.0 mg/1
The resulis of rhese tesrs indicate that rhis well is producing water ihat meeis 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 as specified by client).
i \� Water Clinic, Inc.
����,�
Bill V1�n�i4 afe
a
Analyical laboratory Consultmg Engineer
Water Malysis ReagenL4 Boilcr Waler Chemicals
Lab Certification k 027-053-119