HomeMy WebLinkAboutwell info h'� � STATE OF MINNESOTA DEPARTMENT OF HEALTN T
�3 t.LocnT�orr oF we�t WATER WELL RECORD ,titin�NFso�a uH�eur�wF�t.c No. A����� �
County Name `�
� u�� iNinnesota Statules 156AAL-.OH for Wa(rr Samp(e
i1�iII� 1�
Township Name Township Number Range Number Section No. Fraction �1.WELL UEPTH(compleled) Uate of Completion
� �'�I`�=�1'4�'t 117 'N r:3 y� ;:! R'�,: t�r. :�k; v� jr�3y (�. �^-'i2�7i
Numerical Street Address and Ciry of Well Location or Distance from Road Intersection. 5. DRILLING METHOD
1!jii �.,C.�i.�+;:. �+.��LCi. P�i>���l�L`�� � 1,.��(.7� M3..�' . ❑Cable'lool ❑Reverse ❑Dr�QF
lJl��
' Show exact loca[ion of well in section grid with"X." Sketch map o(w�ell location. �H�11O`9�`� �A'� //��
- N ..�, �� A��'n�
� i i Addition Name �_! � C�2otary ❑Jetted ❑Pou K r
�yhe`: --r--'�- -1 -1- lti;�' 6.DRILLING FLUID
i ' i i
__1_ ___ _ �_ BlockNumber .
W i I E 7. USE �1
� .��;., �y'Domestic ❑M�tbri� r ❑Heat Pump
I �1 i � � Lot Number "� � .• ❑lrrigation ❑Public � J O Industry
' '/_-mi. , � �
� \ ,/� O Test Well ❑Municipal O Commercial
--�- �- ; -r- I �'� 'Y, ,�'Jl ❑Air Conditioning O
� i r!
�—1 milr—� � � ���� ���' 8.CASING HOLE UTAM.
2.PROPERTY OWNER'S NAME Mailin�Address if different[han property address �g�ack HEIGH7':Above/Below
�Threaded
��� � �.,,���.� ��� indica[ed above. Sur(ace (t.
❑Galv. ❑Welded
<<;��,� �"����j �1,�? Drive Shce? Yes r' No—
� ❑Nlastic ❑ l�
;J''.,,, p,�� � ti
�i �� �,; �� ��
�. 7 �'iJW�� iur�� -�� .{) � ia to�tL Weight��-IbsJft. '-r n. to �t.
3. FORMATION L(� COLOR HARDNESS OF p'NOM TO in.to (t. Weight IbsJtt. ��n. ro=�olt.
FOKMATION
in.to (L Weight IbsJft. �n. to—Jt.
. ._� 9.SCREEN Or opea,,h�q�l� .. .�,�
(rum�tt.to ��}t' ft.
Make
�.a,��- �'y,� Diam.
,^
SIoVGauze Length FITT[NGS ���
� s
,p,': .-�f Sel between (t.and (t.
��� 10. STATIC WA'1'ER LEVEL
. f... .� `�t-f- '7C, � �t% (t.�bclow ❑abuve Date Measured L������
land sur(are
;�� I1. PUMPING LEVEL(below land surface)
�,' �� �E (t.atter '� hrs.pumping 1�.� g.p.m. j�
�', `<
ft.after hrs.pumpmg g.p.m.
� ._; I'L.yHEAD WELL COMPLETION ""`
�,�^. 16�Pitless adapter manufacturer�17�.P �lt�' M�uiel
�.-�. '.O Bas-ement,o(fset �"At least 1'2"aboce ground
❑Plastic casfng protecuon �'�
e;;:`,::
i^�+':
ty�, 13.WELLGROL'TEU? .�'l' Yes ❑No :x;+
.�� �`�g' '[i�i: t?Y..y^� m
� ❑Nea�Cement ❑Bentonite ���C'�'L I � �
Grout material from to (l.cu.yds. _ ..�
r
�
� ; ;
14. NF:AREST SOURCES OF POSSIBLE CONTAM[NATION ��
�
- (eet direction type
� Well disin(ected upon complrtion? d3Yes ❑No
lo. NUMN
Uate installed �^}-�-'��� ❑Not installed �:��
Manufacturer's name �E^�-� i
Model number y HP�i.�Volts�'� �
I.ength of drop pipe +«-��� ft. C apacity [� 8 P.m. '�=
Material of drop pipe ��� ��'� ��'?
Type: �ubmersible ❑L.S.Turbine O Heciprocating 'k„'�
`�
❑Jet ❑Centrifagal �O
z_;;�
16. AI3ANDONED WELLS -���
Unused well on property? ❑Yes �No
Use a serond sheef,iJ needed Sealed ❑ Permanent ❑ Temporary ❑ No�sraled
17.REMAHKS,ELEVATION,SOURCE OF DATA,etc.
• I8.WATER WELL CONTRACTOR CERTffICAT10N
This well was drilled under my jurisdiction and lhis report is true to the best o(my
knowledge and belief.
� il�/lA/1J1�1 �11'1".af.i�-� 1.�1r:•�1'N Lhf.� 11.Y1..r �-��/L
Lirensee Business Name Lirense No.
Address 1.�3{)Ei Hzc;I1�'��y �s ?'r �,�:.t� I�3t'1. =i�3�5
s+g��""' � "'�.,s,__�-+„ - '�.� Date 2=11-91
.�t.�L, Authorized Ftepresen(atioe
�`�. �, ��1(�7'�'i�.i",'!'j Date i''"'��-"���
Name ojDriller
C �-} 5/74 30M
LOCAL COPY � � J� lJ � '�'s 3°"'
7/78 30M
HE-01205-03(Rev.9/88) 2/82 tOM
.
:
?u�l�c �� Z�Jate�t ���, 7ir,c,
61713TH AVE.SO. • HOPKINS.MINNESOTA 55343 • 935-3556
Stodola Well Drilling February 27� 1991
15306 Highway 7
Minnetonka, Mn. 55345
REPORT OF WATER ANALYSIS
Our laboratory repoMs th�s�analyticsl rasults,datormined on a sampl� (��c�ived I�om you\ o� February 12� l�l
\ taM�fy-os J
well water
fran
Scott Udell
1290 Loma Linda Ave�
Orono, Mn. �
Unique Well # 475709
Bacteria (Coliform group) less than 1/100 ml
Nitrate nitrogen less than 0.1 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.
� 't ater Clinic, Inc.
.\\
Analytie�l l�bor�tory Con:ultinq enpineer
Wal�r analysis r�ap�nls Bil v Boiler waltr chem�uls
17.1 parlslmfllJon equals 1.0 grainlysllo�