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Home My WebLink Aboutwell info r E - WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIOUE WELL NO. CounlyName WELL AND BORING RECORD ,� Minnesota Statutes Chapter 103! � � �m '�� ' Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed fl. �,. ��. �,. 6� 7-17-OZ House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILIING METHOD [] Cable Tool ❑ Driven [] Dug I-1 Auger �Rotary ❑ Jetted ' Show exact location of weli in section grid with"X". Sk�tch map of well location. f 1 _ ..__ f N_� q j��y Showing property lines, �bvitdings. DRILLING FLUID WELL HYDROFRACTURED? ❑YES �'NO N �entonite _ � � �_ ��uj z �� FROM n.to_ n. ;- -;- -,-- -, �u .,�r USE ❑ Monitoring ❑ Heating/Cooling i i i i .___- _�� `,Domestic ❑ Communit PWS _i_ _a_ _�_ _i_ ❑ Irrigation Y ❑ Industry/Commercial i � i i ❑ Noncommunity PWS ❑ Remedial yy E T ❑ Environ.Bore Hole f 7 Dewatering ❑ :. i i i i I -- -r -7- -r- -r � i i i ��M e � CASING Drive Shoe? �Yes ❑ No HOLE DIAM. � z . _i i i _�_ f �1 Steel �'Threaded — ❑ Welded - � � � � 1 ❑ Plastic �� S �—,M,�e� � � �,t �� CASING DIAMETER WEIGHT ` PROPERTY OWNER'S NAME �____ in.to_��'�ft. ��___. _--Ibs./tt. �__in.to�_�ft � D�Q� 3.h��$QQ -- in.to— ft Ibs./ft. �T! ��V � Property owner's mailing address if different than well bcation address indicated above. .,... ..in.to ft. ______.__ Ibs./ft. in.to__ ft. i: 25h2 E 9800 S�LtC� SCREEN OPENHOLE Sanap� VT C}+4Q(3� Make.�flhjj$�j; from ft.to ft. ./ � TYPe—$��_�—_._.—Diam. �---- Slot/Gauze _•p.�__. Length�_}.____�_� c Set between v ft.and ft. FITfINGS� STATIC WATER LEVEL � WELL OWNER'S NAME ��__. - ft. C�Delow ❑ above land surface Date measured 7—i 7=� PUMPING LEVEL(below land surface) Well owner's mailing address if different than property owner's address indicated above. __2��_ ft. after_�a.�_hrs.pumping�D._. _g.p.m. WELL HEAD COMPLETION � ` �Pitless adapter manufacturer Model � . �i�l��-f!i�7-8�t..'� - — _ -❑ Casing Protection _ __ __ _ �2 in.above grade ❑ A!-grade(Environmental Wells and Borings ONLY) �` GROUTING INFORMATION Well grouted? �Yes ❑ No GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO Grout Material ❑ Neat cement �] Bentonite ❑ Concrete f�CHigh Solids Bentonite MATERIAL from__Q___to�� ft. ��___ ❑ yds.�/bags � from_ to_._ _ft. ___ ❑ yds. ❑ bags t�'�}$Q��, 1}�,$C� $Q�t Q 3 from._ to ft. _ ❑ yds. ❑ bags NEAREST KNOWN SOURCE OF CONTAMINATION Cl�y gray soft J 9d -- ,� "�.�- feet _.____.� _diredion __ type Well disinfected upon completion? t�'�Yes ❑ No clay/sand gray soft 90 I6fl PUMP : ❑ Not installed Date installed__.__ _�d�� L�.C1� sand gray ��ft �6� 170 Manufacturer'sname __ �C��.4_ — — _ Modetnumber��.,J��_��HP .�� Volts . _ � clay/sand gcay soft 17f? 2S7 Lengthofdroppipe s_��_ _ _ ft Capacity _ __ gp.m. ` coarse Type: ' ubmersible �_ lS Turbine ❑ Reciprocating ❑ Jet ❑ . sandstc�ne xhite �oft 257 268 ABANDONED WELLS Does property have any not in use and not sealed well(s)? C Yes C�No VARIANCE Was a variance granted from the MDH for this well? ❑ Yes o TN# WELL CONTRACTOR CERTIRCATION i= = Use a second sheet,il needed This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. ��" The information contained in this report is Vue to the best of my knowledge. REMARKS,ELEVATION,SOURCE OF DATA,etc. Don Stodola Well Drilling Co. , inc. 2 172 � icen �e Business Name . L� -or Reg.No. �� _ i L%�S�' ut orized Representative ignature ' �'�at��_�� Chuck Moore 7-i7-02 ---- --- � �q Name of Driller Date LOCAL COPY `�-� � r �� T HE-01205-07(Rev.2/99) IC#140-0020 � . .. rw� c�-y w�� c � � , r�,� 617 13th Ave So • Hopkins, Minnesota 55343 • (612) 935 - 3556 07/22/2002 Siodola INell Drilling 3841 North Main Sr. Boni facius MN 55375 938-21 1 1 REPORT OF WATER ANALYSIS Lab #: 719 Our Laboratory reports chese analytical results, determined on a sumple taken by CLIENT on 07/17/2002 from the following location: Dave Thompson 3262 N. Shore Dr. Orono,Mn Unique Well#677864 Coliform Bacteria <1/100 ml Nitrutes Nitrogen <1.0 mg/1 The resulCs of these tesrs indicace that this well is producing waier that meets the stundards for F.H.A., V.A., or conventional loans. This repori is an analysis for coliform and nitrate only and does noc include analysis of Lead and other contaminants. (Unless as speci�ed by client). Ci Water Clinic, Inc. . Bill le Lab Certification#027-053-I 19