HomeMy WebLinkAboutwell info STATE OF MINNESOTA DEPARTMENT OF HEALTH
1' WATER WELL RECORD MlNNESOTA UN/QUE WELL NO. �A����
Cwnty Name Im Wafer Samp/e b
' - ���i � Mie�esola Slatwfes 156A.0I�.08
Township Namei . ownship Numher Range Number Section No. Fraction 4.WELL DEPTH(compkted) Date of Completion
Ul�'IIG 1�I a G� µ UL�� �� �h / p.r.L3'"�."�ti I11�f F fl. L7'-.L.Ci'-7i1
Numeri yty_of m Road[ntersec[ion. 5.DRILLING METHOD
�/L� O CableTaol O Reverse O Driven ❑p�g
�.�'.��� ���:�2 3d1�"3�'� �..-'2:.11�'�: CiY.Y'`i'LCS t��,I2F1.
ow exact location d well in section grid with"X." Sketch map of well loration. ❑HollowNod ❑Air ❑Bored ❑
N
� � i i --�-�--- "�--��AdditionName ���- . _ . _, 4Rotary OJetted OPower�Auger
'-r- y- -1 -1- ' .
� � 6.DRILLING FLUID
� , . ._.._- A Q
•-�- -1- �- �- Blak Number �• t�/'��
W � � � E 7.USE
i �,..��.��.
_1_ 1_ _'_ __ - �� 4'�.Domestic ❑Monitoring ❑Heat Pump
I ; � � . Lot Number -- ' - �r�J " - � � O Irrigation O Public ❑Industry
'E,m�.
' � � I ❑Test Well L7 Municipal ❑Commercial
� � !� 1 ❑Air Conditioning ❑
I mile—� 8.CASING HOLE DIAM.
2.PROPERTY OWNER'S NAME Mailing Address if diffe�en[than property address ❑g�ack HEIGHT:Above/Below
❑Threadtd
indica[ed above. Surface (t.
�`�i_:�k:� t Se:.ii�.1`:3,.,"f,:2!i. O Galv. ❑Welded
O Drive Shce? Yes�No_ � �Jf«2
C��lastic
� in.to �-��' tt. Weight ���l� Ibs./tt. �n. t��4 t.
3. FORMATION LOG COLOR HARDNESS OF FROM TO in.to ft. Weight Ibs✓ft. �n. to�t.
FORMATION
in.[o (t. Weight Ibs./tt. �n. to�t.
�� � �� 9.SCREEN Or�open hole
n 1 Make J���� from ft.to. (t.
�7e3�. 7� li..'� TYPe a.�t`+.i"3Ytil�S :3�rti1 Diam. „2H
Slot/Gauze �� Length �;
j`,,� FITTINGS:
Set hetween # j ft.and�L1L�ft.
10.STATIC WATER LEyVEL
�-7 (t.!}below ❑above DateMeasured �'�"`�"`�t3
land sur(ace
11.PUMPING LEVEL(below land sur(ace)
-�� ft.after � hrs.pumping �=Z$ g.p.m.
ft.after hrs.pumping g.p.m.
12.vEAD WELL COMPLETION
[#SPitless adapter manufacturer��-� ��-� Modei _
❑Basement o(fset �"A[least 12"above ground
❑Plastic casing protection
13.WELL GROUTED? q�'es ❑No
43Neat Cement D Bentonite L]
t
Grout material from ` to � (t.w.yds.
14. NEAREST SOURCES OF POSSIBLE CONTAMINATION
feet direc[ion �ype
Well disinfected upon rnmple[ion? �.Yes ❑No
15.PUMP
Da[e installed ❑Not installed
Manufacturer's name .—
Model number HP Volts__
Length o(drop pipe f[. Capacity .g.p.m.
Ma[erial of drop pipe __
Type: �Submersibie ❑L.S.Turbine LJ Reciprocating
❑Jet ❑Centri(ugal O
16. ABANDONED WELLS
Unused well on�xoperty? O Yes �Plo
Use a second sheet,if needed �� ❑ Permanen[ ❑ Temporary ❑ No[sealed
17. REMARKS,ELEVATION.SOURCE OF DATA,etc.
18.WATER WELL CONTRACTOR CERTIFICATION
This weli was drilled under my jurisdiction and this reporl is[rue to the best of my
knowledge and beliet.
�.+�:!'i .�,d�l{L7:�1.Y1 YYy7rtfu aM�.L�.a6a�.t7c3 �li: 1t'N... G/i�6:
Lrcensee Business Name License No.
Address �,;?✓'i,'�? �1.���.i�� � �� ���'�t3� �"��1. �=7-:�C:J
SiBned ,��r...��,r .���Date g"G7—��+'
Au[hortzed presentatlue
t. �. �li.'+I7 Date t?' - .
Name oJDrtller
LOCAL COPY �� � /� ` 5����
.� -;ry �ne�
r '� ��- HE-01205-03(Rev.9/88) ziB2�O�AA
'7� �?� ?�� �'�,�c, ��c.
617 13th AVE. 50. • HOPKINS, MINNESOTA 55343 • 935-3556
Stodola Well Drilling r : September 11, 1990
15306 Highway 7 }�. �
Minnetonka, Mn. '_� ;.. . :._ .
��� � C� ������
REPORT OF W�ER ANALVSIS
Creceived irom you\
Our laboratory nports th�s�snalytical rasults, determined on s sample � � on Au{�uQt 30. 1 99Q
Well water
from
Albert Ackerman
3530 North Shore Dr.
Orono, Mn.
Unique Well # 466482
Bacteria (Coliform group) less than 1/100 ml
Nitrate nitrogen less than 0.1 mg/1
Conductivity, Specific 510. micromh
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.
i W er Clinic, Inc.
,
An�lytfc�l I�bw�tory � Consul:i�p�nqin��r
Wabr�naly�l�n�y�nts \\� \ �� Boibr wat�r eMmluls
V � �
Blll �/ � 2
17.1 partslmillion�quals 1.0 yr�inlp�llon