HomeMy WebLinkAboutWell info WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO.
County Name WELL AND BORING RECORD 68657 :5::]
H Minnesota Statutes Chapter 103/
Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) itDate Work Completed
8 1-7-03 Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD
❑ Cable Tool ❑ Driven ❑ Dug
70 N Shore Dr W. Orono, 55359 ❑ Auger L otary ❑ Jetted
Show exact location of well in section grid with'X". Sketch map of well location. ❑ ,`
Showing roperty lines,
roa rrd buildings. DRILLING FLUID WELL HYDROFRACTURED? ❑YES f(NO
N ,
bentonite .FROM—ft.to ft.
USE [IMonitoring ❑ Heating/Cooling
Domestic ❑ CommunityPWS
1-1 Irrigation ❑ Industry/Commercial
❑ Noncommunity PWS ❑ Remedial
W 1 i i E ❑ Environ.Bore Hole ❑ Dewatering ❑
-r CASING Drive Shoe? ❑ Yes KNo HOLE DIAM.
zMoe
L- ,- I ❑ Steel ❑ Threaded ❑ Welded
i -i- i i 1
�"Plastic ❑
s
CASING DIAMETER WEIGHT
PROPERTY OWNER'S NAMEIS in.to I Qa ft. 2 0 lbs./ft. 8.—in.to-30 ft.
in.to ft. lbs./ft. in.10498
Property own(7's mailing address if different than well location address indicated above. in.to ft. lbs./ft. in.to ft.
16913 Excelsior Blvd SCREEN OPEN HOLE
Make Johnson from ft.to ft.
Minnetonka, MN 55345 Type Stainissgtj Diam. 2"
Slot/Gauze Ain Length
Set between ft.and ft. FITTINGS:
9"W113" MAD
STATIC WATER LEVEL
WELL OWNER'S NAME 94 _ft.Kbelow, ❑ above land surface Date measured_1-7-03
PUMPING LEVEL(below land surface)
Well owner's mailing address if different than property owner's address indicated above. 1 ft. after 2 hrs.pumping 45 g.p.m.
WELL HEAD COMPLETION obite�Tater
? Pitless adapter manufacturer Model
❑ Casing Protection L➢It2 in.above grade
❑ At-grade(Environmental Wells and Borings ONLY) /`
GROUTING INFORMATION
Well grouted? )1(Yes ❑ No
GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO Grout Material ❑ Neat cement ❑ Bentonite ElConcrete High Solids Bentonite
MATERIAL from to— 30 ft. —3 ❑ yds. Ybags
from to_1.90 ft. natural Hyt 11 bags
clay yellow soft 0 3 from to ft. ❑ yds. ❑ bags
^ NEAREST KNOWN SOURCE OF CONTAMINATION
clay gray soft 30 9 T--) —feet _ direction type
Well disinfected upon completion? Wyes 1:1 No
clay/sand gray medium 90 12 PUMP T
❑ Not installed Date installed - ,.,!9 03
gravel brown medium 120 14q Manufacturer's name a mo_
Model number HP--,5 Volts 230
sand/gravel brown Soft 140 198 Length of drop pipe ''''rr� ft. Capacity g.p.m.
Type: ('Submersible ❑ L.S.Turbine ❑ Reciprocating ❑Jet ❑
ABANDONED WELLS
Does property have any not in use and not sealed well(s)? ❑ Yes No
VARIANCE
Was a variance granted from the MDH for this well? ❑ Yes o TN#
WELL CONTRACTOR CERTIFICATION
Use a second sheet,it 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 report is true to the best of my knowledge.
Don c+F�..�..�=- ,,eseAXve_Sq4ffatuFe
�?�.l nr-l=ines 27172
e. ame Lic.or eg. o.
/ 7-28-83
Date
7 NameofGrille ae
� 68
LOCAL COPY �5 t 5 HE-01205-07(Rev.2/99)
IC#140-0020
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617 13th Ave So Hopkins, Minnesota 55343 (612) 935 - 3556
01/09/2003
Stodola Well Drilling
3841 North Main
St. Bonifacius MN 55375
938-2111
REPORT OF WATER ANALYSIS
Lab #: 17
Our Laboratory reports these analytical results, determined on a sample taken
by CLIENT on 01/07/2003 from the following location:
Jerry Boldenow
70 N.Shore W
Orono,Mn
Unique Well#686575
Coliform Bacteria <1/100 ml
Nitrates Nitrogen <1.0 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. 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).
N. in City Water Clinic, Inc.
Bifrsd al e
Lab Certification#027-053-119