HomeMy WebLinkAboutwell info WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO.
County Name WELL AND BORING RECORD 615576
Hen Minnesota Statutes Chapter 1031
Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed
Or on 164 n. 9-10-98
House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD
n
El Cable Tool El Driven ❑ Dug
150 N Shor r We Orann ❑ Auger „14lotary ❑ Jetted
Show exact location of well in sectio grid with" Sketch map of well location. ❑
Showing property lines,
roads and buildings. DRILLING FLUID WELL HYDROFRACTURED? ❑YES O
N
d natural FROM ft.to ft.
USE ❑ Monitoring ❑ Heating/Cooling
,,ffomestic ❑ CommunityPWS
❑ Irrigation ❑ Industry/Commercial
((('''''''''l
❑ Noncommunity PWS ❑ Remedial
W E ::
�L� ❑ Test Well
❑ Dewatering ❑
/ e n CASING Drive Shoe? ❑ Yes o HOLE DIAM.
ae
_..J! � ❑ Steel ❑Threaded 11 Welded
�Flastic ❑
s --
1 Mile
CASING DIAMETER WEIGHT
PROPERTY OWNER'S NAME 4 n.to 156 ft. 1 9 lbs./ft. 8in.to 3
Robert Mattson Cont '`y
4
in.to ft. lbs./ft. fl-k-in.to ■
Property owner's mailing address if different than well location address indicated above. in.to ft. lbs./ft. in.to _ft.
10420 0 f.9 t h Ave „y SCRFW)"nson OPEN HOLE
1�f L 'i iY Mak from 1 from. ft.to fl.
Plymouth, MN 55442 Type st8 n ess Steel Diam. Z __
Slot/Gauze -010 Length 41 i 4
Set between 15&-ft.and--1-6,4--tt. FITTINGS: Y
STATIC WATER LEVEL f
WELL OWNER'S NAME 90 ft./below ❑ above land surface Date measured 10 9— —9
PUMPING LEVEL(below land surface) L7”
Well owner's mailing address if different than property owner's address indicated above. Iri O -ft. after 2 hrs.pumping�_g.p.m.
7PiL HEAD COMPLETION
tless adapter manufacturer wh f t esa t e r Model
❑ Casing Protection f 2 in.above grade
❑ At-grade(Environmental Wells and Borings ONLY)
GROUTING INFORMATION
Well grouted? !/Yes ❑ No
HARDNESS OF Grout Material ❑ Neat cement ❑ Bentonite ❑ Concrete C�ligh Solids Bentonite x
GEOLOGICAL MATERIALS COLOR MATEfiIAL FROM TO
from to 30 ft. 3 ❑ yds. lXbags
from_to 156 ft. n ❑ yds. Elbags
Top soil black soft C from to ft. ❑ yds. ❑ bags
NEAREST NOWN SOURCE OF CONTAMINATION
Clay yellow Soft 5 25 feetdirection �t�HQ�/j'bPe
Well disinfected upon completion? Yes ❑ No
Clay gray soft 25 90 PUMP
❑ Not installed Date installed 11-24-98
Sand, fine gray Sort 9C 14q Manufacturer's name Red .racket
Model number 1 5t1CNSt_Gh7C1 7 CC 5 volts
Sand/Gravel brown hard 161�•T
Length of drop pipe 126 ft. Capacity 18 g.p.m.
Type: Xsubmersible ❑ L.S.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 XNo
WELL CONTRACTOR CERTIFICATION
Use a second sheet,if 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 S
.� Licensee us/ness m tf.*. • 172
12-21-98 Represaawfive Signature Date
Chuck Moore
Name of Driller Date
LOCAL COPY 15 5 7 6 HE-01205-06(Rev.9/97)
J.i. City W.1",
Clinic, Jnc.
617 13th Ave So Hopkins, Minnesota 55343 • (612) 935 - 3556
09/18/1998
Stodola Well Drilling
15306 Hwy 7
Minnetonka MN 55345
938-2111
REPORT OF WATER ANALYSIS
Lab#: 35770
Our Laboratory reports these analytical results, determined on a sample taken
by CLIENT on 09/15/1998 from the following location:
150 n. Shore Dr.W
Orono,Mn
Unique Well#615576
Coliform Bacteria <1/100 ml
Nitrates Nitrogen <1.0 mg/I
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).
1a r Clinic, Inc.
&11V� 1
Analyical leborwk" Co-u tick
Ergi—
Water Analysis lteagenta Boiler water Chemicals
Lab Caffication#027-053-119