HomeMy WebLinkAboutwell info WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO.
County Nare - • WELL AND BORING RECORD
Hennepin5 8 8 9 3 2
Minnesota Statutes Chapter 1031
Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed C+
"0.40c t 10-9-%
C.r£cax; 117 2w !>9 v.
House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD
e t. . �)- i, ❑ Cable Tool ❑ Driven El Dug
850 Old Crystal Bay Road Orono, 1.55tt ❑ Auger a Rotary ❑ Jetted
Show exact location of well in section grid with"X". Sketch map of well location. ❑
Showing property lines,
-, roads and buildings. DRILLING FLUID �.,./..,,
N
i H i�t� L.
,1 r USE ❑ Monitoring ❑ Heating/Cooling
I
Domestic ❑ CommunityPWS
_ ❑ Industry/Commercial
I-, CI Irrigation
0 NoncommunityPWS
i ❑ Remedial
yy i E T ❑ Test Well 0 Dewatering ❑
-r---r- I
f - V,M��./ CASING Drive Shoe? ❑ Yes ❑ o HOLE DIAM.
L ❑ Steel
CIThreaded 0 Welded
lastic ❑
S
Mile
CASING DIAMETER WEIGHT
�r
PROPERTY OWNER'S NAME in.to 100
n. 1.9 lbs./ft. r
. V§ 31i
Lake Associates in.to ft. lbs./ft. b 1,'„�Ae 1:On.
-
Property owner's mailing address if different than well location address indicated above.c� in.to ft. lbs./n. in.to ft.
1212East Wayz to Blvd. SCREEN HOLE
C?�dsCI3
Wayzata, Mn. 55391 Make , from ft.to ft.
Type
Stainless Steel ,
YP t
Diam. . 8 t
o
Slot/Gauze 10/10 Length °
Set between 100() n.and 1 4.ft. FITTINGS: t 80~w/ '- `
STATIC WATER LEVEL
WELL OWNER'S NAME . _ft. X below 0 above land surface Date measured 1G-9-96
PUMPING LEVEL(below land surface)
Well owner's mailing address if different than property owner's address indicated above. jl' ft. after hrs.pumping ? air g.p.m.
WELL HEAD COMPLETION
1 Pitless adapter manufacturer ` "#'- `�` Model _.._
O Casing Protection all,12 in.above grade
❑ At-grade(Environmental Wells and Borings ONLY)
GROUTING INFORMATION
Well grouted? 4 Yes 0 No
HARDNESS OF Grout Material Neat cement ❑ Bentonite, Concrete y igh Solids Bentonite
GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO ID
from �) 's� f0
tft. E?a ❑ yds. O='bags
from to ft. 0 yds. 0 bags
Clay I3rcw l `' 0' 201 from to ft. ❑ yds. 0 bags
NEAREST- /
-y K,NO�WN>SOURCE OF CONTAMINATIOa„� + _
l- �' ( i l ty) Grey r,t.. t 90' ! 4/ feet ` C)r- 141 direction -..>CP! `C'type
Well disinfected upon completion? l(Yea 0 No
W6ter Sand Grey _ '.'r 108'PUMP
0 Not installed Date inst GouldsIled
1(:-14-ab
Manufacturer's name Goulds
Model number 188..1�i 4 7f'T. 13F cyolts 23C;
f
Length of drop pipe �''r ft. Capacity 1 g.p.m.
Pressure Tank Capacity #26 X-Trcl
Type: 3'Submersible ❑ L.S.Turbine 0 Reciprocating ❑ Jet 0
ABANDONED WELLS
Does property have any not in use and not sealed well(s)? ❑ Yes L No
VARIANCE
Was a variance granted from the MDH for this well? ❑ Yes ❑'No
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.
WN STODOLA WELL DRILLT.JNa CO., INC. 27172
Licensee Business Name Lic.or Reg.No.
10-9-96
Authorized Representative Signature Date
C:huclt Pcxx;i:e 1 -< -(it..
Q Name of Driller Date
LOCAL COP'( 5 8 8 9 3 2 HE-01205-05(Rev.1/95)
- _ 3win Cit Water Clinic, inc.
617 13th Ave So • Hopkins, Minnesota 55343 • (612) 935 - 3556
10/15/1996
Stodola Well Drilling
15306 Hwy 7
Minnetonka MN 55345
938-2111
REPORT OF WATER ANALYSIS
Lab#: 31147
Our Laboratory reports these analytical results, determined on a sample taken
by CLIENT on 10/09/1996 from the following location:
850 Crystal Bay Rd
Orono,Mn
Unique Well#688932
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).
T ''t ater Clinic, Inc.
Bill V: - -
Water Analysis Raw* Boiler Water Chemical.
Lab Certdioation 0 027-033-119