HomeMy WebLinkAboutwell info WELL LOCA i ION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO.
Cou,.ty Name
WELL AND BORING RECORD�':;I':i2:. 1. " Minnesota Statutes Chapter 103/ 5 8 0 5 19
Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed
-, ft.
House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD
• ' I- "_4. t..-,y ti! . i. .r,.-•:-.. : ,i........ . ' ❑ Cable Tool ❑ Driven ❑ Dug
❑ Auger ❑ Rotary ❑ Jetted
Show exact location of well in section grid with"X". map of well location. L(
owing property lines,
1 t. roads and buildings. DRILLINGFLUID
N \
USE ❑ Monitoring ❑ Heating/Cooling
i 1 ,❑ Domestic ❑ Community PWS
_i - -I 1 ❑ Irrigation
❑ Industry/Commercial
/ ❑ Test Well ❑ Noncommunity PWS El Remedial
w T IA Dewatering ❑
T- r-
i! 7 �
J N a G Drive Shoe? ❑ Yes g No HOLE DIAM.
� �/p Mile l\
I-
-1-
- ❑ Steel ❑ Threaded ❑ Welded
1 `,_yam CI Plastic
s
Mile
CASING DIAMETER WEIGHT
PROPERTY OWNER'S NAME ++ in.to ft. lbs./ft. in.to tt.
. e'v-c"oi, I.)c,v ,...d.Or T.,ert t. 1 . E,
in.to ft. lbs./ft. t, f iv.to I •ft.
Property owner's mailing address if different than well location address indicated above. in.to_ ft. lbs./ft. in.to - ft.
1 . i .t.2.6 t lei?, `Lata R j•' SCREEN OPEN HOLE
W _: i,a}22, MN.5'191 Make LTC',,:' ., from ft.to ft.
c-a_. ,
Type 7: L s?a f Diem.
Slot/Gauze Length
Set between 1 i.'' '' ft.and I ( i" 'ft. FITTINGS: .
STATIC WATER LEVEL
WELL OWNER'S NAME _ tt. ❑,below ❑ above land surface Date measured '
PUMPING LEVEL(below land surface)
Well owner's mailing address if different than property owner's address indicated above. ft. after - hrs.pumping It g.p.m.
WELL HEAD COMPLETION
❑ Pitless adapter manufacturer ' ' Model
❑ Casing Protection 0 12 in.above grade
❑ At-grade(Environmental Wells and Borings ONLY)
GROUTING INFORMATION
Well grouted? 0 Yes 0 No
GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO Grout Material ❑ Neat cement ❑ Bentonite ❑ Concrete 04-ligh Solids Bentonite
MATERIAL from to ft. _ 0 yds. 0,bags
from to ft. U yds. 0 bags
SCA 1 11 Er(... • - i ' from to ft. 0 yds. 0 bags
NEAREST KNOWN SOURCE OF CONTAMINATION
Gr-,••_.7e3 L! i ° , ,- ` feet j CY direction type
Clay Well disinfected upon completion? ❑'Yes 0 No
;3i 1ty Clay Li..-,_.' :.re' - 1 t-';. PUMP
10Not installed Date installed _.- ` 4-9-11;
z Manufacturer's name Sta--R1tE'-
`_
3 .
Model number HP 1 Volts f.• t
T
Length of drop pipe f? o t ft. Capacity 1 tl g.p.m.
Pressure Tank Capacity 8 0 Gallon Epoxy
Type: ).Submersible 0 L.S.Turbine 0 Reciprocating 0 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? 0 Yes 0 14;1;
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.
tr i. . 2i IA 1,-, S,i- L 1 t.f,J .Liat
Licensee Business Name Lic.or Reg.No.
Authorized Representative Signature " Date
/� (�C
Name of Driller Date
L OCAS, coOP` 5 8 0 5 x 9 HE-01205-05(Rev.1/95)
Jwin City Water Clinic, inc.
617 13th Ave So • Hopkins, Minnesota 55343 • (612) 935 - 3556
02/25/1997 1
Stodola Well Drilling
15306 Hwy 7
Minnetonka MN 55345
938-2111
REPORT OF WATER ANALYSE
Lab 0: 32083
Our Laboratory reports these analytical results, determined on a sample taken
by CLIENT on 02/20/1997 from the following location:
Lakewood Devolpment
880 Old Crystal Bay Rd.
Orono,Mn
Unique Wbll 0580579
Coliform Bacteria <1/100 ml
Nitrates Nitrogen <1.0 mg/l
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).
c.
• er Clinic, Inc.
Bill n
--
Analyieal laboratory
Water Analysis Uwe* Boiler water Cbl
Lab Codification 9 027-033-119