Laserfiche WebLink
WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. <br /> County Name WELL RECORD 5 5 5 413 <br /> Hennepin Minnesota Statutes Chapter 1031 <br /> Township Name Township No. I Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed <br /> ft <br /> 117 23 13 117 11/7/94 <br /> Numerical Street Address and City of Well Location or Fire Number DRILLING METHOD <br /> 245 Tonka Ave. Orono MN <br /> 1] Cable Tool El Driven El Dug <br /> � ❑ Auger ❑ Rotary ❑ Jetted <br /> Show exact location of well in section grid with"X". Sketch map of well location. C <br /> Showing property lines, <br /> N roads and buildings. DRILLING FLUID <br /> I <br /> --�- -1 -1- Bentonit<.. <br /> r i ,USE ❑ Heating/Cooling <br /> -y_ _ _ Domestic ❑ Monitoring <br /> W i I E Irrigation ElPublic ❑ Industry/Commercial <br /> ! T ❑ Test Well ❑ DewateringEl <br /> ❑ Remedial <br /> CASING Drive Shoe? ❑ Yes Wo HOLE DIAM. <br /> ❑ Steel ❑ Threaded ❑ Welded <br /> i <br /> fl.Plastic I <br /> giue <br /> CASINGDIAMETERli WEIGHT <br /> PROPERTY OWNER'S NAME _4 in.to 112 ft. lbs./ft. 81 in.to <br /> Mary K McCarty in.to e. -__--lbs/ff. in.to ff. <br /> Mailing address if different than property address indicated above. in.to ft. lbs./ft. in.to_ft. <br /> 6250 Highway 12 W. SCREEN OPEN HOLE <br /> Maple Plain, MN 55359 Make Ajay n from _ft.to ff. <br /> Type PVC Diam. 3 n <br /> Slot/Gauze 18 Length 511 <br /> Set between 1 1 7 ft.and l 1.7 ft. FITTINGS: <br /> HARDNESS OF STATIC WATER LEVEL <br /> GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO _ 5 ft. C-Welow ❑ above land surface Date measured__l—J_ 7./.9 <br /> PUMPING LEVEL(below land surface) <br /> clay 0 43 h. after __ hrs.pumping__ 150 g.p.m. <br /> WELL HEAD COMPLETION <br /> clay gr a 43 69 XPitless adapter manufacturer MUS Model <br /> ❑ Casing Protection ❑ 12 in.above grade <br /> clay & sand gray 69 71 GROUTING INFORMATION <br /> Well grouted? )LYes ❑ No <br /> sand gray fine 71 105 Grout Material XNeat cement ❑ Bentonite <br /> from_.i n to_7r,ft. A ❑ yds. L­Xbags <br /> from to ft. ❑ yds. ❑ bags <br /> sand & gravel gray cour5 105 117 from to ft. ❑ yds. ❑ bags <br /> NEAREST KNOWN SOURCE OF CONTAMINATION <br /> _feet direction type <br /> Well disinfected upon completion? ❑ Yes ❑ No <br /> OF <br /> ORONOnn , PUMP <br /> +` -r� r ❑ Not installed Date installed 1/13/9 5 <br /> 15 <br /> - - �; Manufacturer's name U iQ4jor FS <br /> Modelnumber r] SS1er HP_3/4 volts <br /> Length of drop pipe 6 0 if ft. Capacity 5 g.p.m. <br /> Pressure Tank Capacity 40 g 1 <br /> SAN2 3 1 9' Type: K Submersible ❑ L.S.Turbine El Reciprocating 11 Jet ❑ <br /> .L�7 <br /> ABANDONED WELLS <br /> Does property have any not in use and not sealed well(s)? Cl Yes ❑ No Unknown <br /> WELL CONTRACTOR CERTIFICATION <br /> This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. <br /> The information contained in this report is true to the best of my knowledge. <br /> Use a second sheet,it needed 'teypnr, Drillinc �� En"! 866ri <br /> REMARKS,ELEVATION,SOURCE OF DATA,etc. Licensee Business Name Lic.or Reg.No. <br /> - - I.— - <br /> Authonzed Representative Signature a e <br /> 1/13 95 <br /> Randy Johnson <br /> Name of Driller Date <br /> LOCAL COPY 555413 HE-01205-04(Rev.5/92) <br />