Laserfiche WebLink
WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. <br /> County Name WELL AND BORING RECORD 623570 <br /> A Hennepin Minnesota Statutes Chapter 103/ <br /> Township Namel Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed <br /> ft. <br /> /. /. 'L1281 <br /> House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD <br /> ❑ Cable Tool ❑ Driven ❑ Dug <br /> y C Auger EX Rotary ❑ Jetted <br /> Show exact location of well in section grid with"X'. Sketch map of well location. ❑ _ __ __ _ <br /> h, Showing property lines, <br /> Vt roads and buildings. DRILLING FLUID WELL HYDROFRACTURED? ❑YES J NO <br /> FROM ft.to ft. <br /> - <br /> 1 USE Domestic ❑ Monitoring ❑ Heating/Cooling <br /> El Community PWS ❑ Industry/Commercial <br /> ❑ Irrigation El PWS 1-1Remedial <br /> w E ❑ Environ.Bore Hole <br /> 1 O 11 Dewatering ❑ <br /> CASING Drive Shoe? ❑ Yes IXNo HOLE DAM. <br /> _i _ <br /> [I Steel El Threaded El Welded <br /> {{ti X Plastic ❑ <br /> —1 md, <br /> CASING DIAMETER WEIGHT <br /> PROPERTY OWNER'S NAME __g_ in.to170 ft. 1 _Q lbs./ft. in.to_3Qft. <br /> Greq Dahl Construction -- _ _—in.to ft. lbs./ftin.to 121 <br /> Property owner's mailing address if different than well location address indicated above. in.to ft. lbs./ft. in.to ft. <br /> 300 gest Point Roar] SCREEN OPEN HOLE <br /> Tonka Bay, Kn. 5555331 Make Johnson from ft.to ft. <br /> Type—Stainless—_.C'.LZ:c�Diam. 2 M <br /> Slot/Gauze Length $• <br /> Set between �_2.� .and_i_�_p ft. FITTINGS:2 44 X 3 0 a <br /> STATIC WATER LEVEL A 7 V <br /> WELL OWNER'S NAME 401 ft. [below ❑ above land surface Date measured 1 2_2 Q_ 9 <br /> PUMPING LEVEL(below land surface) <br /> Well owner's mailing address if different than property owner's address indicated above. 11 15 i __ 1 1 5 1 ft. after hrs.pumping 3) <br /> WELL HEAD COMPLETION <br /> Pitless adapter manufacturer Model <br /> Casing Protection X 12 in.above grade <br /> ❑ At-grade(Environmental Wells and Borings ONLY) <br /> GROUTING INFORMATION <br /> Well grouted? X Yes ❑ No <br /> GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO Grout Material ❑ Neat cement ❑ Bentonite ❑ Concrete X High Solids Bentonite <br /> MATERIAL from$ to_ 30 ft. _3_ ❑ yds. EX bags <br /> Clay Sand Brown S 01 is from to ft. ❑ yds. ❑ bags <br /> from to ft. ❑ yds. ❑ bags <br /> o NEAREST WOWN SOURCE OF CONTAMINATION r (� <br /> Clay Grey S i 8 110 feet .-- J 1-'E j <br /> ti,.�G"?[J direction type <br /> Well disinfected upon completion? [ji Yes ❑ No <br /> Water Sand Grey S 110 126PUMP <br /> ❑ Not installed Date installed 1_13_99- <br /> Manufacturer's name Red J ac tc e t <br /> Model number 0127907 HP 3/4 Volts 2 3 0 <br /> Length of drop pipe 63 ft. Capacity 12 g,p.m. <br /> Type: ['Submersible ❑ L.S.Turbine ❑ Reciprocating ❑ Jet ❑ <br /> ABANDONED WELLS <br /> Does property have any not in use and not sealed welts)? ❑ Yes XNo <br /> VARIANCE <br /> Was a variance granted from the MDH for this well? ❑ Yes -k❑ No TN# <br /> WELL CONTRACTOR CERTIFICATION <br /> Use a second sheet,if needed This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. <br /> REMARKS,ELEVATION,SOURCE OF DATA,etc. The information contained in this report is true to the best of my knowledge. <br /> ON STODOLA WELL DRILLING CO. , INC. <br /> Licensee Business Name Lic.or Reg.No. <br /> 1-26-99 27172 <br /> Authorized Represcrntative Signature Date <br /> Chuck Moore 12-29-98 <br /> Name of Driller Date <br /> LOCAL COPY � 623570 HE-01205-06(Rev.7/96) <br />