Laserfiche WebLink
WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. <br /> County Name WELL AND BORING RECORD 618575. <br /> Hennepin Minnesota Statutes Chapter 103/ <br /> Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed <br /> Orono 117 23 8 Nw,, S,A Sg, 162. ft 12/2/98 <br /> House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD <br /> 1315 Tonkawa ❑ Cable Tool ❑ Driven ❑ Dug <br /> ❑ Auger Xf Rotary ❑ Jetted <br /> Show exact location of well in section grid with"X'. Sketch map of well location. ❑ <br /> Showing property lines, <br /> Wayzata, Mn 55 391 roads and buildings. DRILLING FLUID WELL HYDROFRACTURED? [I YES WO <br /> N I 1 <br /> ( <br /> Baroid quik gel I FROM ft.to ft. <br /> USE ❑ Monitorin <br /> ❑ <br /> V t X Domestic g Heating Cooling <br /> _ ?'��^*�^y-(y <br /> ❑ Irrigation ElW <br /> Community PS ❑ Indust /Commercial <br /> ❑ NoncommunityPWS Industry/Commercial <br /> W <br /> E T ❑ Test Well El <br /> IA ❑ Dewatering El <br /> r ZMi1e CASING Drive Shoe? ❑ Yes ❑Xo HOLE DIAM. <br /> ,G ❑ Steel ❑ Threaded ❑ Welded <br /> i i # <br /> ❑X'lastic ❑ <br /> S <br /> �1 Mile / <br /> CASING DIAMETER WEIGHT <br /> PROPERTY OWNER'S NAME 4 in.to 152 ft. 1.9 lbs./ft. in.to:3P_ft. <br /> Jim Render in.to ft. <br /> lbs./ft-in.to],-2ft. <br /> Property owner's mailing address if different than well location address indicated above. in.to ft. lbs./ft. in.to T ft. <br /> SCREEN OPEN HOLE <br /> Mffict es a from ft.to ft. <br /> Type ;,lactic Diam. <br /> Slot/Gauze ti Length_ ioft. <br /> Set betweeni ft.and ft. FITTINGS: <br /> STATIC W{\ R LEVEL y 12 <br /> WELL OWNER'S NAME _ ft.4 below ❑ above land surface Date measured 12/2 <br /> PUMPING LEVEL(below land surface) <br /> Well owner's mailing address if different than property owner's address indicated above. 5 ft. after I hrs.pumping 5_Q9.p.m. <br /> WELL HEAD COMPLETION <br /> ]V Pitless adapter manufacturer Model s 1 45L,- <br /> El <br /> 5❑ Casing Protection ❑ 12 in.above grade <br /> ❑ At-grade(Environmental Wells and Borings ONLY) <br /> GROUTING INFORMATION <br /> Well grouted? (XYes ❑ No <br /> GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO Grout Material ❑ Neat cement L3Bentonite ElConcrete X High Solids Bentonite <br /> MATERIAL from 30 to 0_--_ft. 3 ❑ yds. ❑bags <br /> from to ft. ❑ yds. ❑ bags <br /> >i d n+",l Aray Soft 5from to ft. ❑ yds. ❑ bags <br /> NEAREST KNOWN SOURCE OF CONTAMINATION <br /> }. 601 feet north direction city pe <br /> ty <br /> clay .�ra� �a � 5 12 �- <br /> Well disinfected upon completion? D.Jes ❑ No sewer <br /> clay & sand ; ra' soft 12 14f PUMP <br /> ❑ Not installed Date installed <br /> Sarid & raved ra y r"ioft 14 162 Manufacturer's name A2rmntQr <br /> Model number HP 11/2 Volts 220 <br /> Length of drop pipe 6 ft. Capacity 12 g.p.m. <br /> Type: ❑fiubmersible ❑ L.S.Turbine ❑ Reciprocating ❑ Jet ❑ <br /> ABANDONED WELLS <br /> Does property have any not in use and not sealed well(s)? ❑ Yes D"o <br /> VARIANCE <br /> Was a variance granted from the MDH for this well? ❑ Yes ❑Ao <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 /> Leuthner Well Inc. 10125 <br /> Licensee Business Name L' or Reg.No. <br /> Authorized Representative Signature Date <br /> Maurice L. Leuthner 5/24/99 <br /> 618 5 7 5 Name of Driller Date <br /> LOCAL COPY HE-01205-06(Rev.9/97) <br />