Laserfiche WebLink
WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. <br /> County Name WELL AND BORING RECORD <br /> Hennepin Minnesota Statutes,Chapter 1031 715840 <br /> Township Name Township No. Range No. Section No. Fraction ,, WELL DEPTH(completed) Date Work Completed <br /> Aron* 118N 23W 31 ,, ,, MI 178 ft. 9-8-04 <br /> GPS DRILLING METHOD <br /> LOCATION: Latitude degrees minutes _ seconds <br /> Longitude degrees minutes seconds ❑Cable Tool ❑Driven ❑Dug <br /> ❑Auger XRotary ❑Jetted <br /> House Number,Street Name,City,and Zip Code of Well Location or Fire Number ❑ <br /> 4605 Watertown Rd, Maple Plain DRILLING FLUID WELL HYDROFRACTURED? ❑Yes X No <br /> Show exact location of well in section grid with X". Sketch map of well location. water FROM ft.TO ft. <br /> Showing property lines, <br /> N roads and buildings USE Monitoring ❑Heating/Cooling <br /> 1 /� Domestic ❑Environ.Bore Hole ❑Industry/Commercial <br /> armit e>i, iy —" Noncommunity PWS ❑Irrigation g ❑Remedial <br /> ❑Community PWS ❑Dewatering ❑ <br /> CASING HOLE DIAM. <br /> w E TkW Drive Shoe? ❑Yes No <br /> ___ ___________________ I ❑Steel ❑Threaded ❑Welded <br /> h Mile Wel <br /> �iil Plastic mil gills <br /> 1 wC �I CASING DIAMETER V. <br /> WEIGHT <br /> , 9 * i <br /> 4 in.to 173 ft. lbs./ft. 81 in.to" ft. <br /> I -1 MIle-----1 <br /> She(`f in.to ft. lbs./ft. 61 in.to 178ft. <br /> PROPERTY OWNER'S NAME/COMPANY NAME <br /> in.to ft. lbs./ft. in.to ft. <br /> John F. & Joan M. Serena SCREEN OPEN HOLE <br /> Proop_erty owner's mailing address if different than well location address indicated above. Make Jayco FROM ft. TO ft. <br /> 4605 Watertown Type PVCDian. <br /> Maple Plain, MN 55359 Slot/Gauze 15 Length 51 <br /> Set between 173 ft.and 178 ft. FITTINGS k picker <br /> STATICWATERLEVEL <br /> 104 ft.Xbelow ❑above land surface Date measured 9-8-04 <br /> PUMPING LEVEL(below land surface) <br /> WELL OWNER'S NAME/COMPANY NAME <br /> John F. & Joan M. Serena ft.after hrs.pumping 60+ g.p.m. <br /> ELL HEAD COMPLETION <br /> Well owner's mailing address if different than property owners address indicated above. Pitless adapter manufacturer !loos Modelo" <br /> asing Protection ❑12 in.above grade • <br /> ❑At-grade(Environmental Wells and Boring ONLY) <br /> GROUTING INFORMATION <br /> Well grouted Yes ❑No <br /> Grout material Neat cement❑Bentonite ❑Concrete Vigh Solids Bentonite <br /> from_10 too_ft. ❑yds. X,bags <br /> from to ft. ❑yds. ❑bags <br /> GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO from to ft. ❑bags <br /> MATERIAL ❑yds. <br /> NEAREST KNOWN SOURCE OF CONTAMINATION <br /> over 50, from sewer <br /> clay yellow 0 20 feet direction type <br /> Well disinfected upon completion )1Yes ❑No <br /> clay gray 20 90 PUMP R may/ <br /> 0 Not installed Date installed <br /> gravel mixed 90 135 Manufacturer's name Vire <br /> Model number HP I Volts <br /> clayLength of drop pipe ��V& gravel red 135 150 ,, }} [ ft. Capacity AT g.p.m. '#4' <br /> Type. Submersible ❑L.S.Turbine ❑Reciprocating El Jet ❑ <br /> clay & gravel gray 140 155 ABA DONED WELLS <br /> Does property have any not in use and not sealed well(s) ❑Yes I No <br /> sand & gravel mixed 155 178 VARIANCE <br /> Was a variance granted from the MDH for this well? ❑Yes gNo TN# <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,if needed <br /> REMARKS,ELEVATION,SOURCE OF DATA,etc. Stevens Drilling & Environmental Svc 86654 <br /> Licensee Business Name Lic.or Reg.No. <br /> i y;'' — 9 30 <br /> Authorized Representative Signature Date <br /> Randy Johnson <br /> LOCAL COPY <br /> 715840 Name of Driller <br /> IC 140-0020 HE-01205-08(Rev.5/02) <br />