Laserfiche WebLink
WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. <br /> County Name - WELL AND BORING RECORD 591541 <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 33 NE SW SW 74 4/29/98 <br /> House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD <br /> 2900 Wear Circle 0 Cable Tool 0 Driven 0 Dug <br /> ❑ Auger (XRotary 0 Jetted <br /> Show exact location of well in section grid with"X". y j/r` Sketch map of well location. 0 <br /> /v Showing property lines, <br /> roads and buildings. DRILLING FLUID <br /> N WdLcIr <br /> 1/ USE <br /> Q[Domestic 0 Monitoring <br /> 0 Communi 0 Heating/Cooling <br /> X h PWS 0 Industry/Commercial <br /> J i 0 Irrigation ❑ Noncommunity PWS 0 Remedial <br /> wr E ❑Test Well <br /> 0 Dewatering ❑ <br /> r <br /> rEil:/ CASING Drive Shoe? 0 Yes CNo HOLE DIAM. <br /> V2 MNL ❑ Steel 0 Threaded 0 Welded <br /> XPlastic 0 <br /> s <br /> 1 MAe <br /> CASING DIAMETER WEIGHT <br /> PROPERTY OWNER'S NAME 4 in.to 69 tt. 200 _lbs./ft. in.t74_ft. <br /> Dwight Post in.to ft. lbs./ft. in.to_ft. <br /> Property owner's mailing address if different than well location address indicated above. in.to ft. lbs./ft. in.to ft. <br /> A & T Development SCREEN OPEN HOLE <br /> 575 Sussex Cirlte Make Jayco from ft.to ft. <br /> " Orono, MN 55356 Type PVC Diem. 3 a <br /> Slot/Gauze 20 Length 76 <br /> Set between 69 ft.and 74 ft. FITTINGS: <br /> STATIC WATER LEVEL <br /> WELL OWNER'S NAME 27 ft,1Q below 0 above land surface Date measured <br /> PUMPING LEVEL(below land surface) <br /> Well owner's mailing address if different than property owner's address indicated above. 60 ft. after 3 hrs.pumping _ 40 _g.p.m. <br /> WELL HEAD COMPLETION <br /> IN.Pitless adapter manufacturer Whitewater Model S-5-4 <br /> ❑ Casing Protection 0 12 in.above grade <br /> ❑ At-grade(Environmental Wells and Borings ONLY) <br /> GROUTING INFORMATION <br /> Well grouted? R Yes 0 No <br /> GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO Grout Material 0 Neat cement Q(Bentonite 0 Concrete 0 High Solids Bentonite <br /> MATERIAL from 46 to 6 ft. 3 0 yds) J bags <br /> 0 17 from to ft. 0 yds. 0 bags <br /> clay brown med• from to ft. 0 yds. 0 bags <br /> NEAREST KNOWN SOURCE OF CONTAMINATION <br /> sandy clay blue tiled./ <br /> soft 17 46 50 feet South directiosekler pi pope <br /> Well disinfected upon completion? 20 Yes 0 No <br /> sand & ravel brown med. 46 74 <br /> PUMP <br /> ❑ Not installed Date installed 6/13/98 <br /> Manufacturer's name Sta-Rite <br /> Model number HP I I/ZoIts 2.30 <br /> Length of drop pipe 58 ft. Capacity 20 g.p.m. <br /> Pressure Tank Capacity 250 <br /> TypeX=I Submersible 0 L.S.Turbine 0 Reciprocating 0 Jet 0 _ <br /> ABANDONED WELLS <br /> Does property have any not in use and not sealed well(s)? 0 Yes X No <br /> VARIANCE <br /> Was a variance granted from the MDH for this well? 0 Yes X] No <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 /> The information contained in this report is true to the best of my knowledge. <br /> REMARKS,ELEVATION,SOURCE OF DATA,etc. <br /> RES Well Drilling 27276 <br /> Licensee Business Name Lic.or Reg.No. <br /> Authorized Representative Signature Date <br /> 7 Robert E. Stodola, 44.16/18/98 <br /> Name of Driller Date <br /> LOCAL COPY 591541 HE-01205-05(Rev.1/95) <br />