2008 Well & Boring Record - Laserfiche WebLink

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i I MINNESOTA UNIQUE WELL WELL OR BORING LOCATIONMINNESOTA DEPARTMENT OF HEALTH AND'BORING NO. County Name WELL ND ^ 1 EtCORD Q ' Mig esota St tf'8pter 1031 ° IN at Township Name ` Township No. Range No. Section No. FractionWEL vA1�7G DEPTH(completed) DATE WORK COMPLETED Orono 118 t 23 33 Pir,MAK - 150 n. 7- GPS DRILLING METHOD: LOCATION: - Latitude degrees minutes seconds - Longitude degrees minutes secondsr ❑Cable Tool ❑Driven ❑Dug _ X ❑Auger i•y,f ❑Jetted House Number,Street Name,City,and Zip Code of Well Location or Fire Number-:' -. Ilc�r N 553% DRILLING❑FLUID WELL HYDROFRACTURED? ❑Yes [ `t Show exact location of well/borid j in section grid with"X" Sketch map of well/boring loc.ion. bentoelte From ft.To Showing property es, N roads buildin.s,and dire Ion. USE`. omestic ❑Monitoring ❑Heating/Cooling t ❑Noncommunity PWS ❑Environ.Bore Hole ❑Industry/Commercial ` � ' 0 Community PWS ❑Irrigation ❑Remedial �'- ------ ---- --------- , }Eleoator ❑Dewatering ❑ w E 4 0 CAST [ K.ERIAL Drive Shoe? ❑Yes [ fCo HOLE DIAM': T .. :. •Steel ❑Threaded ❑Welded 'h Mile stiC Ila CI -- CASING S Diameter Weight Specifications 1 Mile - IIII in.to Ib2 ft. 49 lbs./ft. ___gletal in.to_301. PROPERTY OWNER'S NAME/COMPANY NAME in.to ft. lbs to in.to _ Steven in.to ft. lbs./ft. in.to ft. aJ��l SCREEN OPEN HOLE Property owner's mailing address if different than well location address indicated above. N �60 Fairway Ridge .fit, Make _jet t' From ft. To ft. -_ iiirn3etri$t$ 5�7E7�F Type etain.le5$ st1 Diam. 2" t Slot/Gauze �� -410 Length 41 } 4t Set between STATIC WATEFilEVEL ft.and 142 ft. FITTINGS r w j _ 4 Measured from_ rAk 106 ft.[(elow❑Above land surface Date measured 7-2 WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) 139 ft.after 2 hrs.pumping 13 g.p.m. Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION EXmanufacturer *it }`�. Model ❑Casing Protection EXf2 in.above grade ❑At-grade(Environmental Well and Boring ONLY) GROUTING INFORMATION Well grouted Dlikes ❑No Grout materials ❑Neat cement Ddrentonite ❑Concrete ❑Other 3 From 0 To_____ _ft. ❑Yds. [ rags GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO From 30 To 142 ft.tilltIZILLMts. ❑Bags MATERIAL From To ft. ❑Yds. ❑Bags 1 soft NEAREST KNOWN SOURCE OF CONTAMINATION topsoil black © 2 .S feet Al direction p 2 Well disinfected upon completion? Dees ❑No ()LA's.' -. yellowLA's.' et..QU clay soft' 23 PUMP ��L��pQ clay/send ❑Not installed Date installed 8.4- 8 y/ �y soft 23 140 Manufacturer's name Aermotor sand Model Number HP Volts 230 gray soft 1 15°Length of drop pipe 126 ft. Capacity g.p.m. Type:[ ibmersible ❑L.S.Turbine ❑Reciprocating ❑Jet ❑ 7,-- -• ABANDONED WELLS ff;t-:i Does property have any not in use and not sealed well(s)? ❑Yes Delo VARIANCE Was a variance granted from the MDH for this well? ❑Yes Eo TN# WELL CONTRACTOR CERTIFICATION This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. The information contained in this report is true to the best of my knowledge. Use a second sheet,if needed. REMARKS,ELEVATION,SOURCE OF DATA,etc. Don Stodola Well Drilling Co,. Inc. 1691 Licensee Business Name Lic.or Reg.No. /.J�' .. , /./�s1'. 12-10-08 C:''i:•re.resentativeSignature Certified Rep.No. Date LOCAL COPY 7 0 0 0 4 0 Name of Driller ick Moore IC 140-0020 HE-01205-11(Rev.3/07)