5-22-2018 - well & boring construction record

Home Browse Search

MINNESOTA UNIQUE WELL WELL OR BORING LOCATION SCAWE�N� ��nn NNESOTA DEPARTMENT OF HEALTH AND BORING NO. CountyName LL" DBORING CONSTRUCTION RECORD Minnesota Statutes,Chapter 1031 827818 RAnmQpi n Township Nam Township No. Range No. Section No. Fraction(sm.—.Ig.) WELL/BORING DEPTH(completed) DATE WORK COMPLETED Orono 117 23 07 NE SE NF/ 40 n 5-22-18 GPS LOCATION—decimal degrees(to four decimal places). DRILLING METHou Latitude Longitude ❑Cable Tool ❑Driven ❑Dual Rotary ❑Auger ... ..Rotary ❑Rotasonic House Number,Street Name,City,and ZIP Code of Well Location ❑Other 1151 forth Arm Dr (Iron? 55364DRILLING FLUID WELL HYDROFRACTURED? ❑Yes �7;lo Show exact location of well/bonng in section grid with" " Sketch map of well/boring lo ration. bentonite From ft.To ft. Showing propert lines, N roads,buildings,and dirvction. USE ❑Domestic ❑Monitoring ❑Heating/Cooling I - Q- _____i____ ! ❑Noncommunity PWS ❑Environ.Bore Hole ❑Industry/Commercial 3 ` 0 Community PWS ❑Irrigation ❑Remedial '---.--'--- : -----;--- j ❑Elevator ❑Dewatering 0 w ; E T CASING MATERIAL Drive Shoe? ❑Yes ❑No HOLE DIAM. r\ Steel ❑Threaded ❑Welded ',,4 mile (�J 'lastic ❑ 1 11 ks1 CASING S Diameter Weight Specifications 1 Mile N 4 in.To 130 ft. lbs./ft. -L$ in.To�_ft. PROPERTY OWNER'S NAME/COMPANY NAME in.To ft. lbs./ft. 6� in:Toli40 ft. Paul Vogst rom in.To ft. lbs./ft. in.To ft. Property owner's mailing address if different than well location address indicated above. SCREEN OPEN HOLE 10231 Beebe Lake Rd Make Johnson From ft. To ft. Hanover, MN 55341 Type stsintpss sty 1 Diam. 2" SIoVGauze 3/010 Length (�I� r 4.,,-` Set between 130 ft.ands! 140 ft. FITTINGS Z ler STATIC WATER LEVEL 73 ft.0elow ❑Above land surface ' Measured fromtOP of wellate measured 5-22-18 Dry hole.❑Yes ,o WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) 30 125 ft.after 2 _ hrs.pumping 9.1,.71. Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION Aa gPitless/adapter manufacturer Wttitewater Model 0 Casing protection Igi2 in.above grade ❑At-grade ❑Well House ❑Hand Pump GROUT INFORMATION., (specify bentonite,cement-sand,neat-cement,concrete,cuttings,or other) bentonite ntoniteFrom 0 To 50 ft. 3 ❑Yds. al5"ags Material int t i ngs From 50 To 110 ft. ❑Yds. ❑Bags HARDNESS OF Material From To ft. ❑Yds. ❑Bags GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO bag= One 94 lbs.cement Driven casing seal From To Bags or 50 lbs.bentonite NEAREST KNOWN SOURCE OF CONTAMINATION clay brown . medium 0 17ri Well is ."J feet direction from e..-1'Q-1-0 Well disinfected upon completion? es ❑No ( A-A_ clay grey medium 17 55 PUMP A ❑Not installed Date installed 6-7-18 clay/sand gray medium 55 66 Manufacturer's name Schaefer 66 87 Model Number QpHP %/4 Volts 230 fine sand gray medium Length of drop pipe 84 ft. Capacity g.p.m. brown medium 87 Type:XSubmersible ❑L.S.Turbine ❑Reciprocating ❑Jet ❑ sand v/ 140 ABANDONED WELLS Does property have any not in use and not sealed well(s)? ❑Yes kNo VARIANCE Was a variance granted from the MDH for this well? ❑Yes Jflo 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. ^r�,,.. [� REMARKS,ELEVATION,SOURCE OF DATA,etc. Don Stodola Well Drilling Co,. Inc• 1691 Licensee Business Name Lic.or Reg.No. 7-25-18 e/d/zepentati Signature ' Certified Rep.No. Date LOCAL COPY 8 2 7 818 Name of Driller Rob stodola ID#52603 HE-01205-16(Rev.5/16)