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Brown Road South
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680 Brown Road South - PID: 03-117-23-43-0003
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Last modified
8/22/2023 4:38:37 PM
Creation date
2/5/2016 11:52:14 AM
Metadata
Fields
Template:
x Address Old
House Number
680
Street Name
Brown
Street Type
Road
Street Direction
South
Address
680 Brown Rd S
Document Type
Land Use
PIN
0311723430003
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s ` <br /> ti � <br /> WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. <br /> � CountyName WELL AND BORING RECORD 6 4 9 2 01 <br /> R�III2@ in Minnesota Statutes Chapter f03/ <br /> Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed <br /> n. <br /> Orono 117 23 03 ��. ��� ��� 1 3 <br /> House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD <br /> 6Q/� O ❑ Cable Tool ❑ Driven ❑ Dug <br /> C7V �7 Brown Rd �r�n0 5 C7 Auger �Rotary ❑ Jetted <br /> Show exact location of well in section grid with" " Sket h map of well location. ❑ <br /> 1�howing property lines, <br /> A. o,}� roa s a d buildings. DRILLING FLUID WELL HYDROFRACTURED? ❑YES �O <br /> — N — � � <br /> i � i � � FFOM_ ft.to ft. <br /> i -i- -i- -i <br /> USE fJ Monitoring ❑ Heating/Cooling <br /> i i i i � ��� �Domestic �j Communi PWS <br /> _I_ _J_ _L_ _I_ t„ <br /> ❑ Irrigation ry ❑ Industry/Commercial <br /> i i i i .� ❑ Noncommunity PWS ❑ Remedial <br /> yy E T -�>� � ❑ Environ.Bore Hole <br /> i i i i � ❑ Dewatering ❑ <br /> i i i -� I � CASWG Drive Shoe? ❑ Yes �lo HOLE DIAM. <br /> 'IzMne .-� <br /> _i i 1 i � ❑ Steel ❑ Threaded ❑ Welded <br /> i- -l- i i <br /> �!Plastic ❑ <br /> s <br /> �-1Mile—� ..���� <br /> CASING DIAMETEF WEIGHT <br /> PROPERTY OWNER'S NAME _�__.__in.to_��.�ft. � fl���Ibs./tt. __in.to__��tt. <br /> T ll! $ ��.co n. _ib5.in. t ��.�o�Z_�n. <br /> Property owner's mailing address it different than well location address indicated above. ___in.to__ fl. IbsJft. in.to ft. <br /> 7526 Turner �d SCREEN OPENHOLE <br /> Inde end�nce M� 55328 "'ake__�1°hns°� ``°m___ n`° n. <br /> P 1 Type�_��#�;�.��_ e�t�s�Diam �___ <br /> ��` SbUGauze� _._ Length _ <br /> � Set between _� _ ft.and R. FITTI GS: <br /> STATIC WATER LEVEL <br /> WELL OWNER'S NAME __5_5—_ R. C�below ❑ above land surface Date measured ��77.+11 <br /> PUMPING LEVEL(below land surface) <br /> Well owner's mailing address if different than property owner's address indicated above. 1_1_�___ ft. after __,___,�_ _hrs.pumping �_._g.p.m. <br /> WELL HEAD COMPLETION <br /> f�Pitless adapter manufacturer ..L.1 •....�����Model <br /> • f� Casing Protection__. __._ �12 in.above grade ��� <br /> ❑ At-grade(Environmental Wells and Borings ONLY) <br /> GROUTING INFORMATION <br /> Well grouted? �Yes ❑ No <br /> GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO Grout Material ❑ Neat cement f7 Bentonite I� Concrete �High Solids Bentonite <br /> MATERIAL from�__to__ 3i�.ft. ___^y_�5❑ yds.�'bags <br /> from_��--to�_'}�ft. �a���a_� f��d�1 bags <br /> i <br /> from to ft. ❑ yds. ❑ bags <br /> � NEAREST KNOWN SOURCE OF CONTAMINATION <br /> __ 1`in_feet _ _�. direction`+��y _Qn�2.pt�pe <br /> ) .��.�.. <br /> Well disinfected upon completion? ,jS�Yes f 1 No <br /> PUMP <br /> ❑ Not installed Date installed 6'1��Q <br /> Manutacturer's name - <br /> Model number_ HP �_ . Volts��8_ _ <br /> 7 Length of drop pipe___�_ ft. Capaciry _ g.p.m. <br /> Type: �Submersible ❑ L.S.Turbine f7 Reciprocating ❑ Jet ❑ _ f <br /> ABANDONED WELLS <br /> Does property have any not in use and not sealed well(s)? ❑ Yes �No <br /> VARIANCE <br /> Was a variance granted from the MDH for ihis well? ❑ Yes �No TN#_ : <br /> i <br /> - WELL CONTRACTOR CERTIFICATION <br /> Use a second sheet,il 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 ot my knowledge. i <br /> REMARKS,ELEVATION,SOUf10E OF DATA,etc. <br /> Licensee u*smes' s Nam����'`��fl�or'R�g.7J�� �� , <br /> �:.=f�,.:_....� ��-��-d.�-*�-`�10-4-00 ; <br /> - - --- - _ —_ ---- -- <br /> � � Authorized Represenlative Signature Date <br /> i <br /> Chuck Maore 5-22-00 r <br /> . _ _------ - -— - <br /> 6 4 9 2 01 Name o�Driller Date <br /> LOCAL COPY HE-01205-07(Rev.2/99) <br />
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