Well info - Laserfiche WebLink

Home Browse Search

. - .. _. , .._.. u.: �<_. �.. .�. .__ ,.�. . _., T ... . ,. . .., . , .- .. . . : .. MINNESOTA UNIQUE WELL � ' WELL OR BORI�OCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. : co,,,,tY Name�"- ,, � WELL AND BORING RECORD 7 8$2 4 O Minnesota Statutes,Chapter 1037 Township Name Township No. Range No. Section No. Fraction WELL/BORWG DEPTH(completed) DATE WORK COMPLETED � Zt7 23 os ,sw �,B riE,, 1s5 n 4-2�-12 GPS DRILLING METHOD LOCATION: Latitude degrees minutes _ seconds _ Longitude degrees minutes seconds ❑Cable Tool riven ❑Auger �Rot�ry House Number,Street Name,City,and ZIP Code of Well Location Fire Number ❑p�her DRILLWG FLUID �"'�'WELL HYDROFRACTURED? ❑Yes No Show exact location of welUboring in section grid with"X:' Sketch map of well/boring locati . �te� From ft.To ft. Showing praperty lin s, - roads,buildings,and direcf n. USE f .' N Domestic U Monitoring ❑Heating/Cooling �� __j___._i____;__ ___;__ i �Noncommunity PWS n Environ.Bore Hole ❑Industry/Commercial i ,,:. , � � _ � Community PWS [.�Irrigation �]Remedial � __�_____; < <__ � [�Elevator U Dewatering - w ' ; ; E T � �� CASING MATERIAL Drive Shoe? ❑Yes �No. HOLE DIAM. �- - ' -�-----� I .. "t�.�Steel- i�Threaded �'Welded , , � '/e Mlle � -_, Plastic ❑ ` --�--- --�--- ---%-----�- ; ; ; ; CASING S Diameter Weight Specifications i �1Mile-� � in.To�� ft. Ibs./ft. � in.To �� ft PROPERTY OWNER'S NAME/COMPANY NAME ____in.To ft. Ibs./ft. �in.T�ft �vpL. &�ld�rp __ in.To ft. Ibs./ft. in.To ft j... ..� SCREE OPEN HOLE Property owner's mailing address if different than well location address indicated above. -- $� J�i35 Ct'� Ra 1�1 Make From _ft. To ft. " �(�tV[liV;e� �+I 55345 TYPe--$t�inless atee Diam. / - `. SIoVGauze ____. .OiO_ Length 4! "�'��___ Set between ft.and ft. FITTINGS R * �� STATIC WATER LEVEL Measured from ft.�Below ��Aboveland surface Date measured � WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) �� fl.afler � hrs.pumping �� g.p.m. Well/boring owner's mailing address if different than properry owner's address indicated above. �LLHEAD COMPLETION ' Pitless/adapter manufacturer��-- Model ❑Casing protection �12 in.above grade � ❑At-grade ❑Well House ❑Hand Pump GROUTING INFORMATION(specify bentonite,cement-sand,neat-cement,concrete,cuttings,or other) Matenal �r��rom O To_5" ft. � ❑Yds. �.'Bags Material natucsl f��. 50 To 1� ft. ❑Yds. ❑Bags HARDNESS OF Material From To ft. ❑Yds. ❑Bags GEOLOGICALMATERIALS COLOR MATERIAL FROM TO Drivencasingseal From To Bags NEAREST KNOWN SOURCE OF CONTAMINATION a �/C.l feel w direction ��. �a-e4' type Well disinfected upon completian? �Yes ❑No PUMP A +�f ❑Not installed Date installed_ �`��L ___ Manufacturer's name �`�I�� _____ Model Number HP 1�5 Volts �� Length of drop pipe �9L ft. Capaciry_ g.p.m i Type:�Submersible ❑LS.Turbine ❑Reciprocating ❑Jet U ; ABANDONED WELLS Does property have any not in use and not sealed well(s)? ❑Yes No VARIANCE . Was a variance granted from the MDH for this well? f�Yes �No 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,il needed. REMARKS,ELEVATION,SOURCE OF DATA,etc. JUN Don Stodola Well Dri113 Co . Inc. 1691 CITYOF ORONO Licensee Business Name ic or Reg.No. _--- � if' epresentative Signa e, Certified Rep.No. Date 7 8 8 2 4 0 �rt st«�o18 ` ,-�rv;� ,�,,; _- -- � Name of Driller � IC 140-0020 HE-01205-13(Rev.11/10)