Laserfiche WebLink
WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. <br /> County Name WELL AND BORING RECORD <br /> Minnesota Statutes Chapter 1031 580411 <br /> Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed <br /> Orono 117 23 09 101 n. 4-11-96 <br /> House Number,StreetoName.City,and Zip Code of Well Locationyor Fire Number DRILLING METHOD J U N QCSL' <br /> tw1een 870 & 89(; Old ryEtc,'�l Ba Rd. 0 Auger Tool U Dmevn�V 0 Dug <br /> Y ❑Auger Notary 0 Jetted <br /> Show exact location of well in section grid with X. Sketch map of well location. 0 •••' <br /> Showing property lines, <br /> N Ori], (4 p roads and buildings. DRILLING FLUID <br /> �i�S' Eer:tt'.;1.`.e.. <br /> USE 0 Heating/Cooling <br /> __�__�_-_L_--`- G 0 Jlomestic <br /> 0 CommunityPWSg <br /> W Q 0 Irrigation 0 Industry/Commercial <br /> w r W E 0� vt <br /> ❑ Test Well ❑ Noncommunity PWS ❑ Remedial <br /> W - ❑ Dewatering ❑ <br /> iI - Yiaw CASING Drive Shoe? ❑ Yes ❑ No HOLE DIAM. <br /> 1 LI ) ❑ Steel ❑ Threaded ❑Welded <br /> S <br /> 1 �Plastc 0 <br /> —'Ude— I <br /> CASING DIAMETER WEIGHT <br /> PROPERTY OWNER'S NAME 4 93 7/6 3(1 <br /> Lake Associates <br /> in.to ft. lbs./ft. in.to_ft. <br /> in.to ft. IbsJft. _6_it r K1 <br /> Property owner's mailing address if different than well location address indicated above. in.to ft. lbs./ft. in.n.to to ft. <br /> 1 212 E Wayzata Blvd. SCREEN OPEN HOLE <br /> Wayzatar Mn. `55 9'1 Make Johnson from ft.to ft. <br /> Type Sta 7 nles= Steel Diam. '.w <br /> Slot/Gauze 1 /10 Length 6' <br /> Set between 93 ft.and 1 L 1 ft. FITTINGS: <br /> STATIC WATER LEVEL <br /> WELL OWNER'S NAME 38 ft. ❑Nielow 0 above land surface Date measmed'4-11-96 <br /> PUMPING LEVEL(below land surface) <br /> Well owner's mailing address if different than propertyowner's address indicated above. ft. after hrs.pumping <br /> g.p.m. <br /> WELL HEAD COMPLETION N/A <br /> ❑ Pitless adapter manufacturer Model <br /> ❑ Casing Protection 0 12 in.above grade <br /> ❑ At-grade(Environmental Wells and Borings ONLY) <br /> GROUTING INFORMATION <br /> Well grouted? pi Yes 0 No <br /> GEOLOGICAL MATERIALS COLOR HARDNESS RIALOF FROM TO Grout Material 0 Neat cement ❑h3.Bentonite 0 Concrete 0 High Solids Bentonite <br /> MATE1 ,,�� from 3 0 to 30 ft. 3 0 yds. IjCbags <br /> Top Soil Black S 0+ 10 l from to ft. 0 yds. 0 bags <br /> from to ft. 0 yds. 0 bags <br /> • <br /> NEARE u Mpl SOURCE OF CON IINATION <br /> Clay Dark Grey M 10' 30' /.� feet J d ti <br /> �f direction S&6T/‹. tYlm <br /> /rte,,, Well disinfected upon completion? ❑res 0 No <br /> Gravel Black/Tan A 30' 40 PUMP <br /> _ <br /> 0 Not installed Date installed 4-16-96 <br /> Clay-mixed w/Gravel Grey S 401 80 l Manufacturer's name Red jacket <br /> Model number N12GC HP 2 vats 230 <br /> Sand—fine Grey S 80 O{i, Length of drop pipe 63 N/A ft. Capacity G s g.p.m. <br /> Pressure Tank Capacity <br /> Type:ury] Submersible 0 L.S.Turbine 0Reciprocating 0Jet ❑ <br /> Water Sand Colored S 90 11;1 <br /> ABANDONED WELLS <br /> X <br /> Does property have any not in use and not sealed well(s)? 0 Yes U No <br /> VARIANCE • <br /> Was a variance granted from the MDH for this well? 0 Yes CIWNo <br /> WELL CONTRACTOR CERTIFICATION . <br /> Use a second sheet,if needed This well was drilled under my supervision and in accordance with Minnesota Rules,C <br /> REMARKS,ELEVATION,SOURCE OF DATA,etc. The information contained in this report is true to the best of m y knowledge ►Wepfer 4725. <br /> . <br /> DON STODOLA WELL DRILLING CO., INC. 27172 <br /> Licensee Business Name Lic.or Reg.No. <br /> 4-11-96 <br /> Authorized Representative Signature Date <br /> Mark Sto&ola 4-11-96 <br /> LOCAL COPY 580411 <br /> Name o/Odller Date <br /> HE-01205-05(Rev.1/95) <br />