Laserfiche WebLink
illi . <br /> WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. <br /> County Name WELL AND BORING RECORD <br /> Atrrtnrpi n Minnesota Statutes Chapter 103/ <br /> Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed <br /> n. <br /> Orono 117 23 09 108 7-15-02 <br /> House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD <br /> ❑ Cable Tool ❑ Driven ❑ Dug <br /> 9pn nt d Crystal Bay Rd So Orono 55391 El / <br /> Auger lotary ❑ Jetted <br /> Show exact location of we in section grid with" Sketch map of well location. ❑ . <br /> Showing property lines, <br /> roads and buildings. DRILLING FLUID WELL HYDROFRACTURED? ❑YES 4..1/0 <br /> N ' wa t e r .FROM ft.to ft. <br /> t USE ❑ Monitoring 0 Heating/Cooling <br /> Domestic <br /> J i _ J.l._. El Community PWS DIIndustry/Commercial <br /> i ❑ Irrigation ❑ Noncommunity PWS 0 Remedial <br /> w E El Environ.Bore Hole ❑ Dewatering ❑ <br /> r CASING Drive Shoe? ❑ Yes �1tJ❑oWelded HOLE DIAM. <br /> V2M,ie / <br /> I I ❑ Threaded1 ❑ PSteellastic ❑ <br /> S �� J <br /> I ,Mile I / <br /> if CASING DIAMETER WEIGHT <br /> PROPERTY OWNER'S <br /> �fNAME _ _in.to4AO—ft. 2.01 lbs./ft. $ in.to 30. <br /> Ken/Julie Riffr in.to ft. _lbs./ft. 61/4 in.to-108 <br /> Property owner's mailing address if different than well location address indicated above. in.to ft. .___ lbs./ft. V in.to ft. <br /> same as above <br /> SCREE OPEN HOLE <br /> Make from ft.to ft. <br /> Type stainise 4 4 <br /> etl Diam. E/y2M <br /> Slot/Gauze .010 Length ' ♦ 4 <br /> Set between 140 ft.and 108 ft. FITTINGS: 2.'730" w/kp <br /> STATIC WATER LEVEL <br /> WELL OWNER'S NAME 53 ft. 1.tfelow 0 above land surface Date measured 7-15-02 <br /> PUMPING LEVEL(below land <br /> surface) <br /> Well owner's mailing address if different than property owner's address indicated above. 85 ft. after 2 hrs.pumping 25 __g.p.m. <br /> WELL HEAD COMPLETION Whitewater Whitewater Model _ <br /> ❑ 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 0 Bentonite 0 Concrete /High Solids Bentonite <br /> MATERIAL fom- to 30 ft. x.59 yds. a9 <br /> s <br /> from_ 0 to 104__ft.natural-fj4sl❑ bags <br /> topsoil black soft 0 3 from to ft. 0 yds. ❑ bags <br /> NEAREST KNOWN SOURCE OF CONTAMINATION <br /> clay gray soft 3 90 - ) feet direction - _ type <br /> Well disinfected upon completion? [ 'yes CI No <br /> watersand tan soft 90 108 PUMP / <br /> 0 Not installed Date installed _ _ 7-17-02 — <br /> Manufacturer's name Aermotor <br /> Model number HP 1 Volts_ 230 <br /> Length of drop pipe 63 ft. Capacity g.p.m. <br /> - <br /> Type: Crubmersible ❑ L.S.Turbine ❑ Reciprocating 0 Jet El <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 this well? 0 Yes '�No TN# <br /> WELL CONTRACTOR CERTIFICATION / <br /> Use a second sheet,if needed This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. <br /> REMARKS,ELEVATION,SOURCE OF DATA,etc. The information contained in this report is true to the best of my knowledge. A <br /> BO - - s _ Y . c - 122 <br /> ice.•ee:usme Name ._ 'c.or-e..No. <br /> ,,,• "' �1 ► 9=25-e2 <br /> P ,'Au orized Re)rese.-title Signa ure Date <br /> Chuck Moore 7-15-02 <br /> Name of Driller Date <br /> LOCAL COPY 67 7871 HE-01205-07(Rev.2/99) <br /> IC#140-0020 <br />