HomeMy WebLinkAboutwell info WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO.
County Name WELL AND BORING RECORD 572707
Hennepin Minnesota Statutes Chapter 103/
T 3pohip�Naame To�wrlsf�No. R�j No. Section No. ctioNW NE WELL DEPTH(completed) Date Work Completed
11 4 91 tt 8/6/96
House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD
2600 Thoroughbred Lane ❑ Cable Tool ❑ Driven ❑ Dug
❑ Auger Rotary ❑ Jell
Show exact location of well in section grid with"X". Sketch map of well location. ❑ _
Showing property lines, polo
roads and buildings. DRILLING FLUID
N Bentonite
USE ❑ Monitoring ❑ Heating/Cooling
1K Domestic ❑ Communit PWS
El Irrigation y ❑ Industry/Commercial
�- ❑ Noncommunity PWS El Remedial
w E T r„__,,,,-_,/ ❑ Test Well ❑ Dewatering ❑
/ZM1e /'E CASING Drive Shoe? ❑ Yes ❑ No HOLE DIAM.
❑ Steel ❑ Threaded L-1 Welded
pQ Plastic ❑
Mile
CASING DIAMETER WEIGHT
PROPERTY OWNER'S NAME 4 in.to 86 ft. 200 lbs./ft. 81 in.to 60 ft.
Lecy Construction in.to ft. lbs./ft. in.to�ft.
Property owner's mailing address if different than well location address indicated above. in.to ft. lbs./ft. in.to _ ft.
10340 Viking Drive SCREEN OPEN HOLE
Make Ja eofrom ft.to_____...__ft.
Eden Prairie, Mn 55344 Type rYl. Diam.
Slot/Gauze Length - Y—
Set between ft.and 91 ft. FITTINGS: K ae er
STATIC WATER LEVEL
WELL OWNER'S NAME 42 ft. rsroelow ❑ above land surface Date measured
PUMPIN4YVEL(below land surface) 3 50
Well owner's mailing address if different than property owner's address indicated above. L ft. after hrs.pumping C g.p.m.
AWELL HEAD COMPLETION Whitewater S-S-4
Pitless adapter manufacturer Model
❑ Casing Protection ❑ 12 in.above grade
❑ At-grade(Environmental Wells and Borings ONLY)
GROUTING INFORMATION
Well grouted? 1� Yes [I No
HARDNESS OF Grout Material ❑ Neat ce t *13ento to ❑ Concrete ElHigh Solids Bentonite
GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO `�°
from to ft. 71yds. 11bags
t med. 0 5 from to ft. ❑ yds. E] bags
Tod; soil black
from to ft. ❑ yds. ❑ bags
NEAREST KNO OURCE OF CONTAMINATI
clay brown med. 5 I9 floor drain
y feet direction type
clay blue med. 19 48 Well disinfected upon completion? AYes ❑ No air t e s a d
PUMP 8/8/96
❑ Not installedDate t II d
sand & gravel mix mod. 48 91 Manufacturer's nar� Stal"YIt
Model number S' /5M HP 3/4 Volts
Length of drop pipe 85 ft. Capacity 1
Pressure Tank Capacity
Type: f�rSubmersible ❑ L.S.Turbine ❑ Reciprocating ❑ Jet ❑
ABANDONED WELLS 5�
Does property have any not in use and not sealed well(s)? ❑ Yes `r 1 No
VARIANCE
Was a variance granted from the MDH for this well? ❑ Yes ]EI No
WELL CONTRACTOR CERTIFICATION
Use a second sheet,it needed This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725.
REMARKS,ELEVATION,SOURCE OF DATA,etc. The information contained in this report is true to the best of my knowledge.
R.E.S. Well Drilling 27276
Licensee Business Name Lic.or Reg.No.
Authorized Representative Signature Dag
Robert E. Stodola, Jr. 8/7/96
Name of Driller HE-01 205-05(Rev.1/95)
LOCAL COPY 1572707 �