HomeMy WebLinkAboutwell info WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH RECEIVED MINNESOTA UNIQUE WELL NO.
County Name WELL AND BORING RECORD
Hennepin Minnesota Statutes Chapter 1031 0 3 20 692845
Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed
Orono 11711 2311 S 511,11E / 122 Y V�ORONO 9—"3
GPS DRILLING METHOD
LOCATION: Latitude degrees minutes seconds
Longitude degrees minutes seconds ❑Cable Tool ❑Driven Dug
i�I Auger Rotary ❑Jetted
House Number,Street Name,City,and Zip Code of Well Location or Fire Number �l
205 Tanta ATI, Orono 55356 DRILLING FLUID WELL HYDROFRACTURED? ❑Yes NNo
Shop exact location of well in section grid with"X". Sketch map of well location. Muer FROM ft.TO ft.
Showing property lines,
N roads and buildings USE ❑Monitoring ❑Heating/Cooling
XDomestic ❑Environ.Bore Hole ❑Industry/Commercial
❑Noncommunity PWS ❑Irrigation ❑Remedial
❑Community PWS ❑Dewatering ❑
-------- ----- - --`-- ?
CASING HOLE DIAM.
w ET � Drive Shoe? ❑Yes No
Steel ❑Threaded Welded
'h Mile Plastic 1.
-------- -- 1
CASING DIAMETER WEIGHT
S 4 in.to 117 ft. lbs./ft. al—in.to 45 ft.
1 Mile t ��
in.to ft. lbs./ft. y;_in.to 122
PROPERTY OWNER'S NAME/COMPANY NAME
in.to ft. lbs./ft. in.to f
Ti: & Natalie Vaughan SCREEN OPEN HOLE
Property owner's mailing address if different than well location address indicated above. Make IYCO FROM ft. TO ft.
425 Dexter Drive Type "C Diam.
Long Late, MPI 55356 Slot/Gauze Length 5
Set between 117 ft.and 122 ft. FITTINGS k"cker
STATIC WATER LEVEL ��9_-_-p9�-0�
62 ft. below [I above land surface Date measured___ i3]t111i�i
PUMPING LEVEL(below land surface)
WELL OWNER'S NAME/COMPANY NAME
Tia & Natalie Vaughan ft.after hrs.pumping 50+ g.p rn
WELL HEAD COMPLETION
Well owner's mailing address if different than property owners address indicated above. )(Pitless adapter manufacturer Naals Model__■
❑Casing Protection 12 in.above grade
❑At-grade(Environmental Wells and Boring ONLY)
GROUTING INFORMATION
Well grouted A Yes ❑No
Grout material ❑Neat cement Apentonite ❑Conc►ete ❑High Solids Bentonite
from 6 1 to 45 ft. 3 ❑yds. %bags
from to ft. _ ❑yds. ❑bags
GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO from to ft. ❑yds. ❑bags
MATERIAL
NEAREST KNOWN SOURCE OF CQNTAMINATION
Wk?riGtilrr �U� rlJYY ; 1..4JP✓�
Clay Yellow 0 30 _feet direction type
Well disinfected upon completion Yes ❑No
Clay Gray 30 80 PUMP /� f
❑Not installed Date installed
Gravel & Sand Mixed 80 122 Manufacturers name A4.j j ee
Model number / HP Volts
Length of drop pipe r✓ ft. Capacity g.p.m.
Type:XSubmersible ❑L.S.Turbine ❑Reciprocating ❑Jet ❑
ABANDONED WELLS
Does property have any not in use and not sealed well(s) ❑Yes )QNo
VARIANCE
Was a variance granted from the MDH for this well? ❑Yes X 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,if needed 7 Em1
REMARKS,ELEVATION,SOURCE OF DATA,etc. Stevens Drilling rirommutal $TC 86654
Licensee Business Name Lic.or Reg.No.
Authorized Representative Signature Date
Bandy Johnson /0 " -1 ,,—,/I--'Z,
LOCAL COPY � 692845 Name of Driller Date
HE-01205-08(Rev.5/02)
IC 140-0020