HomeMy WebLinkAboutwell info WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO.
County Name WELL RECORD 5 5 5 413
Hennepin Minnesota Statutes Chapter 1031
Township Name Township No. I Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed
ft
117 23 13 117 11/7/94
Numerical Street Address and City of Well Location or Fire Number DRILLING METHOD
245 Tonka Ave. Orono MN
1] Cable Tool El Driven El Dug
� ❑ Auger ❑ Rotary ❑ Jetted
Show exact location of well in section grid with"X". Sketch map of well location. C
Showing property lines,
N roads and buildings. DRILLING FLUID
I
--�- -1 -1- Bentonit<..
r i ,USE ❑ Heating/Cooling
-y_ _ _ Domestic ❑ Monitoring
W i I E Irrigation ElPublic ❑ Industry/Commercial
! T ❑ Test Well ❑ DewateringEl
❑ Remedial
CASING Drive Shoe? ❑ Yes Wo HOLE DIAM.
❑ Steel ❑ Threaded ❑ Welded
i
fl.Plastic I
giue
CASINGDIAMETERli WEIGHT
PROPERTY OWNER'S NAME _4 in.to 112 ft. lbs./ft. 81 in.to
Mary K McCarty in.to e. -__--lbs/ff. in.to ff.
Mailing address if different than property address indicated above. in.to ft. lbs./ft. in.to_ft.
6250 Highway 12 W. SCREEN OPEN HOLE
Maple Plain, MN 55359 Make Ajay n from _ft.to ff.
Type PVC Diam. 3 n
Slot/Gauze 18 Length 511
Set between 1 1 7 ft.and l 1.7 ft. FITTINGS:
HARDNESS OF STATIC WATER LEVEL
GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO _ 5 ft. C-Welow ❑ above land surface Date measured__l—J_ 7./.9
PUMPING LEVEL(below land surface)
clay 0 43 h. after __ hrs.pumping__ 150 g.p.m.
WELL HEAD COMPLETION
clay gr a 43 69 XPitless adapter manufacturer MUS Model
❑ Casing Protection ❑ 12 in.above grade
clay & sand gray 69 71 GROUTING INFORMATION
Well grouted? )LYes ❑ No
sand gray fine 71 105 Grout Material XNeat cement ❑ Bentonite
from_.i n to_7r,ft. A ❑ yds. LXbags
from to ft. ❑ yds. ❑ bags
sand & gravel gray cour5 105 117 from to ft. ❑ yds. ❑ bags
NEAREST KNOWN SOURCE OF CONTAMINATION
_feet direction type
Well disinfected upon completion? ❑ Yes ❑ No
OF
ORONOnn , PUMP
+` -r� r ❑ Not installed Date installed 1/13/9 5
15
- - �; Manufacturer's name U iQ4jor FS
Modelnumber r] SS1er HP_3/4 volts
Length of drop pipe 6 0 if ft. Capacity 5 g.p.m.
Pressure Tank Capacity 40 g 1
SAN2 3 1 9' Type: K Submersible ❑ L.S.Turbine El Reciprocating 11 Jet ❑
.L�7
ABANDONED WELLS
Does property have any not in use and not sealed well(s)? Cl Yes ❑ No Unknown
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,it needed 'teypnr, Drillinc �� En"! 866ri
REMARKS,ELEVATION,SOURCE OF DATA,etc. Licensee Business Name Lic.or Reg.No.
- - I.— -
Authonzed Representative Signature a e
1/13 95
Randy Johnson
Name of Driller Date
LOCAL COPY 555413 HE-01205-04(Rev.5/92)