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Home My WebLink Aboutwell info WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. County Name WELL AND BORING RECORD 633587 Henne. i a Minnesota Statutes Chapter 1031 Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed Orono 117 23 5 SW,,, SW 'tri, n House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD R 3.30 'Tonka Ave. Orono ❑ Cable Tool ❑ Driven ❑ Dug ❑ Auger Rotary ❑ Jetted Show exact location of well in section grid with"X". Sketch map of well location. ❑ C Showing property lines, - - - -- V roads and buildings. DRILLING FLUID WELL HYDROFRACTURED? ❑YES CCNO N Paroid "uik el FROM -ft.to ft. USE El Monitoring ElHeating/Cooling l Domestic ❑ Community PWS J{.µw .� Y ❑ Industry/Commercial G -�,_ ,-// ❑ Irrigation ❑ Noncommunity PWS w i i E j �f f ❑ Environ.Bore Hole y El Remedial El Dewatering ❑ /2M_18 1 B CASING Drive Shoe? ❑ Yes No HOLE DIAM. ❑ Steel ❑ Threaded ❑ Welded ;k7 Plastic ❑ s CASING DIAMETER WEIGHT 1 PROPERTY OWNER'S NAME �' in.to 91 ft. 1 .9 lbs./ft. in.`� Co� ft. Fill 1. U '✓!?r --in.to ft. lbs./ft. L�3 in. o �ft. Property owner's mailing address if different than well location address indicated above. _ in,to ft. lbs./ft. in.to ft. SCREEN OPEN HOLE Make c r e s l lie from ft.to ft. Type j,%l a c t i c Diam. 11 Slot/Gauze 1 5 Length 1 O f f Set between -3 1 ft.and 1 01 ft. FITTINGS: STATIC WATER LEVEL WELL OWNER'S NAME 30 ft.A below ❑ above land surface Date measured 1/27 PUMPING LEVEL(below land surface) Well owner's mailing address if different than property owner's address indicated above. ft. after hrs.pumping 40 g.p.m. WELL HEAD COMPLETION -)t Pitless adapter manufacturer DIY h.i t ed a t e r Model sit 4 5 ❑ Casing Protection ❑ 12 in.above grade ❑ At-grade(Environmental Wells and Borings ONLY) GROUTING INFORMATION Well grouted? `L Yes ❑ No GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO 1 Grout Material ❑ Neat cement ❑ Bentonite ❑ Concrete CCHigh Solids Bentonite MATERIAL from -10 to 0 ft. 7 ❑ yds.7L"1 bags black dirt black s o f t Q 1 3 from to ft. ❑ yds. ❑ bags from to ft. ❑ yds. ❑ bags NEAREST KNOWN NSOURCE OF CONTAMINATION c1� Ygray yUf t 13 �1 © feet 'west direction Citi hype - - -•- Well disinfected upon completion? m Yes ❑ Nosewer sant. & ciay gray- - Salt_ 61 87 PUMP ' '---•------_.... ❑ Not installed Date installed sand -�,ra'�------ _sof._t 87 101 Aero or -" -•-- - Manufacturer's name �- 1/2 220 -•^� .^ -.-~-_ Model number ._HP V1 V Ij5 ~ - '""` Length of drop pipe ft. Capacity g.p.m. -•-.. Type: A Submersible ❑ L.S.Turbine ❑ Reciprocating ❑ Jet ❑ _ ASAWONEV XVgLL_S 5yc Does property have any not in use and not sealed well(s)?- El Yes LY No _..`.. VARIANCE._.... Was a variance granted from the MDH for this well? ❑ Yes 1�No TN# WELLCOWRACTORCERTIFICATION Use a second sheet,if needed` -* ----- -._.._ This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. REMARKS.,.ELEVATION,SOURCE OF DATA,etc. The information cwtained in this report is true to the best of my knowledge. Leuthner Well Inc. 10125 Licensee Business Name, Lic or Reg _ - - 6 uthonzed Re sentative Signature ate Maurice L. Leuthner 3/2/00 LOCAL �/ Name of Driller Date LOCAL COPi 1633587 HE-01205-06(Rev.7/98)