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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 648563 Hennepin Minnesota Statutes Chapter 1031 Township Name Township No. I Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed Orono 118 23 21 Sii,NR,,SW 166 n 7/26/00 House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD ❑ Cable Tool ❑ Driven ❑ Dug 340 Turnhas Road Orono ❑ Auger Rotary ❑Jetted Show exact location of well in section grid with"X'. Sketch map of well location. ❑ I� Showing property lines, roads and buildings. DRILLING FLUID WELL HYDROFRACTURED? El /k YES 1NO N � Water FROM ft.to ft. USE ❑ Monitoring ❑ Heating/Cooling i Domestic ❑ CommunityPWS -1- -J- -�- -�- ♦ r Irrigation ❑ Industry/Commercial ❑ Noncommunity PWS ❑ Remedial w E � ) ` ❑ Environ.Bore Hole ❑ Dewatering ❑ CASING Drive Shoe? ❑ Yes 41,No HOLE DIAM. -i 1 -L- -i- t-•— •---'' ❑ Steel ❑ Threaded ❑ Welded Ll Plastic . s !` —1 Mile -i CASING DIAMETER WEIGHT PROPERTY OWNER'S NAME 4 in.to 161 ft. lbs./ft. 81 in.to45 ft. Eric Menge in.to ft. lbs./ft. If— in.tel6L6-ft. Property owner's mailing address if different than well location address indicated above. in.to ft. lbs./ft. in.to_ft. 360 Turnh" Road SCREEN OPEN HOLE Orono, MN 55323 Make J$VCQ from ft.to h. Type "C Diam. '3 Slot/Gauze 15Length 5I '`G Set between 161 ft.and 166 FITTINGS: Y�nnnlrnr STATIC WATER LEVEL WELL OWNER'S NAME 132 ft.�Q below ❑ above land surface Date measured Saine PUMPING LEVEL(below land surface) Well owner's mailing address if different than property owner's address indicated above. ft. after hrs.pumping 20 g.p.m. WELL HEAD COMPLETION *Pitless adapter manufacturer Model 4" ❑ Casing Protection ❑ 12 in.above grade ❑ At-grade(Environmental Wells and Borings ONLY) GROUTING INFORMATION Well grouted? lk Yes ❑ No GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO Grout Material ❑ Neat cement X Bentonite ❑ Concrete ❑ High Solids Bentonite MATERIAL from to ft. -3 ❑ yds.g bags Topsoil Black O 3 from to ft. ❑ yds. ❑ bags from to ft. ❑ yds. ❑ bags NEAREST KNOWN SOURCE OF CONTAMINATION Clay Gray 3 56 feet direction none —type Well disinfected upon completion? X Yes ❑ No Cloy/gravel Gray 54 95 PUMP Gravel Mixed 95 160 ❑ Not installed Date installed $/3/00 Manufacturer's name Myers Sand Gray 140 166 Model number to HP 3/4 volts Length of drop pipe 140 ft. Capacity 12 _g.p.m. Type:IV Submersible ❑ L.S.Turbine ❑ Reciprocating ❑ Jet ❑ ABANDONED WELLS Does property have any not in use and not sealed well(s)? ❑ Yes V No VARIANCE Was a variance granted from the MDH for this well? ❑ Yes T No TN# WELL CONTRACTOR CERTIFICATION 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 contained in this report is true to the best of my knowledge. Li ensee Busines me14�Lic.or Reg.No. $/4/00 Authorized Represents a Signature / Date 16485631 a Date LOCAL COPY HE-01205-07(Rev.2J99) WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring i 3 H �!� WELL AND BORING SEALING RECORD Sealing to Count'Name Minnesota Unique Well No. — — � 487 HenneHennepin Minnesota Statutes,Chapter 1031 or W-series No. pin ILaeve Hank tl not known) —J Township Name Township No. Range No Section No. Fraction(sm.y Ig.) Date Seated Date Well or Boring Constructed Orono 118 23 31 Ski NE SSI 8/7/00 Numerical Street Address or Fire Number and City of Well or Boring Location l 340 Turnham Road, {Trona Depth Before Sealing 147 -_ft Original Depth _ __ft Show exact location of well or boring ki Sketch map of well or boring AQUIFER(S) STATIC WATER LEVEL in section grid with"X'. location, showing property *Single Aquifer ❑ Mult aquifer lines,roads,and buildings. N WELL/BORING `,Measured ❑ Estimated Water Supply Well ❑Monit.Well 133 Env.Bore Hole ❑Other tt. below ❑ above land surface W --I- -�-- -i-- --i-- E i CASING TYPE(S) f r LL` I --�- -�-- --�-- --�-- � � T4 Steel ❑ Plastic ❑Tile ❑ Other }rl mile I = CASING(S) DiamLeter n Depth 1 L Set in oversize hole? Annular space initially grouted? S +i 0 i42 Yes r No ❑ ❑ r mile in.from to ft. ❑ '�"^ Yes No /7 Unknown PROPERTY OWNER'S NAME in.from to ft. ❑ Yes ❑No ❑ Yes ❑ No ❑ Unknown Erie Menge Property owner's mailing addressitdifferent than well location address indicated above. in.from — to ft. E] Yes E] No E] Yes ❑ No ❑ Unknown 34th Turnh:gym Road SCREEN/OPEN HOLE Orono, IMN 55323 Screen from 142 to 147 ft. Open Hole from to ft. OBSTRUCTIONS WELL OWNER'S NAMEE] Rods/Drop Pipe p El Check Valves) E] Debris E] Fill *No Obstruction Well owner's mailing address if different than property owner's address indicated above Type of Obstructions(Describe) Obstructions removed? ❑ Yes ❑ No Describe PUMP Type GEOLOGICAL MATERIAL COLOR HARDNESS OF FROM TO Removed ❑ Not Present ❑ Other FORMATION If not known,indicate estimated formation log from nearby well or boring. METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: �No Annular Space Exists ❑Annular space grouted with tremie pipe ❑Casing Perforation/Removal in.from to ft. ❑ Perforated ❑ Removed in.from to ft. ❑ Perforated ❑ Removed Type of perforator ❑ Other GROUTING MATERIAL(S) (One bag of cement=94 lbs.,one bag of bentonite=50 lbs.) y g Grouting Material NecIt Ce*. from U to 147 ft. yards _13 bags from to ftyards bags from to ft. yards bags from to_ ft. yards bags REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING OTHER WELLS AND BORINGS Other unsealed and unused well or boring on property? ❑Yes No How many? LICENSED OR REGISTERED CONTRACTOR CERTIFICATION This well or boring was sealed in accordance with Minnesota Rules,Chapter 4725. The information contained in this report is true to the best of my knowledge. Stevens Drilling & Env. Services, Inc. 86654 Contractor Business Name License or Registration Aii 8/7/00 Authorized Representative Signature Date Randy Johnson =J�,AL COPd JH 163487 634O Name of Person Sealing Well or Boring