HomeMy WebLinkAboutwell info WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO.
County Name WELL AND BORING RECORD
Hennepin Minnesota Statutes,Chapter 1031 727744
Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed
Orono 110 23V 32 ,/, y, $4 160 May 18, 2006
GPS seconds DRILLING METHOD
LOCATION: Latitude degrees minutes
Longitude degrees minutes seconds ❑Cable Tool ❑Driven ❑Dug
❑ Gl ❑
House Number,Street Name,City,and Zip Code of Well Location �or Fire Number ❑Auger Rotary Jetted
7C
3240 Waterton n Rd, Orono DRILLING FLUID WELL HYDROFRACTURED? ❑Yes No
Show exact location of well in section grid with"X' Sketch map of well location. rater FROM ft.TO
Showing property lines,
N �;ii` roads and buildings USE ❑Monitoring ❑Heating/Cooling
I Domestic ❑Environ.Bore Hole ❑Industry/Commercial
t
Noncommunity PWS [__1 irrigation Ll Remedial
1 L L ❑Community PWS ❑Dewatering ❑
CASING HOLE DIAM.
W E Drive Shoe? ❑Yes No
_____ ❑Steel ❑Threa ed ❑We ed
' Mile Plastic
h } 1!4 { t 10
CASING DIAMETER WEIGHT
S
,/ - 4 in.to 155 ft. lbs./ft. 81 in.to40 ft.
�1Mile _(.
� riL. (_�.,�,jr� i
in.to ft. lbs./ft. 6} in.to 160 ft.
PROPERTY OWNER'S NAME/COMPANY NAME in.to ft. lbs./ft. in.to ft.
Hickory Fine Rome SCREEN OPEN HOLE
Property owner's mailing address if different than well location address indicated above. Make 0 FROM ft. TO ft.
1844 Wayzata Blvd Type Diam. 51
PBoa 815 Slot/Gauze 18 Length
Long Lake, MN 55356 Set betweenft.and 160 ft. FITTINGS k packer_
STATIC WATER LEVEL
72 ft.41below ❑above land surface Date measured 5-18-06
WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below and surface)
Hickory Fine Rome WELL
after hrs.pumping 50+ g.p.m.
WELL HEAD COMPLETION M
Well owner's mailing address if different than property owners address indicated above. }�pltless adapter manufacturer Miss Model 4
u Casing Protection X 12 in.above grade
❑At-grade(Environmental Wells and Boring ONLY)
GROUTING INFORMATION
Well grouted Yes F1 No
Grout material Neat cemeent *Sentonite ❑Concrete E]High Solids Bentonite
from 10 to 40 ft. 3 ❑yds. bags
from to ft. ❑yds. bags
GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO from to ft. ❑yds. [I bags
MATERIAL
rt NEAREST KNOWN SOURCE OF CONTAMINATION over fron seiner
0
clay tan 30 feet direction type
Well disinfected upon completion Yes ❑No
clay gray 30 89 PUMP
❑Not installed Date installed'
sand 4 gravel gray 89 11A5 Manufacturer's name
clay & sand red 115 146 Model number t ' /t HIP Volts y
Length of drop pipe J ✓ /! ft. Capacity 12 f ) g.p.m.
Type: Submersible ❑L.S.Turbine ❑Reciprocating El Jet
❑
sand & gZ1Ye1 mixed 140 16a ABANDONED WELLS
Does property have any not in use and not sealed well(s) ❑YesNo
VARIANCE X.
Was a variance granted from the MDH for this well? ❑Yes XNo 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 L
REMARKS,ELEVATION,SOURCE OF DATA,etc. Stevens Drilling '& Eneirormente.l Svc 86654
Licensee Business Name Lic.or Reg.No.
Authorized Representative Signature Date
Randy Johnson
IC 140-0020 LOCAL COPY
1727744 Name of Driller
HE-01205-08(Rev.5/02)