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Home My WebLink AboutWell and Boring Record ... : '''''',,!k' ,!#' [it - ; a.',''T ar. to i "4 at°' �t fir- r .- . rt1.4.4.--;,".2...u: au :ay.�$:, i s° �'.�'-`-,` t,. , r MINNESOTA UNIQUE WELL NO. WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH County Name WELL AND BORING RECORD {-. 615. 83 Hennepin Minnesota Statutes Chapter 1031 ��- Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) ft Date Work Completed Orono 118 23 31 172 9-24-98 House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD t ® 0 Cable Tool 0 Driven ❑ Dug 4440 $t e r t�? Rd ©ron© 55359 ❑ Auger WRotary 0 Jetted 4A q Show exact location of well in section grid with"X". Sketch map of well location. ❑ ,t r' Showing property lines, roads and buildings. DRILLING FLUID WELL HYDROFRACTURED? ❑YES ICAO )�� (16. water FROM ft.to ft. i// USE 0 Monitoring ❑ Heating/Cooling Domestic ❑ CommunityPWS 0 Irrigation 0 Industry/Commercial J i ❑ Noncommunity PWS 0 Remedial w I s C:D ❑ Test Well 0 Dewatering 0 r 1 CASING Drive Shoe? 0 Yes 0 No HOLE DIAM. I 1/2M40 ❑ Steel 0 Threaded 0 Welded ____ l �astic Els 1 Mlle ) 611:› CASING DIAMETER WEIGHT PROPERTY OWNER'S NAME �YjLICJ "'^ 4 in.to 16 3,. sd r-21 Ibs./ft. $ 740 f .0 Cathy Smie ja �`ll.�-- n.to ft. lbs./,. V( n.to�f Property owner's mailing address if different than well location address indicated above. in.to ,. Ibs./ft. in.to ft. SCREEN OPEN HOLE Make Johnson from ft.to ft. Type .�+Sa6ainle` — ! Diam. _ *!M Slot/Gauze .010 01o Length ( + Set between 172 ft.and ,. FITTINGS: STATIC WATER LEVEL ,,��..!! WELL OWNER'S NAME 100 ft./6elow 0 above land surface Date measured 9--24-98 PUMPING LEVEL(below land surface) Welt owner's mailing address if different than property owner s address indicated above. 160 ft. after 1 hrs.pumping 2 2 g.p.m. WELL HEAD COMPLETION y( i Pitless adapter manufacturer whi tewa t r Model Casing Protection j'12 in.above grade 0 At-grade(Environmental Wells and Borings ONLY) GROUTING INFORMATION Well grouted? L Yes 0 No HARDNESS OF Grout Material ❑ Neat cement ❑ Bentonite ❑ ConcretefHi9h Solids Bentonite GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO from 0 to ft. 5 0 yds. "'bags fromto ,. 0 yds. ❑ bags Clay ;yellow soft 0 27 34 nab from r NEAREST KNOWN SOURCE OF CONTAMINATION (/�� Clay ,r B o i t 2 7 5 O ft. u feet 714 direction "�• /�❑ yds. ❑ bags type Well disinfected upon completion? Yes 0 No 51G�eg 9 Sand/ ;ravel tan soft 85 172 PUMP n A 0 Not installed Date installed "2 5-98 Manufacturer's name Homeowners pump, pipe, wire Model number HP 1/2 Volts Length of drop pipe ft. Capacity g.p.m. Type: f' Submersible 0 L.S.Turbine 0 Reciprocating 0 Jet 0 ABANDONED WELLS Does property have any not in use and not sealed well(s)? 0 Yes 46o VARIANCE Was a variance granted from the MDH for this well? 0 Yes $No WELL CONTRACTOR CERTIFICATION Use a second sheet,if needed 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. REMARKS,ELEVATION,SOURCE OF DATA,etc. ECE QED Don Stodola Well Drilling Co., Inc. 27172 MAR 01 1999 Liic-nnse•Business .me Lic.or Reg.No. GiiY U1— /" _ _, 11-12-98 Uuf'JN° - Authorized Re•e- '"e ignature Date Fred Leiby 9-24-98 Name of Driller Date LOCAL COPY 615583 HE-01205-06(Rev.9/97)