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Home My WebLink AboutWell and Boring Record WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. County Name WELL AND BORING RECORD Hennepin Minnesota Statutes,Chapter 1031 715840 Township Name Township No. Range No. Section No. Fraction ,, WELL DEPTH(completed) Date Work Completed Aron* 118N 23W 31 ,, ,, MI 178 ft. 9-8-04 GPS DRILLING METHOD LOCATION: Latitude degrees minutes _ seconds Longitude degrees minutes seconds ❑Cable Tool ❑Driven ❑Dug ❑Auger XRotary ❑Jetted House Number,Street Name,City,and Zip Code of Well Location or Fire Number ❑ 4605 Watertown Rd, Maple Plain DRILLING FLUID WELL HYDROFRACTURED? ❑Yes X No Show exact location of well in section grid with X". Sketch map of well location. water FROM ft.TO ft. Showing property lines, N roads and buildings USE Monitoring ❑Heating/Cooling 1 /� Domestic ❑Environ.Bore Hole ❑Industry/Commercial armit e>i, iy —" Noncommunity PWS ❑Irrigation g ❑Remedial ❑Community PWS ❑Dewatering ❑ CASING HOLE DIAM. w E TkW Drive Shoe? ❑Yes No ___ ___________________ I ❑Steel ❑Threaded ❑Welded h Mile Wel �iil Plastic mil gills 1 wC �I CASING DIAMETER V. WEIGHT , 9 * i 4 in.to 173 ft. lbs./ft. 81 in.to" ft. I -1 MIle-----1 She(`f in.to ft. lbs./ft. 61 in.to 178ft. PROPERTY OWNER'S NAME/COMPANY NAME in.to ft. lbs./ft. in.to ft. John F. & Joan M. Serena SCREEN OPEN HOLE Proop_erty owner's mailing address if different than well location address indicated above. Make Jayco FROM ft. TO ft. 4605 Watertown Type PVCDian. Maple Plain, MN 55359 Slot/Gauze 15 Length 51 Set between 173 ft.and 178 ft. FITTINGS k picker STATICWATERLEVEL 104 ft.Xbelow ❑above land surface Date measured 9-8-04 PUMPING LEVEL(below land surface) WELL OWNER'S NAME/COMPANY NAME John F. & Joan M. Serena ft.after hrs.pumping 60+ g.p.m. ELL HEAD COMPLETION Well owner's mailing address if different than property owners address indicated above. Pitless adapter manufacturer !loos Modelo" asing Protection ❑12 in.above grade • ❑At-grade(Environmental Wells and Boring ONLY) GROUTING INFORMATION Well grouted Yes ❑No Grout material Neat cement❑Bentonite ❑Concrete Vigh Solids Bentonite from_10 too_ft. ❑yds. X,bags from to ft. ❑yds. ❑bags GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO from to ft. ❑bags MATERIAL ❑yds. NEAREST KNOWN SOURCE OF CONTAMINATION over 50, from sewer clay yellow 0 20 feet direction type Well disinfected upon completion )1Yes ❑No clay gray 20 90 PUMP R may/ 0 Not installed Date installed gravel mixed 90 135 Manufacturer's name Vire Model number HP I Volts clayLength of drop pipe ��V& gravel red 135 150 ,, }} [ ft. Capacity AT g.p.m. '#4' Type. Submersible ❑L.S.Turbine ❑Reciprocating El Jet ❑ clay & gravel gray 140 155 ABA DONED WELLS Does property have any not in use and not sealed well(s) ❑Yes I No sand & gravel mixed 155 178 VARIANCE Was a variance granted from the MDH for this well? ❑Yes gNo 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 REMARKS,ELEVATION,SOURCE OF DATA,etc. Stevens Drilling & Environmental Svc 86654 Licensee Business Name Lic.or Reg.No. i y;'' — 9 30 Authorized Representative Signature Date Randy Johnson LOCAL COPY 715840 Name of Driller IC 140-0020 HE-01205-08(Rev.5/02) WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring H 222472 County Name WELL AND BORING SEALING RECORD Sealing No. Minnesota Unique Well No. Hennepin Minnesota Statutes,Chapter 1031 or W-series No. (Leave blank it not known) Township Name Township No. Range No. Section No. Fraction(sm-a.-Ig) Date Sealed Date Well or Boring Constructed Orono 118H 23W 31 HE' 9-10-04 GPS Latitude degrees minutes seconds Depth Before Sealing 104 ft. Original Depth ft. LOCATION: Longitude degrees minutes seconds AOUIFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location �II�.�{�-��Single Aquifer ❑Multiaquifer 46033 Watertown Rd, Maple Plain WELLIBORING j Measured ❑Estimated igr. Water Supply Well ❑Monit.Well Show exact location of well or boring Sketch map of well or boring in section grid with"X" location,showing property 0 Env.Bore Hole ❑Other 104 ft. f Velow 0 above land surface lines,roads,and buildings. N rASING TYPE(S) 7� -t ler ;yfxti ,C fV Steel ❑Plastic 0 Tile ❑Other W E Itt113::.�++�� WELLHEAD COMPLETION Outside: 0 Well rouse Inside: ❑Basement Offset I } I I ..,k, 4ew-�� f�/Pitles Adapter/Unit 0 Well Pit Sk4 ❑Well Pit El Buried S � �--- --anis ' Wel( ._ t1i-i 0 Buried PROPERTY OWNER'S NAME/COMPANY NAME CASING(S) John F & Joan M Serena Diameter Depth J._15_ Set in oversize hole? Annular space initially grouted? Property owner's mailing address if different than well location address indicated above 4 0 to ft. 0 Yes 1 No ❑Yes ❑No Unknown in.fromT 4605 Watertown Rd Maple Plain, y 55359 in.from to ft. 0 Yes ❑No ❑Yes ❑No 0 Unknown in.from to ft. 0 Yes 0 No ❑Yes ❑ No 0 Unknown WELL OWNER'S NAME/COMPANY NAME SCREEN/OPEN HOLE John F & Joan,M Serena Well owner's mailing address if different than property owner's address indicated above Screen from 135 to 140 ft. Open Hole from to ft. OBSTRUCTIONS pods/Drop Pipe 0 Check Valve(s) 0 Debris 0 Fill It No Obstruction Type``of Obstructions(Describe) GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? L' Yes 0 No Describe FORMATION 777�� If not known,indicate estimated formation log from nearby well or boring PUMP Type submersible Removed ❑ Not Present 0 Other METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: No Annular Space Exists 0 Annular space grouted with tremie pipe 0 Casing Perforation/Removal in.from to ft. ❑ Perforated 0 Removed in.from to ft. 0 Perforated ❑ Removed Type of perforator -- ❑ Other GROUTING MATERIAL(S) (One bag of cement=94 lbs.,one bag of bentonite=50 lbs.) 1 7 1 Grouting Material Neat went from 0 to 140 ft. yards _lbags from to ft. - yards bags from - to ft. yards bags OTHER WELLS AND BORINGS REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING Other unsealed and unused well or boring on property? ❑ Yes kNo 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 & Environmental Svc 86654 Contractor Business Name License or Registr tion No. . -"-"'"---....____ q/ , 6L1 Authorized Representative Signature Date Tim Stevens LOCAL COPY f�//�2 2 4 7 2 Name of Person Sealing Well or Boring • • rr . • •f •