HomeMy WebLinkAbout1998 well and boring record WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO.
County Name - WELL AND BORING RECORD 591541
Hennepin Minnesota Statutes Chapter 103/
Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed
Orono 117 23 33 NE SW SW 74 4/29/98
House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD
2900 Wear Circle 0 Cable Tool 0 Driven 0 Dug
❑ Auger (XRotary 0 Jetted
Show exact location of well in section grid with"X". y j/r` Sketch map of well location. 0
/v Showing property lines,
roads and buildings. DRILLING FLUID
N WdLcIr
1/ USE
Q[Domestic 0 Monitoring
0 Communi 0 Heating/Cooling
X h PWS 0 Industry/Commercial
J i 0 Irrigation ❑ Noncommunity PWS 0 Remedial
wr E ❑Test Well
0 Dewatering ❑
r
rEil:/ CASING Drive Shoe? 0 Yes CNo HOLE DIAM.
V2 MNL ❑ Steel 0 Threaded 0 Welded
XPlastic 0
s
1 MAe
CASING DIAMETER WEIGHT
PROPERTY OWNER'S NAME 4 in.to 69 tt. 200 _lbs./ft. in.t74_ft.
Dwight Post in.to ft. lbs./ft. in.to_ft.
Property owner's mailing address if different than well location address indicated above. in.to ft. lbs./ft. in.to ft.
A & T Development SCREEN OPEN HOLE
575 Sussex Cirlte Make Jayco from ft.to ft.
" Orono, MN 55356 Type PVC Diem. 3 a
Slot/Gauze 20 Length 76
Set between 69 ft.and 74 ft. FITTINGS:
STATIC WATER LEVEL
WELL OWNER'S NAME 27 ft,1Q below 0 above land surface Date measured
PUMPING LEVEL(below land surface)
Well owner's mailing address if different than property owner's address indicated above. 60 ft. after 3 hrs.pumping _ 40 _g.p.m.
WELL HEAD COMPLETION
IN.Pitless adapter manufacturer Whitewater Model S-5-4
❑ Casing Protection 0 12 in.above grade
❑ At-grade(Environmental Wells and Borings ONLY)
GROUTING INFORMATION
Well grouted? R Yes 0 No
GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO Grout Material 0 Neat cement Q(Bentonite 0 Concrete 0 High Solids Bentonite
MATERIAL from 46 to 6 ft. 3 0 yds) J bags
0 17 from to ft. 0 yds. 0 bags
clay brown med• from to ft. 0 yds. 0 bags
NEAREST KNOWN SOURCE OF CONTAMINATION
sandy clay blue tiled./
soft 17 46 50 feet South directiosekler pi pope
Well disinfected upon completion? 20 Yes 0 No
sand & ravel brown med. 46 74
PUMP
❑ Not installed Date installed 6/13/98
Manufacturer's name Sta-Rite
Model number HP I I/ZoIts 2.30
Length of drop pipe 58 ft. Capacity 20 g.p.m.
Pressure Tank Capacity 250
TypeX=I 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 X No
VARIANCE
Was a variance granted from the MDH for this well? 0 Yes X] 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.
RES Well Drilling 27276
Licensee Business Name Lic.or Reg.No.
Authorized Representative Signature Date
7 Robert E. Stodola, 44.16/18/98
Name of Driller Date
LOCAL COPY 591541 HE-01205-05(Rev.1/95)