Laserfiche WebLink
WELL OR BORING LOCATION <br /> MINNESOTA DEPARTMENT OF HEALTH MINNESOTAAND BORINGG UE NO.WELL <br /> County Name - – WELL AND BORING CONSTRUCTION RECORD 857012 <br /> Minnesota Statutes,chapter 1031 <br /> Hennepin <br /> Township Name Township No. Range No. Section No. Fraction(sm.—.Ig.) WELUBORING DEPTH(completed) DATE WORK COMPLETED <br /> � <br /> Orono 117 23 07 SE SE N& 134 f. 9/2/21 <br /> GPS LOCATION—decimal degrees(to four decimal places). DRILLING METHOD <br /> Latitude Longitude ❑Cable Tool ❑Driven ❑Dual Rotary <br /> ❑Auger ®Rotary ❑Rotasonic <br /> House Number,Street Name,City,and ZIP Code of Well Location E ❑Other <br /> 4709 Highwood Drive, Orono 55364 DRILLING FLUID WELL HYDROFRACTURED? ❑Yes X No <br /> Show exact location of well/boring in section grid with"X." Sketch map of well/boring location. Bentonite From ft.To ft. <br /> Showing property lines, <br /> N roads,buildings,and direction. USE ®Domestic ❑Monitoring ❑Heating/Cooling <br /> .__:_____ __ ❑Noncommunity PWS ❑Irrigation ❑Industry/Commercial <br /> ❑Community PWS ❑Dewatering ❑Remedial <br /> ❑Elevator ❑ <br /> W' E T CASING MATERIAL Drive Shoe? ❑Yes ❑No HOLE DIAM. <br /> --4,'-----t----F--•- --- I` —L....] <br /> V M ❑Steel ❑Threaded ❑Welded <br /> • Fe mile g Plastic ❑ <br /> CASING <br /> S Diameter Weight Specifications �{ ^ <br /> 1 Mile 4 in.To 125 ft. lbs./ft. 8 in.T 5°`ft. <br /> PROPERTY OWNER'S NAME/COMPANY NAME in.To ft. lbs./ft. 65 in.Tom 3 5 ft. <br /> Creek Hill Ca tom Homes in.To ft. lbs./ft. in.To ft. <br /> SCREEN e$ <br /> JOPEN HOLE <br /> Property owner's mailing address if different than well location address indicated above. <br /> Make o neon From • ft. To ft. <br /> w <br /> 15235 65th Place, Type stainless Diam. 2 8* <br />. Maple Grove MN 55311 <br /> Slot/Gauze e25 4,15 Length3* <br /> Set between 125 ft.and 1 34 ft. FITTINGS lead <br /> STATIC WATER LEVEL 58 ft.X(Below ❑Above land surface <br /> Date measured 9i 2/21 Dry hole ❑Yes M No <br /> WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) 2 , <br /> 120 ft.after hrs.pumping 35 g.p.m. <br /> Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION y <br /> A Pitless/adapter manufacturer white water Model <br /> ❑Casing protection 12 in.above grade <br /> ❑At-grade ❑Well House ❑Hand Pump <br /> GROUT INFORMATION(specify bentonite,cement-sand,neat-cement,concrete,cuttings,or other) <br /> Material rut ting$om 125Th 50 ft ❑Yds. ❑Bags <br /> Materialbe n t on i t lwom To —ft. 3 ❑Yds. X Bags <br /> HARDNESS OF Material From To ft. ❑Yds. CIBags <br /> GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO One bag94 lbs.cement <br /> Driven casing seal From To Bags <br /> or 50 lbs.bentonite <br /> ` NEAREST KNOWN SOURCE OF CONTAMINATION <br /> Clay <br /> con in 0 33 Well is CI 0 feet direction from . - <br /> type <br /> Well disinfected upon completion? X Yes ❑No <br /> sandy clay gray a 33 46 PUMP <br /> ❑Not installed Date installed /3/2l _ <br /> fine sand brown = 46 104 Manufacturer's name chafe9r <br /> silty/fine r� Model Number HP 3+ 4 volts <br /> 230 <br /> clay sand ,gray m 104 12�`y }��j <br /> Length of drop pipe 8 T ft. Capacity / g.p.m <br /> sand/gravel mix s 122 135 Type: Submersible ❑L.S.Turbine ❑Reciprocating ❑Jet ❑ <br /> ABANDONED WELLS <br /> Does property have any not in use and not sealed well(s)? ❑Yes Zq No <br /> VARIANCE <br /> Was a variance granted from the MDH for this well? ❑Yes [!No TN# <br /> WELL CONTRACTOR CERTIFICATION <br /> This well was drilled under my supervision and in accordance with Minnesota Rules,chapter 4725. <br /> The information contained in this report is true to the best of my knowledge. <br /> Use a second sheet,if needed. <br /> REMARKS,ELEVATION,SOURCE OF DATA,etc. <br /> Don Stodola Well Drilling 1691 <br /> Licensee Business Name Lic.or Reg.No. <br /> "Air, 558 9/2/21 <br /> Certs led"epre.sentifiVe Signa ure f Certified Rep.No. Date <br /> Rob Stodola <br /> LOCAL COPY 857 012 <br /> Name of Driller <br /> ID#52603 HE-01205-18(Rev.3/19) <br />