HomeMy WebLinkAbout07-30-2021 Well & Boring Construction RecordIIAIAIAIFQnTG I muni IF Wrl I
WELL OR BORING LOCATION
MINNESOTA DEPARTMENT OF HEALTH AND BORING NO.
WELL AND BORING CONSTRUCTION RECORD
857047
County Name
ITenneoln
Minnesota Statutes, chapter 1031
Township Name
Township No.
Range No.
Section No. Fraction
(sm. —. Ig.)
WELUBORING DEPTH (completed)
DATE WORK COMPLETED
nrnnn
� 117
23
6
SM SW'
150
7/30121
GPS LOCATION — decimal degrees (to four decimal places).
DRILLING METHOD
Latitude Longitude
❑ Cable Tool Driven ❑ Dual Rotary
❑ Auger Rotary ❑ Rotasonic
❑ Other
House Number, Street Name, City, and ZIP Code of Well Location
705 Pine Hurst Ct, Orono 55364
DRILLING FLUID WELL
n C �� i t e From
HYDROFRACTURED? E] Yes No
ft. To ft.
Show exact
location
of well/boring in section grid with "X" Sketch map of well/boring location.�A
howing property lines,
N road.- ildings, and direction.
USE ® Domestic ❑Monitoring ❑ Heating/Cooling
❑Noncommunity PWS ❑irrigation ❑Industry/Commercial
❑ Community PWS ❑Dewatering ❑Remedial
i
---
---`- ---`- '
❑ Elevator
w
E :\
CASING MATERIAL Drive Shoe? E] Yes No
HOLE DIAM.
❑ Steel ❑ Threaded ❑ Welded
'/ Mile
~ t
®Plastic ❑
CASING
Diameeter 7 / Weight Specifications
4in1 ` . To 0 ft. lbs./ft.
in. To ft. lbs./ft.
--�---
-T--
-- �-- —t-- '
1
s
��--� f
8 in. To 5 /oft.
5.5 in. TJ 5 0 ft.
1 Mile
PROPERTY OWNER'S NAME/COMPANY NAME
Swanson Hopes
in. To ft. lbs./ft.
in. To ft.
SCREENYea
_
OPEN HOLE�
From ft. To ft.
Property owner's mailing address if different than well location address indicated above.
1360 Hamel Road
Make neon
Type stainless Diam.
115
Medina, ! 55340
Slot/Gauze • Length 9
Set between 0 ft. and 150 ft. FITTINGS 3 Iflead
STATIC WATER LEVELft. Below [:]Above land surface
Date measured 7/30/21 Dry hole ❑ Yes X] No
WELL OWNER'S NAME/COMPANY NAME
PUMPING LEVEL (below land surface)
135 ft. after 2 firs. pumping 40 V g.p.m.
Welliboring owner's mailing address if different than property owner's address indicated above.
WELLHEAD COMPLETION
Wrl Pitless/adapter manufacturer ildhi t o tog t a r Model
Casing protection [ 12 in. above grade
❑ At -grade ❑ Well House ❑ Hand Pump
GROUT INFORMATION (specify bentonite, cement -sand, neat -cement, concrete, cuttings, or other)
Material CUt t in_98From 140 To 50 ft. ❑ Yds. ❑ Bags
Material eT*nn to%m 50 To 0 ft. 3 —[]Yds. [Bags
Material From To ft. [-]Yds. E] Bags
One ba 94 lbs. cement
Driven casing seal From To _ Bagsg -
or 50 lbs. bentonite
GEOLOGICAL MATERIALS
COLOR
HARDNESS OF
MATERIAL
FROM
TO
clay
brown
M
0
17
NEAREST KNOWN SOURCE OF CONTAMINATION
/// p 10
Well is feet ! Y direction from �G type
Well disinfected upon completion? [XYes ❑ No If
Clay/ Sand
Ura y
117
75
1 PUMP
F-1Notinstalled Date installed 9/29/21
Manufacturer's name Shafer
Sand/Gravel
Mix
S
75
93
Fine Sand
raven
S
9 3
11$
Model Number 126 HP 1 e 5 volts 2 30
Length of drop Pi e ft. Capacity 9�P�m
Gravel
Mix
4
118
133
Type: [submersible ❑ L.S. Turbine ❑ Reciprocating ❑ Jet ❑
ABANDONED WELLS
Sand
r n LJn
S
1 9
J
1 5 r>
1 0
Does property have any not in use and not sealed well(s)? ❑ Yes o
VARIANCE
Was a variance granted from the MDH for this well? ❑ Yes No TN#
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.
Don Stodola Well Drilling Co 1691
Licensee Business Name Lic. or Reg. No.
f.. 558 7130/2
i epresentati a Signa re Certified Rep. No. Date
Rob Stodola
LOCAL COPY
857047
Name of Driller
IIE-01205-18 (Rev.3/19)