HomeMy WebLinkAbout10/22/2021 Well & Boring Construction RecordMINNESOTA UNIQUE WELL
WELL OR BORING LOCATION
MINNhbU IA ULFAK I MrN I Ur MCHL I n
WELL AND BORING CONSTRUCTION RECORD
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County Name
Menne in
Minnesota Statutes, chapter 103I
Township Name
Orono
Township No.
1
Range No.
23
Section No.
08
Fraction (sm. — Ig.)
SW SW SET
WELUBORING DEPTH (completed)
$� 't.
DATE WORK COMPLETED
10/22/21
GPS LOCATION — decimal degrees (to four decimal places).
Latitude Longitude
DRILLING METHOD
❑ Cable Tool Driven ❑ Dual Rotary
❑ Auger Rotary ❑ Rotasonic
❑ Other
House Number, Street Name, City, and ZIP Code of Well Location
1525 Minnie Ave Mound MN 55364
DRILLING FLUID WELL HYDROFRACTURED? [-]Yes ®No
Bentonite From ft. To ft.
Show exact
location
of well/boring in section grid with "X" Sketch map of well/boring location.
Showing property lines,
N roads, buildings, and direction.
Q❑
USE ® Domestic ❑ Monitoring ❑ Heating/Cooling
Noncommunity PWS ❑ Irrigation ❑ Industry/Commercial
❑Community PWS ❑ Dewatering E]Remedial
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!
w
_ 11
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E T�
❑Elevator
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CASING MATERIAL Drive Shoe? ❑ Yes [NNoH
❑ Steel El Threaded ❑Welded
OLE DIAM.
�'k Me
% I
s 1 V+OU 4—
EXPlastic ❑
A
S in. Toy O ft
6 • 5 in. Tog 0 ft.
in. To ft.
'
CASING
Diameter Weight Specifications
4 in. To 80 ft. lbs./ft.
in. To ft. lbs./ft.
in. To ft. lbs./ft.
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t Mae
PROPERTY OWNER'S NAME/COMPANY NAME
Mark Duenowe�
OPEN HOLE
SCREEN
Make .�o neon From ft. To ft.
Type stainless Diam.
Property owner's mailing address if different than well location address indicated above.
Slot/Gauze • Length
Set between ft. and 89 ft. FITTINGS lead
STATIC WATER LEVEL 50 ft. :�] Below ❑ Above land surface
Date measured 10/22/21 Dry hole ElYes No
WELL OWNER'S NAME/COMPANY NAME
PUMPING LEVEL (below land surface)
75 ft. after 3 hrs. pumping 40 o.p.m.
Well/boring owner's mailing address if different than property owners address indicated above.
WELLHEAD COMPLETION �
5LPitless/adaptermanufacturer kA:kl L, VLj0 r Model
❑ Casing protection �kQ in. above grade
❑ At -grade ❑ Well House ❑ Hand Pump
GROUT INFORMATION (specify bentonite, cement -sand, neat -cement, concrete, cuttings, or other)
Material cut t inglrom 80 ToSOA�ft. E] Yds. ❑ Bags
Material e n t on t pRom Toy ft. — ❑ Yds. Pq Bags
Material From To ft. ❑ Yds. E] Bags
Driven casing seal From To _Bags One bag = 94 obs. cement
or 50 lbs. bentonite
GEOLOGICAL MATERIALS
COLOR
HARDNESS OF
MATERIAL
FROM
TO
1
v
I
NEAREST KNOWN SOURCE OF CONTAMINATION . �n
Well is v feet direction from stype
Well disinfected upon completion? dGes E]No
(
6
PUMP
❑ Not installed Date installedcno—! 1)
Manufacturer's name 45 \lX�
Model Number HP % Volts �\
/n1► .`tl►�`1
YAC- tJ,/`��i
(�
1 '
Length of drop pipe tUvJ ft. Capacity 9 -p -m
Type: ubmersible ❑ L.S.Turbine ❑ Reciprocating ❑ Jet ❑
ABANDONED WELLS
Does property have any not in use and not sealed well(s)? ❑ Yes No
VARIANCE
Was a variance granted from the MDH for this well? ❑ Yes 00o 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, it needed.
Don Stodola Well Drilling Co Inc 1691
REMARKS, ELEVATION, SOURCE OF DATA, etc.
Licensee Business Name Lic. or Reg. No.
558 10/22/
/Ce1I6. Fepresentative Signature Certified Rep. No. Date
Rob Stodola
LOCAL COPY
860822
Name of Driller
H F -!N 9n5-1 R ! R nv.7/ 191
10 #52603