HomeMy WebLinkAbout07-28-21 Well & Boring Construction RecordMINNESOTA UNIQUE WELL
WELL OR BORING LOCATION
MINNESOTA DEPARTMENT OF HEALTH AND BORING NO.
WELL AND BORING CONSTRUCTION RECORD 857048
County Name
Iu-nnepin
Minnesota Statutes, chapter 1031
Township Name
Township No.
Range No.
Section No.
Fraction (sm. Ig.)
WELUBORING DEPTH (completed)
DATE WORK COMPLETED
Orono
117
23
06
SE SW% SW %125
7/28/21
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
710 Lakeview Parkway Orono W 55364
DRILLING FLUID WELL
Bentonite From
HYDROFRACTURED? ❑ Yes ® No
ft. To ft.
Show exact location
of well/boring in section grid with "X" Sketch map of welllboring location.
Showing property lines,
N roads, buildings, and direction.
USE ® Domestic ❑ Monitoring ❑ Heating/Cooling
❑Noncommunity PWS ❑Irrigation ❑ Industry/Commercial
❑ Community PWS ❑Dewatering ❑ Remedial
'---
W
--- ------
E i`
Elevator
CASING MATERIAL ve Shoe? �J No
i ❑
Dr Yes
HOLE DIAM.
'"""
"" "" ""'"" T `r
❑ Steel ❑ Threaded ❑ Welded
--�--- --�---
1 Mile
'h Mile ``v
-- �-- --%-- I / x W f_' 11
s 1
Plastic ❑
p
$ in. To 50 n.
CASING
Diameter Weight Specifications
4 in. To 115 ft. lbs./ft. t.
in. To ft. lbs./ft.
in. To12-5 ft.
PROPERTY OWNER'S NAME/COMPANY NAME
tbrton ftnes
in. To ft. lbs./ft.
in. To ft.
SCREEN ye"g
OPEN HOLE
From ft. To ft.
Property owners mailing address if different than well location address indicated above.
g
18215 45th Ave N
Plymwth, M 55446
Make .�� i
Type s & n ea Diam.
Slot/Gauze Length 13
lead
Set between n. and ft. FITTINGS 31 leadt
STATIC WATER LEVEL 44 ft. [N Below LJ -Above land surface
Date measured 7//28/21 Dry hole ❑ Yes X1 No
WELL OWNER'S NAME/COMPANY NAME
PUMPING LEVEL (below land surface)
110 ft. after 2 hrs. pumping 40 q.p.m.
Well/boring owner's mailing address if different than property owner's address indicated above.
WELLHEAD COMPLETION Ll
Pitless/adapter manufacturer .ftteWater 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)
Materials�CuttinSIS From 115 To 50 ft. E]Yds. E]Bags
Materiatbentoni.te From 50 To 0 ft. 3 ❑ Yds. J ] Bags
Material From To ft. ❑ Yds. L]Bags
Driven casing seal From To _ Bags One bag = 94 lbs. cement
or 50 lbs. bentonite
GEOLOGICAL MATERIALS
COLOR
HARDNESS OF
MATERIAL
FROM
TO
Clay
Brown
M
0
16
NEAREST KNOWN SOURCE OF CONTAMINATION
Well is ) � _/ \ feet / CO direction from Se h C' type
Well disinfected upon completion? CRYes ❑ No
Clay
Gray
M
L6
77
Ipump
❑ Not installed Dale installed 8/11/21
,9and
Brown
S
77
e
105
Manufacturer's name Shafer
Model Number HP 1.5 Volts 230
Length of drop pipe 63 n. Capacity 9 -p.m
&
Sand Gsa
Mix
M
105
125
Type: [X Submersible ❑ 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 XJ No 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 seco
nd sheet, it needed.
REMARKS, ELEVATION, SOURCE OF DATA, etc.
Wall
Licensee Business Name Lic. or Reg. No.
� 558 7/28/21
Cli a 11e seFl ative tigrratuW Certified Rep. No. Date
R°b stoaoi8
LOCAL COPY �8570481
Name of Driller
ID#52603 Nt .zuo- ie tnevanal