HomeMy WebLinkAbout06-18-2021 Well & Boring Construction Record s
MINNESOTA UNIQUE WELL
WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO.
County Name WELL AND BORING CONSTRUCTION RECORD 8 5 7 3 9
Minnesota Statutes,chapter 1031
Hennepin
Township Name Township No. Range No. Section No. Fraction.(sm.—.Ig.) WELL/BORING DEPTH(completed) DATE WORK COMPLETED
Orono 117 23 03 WJ 11'iiN v 205 ft. 6/18/21
GPS LOCATION—decimal degrees(to four decimal places). DRILLING METHOD
Latitude Longitude ❑Cable Tool ❑Driven ❑Dual Rotary
❑Auger it Rotary ❑Rotasonic
House Number,Street Name,City,and ZIP Code of Well Location ❑Other
2250 Longview Cir, Orono DRILLING FLUID WELL HYDROFRACTURED? ❑Yes ®No
Show exact location of well/boring in section grid with"X." Sketch map of well/boring location. Bentonite From ft.To ft.
Showing property lines,
roads uildings,and direction. USE
N Qi) i.� Domestic ❑Monitoring ❑Heating/Cooling
.__�_______-_ i .+. -- ` --- ❑Noncommunity PWS ❑Irrigation ❑Industry/Commercial
❑Community PWS El Dewatering ❑Remedial
i--- ---- - - >'-- ._._ ----T-T JJ} ❑Elevator ❑
S --
w E T CASING MATERIAL❑Steel Drive Shoe? ❑Yes ®No HOLE DIAM.
r---- .-- I • .. ❑Threaded ❑Welded
'I We - X Plastic ❑
-r- -------------- 1
CASING
' s Diameter Weight Specifications
:x'
1 Mile_ I in.To 197 k. lbs./ft. y 8 in.To 5A ft.
PROPERTY OWNER'S NAME/COMPANY NAME in.To ft. lbs./ft. 6*Sin.T209 ft.
in.To ft. lbs./ft. in.To ft.
'Tim Grit tner SCREEN OPEN HOLE
Property owner's mil' gyt address if different than well location address indicated above.
�i£tt AS EIDOY�I j
Make � From ft. To ft.
Type Sta ess Diam. ` 2w
' Slot/Gauze * � Length S �� -`�
Set between ft.and ft. FITTINGS dial
ky, STATIC WATER LEVEL g b /5 ft. ®Below ❑Above land surface
Date measured 6/18/21 Dry hole ❑Yes *No
WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface)
190ft.after 2 hrs.pumping 50 g.p.m.
Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION
❑Pitless/adapter manufacturer i Model
❑Casing protection ❑12 in.above grade
❑At-grade ❑Well House ❑Hand Pump .I
GROUT INFORMATION(specify bentonite,cement-sand,neat-cement,concrete,cuttings,or other)
Material eating8 From 197 To 50 ft. ❑Yds. ❑Bags
Material t�toniteFrom 50 To 0 ft. 3 ❑Yds. X Bags
HARDNESS OF Maters From To ft. i ❑Yds. ❑Bags
GEOLOGICAL MATERIALS COLOR FROM TO
MATERIAL . Drw4ncasing seal From To Bags =
One bag94 lbs.cement
or 50 lbs.bentonite
0 NEAREST KNOWN SOURCE OF CONTAMINATION
ctay brown. 8 25 Well is ‘2kS feet P4 direction from 1}
i rtype
25 81 Well disinfected upon completion? XJ Yes El No
clay gray in PUMP
l ❑Not installed Date installed \C\ \D-\
clay/sand gray in 81 159 Manufacturer's name
Model Number HP Volts
,ravel/clay gray tn/;h 150 174 ` l
t Length of drop pipe l ' ft. Capacity g.p.m
Ci$y "ray in 174 197 Type:Submersible ❑L.S.Turbine ❑Reciprocating ❑Jet ❑
! ABANDONED WELLS
Sand yellow 9 f 97 209 Does property have any not in use and not sealed well(s)? ❑Yes ❑No
i 9VARIANCE
Was a variance granted from the MDH for this well? ❑Yes. 0 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 second sheet,if needed.
REMARKS,ELEVATION,SOURCE OF DATA,etc.
Don Stodola Well Drilling 1691
Licensee Business Name Lic.or Reg.No.
/'rt �, lir 6/18/21
C p esentativ• ignature Certified Rep.No. Date
Rob St°dole
LOCAL COPY 8 5 7 03 9
Name of Driller
0162603 - HE-01205-181Rev.3/19)