HomeMy WebLinkAbout03-30-2021 Well & Boring Construction Record •
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1MINNESOTA UNIQUE WELL
WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO.
County Name . WELL AND BORING CONSTRUCTION RECORD n
Hennepin - Mi snesota Statutes,chap 8 �]a93I 5 1 0 2`Y'
1
Township Name- 'Township No. Range N . ,Section No. t Fraction(sm. Ig.) WELUBORING D PTH(completed) DATE WORK COMPLETED
Orono117 23 ., 06 - v. SE W 149 ft. 3/30121
DRILLING METHOD
y.
GPS LOCATION—decimal degrees(to foufdecimal places).
Latitude Longitude ❑Cable Tool ❑Driven ❑Dual Rotary
• ❑Auger X Rotary ❑Rotasonic
HH�oLI Parkway .
et Name,City,and ZIP Code of WelfLocati ❑Other
130 ar y. Grono 55391 DRILLING FLUID WELL HYDROFRACTURED? ❑Yes A No
Show exact location of well/boring in section grid with"X." Sketch map of well/boring location. Eentord.te From ft.To ft.
Showing property lines,
• N ' roads,buildings,and direction. USE Xi
Domestic ❑Monitoring ❑Heating/Cooling
J _- __L__-_____,•
\L"."'""*"...a,..:"Ij
❑Noncommunity PWS - ❑Irrigation IDIndustry/Commercial
1 wma ❑Community PWS ❑Dewatering ❑Remedial
1 ❑Elevator El'W - ECASING MATERIAL Drive Shoe? ❑Yes X No HOLE DIAM.
_ --- 'h Mile V Plastic 111 -1
+ Steel ❑Threaded Welded A•
CASING
S
;7'1:
Diameter Weight Specifications
I 1 Mile Iin.To 140 _ft. lbs-/ft. t in.To 5.0_ft.
PROPERTP QWNER'S NAME/COMPANYlNAME i in. o ft. lbs-/ft. 6.5 in.To 150ft.
Swans in.To ft.. lbs./ft. in.To ft.
r SCREEN Yea OPEN HOLE
Property owner's mailing address if different than well location address indicated above.
L 1360 Hate' Roads in 55340 Make Mange From, ft. To ft.
Medina Type Dial 2K
SIoVGauze•15 Lengt AI
tri
• Set between .40 ft.and149 ft. FITTING3f lead
STATIC WATER LEVEL 45 ft.XJ]Below ❑Above land surface
'0 -1 ,,,,J.. .--, Date measured 3/30/21 Dry hole ❑Yes X No
WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface)
i„' z,r. 135 ft.after2
hrs.pumping 40 q.p.m.
Well boring owner's mailing address if different than property owners address indicated above. WELLHEAD COMPLETION# L
Pitless/adapter manufacturer del
❑Casing protection X 12 in.above grade 4i;
❑At-grade ❑Well House ❑Hand Pump
GROUT INFORMATION�{,� (specify bentonite,e,cement-sand,neat-cement,concrete,cuttings,or other)
Material W3ttingQ From 140 To 50 ft. ❑Yds. 0 Bags
4.
Material ROnteln'f tpFrom so To
0 ft. 3 ❑Yds. ]Bags
Material From To ft. ❑Yds. ❑Bags
GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO
MATERIAL Driven casing seal From To Bags One bag=94 lbs.cement
or 50 lbs.bentonite
NEAREST KNOWN SOURCE OF CONTAMINATION
Clay Brown N 0 16 Well is ! / feet Aldirection from Se 't1 type
Well disinfected upon completion? IC Yes ❑No
Clay Gray M 16 Sp PUMP
❑Not installed Date installed
�om-
1 1(1 '�
Sand/Gravel Bream /Y\tS 80 150 Manufacturer's name �
( 11 Y {
Model Number HP r/S Volts .30
Length of drop pipe g4 I
ft. Capacity g.p.m
Type. Submersible ❑L.S.Turbine ❑Reciprocating ❑Jet ❑
ABANDONED WELLS
Does property have any not in use and not sealed well(s)? ❑Yes rg No
VARIANCE
Was a variance granted from the MDH for this well? ❑Yes ANo 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.
4119 f/'
I✓ • -epresentati r:Si.na re Certified Rep.No. Date
r
LOCAL COPY 857024 `��) �j{-.'u L
Name of Driller
ID#52603 HE-01205-18(Rev.3/19)