HomeMy WebLinkAbout05-18-2022 Well & Boring Construction Record MINNESOTA UNIQUE WELL
WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO.
County Name WELL AND BORING CONSTRUCTION RECORD
enn :yn
Minnesota Statutes,chapter 103I 876691
Township Name Township No. Range No. Section No. Fraction(sm.—••lg.) WELL/BORING DEPTH(completed) DATE WORK COMPLETED •
Orono 111 23 06 /< SE Sri, 161 ft. 5/18/22
GPS LOCATION—decimal degrees(to four decimal places). DRILLING METHOD
Latitude Longitude ❑Cable Tool 0 Driven ❑Dual Rotary
❑Auger Rotary ❑Rotasonic
House Number,Street Name,City,and ZIP Code of Well Location []Other
775 Lakeview Parkway Orono DRILLING FLUID WELL HYDROFRACTURED? ❑Yes XI No •
Show exact location of well/boring in section grid with"X." Sketch map of well/boring location. Bentoni to From ft.To ft.
Showing property lines, ,
roads,,buildings and direction. USE
N g Domestic ❑Monitoring ❑Heating/Cooling
{ is ,, �
_ ___,__,___• ;_ ❑Noncommunity PWS ❑Irrigation ❑Industry/Commercial
" . _..M�....� _ _ ❑Community PWS ❑Dewatering ❑Remedial •
-----•--'---• F-- ❑Elevator ❑
w E CASING MATERIAL Drive Shoe? ❑Yes X No HOLE DIAM.
-.- --•"- t__ T ❑Steel ❑Threaded ❑Welded
'/ztue
❑Plastic ❑
CASING
S Diameter Weight Specifications
I--1 Mile I 45 in.To 153 ft. lbs./ft. go5 in.Tq ft.
PROPERTY OWNER'S NAME/COMPANY NAME in.To ft. lbs./ft. in.To ft.
in.To ft. lbs./ft. in.To ft.
Norton Homes OPEN HOLE
Property owner's mailing address if different than well location address indicated above. SCREEN Yeti
Make Johnson From ft. To ft.
15 1 45th Ave N Type *AU stainless Diem. 2*
Ste D SloVGauze •10 Length 8 f
-, Plymouth, MN 55446 Set between153 ft.and_I 1 ft. FITTINGS 3* lead
STATIC WATER LEVEL f 7 ft.X Below ❑Above land surface i
Date measured 5/19• '"" Dryhole ❑Yes XNo
''' WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface)
ft.after hrs.pumping g.p.m.
Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION
X► Pitless/adapter manufacturer used exist i del 9
❑Casing protection Z 12 in.above grade
❑At-grade ❑Well House ❑Hand Pump
GROUT INFORMATION(specify bentonite,cement-sand,neat-cement,concrete,cuttings,or other)
Material eat t ifl8om 13 To ° ft. ❑Yds. Bags
Materiall3'�fl t 0fh t m �0 To ft. ❑Yds. !Bags
HARDNESS OF Material From_ To _ft. ❑Yds. ❑Bags
GEOLOGICAL MATERIALS COLOR FROM TO
MATERIAL Driven casing seal From To Bags One bag=94 lbs.cement ,
or 50 lbs.bentonite .
NEAREST KNOWN SOURCE OF CONTAMINATION
ClayBrown
Well is € feet - direction from , I--»•. type
I Clay 17 Well disinfected upon completion? [ Yes ❑No •
##Cray38 PUMP �!
❑Not installed Date installed 7 I /2
IllayiS T S '" 2
Manufacturer's name Usedexisting
Model Number HP Volts
Sand Brown S 83 16
Length of drop pipe Ilse existing 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 IC No
VARIANCE
I
Was a variance granted from the MDH for this well? ❑Yes aX 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 Stodoja Well Drilling Co Inc 1691 i
Licensee Business Name Lic.or Reg.No. ,
' A ' ' .
Cert Representative Signature Certified Rep.No. Date
ry1C
^h�h+ 4 fob Stodola
LOCAL COPY 8 7 6 6 9 1_ Name of Driller 1
iD#52603 HE-01205-18(Rev.3/19)