HomeMy WebLinkAbout07-12-22 Well & Boring Construction Record MINNESOTA UNIQUE WELL
WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH\ AND BORING NO.
County Name WELL AND BORING OQNSTRUCTION}RECORD
Minnesota Status,chapter 1031 :" 87 670 5
Hennepin ,\ ,
Township Name Township No. Range No. Section No. Fraction(sm.--..lg.) WELL/BORING DEPTH(completed) \ DATE WORK COMPLETED
p
Orono 117 23 07 NE NE N1 125 , n 7/12/22
GPS LOCATION—decimal degrees(to four decimal places). DRILLING METHOD
Latitude Longitude ❑Cable Tool ❑Driven ❑Dual Rotary
❑Auger r,1 Rotary .❑Rotasonic
House Number,Street Name,City,and ZIP Code of Well Location ❑Other
DRILLING FLUID WELL HYDROFRACTURED? ❑Yes X No
860 Windjammer Lanes Oronon + n t
Show exact location of well/boring in section grid with"X." Sketch map of well/boring location. From ft.To ft.
Showing property lines,
N roads,buildin s a direction. USE Domestic E Monitoring ❑Heating/Cooling
-__;___•__i___.___� ;___ g ❑Noncommunity PWS Irrigation Industry/Commercial
VY
W ❑ ❑
•
•
❑Community PWS ❑Dewatering ❑Remedial
- •---i- -- L 1,F ' ❑Elevator ❑
w E \ CASING MATERIAL Drive Shoe? ❑Yes [' No HOLE DIAM: '
T T ❑Steel ❑Threaded ❑Welded
'h Mile X Plastic ❑
-- - . ` .. CASING
S ' • Diameter Weight Specifications
4�----1 Mile I in.To 1 1 ft. lbs./ft. in.T 0 ft.
6
5
25
PROPERTY OWNER'S NAME/COMPANY NAME in.To ft. lbs./ft. in.Td ft.
r
in.To ft. _ lbs./ft. in.To ft.
Joe Ziafermann SCREEN OPEN HOLE
Property owner's mailing address if different than well location address indicated above.
es
Make Ohne From ft. To ft. •
Type Amin es Diam.',� ,
Slot/Gauze'''10 Length '
' Set between 115 ft.and 125 ft. FITTINGS 3' lead
STATIC WATER LEVEL r /+�+ 89 ft. [xelow ❑Above land surface -
Date measured !/1 2I 22 Dry hole ❑Yes It]No
WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface)
110 ft.after 3 hrs.pumping 30 g.p.m.
Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION
ri Pitless/adapter manufacturer Wh i t ewa t e r Model ..
❑Casing protection X 12 in.above grade
❑At-grade ❑Well House ❑Hand Pump
GROUT INFORMATION(specify bentonite,cement-sand,neat-cement,concrete,cuttings,or other)
Materia CU t t i f Bom 115 To ❑Yds. ❑Bags
Material entoni om tsg50 To 0 ft' ❑Yds. X Bags
HARDNESS OF Material From To ft. ❑Yds. ❑Bags
GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO Driven casing seal From To Bags One bag=94 lbs.cement
or 50 lbs.bentonite
1 5
NEAREST KNOWN SOURCE OF CONTAMINATION C�t A L c r t..J e of"--
.1 1 Well is feet I direction from (A%ve P 1#'L) type
Brown 15 2 Well disinfected upon completion? X Yes ❑No
Clay PUMP
fir* 287 ❑Not installed Date installed 7I 22! 22
Clay Manufacturer's name Shafer
Gray S 79 99 Model Number HP ' Volts '�`".
Clay/Sand T Length of drop pipet ft. Capacity g.p.m.
•
gSandrown S 99 125 5 Type:X Submersible ❑L.S.Turbine ❑Reciprocating ❑Jet ❑
ABANDONED WELLS
Does property have any not in use and not sealed well(s)? ❑Yes X No
VARIANCE
Was a variance granted from the MDH for this well? ❑Yes ['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 Dr ling 1624" 3
Licensee Business Name Lic.or Reg.No.
,,,,,,,,:- ,,,-,k' -,,-,:%4'.- 7/22122
Bert ilf a Representative Signature Certified Rep.No. Date
LOCAL COPY
Name of Driller
ID#52603 HE-01205-18(Rev.3/19)