HomeMy WebLinkAbout08-03-22 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
Minnesota Statutes,chapter 1031 876715
Township Name Township No. RangeNo. Section No. Fraction(sm.--*lg.) WELUBORING DEPTH(completed) DATE WORK COMPLETED
Orono 117 23 06 SE SE SW 123 ft. 8/3/22
GPS LOCATION—decimal degrees(to four decimal places). DRILLING METHOD
Latitude Longitude ❑Cable Tool Ull Driven ❑Dual Rotary
❑Auger Rotary ❑Rotasonic
House Number,Street Name,City,and ZIP Code of Well Location ❑Other
735 Lakeview
a evie Parkway,
r wa , Orono DRILLING FLUID WELL HYDROFRACTURED? ❑Yes ]No
Show exact location of well/boring in section grid with"X." Sketch map of well/boring location. Be nt o i t e From ft.To ft.
Showing property lines,
N roads,buildings,and dir USE irj Domestic ❑Monitoring ❑Heating/Cooling ,
❑Noncommunity PWS ❑Irrigation ❑Industry/Commercial
CL. HCommun i t y PWS ❑Dewatering ❑Remedial
...��. E lev at or ❑
W -E T -,:7 4 CASING MATERIAL Drive Shoe? ❑Yes IX No HOLE DIAM.
,- i
"" " ,.,. ❑Steel ❑Threaded ❑Welded
'h Mile �•
r Plastic ❑
CASING
s 5 Diaameter Weight Specifications
I 1 Mile I _ ` in.To 115 _ft. lbs./ft. in.T ft.
in.To ft. lbs./ft. 6.5 in.Toll5ft.
PROPERTY OWNER'S NAME/COMPANY NAME ,
1
in.To ft. lbs./ft. in.To ft.
Norton Homes OPEN HOLE
Property owner's mailing adc4r,ss if different than well location address indicated above. SCREEN Yee
Make Johnson From ft. To ft.
18215 45th AVe No, Ste D Typeata mesa Diam. 2°
Pl h, MN 55446 Slot/Gauze .110 Length
Set between 115 ft.and 123 ft. FITTINGS 31 lead
STATIC WATER LEVEL _41 ft.XBelow ❑Above land surface
8/3/22 XNo
Date measured Dry hole ❑Yes
WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface)
110 ft.after 2 hrs.pumping 50 g.p.m.
Well/borjag owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION White
water
❑Pitless/adapter manufacturer Model
❑Casing protection J 12 in.above grade
- ❑At-grade ❑Well House ❑Hand Pump
GROUT INFORMATION(specify bentonite,cement-sand,neat-cement,concrete,cuttings,or other)
Material cut t Inge. 1.1 El 50 ft. Yds. ❑Bags
Material belt0fl1t 5 To 0 ft. ❑Yds. ❑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
NEAREST KNOWN SOURCE OF CONTAMINATION
Clap brown m 0 12 Well is 1 '" '3, feet •,:`>„,Y...':;3 direction from -*' "f ••1 "` type
ire ark +!'. Well disinfected upon completion? [ Yes ❑No
Clay/Sand Gray 12 PUMP `r +�
El Not installed Date installed 8` 11/2
2
Sand/Gravel Mix S 78 102 Manufacturer's name alle ee ,
Model Number HP 1*5 Volts 230
Pine Sand Brwn S 102 113 20—Length of drop pipe •63 ft. Capacity 23 g.p.m.
i
Water Sand Type: Submersible ❑L.S.Turbine ❑Reciprocating ❑Jet ❑
ABANDONED WELLS
Does property have any not in use and not sealed well(s)? ❑Yes g No
VARIANCE
Was a variance granted from the MDH for this well? ❑Yes'il 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'frue to the best of my knowledge.
Use a second sheet,if needed.
REMARKS,ELEVATION,SOURCE OF DATA,etc. Don Stodola Well 3a
g Co Inc 1691 .
Licensee Business Name Lic.or Reg.No.
--''''':-/"' „, e`A ,, „er . ../
',,, /,',*'‹ ,,k7,;;°#'
558
8/12/22
ortifi‘d Representative•Sr nature Certified Rep.No. Date
Rob Stodola
LOCAL COPY 7 6 715
Name of Driller
ID#52603 HE-01205-18(Rev.3/19)