HomeMy WebLinkAbout10-11-22 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
Hennepin iE Minnesota Statutes,chapter 1031 8 7 6 70 8
Township Name Township No. Range No. Section No. Fraction(sm.—.lg.) WELUBORING DEPTH(completed) DATE WORK COMPLETED
Orono 11.8 23 27 NW NW. SW/4 209 ft- 10/11/2
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
11601M/1llow Dr N, Orono DRILLING FLUID WELL HYDROFRACTURED? ❑Yes X]No
Show exact location of well/boring in section grid with"X." Sketch map of well/boring location. Benton to ,From _ft.To ft.
Showing property lines,
N roads,buildings,and direction. USE lrihr Domestic ❑Monitoring ❑Heating/Cooling
___ ___ ' ❑Noncommunity PWS ❑Irrigation ❑Industry/Commercial
❑Community PWS ❑Dewatering ❑Remedial
❑Elevator ❑
w E CASING MATERIAL Drive Shoe? ❑Yes [ No HOLE DIAM.
T ❑Steel ❑Threaded ❑Welded
Y2 Mile ''`"
X Plastic ❑
1 1 i CASING
Diameter Weight Specifications
5I
1 Mile I f : , 4 in.To 200 ft. lbs./ft. 8 in.To 0 ft.
PROPERTY OWNER'S NAME/COMPANY NAME in.To ft. lbs./ft. '� in.T ft.
in.To ft. lbs./ft. in.To ft.
Near & Streeter OPEN HOLE
Property owner's mailing address if different than well location address indicated above. SCREEN Yee'
Make On From ft. To ft. ,
-w Type stainlessjilting) _Diem.2
,R C 4 r Slot/Gauze *1,d. Length 8*
2
Set between ft.and 20 +�ft. FITTINGS .3R* lead
STATIC WATER LEVEL 143 ft.' ]Below ❑Above land surface
Date measured_10; 11'22 Dry hole ❑ Yes /Co
WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) •
195 ft.after hrs.pumping 35 g.p.m.
Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION
Pitless/adapter manufacturer Monitor bulldog
❑Casing protection lX12 in.above grade
❑At-grade ❑Well House ❑Hand Pump
GROUT INFORMATION(specify bentonite,cement-sand,neat-cement,concrete,cuttings,or other)
Material CUt t in $rom 200 To 50 ft. ❑Yds. ❑Bags
Material benton m 50, 0 ft. 3 E 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.
aa NEAREST KNOWN SOURCE OF CONTAMINATION •
Topsoil Back S 0J Well is feet NE
direction from Sewer type
Well disinfected upon completion? [ 'es ❑No
Clay Brown 3 22 PUMP
11/7/22
❑Not installed Date installed
Clay`Sand Gray 135 Manufacturer's name Shafer
Sandy Clay Model Number HP olts 230
Gravel Dray 14 135 181 168
Length of drop pipe ft. Capacity g.p.m.
Sandy Clay Brown s iRi 190 Type:L*Submersible ❑L.S.Turbine ❑Reciprocating ❑Jet ❑
ABANDONED WELLS
Sand Brown M 190 21 Does property have any not in use and not sealed well(s)? ❑Yes [ No
& VARIANCE
Was a variance granted from the MDH for this well? ❑Yes X 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 Co 1691
•
Licensee Business Name Lic.or Reg.No.
,x
�-� 558 11/7/22
Certified`Representative Signature Certified Rep.No. Date
LOCAL COPY 6.6 Rah Stodola
6 6 Name of Driller
ID#52603 HE-01205-18(Rev.3/19)