HomeMy WebLinkAbout06-03-22 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 6 0 8
Hennepin Minnesota Statutes,chapter 103I
Township Name Township No.
Range No. Section No. Fraction(sm.—+lg.) WELUBORING DEPTH(completed) DATE WORK COMPLETED
Orono 117 2 10 SWI, �I, 121 n. 6 t 312 )
GPS LOCATION—decimal degrees(to four decimal places). DRILLING METHOD
Latitude , Longitude ❑Cable Tool ❑Driven [Dual Rotary
❑Auger X Rotary ❑Rotasonic
House Number,Street Name,City,and ZIP Code of Well Location ❑Other
•
1085 Heritage Lane Orono 55391 DRILLING FLUID WELL HYDROFRACTURED? ❑Yes e 4 No
Show exact location of well/boring in section grid with"X." Sketch map of well/boring location. Ben t o'ni t e From ft.To ft. 1
Showing property lines,
N roads,buildings,and direction. USE ®Domestic ❑Monitoring ❑Heating/Cooling
❑Noncommunity PWS ❑Irrigation ❑Industry/Commercial ,
1t} *. ❑Community PWS ❑Dewatering ❑Remedial
--'---• ---� I. ._ -- _ ❑Elevator ❑
W E t CASING MATERIAL Drive Shoe? ❑Yes X No HOLE DIAM.
T ,fi ,''f ❑Steel ❑Threaded ❑Welded
7,Mile
i
/ \\,,,,, �PlasticCASING
Diameter Weight SpecificationsS `
1 Mile { in.To3 ft. lbs./ft. 8 in.To�0 ft..
PROPERTY OWNER'S NAME/COMPANY NAME in.To ft. lbs
To in.Toft.
Mark 1) Williams in_To ft. lbs./ft. in.To ft.
SCREEN Yes
OPEN HOLE
Property owner's mailing address if different than well location address indicated above.
Make Dlam. se Q stainless From
'� ft. To ft.
3�� � Type
Excelsior, MN 55331 SIoUGauze *1 Length 8'
Set between 113 ft.and 121 ft. FITTINGS 3' lead
STATIC WATER LEVEL
) 44 ft.N Below ❑Above land surface
Date measured 6/ 3/ 2 2 Dry hole ❑ Yes No
WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface)
105 ft.after . 2 hrs.pumping 50, g.p.m.
Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION
XPitless/adapter manufacturer bulldog Model
❑Casing protection "'"° ®12 in.above grade
❑At-grade ❑Well House 4'❑Hand Pump
GROUT INFORMATION(specify bentonite,cement-sand,neat-cement,concrete,cuttings,or other)
Material C U t t I fl S From 113 To 50 ft. ❑Yds. ❑Bags
Material befl t oni t erom 50 To 0 ft. 3 ❑Yds. [Bags ,
HARDNESS OF Material _From___ To ft. ❑Yds. ❑Bags
GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO One bag=94 lbs.cement
Driven casing seal From To Bags
or 50 lbs.bentonite
NEAREST KNOWN SOURCE OF CONTAMINATION ,Is II r`-re 1
Clay/Sand Brown S 17 Well is t.�J feet _ direction from C-i s 1 � type
Well disinfected upon completion? X Yes ❑No
Clay/Sand Gray M 17 87 PUMP
❑Not installed Date installed 6/2 3!
Sandy Clay Brown S 87 105 Manufacturer's name Shafer
Model Number HP I•5 Volts 2 3°
Sand/Gravel 9ix S 105 123Length of drop pipe ft. Capacity 20-23 g.p.m.
Type:[Type:4.Submersible ❑L.S.Turbine ❑Reciprocating 0 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 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.
-/: ' --' �Jy 1 558 / (jy2
Certified Representative Signature Certified Rep.No. Date
LOCAL COPY 860802 Rt 3 S odo
la
Name of Driller
ID#52603 • HE-01205-18(Rev.3/19)