HomeMy WebLinkAbout09-13-2021 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 857037
Minnesota Statutes,chapter 1031
Hennepin -
Township Name Township No. Range No. Section No. Fraction(sm.—.Ig.) WELL/BORING DEPTH(completed) DATE WORK COMPLETED
Orono 117 23 04 NW NW NW 123 ft. 9/13/21
GPS LOCATION—decimal degrees(to four decimal places). DRILLING METHOD
Latitude _ Longitude ❑Cable Tool ❑Driven ❑Dual Rotary
❑Auger lk Rotary ❑Rotasonic
House Number,Street Name,City,and ZIP Code of Well Location C h El Other
3195 Watertown kid. Orono 55391 DRILLING FLUID WELL I'WDROFRACTURED? ❑Yes ®No
Show exact location of well/boring in section grid with"X." Sketch map of well/boring location. water „.';''' '"g ft.To ft.
Showing property lines,
roads,buildings,and direction. USE
IllHeating/Cooling
----I-----1-----L------1--- Gi t.{,s,--*o w--).N ( %4' ❑Noncommunity PWS ❑Irrigation ❑Industry/Commercial
❑Community PWS ❑Dewatering ❑Remedial
f ❑Elevator ❑
w E CASING MATERIAL Drive Shoe? ❑Yes ®No HOLE DIAM.
. . ' T �(
®❑Steel 1 Threaded ❑Welded
M
/z il¢ Plastic
III--1------F-----i---
% 1 CASING
s —S Diameter 1 b Weight Specifications
--
F1 Mn¢ *-- ”— 4 in.To 114 4 ft. lbs./ft. 8 in.To 50 ft.
in.To ft. lbs./ft. 6.5 in.Tot24ft.
PROPERTY OWNER'S NAME/COMPANY NAME --
Beth Tkautiii$n in.To ft. lbs./ft. in.To ft.
Yes OPEN HOLE
Property owner's mailing address if different than well location address indicated above. SCREEN
Make johnson From �y ft. To ft.
same Type stainless Diam. 2"
SloVGauze •10xLength 8 1
Set between 114 ft.and 123 ft. FITTINGS 3" I ead
STATIC WATER LEVEL 77 ft.z[j Below ❑Above land surface
Date measured 9. 1 3/2 1 Dry hole ❑Yes gl No
WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface)
110 ft.after 2 hrs.pumping 40 g.p.m.
I Well/boring owner's mailing address if different than property owners address indicated above. N/ELLHEAD COMPLETION r k`irtu
""- Pitless/adapter manufacturer(i(� Model
❑Casing protection ` 42 in.above grade
❑At-grade ❑Well House ❑Hand Pump
GROUT INFORMATION(specifyci�fyqbentonite,tcement-sand,` neat-cement,concrete,cuttings,or other)
li Material �'U t t i n mm 1 I To 6g ft. ❑Yds. ❑Bags
Materia( be n t o n i t , 50 To ft. 3 ❑Yds. Q Bags
HARDNESS OF Material From To ft. ❑Yds. ❑Bags
GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO One bag94 lbs.cement
Driven casing seal From To Bags =
or 50 lbs.bentonite
1 NEAREST KNOWN SOURCE OF CONTAMINATION
top soil b 1 k in O Well is feet _ direction from type
Well disinfected upon completion? �]Yes ❑No
clay brwn it 4 12 PUMP
❑Not installed Date installed 11 13,;.1 a (
clay/sand gray a 12 85
Manufacturer's name
97 i Model Number HP 112 Volts 3
sandy/clay brown g 85
7 Length of drop pipe O 1 ft. Capacity 0 g.p.m
sand brown s 97 125 Type:NtSubmersible ❑L.S.Turbine ❑Reciprocating ❑Jet ❑
ABANDONED WELLS
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 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. . Inc 1691
Licensee Business Name Lic.or Reg.No.
558 9/13/21.
�a�fl1 dd epresent 'e Signature Certified Rep.No. Date
g°b Stodola
LOCAL COPY
857037
Name of Driller
ID#52603 HE-01205-18(Rev.3/19)