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HomeMy WebLinkAboutwell and boring record WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring H 405041 WELL AND BORING SEALING RECORDNo. County Name Minnlesota Unique Well No. or W-series No. E P IN Minnesota Statutes,chapter 1031 (Laaoo dank i no,known) Township Name Township No. Range No. Section No. Fraction(sm.—.lg.) Date Sealed Date Well or Boring Constructed ORONO 117 23 07 NENEWE'A 9/8/23 GPS LOCATION—decimal degrees(to tour decimal places) 228 Depth at Time of Sealing ft. Original Depth ft. Latitude Longitude /� AQUIFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring L�8AO®Single Aquifer ❑Multiaquifer 941 NORTH ARM �Jt. ©YND,MN. 3 L/BORING Measured Date Measured 9/8/23 ❑Estimated 1 #i) A V!J •I ater-Supply Well ❑Env.Well Show exact location of well or boring Sketch map of well or boring in section grid with"X." . location,showing property ❑Temp.Boring ❑Other ft. ®below ❑above land surface N 4 �l• ines,roads,and buildings. CASING TYPE(S) t rF f E Steel pg Plastic ❑Tile ❑Other iik - 44� WELLHEAD COMPLETION W ET T •utslde: QPftless Adapter/Unit ❑At Grade Inside: ❑Basement Offset %Mi- ❑Well Pit ❑Buried ❑Well House iSor -- -----r-s- ?--- l ❑Other ----- ❑Well Pit ❑Buried i Mile ❑Other For temporary borings,provide additional location CASING(S) information,a site sketch,and geology on a separate page. ' Diameter Depth'q Set in oversize hole? Annular space initially grouted? R'PRciriya S plyju)�/�o grtly_rE 4 in.from I tom ft. ❑Yes ❑No El Yes ❑No A]Unknown Property owner's mailing,address if different than well location address indicated above in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown SCREEN/OPEN HOLE 220 A a�Q 22Si Screen from to ft. Open Hole from to ft. WIl ; SfJAMF,dri Y ti OBSTRUCTIONS Well owner's mailing address it different than property owner's address indicated above 4Rods/Drop Pipe ❑Check Valve(s) ❑Debris ❑Fill '❑No Obstruction DROP PIPE Type of Obstructions(Describe) Obstructions removed? Z]Yes ❑No Describe PUMP GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO FORMATION ❑Not Present El!PPrressent,lpRemooved Prior to Sealing ❑Other If not known,indicate estimated formation log from nearby well or boring. �i Type SUBMERSIBLE MICIF T 1 22tl METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE X No Annular Space Exists ❑Annular Space Grouted with Tremie Pipe ❑Casing Perforation/Removal Casing Diameter in.from to ft. ❑Perforated ❑Removed _ in.from to ft. ❑Perforated ❑Removed Type of Perforator VARIANCE Was a variance granted from the MDH for this well? ❑Yes pi No TN# GROUTING MATERIAL(S) CEMENT 1 a�q 17 22$ 17 Grouting Material from to ft. yards bags from to ft. yards bags from to ft. yards bags OTHER WELLS AND BORINGS Other unsealed and unused well or boring on property? ❑Yes A No How many? LICENSED OR REGISTERED CONTRACTOR CERTIFICATION REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING This well or boring was sealed in accordance with Minnesota Rules,Chapter 4725.The information contained in this report is true to the best of my knowledge. DON STODOLA WELL DRILLING CO.,INC, 1691 Licensee Business Name License or Registration+tr No. fd yW 556 9/8/23 rt `,Representative Signature Certified Rep.No. Date LOCAL COPY H 405 0 41. JERRY BARR Name of Person Sealing Well or Boring HE-01434-17 ID#53159 ivign MINNESOTA UNIQUE WELL R BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. ime WELL AND BORING CONSTRUCTION RECORD 8 f1 e i n Minnesota Statutes,chapter 1031 6 9 4 18 Name Township No. Range No. Section No. Fraction(sm.—•lg.) WELL/BORING DEPTH(completed) DATE WORK COMPLETED no 117 23 7 N7 TT,? m-7- 12.,2 n. 9/7/23 ATION—decimal degrees(to four decimal places). DRILLING METHOD Longitude ❑Cable Tool ❑Driven ❑Dual Rotary ❑Auger n Rotary ❑Rotasonic mber,Street Name,City,and ZIP Code of Well Location 0 ra .o ❑Other e.- ;.T R VV�' DRILLING FLUID kkfELL HYDROFRACTURED? Yes No �r"1 Dr, oj�n� 5536rf ❑ � ct location of well/boring in section grid with"X." Sketch map of well/boring location. Be f t O n i t e From ft.To ft. Showing property lines, N roads,buildings,and direction. USE 21 Domestic ❑Monitoring ❑Heating/Cooling i f I I i J J. / ❑Noncommunity PWS ❑Irrigation ❑Industry/Commercial !!! /� ( J ❑Community PWS ❑Dewatering ❑Remedial ----.---i----i-- I ❑Elevator ❑ E I CASING MATERIAL Drive Shoe? ❑Yes [ No HOLE DIAM. T T r T 1 ❑Steel ❑Threaded ❑Welded 'k Mile l El Plastic ❑ CASING s Diameter Weight Specifications 1 Mile I 4in.To 116 ft. lbs./ft. 1;a/ in.To 50n. IY OWNER'S NAME/COMPANY NAME in.To ft. lbs./ft. 6 ' 5 in.To 1 3' ft. s s a Dahl in.To ft. lbs./ft. in.To ft. miner's mailing address if different than well location address indicated above. SCREEN ye S OPEN HOLE Make ,�ohn son From ft. To ft. Type stainless/rl� Dam. 2r� Slot/Gauze •10 Length th 8 Set between 116 ft.and 120 ft. FITTINGS lc. packer STATIC WATER LEVEL 76 ft. N Below ❑Above land surface Date measured 9/7/23 Dry hole ❑Yes II No INER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) 11 ft.after 2 hrs.pumping �/1n g.p.m. g owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION [.Witless/adapter manufacturer wh 1 t e wa t e r. Model ❑Casing protection N 12 in.above grade ❑At-grade ❑Well House ❑Hand Pump GROUT INFORMATION(specify bentonite,cement-sand,neat-cement,concrete,cuttings,or other) Material CU t t i n t,$om 116 To 50 ft. ❑Yds. ❑Bags Material 17 e n t o n i tret 50 To 0 ft. 3 ❑Yds. ®Bags HARDNESS OF Material From To ft. ❑Yds. ❑Bags )LOGICAL MATERIALS COLOR FROM TO MATERIAL Driven casing seal From To Bags = One bag94 lbs.cement or 50 lbs.bentonite NEAREST KNOWN SOURCE OF CONTAMINATION Brown 0 33 Well is feet direction from . type Well disinfected upon completion? ❑Yes ❑No Gray 33 69 PUMP Op ❑Not installed Date installed 9/8/2 3 .Sian'-' Brown S 69 100 Manufacturer's name Shafer Model Number HP Volts 2 3,J 'r Sand Brawn S 100 125 Lengthpipe 9 drop99 ft. Capacity 10 g.p.m. Sand r o ctn S 12 5 13 Type:ErSubmersible ❑L.S.Turbine ❑Reciprocating El Jet ❑ ABANDONED WELLS Does property have any not in use and not sealed well(s)? ❑Yes L NJo VARIANCE Was a variance granted from the MDH for this well? ❑Yes El 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. 3,ELEVATION,SOURCE OF DATA,etc. `ion Stodola Nell Drilling 1691 Licensee Business Name Lic.or Reg.No. --- e7 558 9/13/23 Certi d epresentative Signature Certified Rep.No. Date LOCAL COPY 8 6 9 418 Rob b Stodola Name of Driller HE-01205-18(Rev.3/19)