HomeMy WebLinkAbout1996-1-23 Water Well and Boring ReportWELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO.
%oui ty Name WELL AND BORING RECORD . f --
Hennepin Minnes
Township Name To%. nship No Range No SOClion No Fraction
Orono
House Number. Street Name. City. and Zip Code of Well Location or Firs! Number
�6?0 Countryside Drive Wert_
Show exact location of well in section grid with 'X'. Sy9�h map of well locallon
Orono � howng property lines.
C r ;4V arca buildings
N ;:„?,
�w(/
I I
t i 1 I
1 1 t I
w E I
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PROPERTY OWNER'S NAME Ton` filen •nipany
Property owners ma:;rg address if diffe•enl than well location address indicated above
41L;u Berkshire Lane
Plylnc;uth, Mn. 55446
WELL OWNER'S NAME
Wag owners mailing address if different than property owners address indicated above
oto Statutes Chapter 1031 1 1 `7 d v
WELL DEPTH (completed) Date Work Completed
170' 1-23-96
DRILLING METHOD
WELL HEAD COMPLETION Whitewater
XI Pi9erss adapter manufacturer -_---- Model------_--__--
.. Casing Protectgn_.-_-- .-_ XI2in above grade
' I Cable Tool
❑ Drwen
❑ Dug
Auger
13 Rotary
❑ Jetted
Well grouted? X Yes ' : No
Grout Material Neat ce rit i(Bent ❑ ConaMa Cl Benlontie
from ` ,to=ilL -
-- --- yds. X �
DRILLING FLUID
COLOR
HARDNESS OF
MATERIAL
FROM
Water
USE
CXDomestic
❑ Monitoring
❑ Heeffirgr401yg
❑ Irrigation
❑ Community PWS
❑ Noncommunity PWS
❑ Y Manifirmcial
❑ parnellW
❑ Test Well
❑ Dewatering
❑
CASING
Drive Shoe? N Yes ❑ No
Grey
HOLE DIAM.
❑ Steel
r Threaded ;-I welded
NEARE KNOWN SOURCE OFC AMI TIO d_ /r�
' - -_ --L _ /-S�T "Cnw
rXPlastic
' '
CASING DIAMETER WEIGHT
4 161 SDR.21 7 71n//,1p8 30
in to — --- -- - ft -- --- __ ba, M.
nbe
_ ih 140
. to _-- . _ r — -M.
_ in. to _- - If ---- - -- -- ---- tbam. in. to — it
SCREEN._. ____ OPENHO(”
Make Halliburton from
Type - S ta+01L1L(l s S.tee I ----Diam. --
'1UU// 1op
SIOVGauze_- _-_-_-_-- _--- _------ ____Length_
Set between , 1-6-1-- _ h. and __-- - 7. Cit. FITTINGS: 6 -.
STATIb WATER LEVEL
- _ If X. below 'I above land surf are Date measured 1-23-9
PUMPI LEVEL (below lanu surface)
— -� V
It after _ _ _ -- hre. pumping -- 17
-g.p.m.
WELL HEAD COMPLETION Whitewater
XI Pi9erss adapter manufacturer -_---- Model------_--__--
.. Casing Protectgn_.-_-- .-_ XI2in above grade
' Al -grade (Environmental Wells and Borings ONLY)
GROUTING INFORMATION
Well grouted? X Yes ' : No
Grout Material Neat ce rit i(Bent ❑ ConaMa Cl Benlontie
from ` ,to=ilL -
-- --- yds. X �
GEOLOGICAL MATERIALS
COLOR
HARDNESS OF
MATERIAL
FROM
TG
Clay
Yellow
S
U'
?.
from- -_ _ __— to _ IL ❑ yds. ❑ logs
from ----_--to it. -- n yds. ❑ bags
Clay
Grey
S
29'
1 1 t
NEARE KNOWN SOURCE OFC AMI TIO d_ /r�
' - -_ --L _ /-S�T "Cnw
-__-'°" _ -_direclbn
Well disinfected upon completion? X Yes ! i No
Send
White
5
116'
1,1
PUMP 2-9-96
i-.: Not.nstalied Date p^sial --------_
Cla-Grrtvel
Arown
S
C. 1
It -
14C
d--
IMenulBcturer4 ne s u�
mW
Modal number N9518053 HP Volt U_
kind
rrc:n
5
'
14C'
1 _/
' Length of drop pipe 126 _ - _ -7�7t kms% _ g.p.m.
PressureTankCapacMy � _
Type. X Sut-ers,ble ❑ L.S. Turbine n Reciprocating ❑ Jet ❑__---
ABANDONED WELLS
Does property have any not in use and not sealed wee(s)? J Yes
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VARIANCE
Was a variance granted from the MDH for this was? :-1 Yes A No
WELL CONTRACTOR CERTIFICATION
Use a second sheet it needed
This wail was drilled under my stpalytgn and in accordance with Minnesota Rules. Chapter 4725.
The information contained In this report Is true to the test of my knowledge
REMARKS. ELEVATION. SOURCE OF DATA. etc.
WN STODOLA WELL DRILLING CO., INC.
LluwtaeNana Uo. or Rap. Na. 27172
Zt
. ,r 1-24-96
" Aurnonzed AaprigrtivMliff! $igriffam DAM
Fred Leiby 1-24-96
Name of DOw — — aro
HE.o,iae.o. (tllsv. ,ns)
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LOCAL COPY
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