HomeMy WebLinkAbout1996-08-20 Well and Boring RecordWELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO.
County Name WELL AND BORING RECORD
Hennepin Minnesota Statutes Chapter 1031 5 7 2 71- 5
Township Name Township No Range No. Sed�on No Fraction WELL DEPTH (completed) Date Work Completed
Orono 117 23 4 N W NW 118 8/20/96
House Number, Street Name, City, and Zip Code of Well Location or Fire Number DRILLING METHOD
60 Cygnet Place Cable Tool Driven Dug
Auger %R Rotary Jetted
Show exact location of well in sccbon grid with ')(' Sketch map of well location
Showing property lines.
I !'\ roads and buildings DRILLING FLUID
ri
J Bentonite
' - - - - ' USE Monito
ring Heating Cooling
- - - - ` �I Domestic Communal Industry,ComfnWW
- - - - - - 1 mga 17 Ilon
J , -; Noncommunity PWS Remedial
w c n Test Wen Dewatenng --- --
i CASING Drive Shoe? . Yes No HOLE Difill
n Stem Threaded Welded
' X Plastic .
S
CASING DIAMETER WEIGHT
PROPERTY OWNER'S NAME 4 at, to113 ft. this nl 8 n to 60"
ll
Don Currier in. to e. ____-_-_ lbs" -. n,o. Oft
Property owner'; mating address t different than well location address indicated above ... _ at. to h. Ibis M. _--_ _ n, to
SCREEN OPEN HOLE
Make Jawco from
Type PVC Dwn
Slot'Gauze _ _ 12 Level ---- -
Set between --3 ft. and_ 11. FITTMI(i3: _X Packer
STATIC WATER BLEVEL �r
WELL OWNER'S NAME _ ft. Xbeow n above land surface Date measures_ -
PUMPING L" (below land surface) 3
Well owner's mailing Address it different than property owner's address mdx;ated above -- _ ft. after _-- __-- _ _ hrs pumping _ .._ _4Q
-g.p.m.
WELL HEAD COMPLETION
A Pitlessadaplermanutacturer�itewater__ del S-5-4
L] Casing Protection---_--- ----- n 12 wi above grade
n At -grade (Emtronmental Wells and Borings ONLY)
GROUTING INFORMATION
Well grouted?] Yes ' : No
GEOLOGICAL MATICRIALS COLOR HARDNESS OF FROM TO Grout Material ' ' Neat cement A Bemonn U Concrete O High Sokla Be ntoorte
MATERIAL from 5010 n. n yds. n bags
clay brown wed. 0 20 from - ---- to -- _ _n. _ n yda n be"
fro._ -- __ 10 _-_ — n. _ n yda. n bew
clay blue e med . 20 49 NEAREST K N SOURCE OF CONTAMIVTION
,,,, `ij .sever pi
Well disinfected upon completion? X Yes No
sand & gravel mix med. 49 70
PUMP 8/22/96
'. Not mstalkW Dale � Mad _ --_-_----
sandy clay blue med. 70 93 Manufacturers name Sta—Rte _
Model number -___ S 7 5M --- _ HP / _ V
230
r7 12 3 L h of dr TOO M. m•
sand Si gravel brown med . -� I �+ oPpp•__ _ mar -- as
Pressure Tank Capadty L 0 L _-- - _.
Type: XSubmersrble n L.S. Turbine '. Reciprocatug i ] Jet n --
ABANDONED WELLS
Does property have any not in use and not sealed well(s)'i Yes X] No
VARIANCE
Was a variance granted from the MDH for this welly . Yen 41 No
WELL CONTRACTOR CERTIFICATION
Use a second street, it needed This well was drilled under my supervision and in accordance with Minnesota Rules. Chapter 4725
REMARKS. ELEVATION. SOURCE OF DATA, etc. The information contained in this report is true to the best of my knowledge.
R.E.S. Well Drilling 27276
Lbensee Buahesa Nama �/—f� - - Lic or Rey. No. /1 /
r - - Aullf-fdRapr.earw"SoWlee _ Date
Robert Be Stodola, Jr- 8/22/96
Name of OAW Date
LOCAL COPY 572715 HE-012064116(Raw.I S)