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Home My WebLink Aboutwell info ! �� . .�.. WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. CountyName WELL AND BORING RECORD 6 5 719 0 Hennep i n Minnesota Statutes Chapter f031 Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed n. Orono 117 23 2 SW,,,NTej SW,,, 2 28 10/31/O1 House Number,Street Name,City,and Zip Code of Well Location or Fire Number DAILLING METHOD - 2120 F��{ �Jt'.. Orono, MN ❑ CableTool ❑ Driven ❑ Dug [7 Auger �Rotary � . ❑ Jetted Show exact location of well in section grid with"X". Sketch map of well iocation. C7 ____.__.___ ____ Showing property lines, roads and buildings. DRILLING FLUID WELL HYDROFRACTURED? ❑YES �NO " :;'-� Baroid uik el i � i � g FROM __ft.to fl. -� -i- -i- -i- '� �1J . � USE ❑ Monitoring ❑ Heating/Cooling � � i i .. . - �Domestic ❑ Communit PWS �npfff�� ❑ Irrigation Y ❑ Industry/Commercial i i i i � � ❑ Noncommunity PWS ❑ Remedial y,� E - ❑ Environ.Bore Hole i i i � ,�,��,� r ❑ Dewatering ❑ -i -�- -r- -r T ,' ��...."t..- i i i i ��2M.1e � -- CASING Drive Shoe? ❑ Yes C*No HOLE DIAM. _i i i i_ � , ❑ Steel ❑ Threaded ❑ Welded I I I I vj �Plastic ❑ s �,,. �1 Mile--� . � CASING DIAMETER WEIGHT PROPERTY OWNER'S NAME 4 in.to �1�t. I�91bs./ft. 8�n.to 3d n. K1I/1Q HuDt in.to tt. Ibs./fl. ��n.toy�8. Property owner's mailing address if different than well location address indicated above. in.to ft. Ibs./ft. in.to_ft. 18324 Minnetonka �lvd. SCREEN OPEN HOLE Deephaven, Pin 55391 Make cresl ne from n.to n. Type__�7 a�t�t'� Diam. _�p Slot/Gauze � ¢ Length Set between 1 8 ft and � 7 a tt. FITTINGS: � STATIC W��i LEVEL �[ 1 O 3� WELL OWNER'S NAME _ �� ft. L7�elow ❑ above land surface Date measured � PUMPING L EL(below land surface) Well owner's mailing address if ditterent than propeRy owner's address indicated above. � ft. after 1 hrs.pumping 40 g.p.m. WELL HEAD COMPLETION �� i �Pitless adapter manufadurer R��11�ter Model S11 �� _ ❑ Casing Protection___ _ t7 12 in.above grade ❑ At-grade(Environmental Wells and Borings ONLY) GROUTING INFORMATION Well grouted? � Yes ❑ No GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO Grout nnateria� ❑ Neat cement ❑ Bentonite ❑ Concrete '� High Solids Bernonite MATERIAL from__�to�ft. � ❑ yds. �bags - clay �ii Sc7Atl brOi�lA 80ft. Q 3'� trom____to ft. ❑ yds. ❑ bags from to_ ft. ❑ yds. ❑ bags Cla ra $Oft, 37 (�2 NEARE�Tj(NOWNSOURCEOFCONTAMINATION Y 3 Y � feet W�st directia�e�t�C lype Well disinfected upon completion? Q,Yes ❑ No tank sand S clay braxn saft 92 109 pUMP sand brown gOft, 1�9 128 � Notinstalled oateinstaued Manutacturer's name �e=�OtflL' Model number HP_1 1 T� Volts "O 1 L Length of drop pipe_ ft. Capacity g.p.m. Type: �]'Submersible ❑ LS.Turbine ❑ Reciprocating ❑ Jet ❑ ABANDONED WELLS Does property have any not in use and not sealed well(s)? ❑ Yes �No VARIANCE Was a variance granted trom the MDH for this well? ❑ Yes C�No TN# WELL CONTRACTOR CERTIFICATION Use a second sheet,il needed This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. REMARKS,ELEVATION,SOURCE OF DATA,eta The information contained in this report is true to the best of my knowledge. Leuthner Weli Inc. 10125 Licensee Business Name •� 'i' Lic or Reg.No �EF /y.;9 f `��-1. � .ri4`��,r.,� ' . ��1� ' Authorized Representative Signature Date Maurice L. Leuthner 12/15/Ol Name ol Driller Date LOCAL COPY 6 5 719 0 HE-01205-07(Rev.2/99) IC#140-0020 t '� . MINNESOTA DEPARTMENT OF HFALTH Minnesota Well and Boring �� }� � WELL OR BORING LOCATION Sealing No. �H �} Couny Name WELL AND BORING SEALING RECORD Minnesota Unique Well No. r -- � (i M�nnesota Sta�ures.Chapter t031 or W-series No. I �.�.e�u�a k�� L— � Tow ship Name wnship No. Range No. Section No. F tion �I .) Date Sealed Date Well or Boring Constructed i:� �-� 3 ' �� v �� ` � Numencal Street Adtlress o Number and City .f Well or Boring Location � _ .� � i �� - "��*v Depth Before Seahng n. Original Depth h �� Shaw exact Ixation of N•ell or boring Sketch map ol well or bonng ApU1FER(S) STATIC WATEH LEVEL m section gnd with"X'. locahon, showing property �Single Ayuder � MWhaquder lines,roads,antl buildings. N WELL/BORING Measured ❑ Estimated � .'�Water Supply Well ❑Monit.Well ,.,,-.r„� ❑ Env.Bore Hole ❑Other _ �',�tt. ❑ below ❑ above land surtace W --�- - -- - -- --i-- E CASING TYPE(S) , ' �,�.�:_�„ � � � � ,. ' ' -I- -,— --�— � � . �.-�`�' �Steel ❑ Plastic �Tile �Other --r - � I I }lmik { -�-- --i-- ' r X.: CASING(S) —�- ---- � � ,-:, � Dlameter Depth Set in oversize hole7 Annular space initially grouted7 � S {..3 Yes No ❑ �es ❑No ❑ Unknown �m;�� ,c �in.from to�� fl. ❑ ❑ PROPER�`,OWNE�S NAI�E m.from to R. ❑ Yes ❑No ❑ Yes ❑No ❑ Unknown �V,.• � ,y�.. . Pro owMr mai ing etltlress It differem than well Uon addre s in/d+icated above. in.hom to fl. ❑ Yes ❑No ❑ Yes ❑No ❑Unknown � / �/,f / � �� irf ��'.�� .��i../�� SCREEWOPEN MOLE r�r T� �"" ! �/\ � � ��/� Screen from ��'� to� h. Open Hole from to fl. / " OBSTRUCTIONS WELL OWNER' NAME ❑ Rods/Drop Pipe ❑Check Valve(s) ❑Debris ❑ Fill ❑ No Obstruction Well owners mailing address it AiHerent than properry owner's address iMicated above. Type of Obstruclions(DeSCribB) Obstructions removed? ❑ Yes ❑ No Describe PUMP 1� Type `mL-+�-t..�- � (iEOL0f31CAL MATERIAL COLOR MARDNESS OF FHOM TO �`'Removed ❑ Not Present ❑ Other FORMATION N not krawn,indicete estimeted tortnatbn log from ne�rby well or boring. METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: ❑No Annular Space Exists ❑Annular space grouted with tremie pipe ❑Casing Perforation/Removal in.from �o ft. ❑ Pertorated ❑ Removed in.trom to R. ❑ PeAorated ❑ Rertroved Type of peAorator ❑ Omer GROUTING MATERIAL(S) (One bag of cement=84 Ibs.,one bag of bentonite=50 Ibs.) ! � �6- �-�f,-- Grouting Matenal�_ ` ' YiC��',� to� n. from lo ft. yards irom to ft. yards bags from to_— ft. yards begs REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING OTHER WELLS AND BORINCaS Other unsealed and unused well or boring on property? ❑Yes [�}No How many? LICENSED OR REGISTERED CONTRACTOR CERTIFICATION This well or boring wes sealed in accordence with Minnesata Rules,Chapte�4725. The infortnation coMeined in Mis report is . true ro the best of my k�wledge. � /�{ � ��' / / , f rt. ' ,.y , __ �,�./ �,1;(�i /' �� c_�—�i�6 f!a /_. ) Contracfor Bus�ness Nam�e�'��'� L�cense w Reg�� ', �� '�- _...__ \. /� Authonz ignature -� �-� fe �� . ..��.)`��r�-' J,� LOGAL COPY H 1��01�a Name ol PersKii 7ing Well or BoA� ;, ` �