1996-1-23 Water Well and Boring Report

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WELL 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 I I I 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 -- 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) -- LOCAL COPY J i 1 5 S H