07/20/2021 Well and Boring Construction Record

Home Browse Search

WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. WELL AND BORING CONSTRUCTION RECORD County Name Hennepin Minnesota Statutes, chapter 103I 857014 Township Name township No. Range No. Sectio7NOFraction (sm. + Ig.) WELUBORING DEPTH (completed)DATE WORK COMPLETED Orono 117 I 23 0NW SE SE 125 K. 7/20/21 GPS LOCATION —decimal degrees (to four decimal places). DRILLING METHOD Latitude Longitude ❑ Cable Tool ❑ Driven ❑ Dual Rotary ❑ Auger ® Rotary ❑ Rotasonic ❑ Other House Number, Street Name, City, and ZIP Code of Well Location 2455 North Shore Drive, Orono 55391 DRILLING FLUID WELL Bentonite From HYDROFRACTURED? ❑ Yes [XNo ft. To ft. Show exact location of well/boring in section grid with `X" Sketch map of well/boring location. Showing property lines, N roads, buildings, and direction. �1 �� v t __.. _� __ .- ..� .-YX - -_-- ._.__ - USE ®Domestic E] Monitoring ❑Heating/Cooling ❑ Noncommunity PWS ❑ Irrigation ❑ Industry/Commercial ' ❑ Community PWS ❑ Dewatering ❑ Remedial ' W ------"'" 3 I Mile— ------ % . e T ,' ! " '�-------- ' j - J 'k Mile 1 S -- 4-� ❑ Elevator CASING MATERIALDrive Shoe? ❑Yes ®No ❑ Steel ❑ Threaded ❑ Welded QPlastic ❑ HOLE DIAM. r� '9 in. To 50 6.5 in. To125 ft. CASING Diameter Weight Specifications 4in. To 115 ft. lbs./ft. in. To ft. lbs./ft. PROPERTY OWNER'S NAME/COMPANY NAME Streeter and AB in. To h. lbs./ft. in. To ft. SCREEN Y9$ OPEN HOLE Property owner's mailing address than well location address indicated above. l�if,.different 18312 mjjmtonka Blvd �A h$ven 55391 p f MakeJonn From ft. To ft. Type $t e$$ Diam.111 SI.VGauze • t e Length Set between 115 ft. and 12 J ft. FITTINGS STATIC WATER LEVEL 45 ft. :& Below ❑ Above land surface Date measured 7/20/21 Dry hole ❑ Yes ;q No WELL OWNER'S NAMEICOMPANY NAME PUMPING LEVEL (below land surface) n 110 ft. after 2 firs. pumping 50 a.p.m. Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION rr�� y�-- lless/adapter manufacturer � �� lam/ �eModel ❑ Casing protection jk12 in. above grade ❑ At -grade ❑ Well House ❑ Hand Pump f -% GROUT INFORMATION (specify bentonite, cement -sand, neat -cement, concrete, cuttings, or other) Material mitt i 7S From 115 To 50 ft. E] Yds. E] Bags Material n eFrom� T. --CF ft. 3 ❑ Yds. :& Bags Material From To ft. ❑ Yds. E]Bags One ba 94 lbs. cement Driven casing seal From To _Bagsg - or 50 lbs. bentonite GEOLOGICAL MATERIALS COLOR HARDNESS OF MATERIAL FROM TO Sand Cla Sand Brian S ^ 0 17 NEAREST KNOWN SOURCE OF CONTAMINATION L L direction from � t � Q Well is _ 9 feet (- type Well disinfected upon completion? X Yes ❑ No �+�r, Sand Brown S 17 /' 44 PUMP '} / ❑ Not installed Date installed G'� ( 1 1,; Manufacturer's name rc Model Number HP Volts , Length of drop pipe ft. Capacityg.p.m Clay Gray M 44 83 Sand/Gravel 1X S 83 98 Rat©r Sand Brown X A 98 125 Type: ubmersible E]L.S. Turbine E] Reciprocating E] Jet E]7 ABANDONED WELLS Does property have any not in use and not sealed well(s)? ❑ Yes NO VARIANCE Was a variance granted from the MDH for this well? ❑ Yes No TN# WELL CONTRACTOR CERTIFICATION Use a seco nd sheet, it needed. 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. Don Stodola t�ee11 Drilling I691 REMARKS, ELEVATION, SOURCE OF DATA, etc. Licensee Business Name Lic. or Reg. No. 558 7/20/2 Cffif4Wepresenta6e Signature Certified Rep. No. Date Rob stod°la LOCAL COPY �857014 Name of Driller w x5zwra ncu"."a k-.