Well and Boring Construction Record

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' MINNESOTA UNIQUE WELL WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. County Name WELL AND BORING CONSTRUCTION RECORD 8 27810 Henilep fL Minnesota Statutes,Chapter 1031 hp Township Name Township No. Range No. Section No. Fraction(sm.-.Ig.) WELUBORING DEPTH(completed) DATE WORK COMPLETED Orono 117 23 HO6 SE SE SWi _ 151 t 6-15-18 _ GPS LOCATION—decimal degrees(to four decimal places). DRILLING METHOD Latitude Longitude ❑Cable Tool ❑Driven ❑Dual Rotary ❑Auger %Rotary ❑Rotasonic House Number,Street Name,City,and ZIP Code of Well Location ❑Other_ DRILLING FLUID WELL HYDROFRACTURED? ❑Yesio 650 Pinehurst Crt, Orono 55364 Show exact location of well/boring in section grid with'X." Sketch map of well/boring location. bentonite From ft.To ft. Showing property lines, N roads,buildings,and direction. USE .i Domestic ❑Monitoring ❑Heating/Cooling _____ ❑Noncommunity PWS ❑Environ.Bore Hole ❑Industry/Commercial '..4,< ❑Community PWS ❑Irrigation ❑Remedial ---l---.-- l ❑Elevator ❑Dewatering ❑ _ w E CASING MATERIAL Drive Shoe? ❑Yes �(No HOLE DIAM. T ❑Steel ❑Threaded ❑Welded '/Mile 'Plastic Cl 1 i _ CASING s1 41 Diameter Weight Specifications I___1 Mile--I (0 P 4" in.Ta 145 ft. lbs./ft. 86-1 _in.To 50 ft. -- PROPERTY OWNER'S NAME/COMPANY NAME in.To ft. lbs./ft. 6 4 in,To 15 3 ft. Norton Homes n.To ft. lbs./ft. in.To ft. SCREEN OPEN HOLE Property owner's mailing address if different than well location address indicated above. Johnson 18215 45th Ave N, Ste D Make From ft. To ft. Type stainless steel Diam.2" Plymouth, MN 55446 Slot/Gauze .010 Length 41 + 4' Set between 1'5 ft.and 153 ft. FITTINGS 2MX3I leader STATIC WATER LEVEL 70 ft.Xtelow❑Above land surface Measured fromtop of well ate measured 6-15-18 Dry hole ❑ Yes ]a'No — WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) 140 ft.after 2 hrs.pumping 40 q.p.m. Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION Pitless/adapter manufacturer Whitewater Model ❑Casing protection 12 in.above grade ❑At-grade ❑Well House ❑Hand Pump GROUT INFORMATION(specify bentonite,cement-sand,neat-cement,concrete,cuttings,or other) MateriabentOnite From 0 To 50 ft. 3 ❑Yds. igtags Materiacut t ings From 50 To 145 ft. ❑Yds. ❑Bags HARDNESS OF Material From To ft. ❑Yds. ❑Bags GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO Driven casing seal From To Bags = One bag94 lbs.cement or 50 lbs.bentonite NEAREST KNOWN SOURCE OF CONTAMINATION topsoil black medium 0 2 Well is /4./,`-',f-) feet •— direction from 'b---`--" - type Well disinfected upon completion? Wes ❑No clay brown medium 2 , 25 PUMP ❑Not installed Date installed 8-2-ip clay gray soft 25 61 Manufacturer's name SehAPfer Model Number HP 1.5 Volts 230 sandy clay gray medium 61 74 Length of drop pipe 84 ft. Capacity g.p.m sand brown medium 74 7()98 TypeigSubmersible ❑L.S.Turbine ❑Reciprocating ❑Jet ❑ 98 ABANDONED WELLS fine sand gray solC t 120 Does property have any not in use and not sealed well(s)? ❑Yes PKflo VARIANCE gravel mix medium 120 134 Was a variance granted from the MDH for this well? ❑Yes,No TN# WELL CONTRACTOR CERTIFICATION 'r This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. sand medium 134 153 The information contained in this report is true to the best of my knowledge. Use a Seco til needed. 1 ^,, • Co REMARKS,ELEVATION,SOURCE OF DATA,etc. 1 Stodola well Drilling Co,. Inc. 1691 Licensee Business Name Lic.or Reg.No. _2_7', �f��j._ _ z;;,,-- 9-20-18 Cer i �Repres n tive'Signa urs f Certified Rep.No. Date Rob Stodola LOCAL COPY 8 2 7 810 Name of Driller ID#52603 HE-01205-16 IRev.5/16)