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MINNESOTA UNIQUE WELL <br /> WELL OFI_BORINS LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. <br /> County Name WELL AND BORING CONSTRUCTION RECORD 8 2 7 8 3 2 <br /> Hennepin Minnesota Statutes,Chapter 1031 <br /> Township Name Township No. Range No. Section No. Fraction(sm.—.Ig.) WELUBORING DEPTH(completed) DATE WORK COMPLETED <br /> Orono 117 23 06 NE N SW '� 140 "' 8-1-18 <br /> GPS LOCATION—decimal degrees(to four decimal places). DRILLING METHOD <br /> Latitude Longitude ❑Cable Tool ❑Driven ❑Dual Rotary <br /> ❑Auger otary ❑Rotasonic <br /> House Number,Street Name,City,and ZIP Code of Well Location ❑Other <br /> 420 Lakeview Parkway, Orono 55364 DRILLING FLUID WELL HYDROFRACTURED? ❑Yes o <br /> Show exact location of well/boring in section grid with"X." Sketch map of well/boring location. ben0enite From ft.To ft. <br /> Showing property lines, <br /> r bu' 'ngs,and direction. USE <br /> N ( AAS omestic ❑Monitoring ❑Heating/Cooling <br /> I I . <br /> oncommPWS Environ.Bore Hole ❑Industry/Commercial <br /> 1 ---- N unity ❑ <br /> • J •w,,� <br /> . I ❑Community PWS ❑Irrigation ❑Remedial <br /> ------i- / ❑Elevator ❑Dewatering ❑ <br /> w ; ; E T CASING MATERIAL Drive Shoe? ❑Yes o HOLE DIAM. <br /> """" "' "" ❑Steel ❑Threaded ❑Welded <br /> 'h Mile ;� �. ( Plastic <br /> ---�-----T--S-[ ;-- -,,,t3 <br /> � CASING <br /> Diarge(tter 0 13Weight Specifications8 50 <br /> --1 Mile ) in.To 7t/ ft. lbs./ft. 6� in.joft. <br /> PROPERTY OWNER'S NAME/COMPANY NAME n.To ft. lbs./ft. �'2 n.To ft. <br /> n—M� s & ling in.To ft. lbs./ft. in.To ft. <br /> �Xry yea Remodeling SCREEN OPEN HOLE <br /> Property owner's mailing address if different than well location address indicated above. Johnson <br /> _ 1000 Boone Ave N, Ste 400Mstainless steel <br /> m <br /> TypeFroDiam. 2“ -ft. To ft. <br /> Golden Valley, MN 55427 Slot/Gauze .010 Length 41 + 41 <br /> Set between ft.and ft. FITTINGS <br /> STATIC WATEIA L 75 ft. Below ❑Above land surface <br /> w1 <br /> Measured from top of well.measured 8-1-18 Dry hole ❑Yes ›iflo <br /> WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) 40 <br /> 125 ft.after 2 hrs.pumping q.p.m. <br /> Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION <br /> $Pitless/adapter manufacturer WhitPW,3ter Model <br /> ❑Casing protection Ig'12 in.above grade <br /> ❑At-grade ❑Well House ❑Hand Pump / <br /> GROUT INFORMATION(specify bentonite,cement-sand,neat-cement,concrete,cuttings,or other) <br /> Material bentonite From 0 T7Q 50 ft. 3 ❑Yds. Wags <br /> Mate al cuttings From 50 Td.30 ft. ❑Yds. ❑Bags <br /> HARDNESS OF Material From To_ ft. ❑Yds. ❑Bags <br /> GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO One bag94 lbs.cement <br /> Driven casing seal From_ To Bags = <br /> or 50 lbs.bentonite <br /> NEAREST KNOWN SOURCE OF CONTAMINATION <br /> topsoil black medium 0 5 Well is /i <br />