Well & Boring Construction Record

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N MINNESOTA UNIQUE WELL WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. County Name WELL AND BORING CONSTRUCTION RECORD 8 2 7 8 4 6 Hennepin Minnesota Statutes,Chapter 1031 Township Name Township No. 'Range No. Section No. Fraction(sm. .Ig.) WELL/BORING DEPTH(completed) DATE WORK COMPLETED Orono 118 23 33 N1.. NE, 165 e. 12-13-18 GPS LOCATION—decimal degrees(to four decimal places). DRILLING METHOD Latitude Longitude ❑Cable Tool ❑Driven ❑Dual Rotary ❑Auger SRotary ❑Rotasonic House Number,Street Name,TCity,aandd ZIP Code of Well Location LI Other 2845 Lillian Lane, Orono 55356 DRILLING FLUID *' WELL HYDROFRACTURED? ❑Yes (7YNo Show exact location of well/boring in section grid with"X." Sketch map of well/boring locat• bentonite From ft.To j' ft. Showing property li r roads,buildin s,and direct USE N Domestic ❑Monitoring ❑Heating/Cooling -------- --__ !') v h.st.. • ❑Noncommunity PWS ❑Environ.Bore Hole ❑Industry/Commercial \ ❑Community PWS ❑Irrigation ❑Remedial ---- ----- --------- ! � `\, ❑Elevator ❑Dewatering ❑ w E T i CASING MATERIAL Drive Shoe? ❑Yes No HOLE DIAM. ___________4______ T -- --4_-.- I 1 \ ❑Steel ❑Threaded ❑ ed %Mile '1�Plastic ❑ ---.---.--r--------------- l J�� CASING 3 Diameter Weight Specifications 1 Mile —I 0 _44 in.To 155 ft. lbs./ft. .8_in.To 50ft. PROPERTY OWNER'S NAME/COMPANY NAME in.To ft. lbs./ft. v in.To165 ft. Chamberlain Fine Custom Manes in.To ft. lbs./ft. s in.To ft. Property owner's mailing address if different than well location address indicated above. SCREEN John OPEN HOLE stainless Steel Dia 11578 Cghai berlain crt Make From ft. To ft. b typertb7R� Eden Prairie, MN 55344 Slot/Gauze .010 itRgtl+ 41 Set between 155 ft.and 185 ft. FITTINGS 2«x3 t leader. STATIC WATER LEVEL 124 ft"Below ❑Above land surface s Measured fromrafp of w1 late measured 12-13-18 Dry hole ❑Yes XNo WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) 150 ft.after_ 4 hrs.pumping •.p.m. z Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION -^ -..._ gPitless/adapter manufacturer Whitwater Model Casing protection X12 in.above grade ❑At-grade ❑Well House ❑Hand Pump GROUT INFORMATION(specifyFFbentonite,cement-sand,neat-cement,concrete,cuttings,or other) Material bcntonith m 0 To 50 ft. 3 ❑Yds. rags Material ngFrom j 5 0 To 15ft. 7 ❑Yds. ❑Bags HARDNESS OF Material From To l J ft. ❑Yds. ❑Bags GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO Driven casing seal From To Bags ' One bag94 lbs.cement or 50 lbs.bentonite t ..w ,A NEAREST KNOWN SOURCE OF CONTAMINATION clay L tJrown meditu 32 0 Well is 65 feet E direction from septic -- type Well disinfected upon completion? ❑Yes X No clay gray medium 22 41 PUMP ❑Not installed Date installed 12-20eery -1$ clay/sand - brown soft 41 74 Manufacturer's namSchaefer Model Number-_ HP 1.5 Volts 230 sand/gravel mix medium 7 Length of drop pipe 143 ft. Capacity g.p.m. clay graymedium 1.00 133 Type Submersible ❑L.S.Turbine ❑Reciprocating ❑Jet ❑ y ABANDONED WELLS clay/gravelmedium 133 144 Does property have any not in use and not sealed well(s)? ❑Yes XINo y gray meVARIANCE sand/gravel mix-_ d ium144 165 Was a variance granted from the MDH for this well? ❑Yes 14'No TN# WELL CONTRACTOR CERTIFICATION 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. Use a second sheet,if needed. ' REMARKS,ELEVATION,SOURCE OF DATA,etc. Don Stodola Well Drilling Co,. Inc. 1691 Licensee Business Name Lic.or Reg.No. '" 12-21-18 C 'ie a resentata'ig .lure Certified Rep.No. Date Rob Stodola LOCAL COPY 8 2 7 846 Name of Driller ID#52603 HE-01205-16(Rev.5/16)