Well and Boring Construction Record 2-17-19

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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 Pepin Minnesota Statutes,chapter 1031 8 3 9 617 Township Name Township No. Range No. Section No. Fraction(sm.—.Ig.) WELUBORING DEPTH(completed) DATE WORK COMPLETED Orono 117 23 06 ,,,NE Nis sq 147 n. 2-17-19 GPS LOCATION—decimal degrees(to four decimal places). DRILLING METHOD Latitude Longitude ❑Cable Tool ❑Driven ❑Dual Rotary ❑Auger • ,'Rotary ❑Rotasonic House,usNumber,Street Name,City,and ZIP Code of WellLocation ❑Other 480 Park Ave, ©sono 5356 DRILLING FLUID WELL HYDROFRACTURED? ❑Yes 'No :'Show exact location of well/boring in section grid with" Sk-'•ch map of well/boring location. bentonite ,l - From • ft.To ft. owing property lines, N ads,b ildings,and direction. USE Domestic ❑Monitoring ; ❑Heating/Cooling ; � ❑Noncommunity PWS Li Environ.Bore Hole ❑Industry/Commercial { ❑Community PWS ❑Irrigation ❑Remedial '__-__- ❑Elevator ❑Dewatering ❑ w l E r CASING MATERIAL Drive Shoe? ❑Yes Q No HOLE DIAM. ❑Steel ❑Threaded ❑Welded '/z Mile ...,:l) PIBStiC ❑ r . 1CASING s Diameter 9 Weight Specifications ) 1 Mile_____IS 4 in.To 137 ft. lbs./ft. 8 in.To 5Oft. L3 PROPERTY OWNER'S NAME/COMPANY NAME in.To ft. lbs./ft.Todd in.To147ft. Wood n.To ft. lbs./ft. in.To ft. �R7[)C� SCREEN OPEN HOLE Property owner's mailing address if different than well location address indicated above. Make Johnson From ft. To ft. same • 2" Type stainless steel Diam. Slot/Gauze .010 Length 4' 4 4t Set between 137 ft.and 147 ft. FITTINGSZ3 STATIC WATER LEVEL 75 ft.,,{Below ❑Above land surface Date measured 2-17-19- Dry hole ❑ Yes al No WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) 130 ft.after 2 hrs.pumping 30 q.p.m. Well/boring owner's mailing address if different than property owner's address indicated above. � *h WELLHEAD COMPLETION a= /J1Pitless/adapter manufacturer t te= 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) Material_ m O To 50 ft. 3 ❑Yds. [Bags Material caatting From_501-0_13T ft. ❑Yds. ❑Bags HARDNESS OF Material From To ft. ❑Yds. ❑Bags GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO Driven casing seal From To Bags One bag=94 lbs.cement or 50 lbs.bentonite .i 0 NEAREST KNOWN SOURCE OF CONTAMINATION topsoil black ) 3 Well is .'71�') feet direction from '--y - -"'"----19136-- "'"typ8'- brown disinfected upon completion? . "Yes El No J -- clay brown medium 3 17 PUMP �q n q� ❑Not installed Date installed 2-22-19 clay gray medium 17 48 Manufacturer's reefer Model Number HP 1 Volts 230 sandy clay gray medium 48 67105 Length of drop pipe ft. Capacity g.p.m. reddish medium ow Type {Submersible ElL.S.Turbine ❑Reciprocating ❑Jet ❑ sand/gravel brown medi L �e ABANDONED WELLS fine sand brown soft '!9 103 Does property have any not in use and not sealed well(s)? ❑Yes klo VARIANCE . Sand t brown soft 103 147 Was a variance granted from the MDH for this well? ❑Yes,$'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,it needed. REMARKS,ELEVATION,SOURCE OF DATA,etc. t Don Stodola Well Drilling Co,. Inc. 1691 Licensee Business N.,e Lic.or Reg.No. 2-25-19 -e ' -d'epresentativ ,I ature Certified Rep.No. Date LOCAL COPY 839617 _ - Rob Stodola Name of Driller ID#52603 HE-01205-17(Rev.5/17)