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WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. <br /> County Name WELL AND BORING RECORD 596699 <br /> Hennepin Minnesota Statutes Chapter 1031 <br /> Township Name Township No. Range No. I Section No. Fraction WELL DEPTH(completed) n.T12-17-97 <br /> Date Work Completed <br /> Orono 117 23 4 215 <br /> House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD <br /> ❑ Cable Tool ❑`}riven 11 Dug <br /> 2605 2horou fibred Lane Orono55356 ❑ Auger Rotary ❑Jetted <br /> Show exact location of well in section grid with"X'. Sketch map of well location. ❑ <br /> Showing property lines, <br /> roads and buildings. DRILLING FLUID WELL HYDROFRACTURED? ❑YES O <br /> N <br /> - - -i- -i- <br /> bentonite FROM ft.to <br /> -i i ft. <br /> USEElMonitoring ❑ Heating/Cooling <br /> fi/Domestic <br /> ❑ Community PWS ❑ Industry/Commercial <br /> ❑ Irrigation ❑ Noncommunity PWS <br /> w E ❑Test Well ❑ Remedial <br /> I i T ❑ Dewatering 11-r -7- -r- -r <br /> '/,Mi. t:::] D CASING Drive Shoe? ❑ Yes ❑ No HOLE DIAM. <br /> -i- - -i- -i- 1 Steel El Threaded 1.1 Welded <br /> *Plastic ❑ <br /> ,M.a-------- jy2n0`'15149,ef0 Zan/ <br /> CASING DIAMETER WEIGHT <br /> PROPERTY OWNER'S NAME 4 in,to 206 ft, 1.9 —lbs./ft. B—in.to—3Dft. <br /> Tony Eiden Company in.to ft. Ibs./ft. It-in.ta�Sft. <br /> Prope owner's mailing address if different than well location address indicated above. n.to ft. lbs./ft. in.to_ft. <br /> 41 }0 Berkshire Lane <br /> SCREEN I OPEN HOLE <br /> P11r 1b MN 55446 Make Johnson I from ft.to ft. <br /> Type stainleas st1 Diam. <br /> Slot/Gauze.010 Length 41 ; () <br /> Set between ft.and ft. FITTINGS: <br /> STATIC WATER LEVEL <br /> WELL OWNER'S NAME 1.23 ft.Xbelow above land surface Date measured 12-1 <br /> —_L— 7 <br /> PUMPING LEVEL(below land surface) <br /> Well owner's mailing address if different than property owner's address indicated above. 205 ft. after 2.5 hrs.pumping 24 g.p.m. <br /> yWELL HEAD COMPLETIONRhi t evater <br /> op adapter manufacturer Model <br /> ❑ Casing Protection X12 in.above grade <br /> ❑ At-grade(Environmental Wells and Borings ONLY) <br /> GROUTING INFORMATION,/ <br /> Well grouted? fJ`Yes ❑ No <br /> HARDNESS OF FROM TO 0 from 30 to ft. 3Grout Material 1-1 �//Neat cement Lfil3entonite ❑ Concrete ❑ High Solids Bentonite <br /> GEOLOGICAL MATERIALS COLOR MATERIAL g ❑ yds. ❑ bags <br /> 30 from206 to ftna tura I ubtings <br /> Clay from to ft. ❑ yds. ❑ bags <br /> NEAR OyVN SOURCCeE OF CONTVINAAI TIO direction T)C type <br /> Well disinfected upon completion? `Yes ❑ No <br /> Clay/Cravel Gray m e id 111 F PUMP 5-5-98 8 <br /> _ +�e <br /> t ❑ Not installed Date installed l <br /> Clair/L;ravel/ mixed har(3 1.5G 195 Manufacturer's name :ted Jacket <br /> boulders Model number —CNSI I OP I -S—Volts 23o <br /> Sand/Gravel beide soft I1?5 "15 Length g ofP147 ft. Capacity 1$ g.p.m. <br /> fdrop pipe <br /> Type: &&'Submersible ❑ L.S.Turbine ❑ Reciprocating ❑ Jet ❑ <br /> ABANDONED WELLS � <br /> Does property have any not in use and not sealed well(s)? ❑ Yes E No <br /> VARIANCE // <br /> Was a variance granted from the MDH for this well? ❑ Yes A4 <br /> WELL CONTRACTOR CERTIFICATION <br /> Use a second sheet,if needed This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. <br /> REMARKS,ELEVATION,SOURCE OF DATA,etc. The information contained in this report is true to the best of my knowledge. <br /> Don Stofiela WP-11 Drilling, Co Inc771,72 <br /> Licensee smess N Reg.No. <br /> S-5-98 <br /> Authorized RepresentatinS Signature Date <br /> Chuck Moore 12-17-98 <br /> Date <br /> LOCAL COPY <br /> 1596699 Name of Driller HE-01205-06(Rev.9/96) <br />