09-16-19 Well & 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 Minnesota Statutes,chapter 1031 8 4 4 7 8 0 ' ' <: Hennepin Township Name Township No. Range No. Section No. Fraction(sm.—.Ig.), WELL/BORING DEPTH(completed) DATE WORK COMPLETED Orono 117 23 23 '/NE NW SW 108 ft. 9-16-19 GPS LOCATION—decimal degrees(to four decimal places). DRILLING METHOD : Latitude Longitude ❑Cable ,1 '-, Driven ❑Dual Rotary ❑Auiotary f❑Rotasonic House Number,Street Name,City,and ZIP Code of*ell Location ❑Other T 360 Big Island, Orono 55J 71 DRILLING FLUIDLUIWELI,.HYDROFRACTURED? ❑Yes o Show exact location of well/boring in section grid with"X" Sketch ma. • well/boring location. bentonite From ft.To ft. Sh. ' g property lines, N roads,buildin. and direction. USE Domestic ❑Monitoring ❑Heating/Cooling ;_____i__,__ I ]Noncommunity PWS ❑Irrigation ❑Industry/Commercial ❑Community PWS ❑Dewatering ❑Remedial a-___ __-;___ ❑Elevator w E <>;1' CASING MATERIAL Drive Shoe? ❑Yes ❑o HOLE DIAM. -_;_". t `------" T `� ' . ;.❑Steel ❑Threaded El We d h mile P lastic ❑ - - F.--- - 1-- / ...9-"' CASING ' T s )':1- 1 Diameter Weight Specifications I- 1 Mile y // 4 in.To 98 ft. lbs./ft. in.To �ft. 61/2 117ffl PROPERTY OWNER'S NAME/COMPANY NAME in.To ft. lbs./ft. in.Toft. Harwood Gr in.To ft. lbs./ft. in.To ft. Property owner's mailing address if different than well location address indicated above. SCREENJ OPEN HOLE ohnson Make From ft. To ft. 6255 Bury Dr Type stainless steel Diam. 2" Eden Prairie, MN 55346 Slot/Gauze .010 Length 4' + 4' Set between 98 ft.and 108 ft. FITTINGS 2"x3' leader STATIC WATER LEVEL 26 ft, elow ❑Above land surface Date measured 9-16-19 Dry hole ❑Yes o WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) 2 50 95 ft,after hrs.pumpingq.p-m. Well/boring owner's mailing address if different than property owner's address indicated above. leLeLHEAD COMPLETION ite�7i stet 2Pitless/adapter manufacturer wilModel ❑Casing protection - X12 in.above grade ❑At-grade ❑Well House ❑Hand Pump GROUT INFORMATION(specify bentonite,cement-sand,neat-cement,concrete,cuttings,or other), Materialbent�lte From 0 To 50 ft. 3 ❑Yds. drags Materia t ingg From Tog ft. ❑Yds. Bags HARDNESS OF final From To ft. ❑Yds. ❑Bags GEOLOGICAL MATERIALS COLOR FROM TO MATERIAL Driven casing seal From To Bags = One bag94 lbs.cement or 50 lbs.bentonite 0 NEAREST KNOWN SOURCE OF CONTAMINATION fine sand/clay brown soft 15 Well is fi feet -1--' direction from type brown.! Well disinfected upon completion? Xes ❑No swamp clay gray soft 15 44 PUMP ❑Not installed Date installed 9-30-19 Clay/sand brown medium 44 58 Manufacturer's name Schaefer medium O Model Number L^ HP 3/4 Volts 230 sandy clay gray tmeditum 58, 77 Length of drop pipe 60 ft. Capacity g.p.m. sand/claygraysoft 77 92 Type: ubmersible ❑L.S.Turbine ❑Reciprocating ❑Jet ❑ ABANDONED WELLS O Does property have any not in use and not sealed well(s)? El Yes 1114 No sand mix soft 92, 108 VARIANCE ��//// Was a variance granted from the MDH for this well? ❑Yes [�.t�lo TN# WELL CONTRACTOR CERTIFICATION /T 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. Dorb Stodola Well Drilling Co,. Inc. 1691 Licensee Business Name Lic.or Reg.No. 9-17-19 C ifi R res ntative l lure Certified pep.No. Date Rob Stodola LOCAL COPY 8 4 4 7 8 0 Name of Driller ID#52603 HE-01205-18(Rev.3/19)