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WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. <br /> County Name WELL AND BORING RECORD 71. 14 9 3 <br /> Hennepin Minnesota Statutes,Chapter 1031 <br /> Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed <br /> Orono '1�7 23 6 '/, ,, ,, 155 n. 2-24-05 <br /> GPSDRILLING METHOD <br /> LOCATION: Latitude degrees minutes seconds <br /> ❑C2ble Tool ❑Driven ❑Dug <br /> Longitude degrees minutes seconds ;l <br /> ❑Auger Rotary ❑Jetted <br /> House Number,Street Name,City,and Zip Code of Well Location or Fire Number -� <br /> 356 Lake St W, Orono 55356 DRILLING'FLUID WELL HYDROFRACTURED? ❑Yes$o <br /> Show exact location of well in section grid with 'X". Sketch map of well location. bentonite FROM ft.TO ft. <br /> Showing property lines <br /> N N% roads and buildings USE <br /> ❑Monitoring ❑Heating/Cooling <br /> _i___ Domestic ❑Environ.Bore Hole ❑Industry/Commercial <br /> C Noncommunity PWS ❑Irrigation ElRemedial <br /> ❑Community PWS ❑Dewatering ❑ <br /> I I / CASINGk/ HOLE DIAM. <br /> w E Drive Shoe? ElYes J2 No <br /> I ❑Steel ❑Threaded ❑Welded <br /> lh Mile Plastic 111--------r--- ---- 1 <br /> CASING DIAMETER WEIGHT <br /> S , <br /> 4 __ 2 lbs./ft. 8 in.to Oft. <br /> I -1 Mile in.to1_4R ft. <br /> in.to ft. lbs./ft. 63 in.to5ft <br /> _1S 7 <br /> PROPERTYOWNER'SNAME/COMPANY NAME in.to ft. lbs./ft. in.to ft. <br /> Stonewood Design Build SCREEN Johnson <br /> . OPEN HOLE <br /> Property owner's mailing addressFROM if different than well location address indicated above. Make FJiRi <br /> 442- Shoreline Dr Type stainless stlDiam.2 r. ft. TO ft. <br /> Seting Park, MN 55384 Slot/Gauze .010 Length 4' + 4 <br /> Set between _ft.and 155 ft. FITTINGS Z X36) wilp <br /> STATIC WATER LEVEL s� <br /> 52 <br /> ?below ❑above land surface Date measured`-24-05 <br /> PUMPING LEVEL(be owland surface) <br /> WELL OWNER'S NAME/COMPANY NAME 145 <br /> 1 J ft.after hrs.pumping S0 g.p.m. <br /> W LL HEAD COMPLETION a <br /> Well owner's mailing address if different than property owners address indicated above. 1� -itless adapter manufacturer whituter Model <br /> ❑Casing Protection In.above grade <br /> _❑At-grade(Environmental Wells and Boring ONLY) <br /> GROUTING INFORMATION <br /> Well grouted D9 Yes ❑No <br /> • Grout material ❑Neat cement ❑Bentonite ❑Concrete„High Solids Bentonite <br /> from_to3_ft. _3___ ❑yds. bags <br /> from40_to448_ftm flids.fbags <br /> GEOLOGICAL MATERIALS COLOR HARDNESS MATERIA OF FROM TO from to ft. ❑yds. ❑bags <br /> NEAREST KNOWN SOURCE OF CONTAMINATION <br /> (� feet i � <br /> direction ''t �� .”lr Jrr type <br /> clay yellow medium 0 30 <br /> Well disinfected upon completion Yes ❑No <br /> PUMP <br /> clay p <br /> gray medium ❑Not installed Date installed -2 V-05 <br /> clay/sand/gravel gray soft 92 146 Manufacturer's name Amraotor <br /> L Model number HP 1 Volts 230 <br /> watersand , gray medium 146 155 Length of drop pipe 84 ft. Capacity g.p.m. <br /> Type:r Submersible ❑L.S.Turbine ❑Reciprocating ❑Jet ❑ <br /> ABANDONED WELLS <br /> Does property have any not in use and not sealed well(s) ❑Yes �'FJo <br /> VARIANCE ! <br /> Was a variance granted from the MDH for this well? ❑YesNo TN# <br /> WELL CONTRACTOR CERTIFICATION <br /> This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. <br /> The information contained in this report is true to the best of my knowledge. <br /> Use a second sheet,if needed t{1�,,,,.� c t�,� Inc. t1 <br /> REMARKS,ELEVATION,SOURCE OF DATA,etc. Kon Stodola Well Drilling Co., Inc 27172 <br /> 172 <br /> Licensee Business Name Lic.or Reg.No. <br /> 4 / <br /> /i/4 2-24-05 <br /> ,/ ,n ed'epresentative Sigyr- Date <br /> Jim Kohis <br /> LOCAL COPY 71 14 9 3 Name of Driller <br /> HE-01205-08(Rev.5/02) <br /> IC 140-0020 <br />