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%YELL uOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. <br /> County Namegennepin WELL AND BORING RECORD 624937 <br /> Minnesota Statutes Chapter 103/ <br /> Township Name Township No. I Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed <br /> Orono 1117 23 04 ./, 122' n. 7-12-99 <br /> House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD <br /> 405 S. Willow Drive Orono, m. 55356ElCable Tool Q�Driven ❑ Dug <br /> ❑ Auger f�iRotary ❑ Jetted <br /> Show exact location of well in section grid y✓ith�C. Sketch map of well location. ❑ <br /> X V3 G 6 Showing property lines, <br /> DRILLING FLUID WELL HYDROFRACTURED? ❑YES ❑NO <br /> N <br /> Natural FROM to ft. <br /> USE ❑ Monitoring ❑ Heating/Cooling <br /> I I I I IXDomestic <br /> -I- -�- -4- -�- ❑ Irrigation ❑ Community PWS ❑ Industry/Commercial <br /> I I I ❑ Noncommunity PWS ❑ Remedial <br /> W <br /> I E T ❑ Environ.Bore Hole ❑ Dewatering ❑ <br /> /2Ma� CASING Drive Shoe? ❑ Yes ❑ No HOLE DIAM. <br /> ❑ Steel ❑Threaded ❑Welded <br /> l IXPlastic ❑ <br /> s <br /> -1 Mila � <br /> CASING DIAMETER WEIGHT <br /> PROPERTY OWNER'S NAME 4 in.to 114 ft. 2.05 lb../ft. 8 in.to 30 ft. <br /> Lake .Associates in.to ft. lbs./ft. 6k-in.to122 <br /> Property owner's mailing address if different than well location address indicated above. in.to ft. lbs./ft. In.to_ft. <br /> --1212 E. Wayzata Blvd. SCREEN OPEN HOLE <br /> / >Wayzata, Mn. 55391 Make from to ft. <br /> f � <br /> Type Sta nless Steel Diam. <br /> Slot/Gauze -ill 0 Length <br /> Set between1 1 4 ft.and 127 FITTINGS:2 p X 1001 <br /> 1t/k <br /> STATIC WATER LEVEL <br /> WELL OWNER'S NAME 54• —ft.16 below ❑ above land surface Date measured 7-1 2-99 <br /> PUMPING LEVEL(below land surface) <br /> Well owner's mailing address if different than property owners address indicated above. 108 ft. after 1.5 hrs.pumping 3 5 Sa i r g.p.m. <br /> WELL HEAD COMPLETION <br /> Critless adapter manufacturer Vel <br /> ❑ Casing Protection EA42 in.above grade <br /> ❑At-grade(Environmental Wells and Borings ONLY) <br /> GROUTING INFORMATION <br /> Well grouted? IXYes ❑ No <br /> HARDNESS OF Grout Material ❑ Neat cement ❑ Bentonite ❑ Concrete Hi h Solids Bentonite <br /> GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO g <br /> from to 30_ft. 2. 13ydsX bags <br /> from to ft. <br /> Clay Yellow S 0 ❑ yds. ❑ bags <br /> 18' from to ft. ❑ yds. ❑ bags <br /> A NEA OWN,SOURCE OF CO MINATIONN Tf G <br /> 41 <br /> Clay <br /> Grey S 1 g# 98 0 feetOyT/l direction type <br /> Well disinfected upon completion? X Yes ❑ No <br /> Water Sand Grey S 98. 122• PUMP <br /> ❑ Not installed Date installed 8-30-99 <br /> Manufacturers name Red Jacket <br /> Model number 0148443 HP 3/4 vol, 230 <br /> Length of drop pipe 84 ft. Capacity 12 g.p.m. <br /> Type:X Submersible ❑ L.S.Turbine ❑ Reciprocating ❑Jet ❑ <br /> ABANDONED WELLS <br /> Does property have any not in use and not sealed well(s)? ❑Yes A No <br /> VARIANCE <br /> Was a variance granted from the MDH for this well? ❑ Yes :9 No TN# <br /> WELL CONTRACTOR CERTIFICATION <br /> Use a second sheet,i/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 STODOLA WILL DRILLING CO. , INC. <br /> IL Busines Lic.or Reg.No. 27 <br /> 9-28-99 <br /> Authorized R entative Signature Date <br /> Chuck Moore 7-12-99 <br /> Date <br /> LOCAL COPY <br /> 1624937 Name of Driller HE-01205-06(Rev.7/98) <br />