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MINNESOTA UNIQUE WELL -1A1-00TA DEPARTMENT AF MFGI T14 AND BORING NO. WELL OR BORING LOCATION WELL AND BORING CONSTRUCTION RECORD 9 County Name Minnesota Statutes, chapter 10.31 [-77:8:4:4 7 9=9 Henne' in Township Name Township No. Range No. Section No. Fraction (sm. — Ig.) WELUBORING DEPTH (completed) WORK COMPLETED Orono 117 7,3 I 10 +�,': `�� "1�u ]DATE 181 n 12 -27-1Q GPS LOCATION — decimal degrees (to four decimal places). DRILLING METHOD ❑Cable Tool ❑Driven L] Dual Rotary Longitude Latitude g ❑ Auger ;-Rotary (] Rotasonic ❑ Other House Number, Street Name, City, and ZIP Code of Well Location 1QS0 F3erita�,e Lane Orono 55391 DRILLING FLUID bentonite WELL HYDROFRACTURED? ❑Yes o From ft. To ft. Show exact location of we oring in section grid with "X:' Sketch map of welVboring location. Showing property lines, USE Domestic E]Monitoring ❑ Heating/Cooling roads, buildings, and direction. N y� ❑ Noncommunity PWS ❑Irrigation ❑Industry/Commercial --'--- ---`-- ---`-- ---`-- �/T %� ❑ Community PWS ❑Dewatering E] Remedial _ E j� • ❑ Elevator El CASING MATERIAL Drive Shoe? ❑ Yes *0 HOLE DIAM. W , /_„}f{/ M ' tle ❑ Steel E]Threaded ❑ Welded El/z XpIastic -- ---- ---�-- 1 --!--- - T-- CASING Diameter Weighs Specifications s in. To 1771 ft. lbs./ft. �_. in. To S()Lft. 1 Mile{ in. To ft. Ibs./ft. in. To ft. Ibs./OPEN ��11 � p� S r in. Tot " 1 ft. in. To ft. PROPERTY OWNER'S NAME/COMPANY NAME .,Inst Bay tomes Inc • HOLE SCREEN From it. To ft. Property owner's mailing address if different than well location address indicated above. 1(3425 Bluff Rd Make s $ e9s S f'e Diam. ellen Prairie, '`ti+T 55347 Type r + Slo'/Gauze • Length Set between Z]ft. and 1 R1 ft. FITTINGS 7 �leads r STATIC WATER LEVEL %►% ft. Below ❑Above land surface Date measured 12-27-19 Dryhole ❑ Yes K'No WELL OWNER'S NAMEICOMPANY NAME PUMPING LEVEL (below land surface) i 50 ft. after 2 hrs. pumping 40 9 -P.M. Welllboring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION wpilless/adapter manufacturer MiteWHter Model ❑ Casing protection K12 in. above grade ❑ At -grade ❑ Well House ❑ Hand Pump GROUT INFORMATION (specify bentonite, cement -sand, neat -cement, concrete, cuttings, or other) Material be4g4)njtoFrom_To---50- ft. 3 ❑ Yds. ®'Bags Material .,, tl� �_ r�From.____5jq__T0_ _j_7_jft. E] Yds. ❑Bags Material ------From— To ft. ❑ Yds. ❑ Bags GEOLOGICAL MATERIALS COLOR HARDNESS OF MATERIAL FROM TOOne bag = 94 lbs. cement Driven casing seal From To _Bags or 50 lbs. bentonite NEAREST KNOWN SOURCE OF CONTAMIN,A(TIIOON clay/gravel brown .t mef tum n n 12 lr from l�1 JJ type Well is feet direction Well disinfected upon completion? )Yes ❑ Noe�- ctay 6ray sandy clay reddish PUMP ❑Not installed Dale installedI-PY-20 Schaefer fine sand brmm ' mef ltrn ., qr 10q Manufacturers name sandy clay/gravel reddish ._ 121 Model Number HP_I-,5- _Volts Length of drop pipe ft. Capacity 9•P•m Zravel/san,i brmin Tvlivm 171 182 Type:J<Submersible ❑ L.S.Turbine ❑ Reciprocating ❑ Jet ❑ ABANDONED WELLS Does property have any not in use and not sealed well(s)? ❑ Yes ?"o VARIANCE Was a variance granted from the MDH for this well? ❑ Yes XNo 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. Pon Stodola Well Drilling Co., Inc. 16q1 REMARKS, ELEVATION, SOURCE OF DATA, etc. _ Licensee Business Name Lic. or Reg. No. ,9/1,l.rte APR p 3 202 resetur Certified Rep. No. Date Stodola 9Rob LOCAL COPY 8 4 4 7 9 Name of Driller HE -01205-18 (Rev.3/19) ID #52603