01/06/2020 - well and 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 8 4 4 7 9 8 Hennepin Minnesota Statutes,chapter 1031 Township Name Township No. Range No. Section No. Fraction(sm.—.Ig.) WELL/BORING DEPTH(completed) DATE WORK COMPLETED Orono 117 23 06 ''Sr NW,SW ,, 149 n. 1-6-20 GPS LOCATION—decimal degrees(to four decimal places). DRILLING METHOD Latitude Longitude ❑Cable Tool �f Driven ❑Dual Rotary ❑Auger otary ❑Rotasonic House Number,Street Name,City,and ZIP Code oflnWell .�Location _ ❑Other 545 Lakeview Parkway, Orono A64 DRILLING FLUID WELL HYDROFRACTURED? ❑Yes N'flo Show exact location of well/boring in section grid with"X"( Sketch map of well/boring location. bentonite From - ft.To ft. 1 Showing property lines, N roads,buildings,and direction. USE , Domestic ❑Monitoring ❑Heating/Cooling 7 �:i - -----y_____ _________ ❑Noncommunity PWS ❑Irrigation ❑Industry/Commercial ❑Community PWS ❑Dewatering ❑Remedial -. �� ❑Elevator w : - ET �? CASING MATERIAL❑Steel Drive Shoe? ❑Yes KNo ❑Threaded ❑Welded HOLE DIAM. /" 7z Mile , Plastic ❑ r 1 n4 CASING S Diameter Weight Specifications I1 Mile I � 4 in.To 140 ft. lbs./ft. _8_in.Toft. PROPERTY OWNER'S NAME/COMPANY NAME in.To ft. lbs./ft. % in.Tol 49 ft. Conyea Homes & Remodeling in.To ft. lbs./ft. in.To ft. WRemodeling SCREEN OPEN HOLE Property owner's mailing address if different than well location address indicated above. Johnson 1000 Boone AVe N, Ste 400 Make stainless steel From ft. To ft. Type Diam. Golden VAlley, MAN 55427 Slot/Gauze .15 t r� Length 4' + 4 Set between 140 ft.and 149 FITTINGS 2"x3' leader STATIC WATER LEVEL f1�J 't 8 ft. Below ❑Above land surface Date measured 1-6-2020 Dry hole ❑ Yes KNo WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) 135 ft.after 2 hrs.pumping 40 g.p.m. Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION '^�J Citless/adapter manufacturer L1 JT +�Todel asing protection12 in.above grade ❑At-grade ❑Well House ❑Hand Pump GROUT INFORMATION(specify bentonit Ocement-s ndd neat-cement,c ncrete,cuttings,or other) Material bentonite j�.� From C To y stn ft. J ❑Yds. Bags Material cuttings From 50 To 140 ft. ❑Yds. ❑Bags HARDNESS OF Material From To ft. ❑Yds. 11)Bags GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO Driven casing seal From To Bags = One bag94 lbs.cement or 50 lbs.bentonite i NEAREST KNOWN SOURCE OF CONTAMINATION brown medium 0 17 Well is / / L--D>Q '�` feet direction from type clay gray soft 17 59 Well disinfected upon completion? , Yes ❑No clay/gravel gray 'medium 59 77 PUMP V- 30 sand/gravel mix medium 77 92 ❑Not installed Date installed - - a fine sand brown soft 92 124 Manufacturer's name gravel/sand mix /R ium 124 138 Model Number HP , Volts �3O water sand brown soft 138 148 Length of drop pipe 1 QS clay gray medium 148 149 ft. Capacity g.p m. Type: ubmersible ❑L.S.Turbine ❑Reciprocating ❑Jet ❑ ABA DONED WELLS Does property have any not in use and not sealed well(s)? ❑Yes X.No • VARIANCE Was a variance granted from the MDH for this well? ❑Yes„**No 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,if needed. REMARKS,ELEVATION,SOURCE OF DATA,etc. Don Stodola Well Drilling Co,. Inc. 1691 Licensee Business Name Lic.or Reg.No. _____..--.)3,/11/ " ` f1-10-2020 id €d presentative Signature Certified Rep.No. Date Rob Stodola LOCAL COPY 8 4 4 7 9 8 Name of Driller ID 452603 FIE-01M5-18(11e,43/19)