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MINNESOTA UNIQUE WELL <br /> WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. <br /> County Name WELL AND BORING CONSTRUCTION RECORD844815 <br /> Minnesota Statutes,chapter 1031 <br /> Hein <br /> Township Name Township No. Range No. Section No. Fraction(sm.--.Ig.) WELUBORING DEPTH(completed) DATE WORK COMPLETED <br /> Orono 118 23 -' 33 5H NS SW'' 1€30 3-6-20 <br /> GPS LOCATION—decimal degrees(to four decimal places). DRILLING METHOD <br /> Latitude Longitude ❑Cable Tool ❑Driven ❑Dual Rotary <br /> ❑Auger 'Rotary ❑Rotasonic <br /> House Number,Street Name,City,and ZIP Code of Well Location ❑Other <br /> ', <br /> 2970 Lillian Lane, orono 55356 1-DRILLING FLUID WELL HYDROFRACTURED? ❑Yes to <br /> Show exact location of well/boring in section grid with"X"' Sketch map of well/boring location. bentoni t n From ft.To ft. <br /> 1 Showing property lines, _ <br /> roads,buildings,and direction. USE MonitoringHeating/Cooling <br /> N 'Domestic ❑ ❑ 9 g <br /> t r:—/ • ❑Noncommunity PWS ❑Irrigation ❑Industry/Commercial <br /> jt <br /> p r ❑Community PWS ❑Dewatering ❑Remedial <br /> -- --Ft--- Elevator <br /> _ <br /> w E s ; _, CASING MATERIALDrive Shoe? ❑Yes Arlo HOLE DIAM. <br /> ' ' Steel Threaded Welded <br /> - <br /> '/Mie \ — <br /> Plastic ❑ <br /> I F CASING <br /> S Diameterln Weight Specifications <br /> 1— 1 Mile- 4{ in.To 170 ft. lbs./ft. A____in.To 5lft. <br /> ial <br /> PROPERTY OWNER'S NAME/COMPANY NAME in.To ft. lbs./ft. IA in.Toft. <br /> Chamberlain Fine Custom Homes in.To ft. lbs./ft. - in.To ft. <br /> LrLii�IttiXSCREEN OPEN HOLE <br /> Property owner's mailing address if different than well location address indicated above. t <br /> p �. Make Johnson <br /> From <br /> X111578 Chamberlain Crt <br /> Type tE�inles3 Bleat Diar2~ ft. To ft. <br /> Eden Prairie, MN 55344 Slot/Gauze -15 Length_d1 & 4t <br /> Set between�0—ft.and 130 ft. FITTING <br /> STATIC WATER LEVEL 90 ft.g Below Above and <br /> surface <br /> Date measured 3-6-20 Dry hole ❑Yes D'No <br /> WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface)) <br /> 165 ft.after 2 hrs.pumping 35 q.p.m. <br /> WelVboring owner's mailing address if different than property owner's address indicated above. ,Kc�JWEt I HEAD COMPLETION <br /> /Pitless/adapter manufacturer Whitewater Model <br /> ❑Casing protection ,"12 in.above grade <br /> ❑At-grade ❑Well House ❑Hand Pump <br /> GROUT INFORMATION(specify bentonite,cement-sand,neat-cement,concrete,cuttings,or other) <br /> Material h ntni'ti PitFrom 0 To 50 ft. 3 ❑Yds. Jklitags <br /> Material cuttings From 50 To 170 ft. ❑Yds. ❑Bags <br /> HARDNESS OF Material From To ft. ❑Yds. ❑Bags <br /> GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO Driven casing seal From - To Bags = <br /> One bag94 lbs.cement <br /> or 50 lbs.bentonite <br /> NEAREST KNOWN SOURCE OF CONTAMINATION <br /> claybrown medium 0 16 0 <br /> clay <br /> Well is i feet /1) direction from Q_....--,... type <br /> clay gray medium 16 22 Well disinfected upon completion? Yes ❑No <br /> clay/sand brown medium 22 36 PUMP <br /> sand/gravel mix soft 36 71 ❑Not installed Date installed 4-10-20 <br /> clay gray medium 71 106 Manufacturer's namerchaafer <br /> fine sand mix soft 106 129 Model Number HP 1.5 Volts 230 <br /> sandy clay/gravel reddish 126 <br /> Length of drop pipe ft. Capacity g.p.m. <br /> brown medium 1299 168 <br /> gravel/sand mix medium 168 130 Type:[ Submersible ❑L.S.Turbine ❑Reciprocating ❑Jet ❑ <br /> ABANDONED WELLS <br /> Does property have any not in use and not sealed well(s)? ❑Yes k'No <br /> VARIANCE <br /> Was a variance granted from the MDH for this well? ❑Yes, No 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. <br /> REMARKS,ELEVATION,SOURCE OF DATA,etc. <br /> Don Stodola Well Drilling Co, Inc. 1691 <br /> Licensee Business Name Lic.or Reg.No. <br /> � 4 4-16-20 <br /> eC r e epresErifative Signat e Certified Rep.No. Date <br /> LOCAL COPY <br /> 8 4 4 81 5Rob Stodola <br /> Name of Driller <br /> -- uc_mont_on iao,.vi m <br />