03/30/2020 Well & Boring Construction Record

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WELL OR 30RING LOCATION MINNESOTA UNIQUE WELL MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. WELL AND BORING CONSTRUCTION RECORD=848555 County Name it e n a ct �i i n Minnesota Statutes, chapter 10131 Township Name Township No. Range No. Section No. Fraction (sm. —+ Ig.) WELUBORING DEPTH (completed) DATE WORK COMPLETED u r o u u 1117 I 2 3 4 /Ir i SE SSE 131 ft. 9-3p-20 GPS LOCATION — decimal degrees (to four decimal places). DRILLING METHOD Latitude Longitude ❑ Cable Tool ❑ Driven ❑ Dual Rotary ❑ Auger Rotary ❑ Rotasonic ❑ Other House Number, Street Name, City, and ZIP Code of Well Location L 5 5 J F O X 6 L r e e t U r o n 0, &N 37/ DRILLING FLUID P.COt?1C._ WELL HYDROFRACTURED? ❑ Yes ro From ft. To ft. Show exact location of well/boring in section grid with "X" Sketch map of wellfboring location.o Showing property lines, N roads, buildings, and direction. USE 4Domestic ❑ Monitoring ❑ Heating/Cooling �I �, MEN IMM ❑ Noncommunity PWS ❑ Irrigation ❑ Industry/Commercial A �odQ ❑ Community PWS ❑ Dewatering ❑ Remedial ' ❑ Elevator ❑ E T CASING MATERIAL Drive Shoe? ❑ Yes �No HOLE DIAM. E] Steel ❑ Threaded ❑ Welded 'k Mile Iastic ❑ CASING s - Diameter Weight Specifications -1 Mile 4 in. To _�%ft. 123 lbs./ft. 11 Lan. To-3gft. in. To ft. lbs./ft. in. Tol tt. PROPERTY OWNER'S NAMEICOMPANY NAME ,Joe oelano in. To ft. lbs./ft. in. To ft. Property owner's mailing address if different than well location address indicated above. SCREEN OPEN HOLE Make Johnson 939 -Sa d Willow Pass From ft. To ft. Type Dlam. 2"W4 f .* 4 Driftwood, TX 76619 Slot/Gauze stainless ste8 Length Set between 1� ft. and 131 ft. FITTINGS 2"x3l loader STATIC WATER LEVEL35 fL XBelow ❑ Above land surface rt Date measured 9-3LT2Vn Dry hole ❑ Yes o WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL (below land surface) 45 ft. after 1 hrs. pumping 70 a.p.m. Wellfboring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION Pitless/adapter manufacturer WhitMater Model ❑ Casing protection X12 in. above grade ❑ At -grade ❑ Well House ❑ Hand Pump GROUT INFORMATION (specify bentonite, cement -sand, neat -cement, concrete, cuttings, or other) Material ben t()n j t m From____l To --- 3()-- ft. S_ ❑ Yds. >rBags Material ruttl^Ro From -50 -To -472 -1 -ft. [:]Yds. ❑ Bags Material From To ft. ❑ Yds. ❑ Bags One ba 94 lbs. cement Driven casing seal From To g - GEOLOGICAL MATERIALS COLOR HARDNESS OF MATERIAL FROM TO _Bags or 50 lbs. bentonite NEAREST KNOWN SOURCE OF CONTAMINATION clay 30 Well is feet L__j direction from- type Well disinfected upon completion?Ix Yes ❑ No clay/sand 30 75 PUMP �1 E] Not installed Date installed 10-2- 75 90 L,ravel/clay Manufacturer's name Model Number HP 1 Volts 230 Length of drop pipe 63 ft. Capacity 9 -p.m clay/sand 90 110 sa; nd 110 131 Type: Submersible ❑ L.S. Turbine ❑ Reciprocating ❑ Jet ❑ ABANDONED WELLS Does property have any not in use and not seated well(s)? ❑ Yes X<o VARIANCE Was a variance granted from the MDH for this well? ❑ Yes o TN# WELL CONTRACTOR CERTIFICATION This well was drilled under my supervision and in accordance with Minnesota Rules, chapter 4725. Use a second sheet, if needed. The information contained in this report is true to the best of my knowledge. REMARKS, ELEVATION, SOURCE OF DATA, etc. %O,�i S'TODOLA WELL DRILLING CU INC Licensee Business Name Lic. or Reg. No. 1691 11-25-2 558 rf idtl Aepresen0itive Signature Certified Rep. No. Date Rob Stod©1a LOCAL COPY �848555Name of Driller ID #52603 HE -01205-10 (Rev.3/19)