08-03-22 Well & 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 Minnesota Statutes,chapter 1031 876715 Township Name Township No. RangeNo. Section No. Fraction(sm.--*lg.) WELUBORING DEPTH(completed) DATE WORK COMPLETED Orono 117 23 06 SE SE SW 123 ft. 8/3/22 GPS LOCATION—decimal degrees(to four decimal places). DRILLING METHOD Latitude Longitude ❑Cable Tool Ull Driven ❑Dual Rotary ❑Auger Rotary ❑Rotasonic House Number,Street Name,City,and ZIP Code of Well Location ❑Other 735 Lakeview a evie Parkway, r wa , Orono DRILLING FLUID WELL HYDROFRACTURED? ❑Yes ]No Show exact location of well/boring in section grid with"X." Sketch map of well/boring location. Be nt o i t e From ft.To ft. Showing property lines, N roads,buildings,and dir USE irj Domestic ❑Monitoring ❑Heating/Cooling , ❑Noncommunity PWS ❑Irrigation ❑Industry/Commercial CL. HCommun i t y PWS ❑Dewatering ❑Remedial ...��. E lev at or ❑ W -E T -,:7 4 CASING MATERIAL Drive Shoe? ❑Yes IX No HOLE DIAM. ,- i "" " ,.,. ❑Steel ❑Threaded ❑Welded 'h Mile �• r Plastic ❑ CASING s 5 Diaameter Weight Specifications I 1 Mile I _ ` in.To 115 _ft. lbs./ft. in.T ft. in.To ft. lbs./ft. 6.5 in.Toll5ft. PROPERTY OWNER'S NAME/COMPANY NAME , 1 in.To ft. lbs./ft. in.To ft. Norton Homes OPEN HOLE Property owner's mailing adc4r,ss if different than well location address indicated above. SCREEN Yee Make Johnson From ft. To ft. 18215 45th AVe No, Ste D Typeata mesa Diam. 2° Pl h, MN 55446 Slot/Gauze .110 Length Set between 115 ft.and 123 ft. FITTINGS 31 lead STATIC WATER LEVEL _41 ft.XBelow ❑Above land surface 8/3/22 XNo Date measured Dry hole ❑Yes WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) 110 ft.after 2 hrs.pumping 50 g.p.m. Well/borjag owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION White water ❑Pitless/adapter manufacturer Model ❑Casing protection J 12 in.above grade - ❑At-grade ❑Well House ❑Hand Pump GROUT INFORMATION(specify bentonite,cement-sand,neat-cement,concrete,cuttings,or other) Material cut t Inge. 1.1 El 50 ft. Yds. ❑Bags Material belt0fl1t 5 To 0 ft. ❑Yds. ❑Bags HARDNESS OF Material From To ft. ❑Yds. ❑Bags GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO Driven casing seal From To Bags One bag=94 lbs.cement or 50 lbs.bentonite NEAREST KNOWN SOURCE OF CONTAMINATION Clap brown m 0 12 Well is 1 '" '3, feet •,:`>„,Y...':;3 direction from -*' "f ••1 "` type ire ark +!'. Well disinfected upon completion? [ Yes ❑No Clay/Sand Gray 12 PUMP `r +� El Not installed Date installed 8` 11/2 2 Sand/Gravel Mix S 78 102 Manufacturer's name alle ee , Model Number HP 1*5 Volts 230 Pine Sand Brwn S 102 113 20—Length of drop pipe •63 ft. Capacity 23 g.p.m. i Water Sand Type: Submersible ❑L.S.Turbine ❑Reciprocating ❑Jet ❑ ABANDONED WELLS Does property have any not in use and not sealed well(s)? ❑Yes g No VARIANCE Was a variance granted from the MDH for this well? ❑Yes'il 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'frue to the best of my knowledge. Use a second sheet,if needed. REMARKS,ELEVATION,SOURCE OF DATA,etc. Don Stodola Well 3a g Co Inc 1691 . Licensee Business Name Lic.or Reg.No. --''''':-/"' „, e`A ,, „er . ../ ',,, /,',*'‹ ,,k7,;;°#' 558 8/12/22 ortifi‘d Representative•Sr nature Certified Rep.No. Date Rob Stodola LOCAL COPY 7 6 715 Name of Driller ID#52603 HE-01205-18(Rev.3/19)