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MINNESOTA UNIQUE WELL <br /> R BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. <br /> ime WELL AND BORING CONSTRUCTION RECORD 8 <br /> f1 e i n Minnesota Statutes,chapter 1031 6 9 4 18 <br /> Name Township No. Range No. Section No. Fraction(sm.—•lg.) WELL/BORING DEPTH(completed) DATE WORK COMPLETED <br /> no 117 23 7 N7 TT,? m-7- 12.,2 n. 9/7/23 <br /> ATION—decimal degrees(to four decimal places). DRILLING METHOD <br /> Longitude ❑Cable Tool ❑Driven ❑Dual Rotary <br /> ❑Auger n Rotary ❑Rotasonic <br /> mber,Street Name,City,and ZIP Code of Well Location 0 ra .o ❑Other e.- <br /> ;.T R VV�' DRILLING FLUID kkfELL HYDROFRACTURED? Yes No <br /> �r"1 Dr, oj�n� 5536rf ❑ � <br /> ct location of well/boring in section grid with"X." Sketch map of well/boring location. Be f t O n i t e From ft.To ft. <br /> Showing property lines, <br /> N roads,buildings,and direction. USE 21 Domestic ❑Monitoring ❑Heating/Cooling <br /> i f I I i <br /> J J. / ❑Noncommunity PWS ❑Irrigation ❑Industry/Commercial <br /> !!! /� <br /> ( J ❑Community PWS ❑Dewatering ❑Remedial <br /> ----.---i----i-- I ❑Elevator ❑ <br /> E I CASING MATERIAL Drive Shoe? ❑Yes [ No HOLE DIAM. <br /> T T r T 1 ❑Steel ❑Threaded ❑Welded <br /> 'k Mile l <br /> El Plastic ❑ <br /> CASING <br /> s Diameter Weight Specifications <br /> 1 Mile I 4in.To 116 ft. lbs./ft. 1;a/ in.To 50n. <br /> IY OWNER'S NAME/COMPANY NAME <br /> in.To ft. lbs./ft. 6 ' 5 in.To 1 3' ft. <br /> s s a Dahl in.To ft. lbs./ft. in.To ft. <br /> miner's mailing address if different than well location address indicated above. <br /> SCREEN ye S OPEN HOLE <br /> Make ,�ohn son From ft. To ft. <br /> Type stainless/rl� Dam. 2r� <br /> Slot/Gauze •10 Length th 8 Set between 116 ft.and 120 ft. FITTINGS lc. packer <br /> STATIC WATER LEVEL 76 ft. N Below ❑Above land surface <br /> Date measured 9/7/23 Dry hole ❑Yes II No <br /> INER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) <br /> 11 ft.after 2 hrs.pumping �/1n g.p.m. <br /> g owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION <br /> [.Witless/adapter manufacturer wh 1 t e wa t e r. Model <br /> ❑Casing protection N 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 CU t t i n t,$om 116 To 50 ft. ❑Yds. ❑Bags <br /> Material 17 e n t o n i tret 50 To 0 ft. 3 ❑Yds. ®Bags <br /> HARDNESS OF Material From To ft. ❑Yds. ❑Bags <br />)LOGICAL MATERIALS COLOR FROM TO <br /> MATERIAL Driven casing seal From To Bags = <br /> One bag94 lbs.cement <br /> or 50 lbs.bentonite <br /> NEAREST KNOWN SOURCE OF CONTAMINATION <br /> Brown 0 33 Well is feet direction from . type <br /> Well disinfected upon completion? ❑Yes ❑No <br /> Gray 33 69 PUMP Op <br /> ❑Not installed Date installed 9/8/2 3 <br /> .Sian'-' Brown S 69 100 Manufacturer's name Shafer <br /> Model Number HP Volts 2 3,J <br />'r Sand Brawn S 100 125 Lengthpipe <br /> 9 drop99 ft. Capacity 10 g.p.m. <br /> Sand r o ctn S 12 5 13 Type:ErSubmersible ❑L.S.Turbine ❑Reciprocating El Jet ❑ <br /> ABANDONED WELLS <br /> Does property have any not in use and not sealed well(s)? ❑Yes L NJo <br /> VARIANCE <br /> Was a variance granted from the MDH for this well? ❑Yes El 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 /> 3,ELEVATION,SOURCE OF DATA,etc. <br /> `ion Stodola Nell Drilling 1691 <br /> Licensee Business Name Lic.or Reg.No. <br /> --- e7 558 9/13/23 <br /> Certi d epresentative Signature Certified Rep.No. Date <br /> LOCAL COPY 8 6 9 418 Rob b Stodola <br /> Name of Driller <br /> HE-01205-18(Rev.3/19) <br />