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LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. <br />Name WELL AND BORING RECORD 649244 <br />Minnesota Statutes Chapter F03I <br />vp m Township No Range No Seehon No Fraction WELL DEPTH (completed) Date Work Completed <br />Hw"-'Wtrr56M. Street Name. City, F471p Code of <br />2340 ftonSt, Orono <br />Show enact location of well in section oridlwith'%' <br />n <br />183 <br />8-22-00 <br />A ocatan <br />or Fire Number <br />DRILLING METHOD <br />55356 <br />; Cable Tod ; Doren I Dug <br />1 Auger ry . I Jetted <br />0tch map of *all location <br />W <br />.J Showing property lines-�_ <br />DRILLING FLUID <br />WELL IYDROFRACTURED? YES ]rl <br />roads and buildings <br />bentonite <br />FROM It to h <br />USE ----- Monitoring HeabngrCodrng <br />}( Dumestc <br />Community PWS IndublryrCanmerc•al <br />Irngation <br />Noncommundy PWS Remedial <br />W i i n i E T I 1 EnwBo <br />re ore Hole Dewaten <br />I1 n9 <br />-r - _ _ i - _ CASING Drive Shoe? 'Yes HDLE DIAM. <br />J_ _ J _ _ L _ J_ •f f Steel Threaded Welded <br />i i 1 i <br />S r� <br />n r �--� <br />PROPERTY OWNER'S NAME <br />John/Lori Roberts <br />Property owner's mailing address it different than well location address indicateO above <br />same as above <br />WELL OWNER'S NAME <br />Wall owWS marling address d different than property owner's address indicated above <br />I GEOLOGICAL MATERIALS ' COLOR 1—MATERIAL r I FROM I TO <br />-_.-tmft_- - <br />Use a sr_ond shoatit needed <br />REMARKS. ELEVATION. SOURCE OF DATA. etc <br />*OPtaslrc <br />CASING DIAMETER WEIGHT <br />4 in to 175 f1 2.05 Oe.M in 1. <br />in to h MJh. m to 1#2' <br />in to h - _ ft IN _- in to <br />SCREEN OPEN HOLE <br />Make efobi4in from _ Ito M <br />Type Stainless steel- Dram .. ---- - <br />SlettGauie solo. I ---_LNG---�'-�-E----_. - -- <br />Sat between ," It and tm. h FITTINGS: 2�' A <br />STATIC <br />WATER LEVEL <br />It D �,oebw - .' above larw sudace ate measured <br />PUMPING LEVEL (below land surface) <br />-U-0- it after 2 his pumping ..._ .._ gp.m. <br />WELL HEAD COMPLETIOVp i t eva t e r <br />�Pdless adapter manulactur r Model <br />Casing Protection yt2 in above grade <br />Al -grade IEnvironnental Wells and Sormys ONLY) <br />Well grouted' 'WYes No <br />Grout Material Neat cement Senlakle , Concrete $r%ph Solids Benionde <br />from -0. to - - -m- it _ __� El yds. bags <br />from 30 to -M- h. Mt41&CSj_ ftftC.. bills <br />from -- to --- -- It - --- ---. _. C1 1Ms' ^ bags <br />NEAREST KNOWN SOURCE OF CONTAMINATION <br />105 feel IF, wecti08aWe type <br />Well distrdected upon comWetion? _,ees No <br />PUMP /�/� <br />Not installed Date installed 8-24-M <br />Manulaclurers name Gowl4a <br />Model number HP 3/1 Vats 230 <br />Length of drop pope 1 Oi h Capacity g p m <br />Type XSubrnefsdble L S Turbine ' Reciprocating Jet <br />ABANDONED WELLS <br />Does property have any not .n use and not sealed "Its) 7 Yes .11(No <br />VARIANCE <br />Was a vanance granted from the MDH lot this well? Yes WNo TN - <br />WELL CONTRACTOR CERTIFICATION <br />This well was drilled under my supervision and in accordance with Minnesota Rules. Chapter e72S <br />The inhxmahon contained m thn •epon is true to the best of my knowledge <br />Don Stodola Yell Drilling µ Co. Inc. <br />Licenser Huseiess mar <br />A'Aurn�on ed at, burr 10-6-r00 <br />72 <br />"sore 8-22-00 .i . - <br />LOCAL COPY 64924 4 „e-0,2054,,,,,,, 21e, <br />- - ---------------- <br />- - - - --- - <br />