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...�.....a w..�, _�..�. , _ . . ._ . _ . . _ ._. _r . _ _�-� MINNESOTA UN/QUE WELL WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. County Name WELL AND BORING RECORD � ,,�� . ,, ,., ; Minnesota Statutes,Chapter 103I ? '._ '� : � � Township Name Township No. Range No. Section No. Fraction WELUBORWG DEPTH(completed) DATE WORK COMPLETED 112 feet " March 19 2014 GPS DRILLING METHOD Latitude de rees minutes seconds (1 LOCATION: -� 9 � -�� 7 CableTool ❑Driven Longitude _� degrees �3 minutes �_'� seconds �_e.'72 .-�Auger [�,Plotary House Number,Street Name,City,and ZIP Code of Well Location L_�Other � � 1376 North Arm Drive, Orono 55364 DRILLING FLUID WELL HYDROFRACTURED? ❑Yes o Show exact location of well/boring in section grid with"X:" Sketch map of well/boring location. Be11t011lte From ft.To ft. � Showing property lines, N ds,buildings,and direction. USE ��omestic �. 1 Monitoring [J Heating/Cooling __1_____�__ ___�__ __L ❑Noncommunity PWS �LI Erniron.Bore Hole []Industry/Commercial � . - y� (/: U Community PWS '_'Irrigation U Remedial --i--- --;--- --�-- ---�-- � J Elevator [-'Dewatering 4� ❑— W E �-i, CASING MATERIAL J --'-- --�--- --�-----<-- T / h d d [ � �d�d OLE DIAM. Drive Shoe� ]Yes [� lo H ❑Steel ❑T rea e We e �� Mile � '/z � , , , , � lastic `� --�--- --�--- ---�----�- _. „ �t CASING � S � Diameter Weight Specifications ^7 �� -i nniie--{ �� in.To 108 ft. IbsJft +�—_—.. / _._in.Td�� ft ` iy, — _.. _- PROPERTY OWNER'S NAME/COMPANY NAME ._ in.To_ ft Ibs./ft. _ in.To ft . Fieldstone Family Homes —____—��.To ft. �bs.�n. _ ��.To____ft SCREEN OPEN HOLE Property owner's mai�ing address if different than well location address indicated above. _ ___ -._ Make T(l�'111C(lp__-- From_. ._.._ ft. To__..__ ft. <� 801 Cliff Road East, Suite - 135 / �n�� C�� ` Burnsville MN 55337 TYPe��-'v'�=iT'� t�V'tilS —Diam.---_._ � � SIoVGauze__ _-. .�a SI�� ..___ Length d inrh x_�.�D��_- Set between ft.and��2,___fl. FITTINGS ___�IP X.U.ljl�_. ` ; Phone: (952)469-8800 STATIC WATER LEVEL �.1 Measured from��aUe-_- - ft.j�3elow ❑Above land surface Date measured 1 WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) :�; �_� ft.after—�-�---._._ ..---hrs.pumping_.._1_�-------- g.p.m. ' Well/boring owner's mailing address if diflerent than property owner's address indicated above. WELLHEAD COMPLETION � C+ �Pitless/adapter manufacturer _Baker__._ Model Jllappv_ ,; � ,_��Casing protection ._____. .__ �12 in.above grade 'i�At-grade [�Well House �_�Hand Pump � GROUTING INFORMATION(specify bentonite,cement-sand,neat-cement,concrete,cuttings,or other) Material�Ull� VrO�pm � To 7�__ft. _6_ ❑Yds. �Bags � - Matenal____. __._From To fL _ ❑Yds. : I Bags � HARDNESS OF Matenal_ _____From To _ft. ❑Yda � ;Bags � � GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO Driven casing seal From _ To ____, ___Bags Clay BTOWll S O 3 g NEAREST KNOWN SOURCE OF CONTAMINATION r- 2�+ feet EaSt direction Sanitary Sew��e ": Clay Gray S 38 63 Well disinfected upon completion? es No PUMP i ` ' Sand BPOWll S 63 1 13 I�Not installed Date installed March 26�_2�14 _ � Manufacturer's name__ �rLl�7L�fQS--. k _ Modei Number �OSQEDZ2QQ__.HP 3�� _voitS��Q__ Length of drop pipe��,�q" X 9�1 ft. Capacity�_�_______ g.p.m Type:, ' ubmersible i, ,L.S.Turbine j�Reciprocating ❑Jet ❑ ABANDONED WELLS Does property have any not in use and not sealed well�s)? ❑Yes o VARIANCE Was a variance granted from the MDH for this well? [._,Yes - 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 true to the best of my knowledge. Use a second sheet.if needed. �� FEMARKS,ELEVATION.SOURCE OF DATA.etc. � � `: C-165 _ E.H. R�nn�r & Sons, Inc. ____1431 Elevation: 960 ft MSGS Quad: A 105 �'°e�see B�5'�ess"ame `'° °`Re° "° �� Replacement welL . � � - ' ��'��-�'� 467 03/28/14 -- - _ _ _ -- --_ _ ' Certified F�epresentative Signature � Certified Rep.No. Date . . � � Lucas Praught .: , .. � ----- -- -- � , _ -- ---- ` LOCAL COPY �t `� ..- .� Name of Driller IC 140-0020 ' HE-01205-14(Rev 5/12)