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;Ai► MINNESOTA UNIQUE WELL WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. Ottnty Name WELL AND BORING CONSTRUCTION RECORD 8 2 3 4 4 8 Minnesota Statutes,Chapter 1031 uEq n pin Township Name Township No. Range No. Section No. Fraction WELUBORING DEPTH(completed) DATE WORK CO L TED Ore11#4 23 32 SE SW NW' 169 f. 2-11_1 cvE OronoIVED GPS LOCATION—decimal degrees(to four decimal places). DRILLING METHOD Latitude Longitude ❑Cable Tool ❑Driven JUN 1 3 20'17 II]Auger XRotary House Number,Street Name,City,and ZIP Code of Well Location ❑Other 460 Orchard Park Rd, Orono 55356 DRILLING FLUID WELL HYDROF ffik*attikkjo Show exact location of well/boring in section grid with"X." Sketch map of well/boring location. From ft.To ft. Showing property lines, water N roads,buildings,-and direction. USE ❑Monitoring ❑Heating/Cooling ---:---.--1-----1------L- ❑Noncommunity PWS ❑Environ.Bore Hole ❑Industry/Commercial ❑Community PWS ❑Irrigation ❑Remedial ----- ---- --•------ ❑Elevator ❑Dewatering ❑ w E �'� '`, CASING MATERIALHOLE DIAM. f Drive Shoe? ❑YesRlo " ^� --�� i ❑Steel ❑Threaded ❑Welded Ma ❑ 1 •..,„ _ Plastic S CASING `,07 Diameter Weight Specifications �1 I 1 Mile in.To 160 ft. lbs./ft. 8 in.To��5° ft. PROPERTY OWNER'S NAME COMPANY NAME in.To ft. lbs./ft. in.To ft. Konen Homes in.To ft. lbs./ft. in.To ft. Property owner's mailing address if different than well location address indicated above. SCREEN OPEN HOLE 20455 Linwood Rd Make Johnson From ft. To ft. Excelsior, MN 55331 Type at st_el Diam. 2" Slot Gauze '010 ft. 41 4- 4 Set between ft.and ft. FITTINGS leader WATE'{�L 169 2"X31 leader Measured from 98 ft. Below ❑Above land surface Date measured 2-11-17 WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) 255 ft.after 2 hrs.pumping 40 q.p.m. Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION Pitless/adapter manufacturer Whitewater Model Casing protection At12 in.above grade ❑At-grade ❑Well House ❑Hand Pump GROUT INFORMATION(specify bentonite,cement-sand,neat-cement,concrete,cuttings,or other) Material•...._From 0 To_50 ft. 3❑Yds. Al..13ags Material cuttings From 50 To_ Oft. El Yds. ❑Bags HARDNESS OF Material From V To ft. II]Yds. ❑Bags GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO Driven casing seal From To Bags NEAREST KNOWN SOURCE OF CONTAMINATION topsoil black medium 0 2 —,- x.,..J feet direction . ry_, -3---t- type Well disinfected upon completion? (g'Yes ❑No clay yellow medium 2 22 PUMP ❑Not installed Date installed 3-20-17 clay gray medium 22 94 Schaefer Manufacturer's name clay/sand gray soft 94 132 Model Number HP 1.5 Volts 230 Length of drop pipe 120 ft. Capacity g.p.m. gravel/sand mix medium 132 146 Type:, 'Submersible ❑L.S.Turbine ❑Reciprocating ❑Jet ❑ ABANDONED WELLS sand bomwn soft 146 169 Does property have any not in use and not sealed well(s)? ❑Yes R'No VARIANCE Was a variance granted from the MDH for this well? ❑Yes Xr,lo 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. REMARKS,ELEVATION,SOURCE OF DATA,etc. Don Stodola Well Drilling Co,. Inc. 1691 Licensee Business Name Lic.or Reg.No. -�j 3-30-17 ��TfiE ese live Sig -lure Certified Rep.No. Date LOCAL COPY - - 8 2 3 4 4 8 Name of Driller Rob Stodola .. _- ID#52603 HE-01205-15(Rev.8/13)