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