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WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. <br /> County Name WELL AND BORING RECORD6 6 8 0 3 3 <br /> Benne*In Minnesota Statutes Chapter 1031 <br /> Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) ft. Date Work Completed <br /> Orono 117 23 02 286 9-19-01 <br /> House Number,Street Name, <br /> City,and Zip Code of Well Locationioor Fire Number.tDRILLING METHOD <br /> 0 Cable 485 Orono Orchard 8d, Orono 55356 ❑Auger Tool ❑ Doom y,, ❑ Dug <br /> ' 9 ! ry q Jetted <br /> Show exact location of well in section d Sketch mapof well local 0 <br /> ���(�, <br /> %I ..-V..;f.d4 Showing property in <br /> roads and buil rng¢. DRILLING FLUID WELL HYDROFRACTURED? 0 YES 96O <br /> N bentonite <br /> FROM ft.to ft. <br /> USE 0 Monitoring ❑ Heating/Cooling <br /> _i ----N, <br /> -" Ir oic 0 Community PWS 0 Industry/Commercial <br /> Irrigation 0 Noncommunity PWS 0 Remedial <br /> w , E ! 0 Environ.Bore Hole <br /> T 0 Dewatering ❑ <br /> i_ -- .� 1. 4 I t\ CASING-CZ <br /> Drive Shce? ryes 0 No HOLE DIAM. <br /> - _1 ,; i; �' Id.Steel Threaded 0 Welded <br /> 0 Plastic 0 <br /> s <br /> CASING DIAMETER WEIGHT <br /> PROPERTY OWNER'S NAME 6 in.to 262 ft. 19 Ibs./ft. Li___in.to_262 <br /> Yerigan Construction in.to ft. lbs./ft. X18— 286 <br /> Property owner's mailing <br /> address if different than well location address indicated above. in.to ft. lbs./ft. in.to ft. <br /> 2ler741 University Ave NE SCREEN OPEN HOLE <br /> teanti, MN 55040 Make from 262 ft.to_2f46 ft. <br /> Type Diem. <br /> Slot/Gauze Length <br /> Set between ft.and ft. FITTINGS: <br /> STATIC WATER LEVEL "1 <br /> WELL OWNER'S NAME 90 ft.X below 0 above land surface Date measured 9449#0.01 <br /> PUMPING LEVEL(below land surface) <br /> Well owner's mailing address if different than property owner's address indicated above. 245/180 ft. after 2/3 hrs.pumping 120+/7 5.p.m. <br /> WELL HEAD COMPLETION t <br /> ❑ Pitless adapter manufacturer sari t ary_s l{I <br /> ❑ Casing Protection f i2 in.above grade <br /> ❑ At-grade(Environmental Wells and Borings ONLY) <br /> GROUTING INFORMATION <br /> Well grouted? %Yes 0 No <br /> HARDNESSOF Grout Material 0 Neat cement 0 Bentonite 0 Concrete (1CHi h Solids Bentonite <br /> GEOLOGICAL MATERIALS COLOR MATERIAL FROM TOfrom__ to 35+ ❑ X <br /> 12 ds. bag <br /> y s <br /> topsoil black soft 0 3 from 33440 ft. natural_ Tien bags <br /> from to ft. ❑ yds.❑ bags <br /> NEARS T KNOWN SOURCE OF CONT INATION <br /> clay brown medium 3 58 feet UV/ Li <br /> direction JG pric type <br /> Well disinfected upon completion? Yes 0 No <br /> sand/gravel brown soft 58 100 PUMP <br /> ❑ Not installed Date installed <br /> 9-20-01 <br /> clay gray medium 100 262 Manufacturer's name Grundfo$ <br /> green/ Model number HP 7 a 5 Volts 230 <br /> shale/sandstone gray hard 262 286 <br /> Lengthof <br /> drop pipe 147 ft. Capacity g.p.m. <br /> � <br /> Type:�tf Submersible 0 L.S.Turbine 0 Reciprocating 0 Jet 0 <br /> ABANDONED WELLS <br /> Does property have any not in use and not sealed well(s)? 0 Yes DieNo <br /> VARIANCE <br /> Was a variance granted from the MDH for this well? 0 Yes ,(No TN# <br /> WELL CONTRACTOR CERTIFICATION <br /> Use a second sheet,if needed This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. <br /> REMARKS,ELEVATION,SOURCE OF DATA,etc. The information contained in this report is true to the best of my knowledge. <br /> Don Stodola Well Drilling Co., Inc. 2717 <br /> Licen Business Name- Lic.or Reg.No. <br /> f.". ,... .--- ,/ i.--- ,' ''',: 1044041'01 <br /> Authorized Reprebentative Signature Date . <br /> Chuck Moore 9-19-01 <br />