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WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. <br /> County Name • WELL AND BORING RECORD <br /> 624926 <br /> Hennepin Minnesota Statutes Chapter 1037 <br /> Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed <br /> Orono 117 23 02 345' ". 6-15-99 <br /> 7. <br /> House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD <br /> 485 Orono Orchard Road Orono, Mn.55356 0 Cable Tool 0 Driven ❑ Dug <br /> 0 Auger 3t❑ Rotary 0 Jetted <br /> Show exact location of well in section grid with'X'. Sketch map of well location. 0 <br /> Showing property lines, <br /> roads and buildings. DRILLING FLUID WELL HYDROFRACTURED? C YES ❑NO <br /> N <br /> Bentonite <br /> r <br /> FROM ft.to ft. <br /> i USE Domestic ❑Monitoring ❑ Heating/Cooling <br /> r---1-.- ❑Community PWS ❑ Indust /Commercial <br /> I i Al 121 Irrigation ❑ Noncommun' PWS ry <br /> w i r E T ❑ Environ.Bore Hole ❑ Remedial <br /> i I ❑ Dewatering ❑ <br /> lent;,, CASING��rr� Drive Shoe? lt'Yes 0 No HOLE DIAM. <br /> � L <br /> 1 f (Isteel 0 Threaded ❑Welded <br /> ❑ Plastic 0 <br /> s <br /> ~—' —__I k f, 6L LCASING DIAMETER WEIGHT <br /> PROPERTY OWNER'S NAME 0 e C 14/40 0 �� 4 in.to 340 ft. 1 the./ft. 8 In.toy 1 0 n. <br /> Yeriga.n Construction in.to ft. Ibs./ft.3 7/4134514. <br /> Property owner's mailing address if different than well location address indicated above. in.to ft. lbs./ft. in.to ft. <br /> 27741 University Ave. NE SCREEN OPEN pO <br /> ibIsanti, Mn. 55040 Make N/A from T ft.to 346 ft. <br /> Type Diem. <br /> Slot/Gauze Length <br /> Set between ft.and ft. FITTINGS: <br /> - STATIC WATER LEVEL y <br /> WELL OWNER'S NAME 98♦ ft. C below 0 above land surface Date measured 6`i <br /> PUMP4/4 CFI_(below land surface) 6q <br /> Well owner's mailing address If different than property owner's address indicated above. L ft after hrs.pumping 50 a 1 r g,p,m, <br /> WELL HEAD COMPLETION <br /> Pitless adapter manufacturer Whitewater Model <br /> ❑Casing Protection [112 in.above grade <br /> ❑ At-grade(Environmental Wells and Borings ONLY) <br /> GROUTING INFORMATION <br /> Well grouted? 1E Yes 0 No <br /> HARDNESS OF FROM TO <br /> GEOLOGICAL MATERIALS COLOR Grout Material I Neat cement ❑Bentonite 0 Concrete ❑ High Solids Bentonite <br /> MATERIAL <br /> from 0 to 310 ft. 1 0 ❑ yds*T❑ bags <br /> from to ft. 0 yds.0 bags <br /> Clay Yellow S 0' 48' <br /> from to ft. 0 yds.0 bags <br /> NEAREST ispURCE OF CON�A"MINATION 4 76G"4/6 <br /> Clay Brown 14 48'120' / J feet oweariv direction <br /> Mx <br /> t Well disinfected upon completion?CEJ Yes ❑ No <br /> Sand (Fine) Brown S 120/160'PUMP <br /> 6-29-99 <br /> ❑ Not installed Date installed <br /> elegy Grey M160'260°Manufacturer's name Myers +f <br /> Model number HP 3 Volts 230 <br /> Sand Gine) Grey S 250'280' 168' 23 <br /> Length of drop pipe ft. Capacity g.p.m. <br /> Clay Brown M 280'312 5 Type: IYSubmersible 0 L.S.Turbine 0 Reciprocating 0 Jet 0 <br /> 4 ABANDONED WELLS <br /> J <br /> SUa t e Re III <br /> 31 2•325#Does property have any not in use and not sealed well(s)? 0 Yes [y CNo <br /> VARIANCE y <br /> Sandstone Shale White/Green ^s. 325'340 p Was a variance granted from the MDH for this well? 0 Yes CI°No TN# <br /> 'gg�r,�.. WELL CONTRACTOR CERTIFICATION <br /> Sandstone Use a second srwall.i 4 340'345 s 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 /> REMARKS,ELEVATION,SOURCE OF DATA,etc. <br /> DON STODOLA WELL DRILLING CO., INC. <br /> ".,n ::Busine-•Name Lic.or Reg.No. 27172 <br /> -- qr/ '�' 9-10-99 <br /> Fd ig _-- <br /> Authorized Representative Signature Date <br /> Chuck Moore 6-15-99 <br />