7-27-18 Well & Boring Construction Record

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MINNESOTA UNIQUE WELL WELL OR BARING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. County Name WELL AND BORING CONSTRUCTION RECORD 8 2 7 8 3 0 Hennepin Minnesota Statutes,Chapter 1031 Township Name Township No. Range No. Section No. Fraction(sm.—..Ig.) WELL/BORING DEPTH(completed) DATE WORK COMPLETED Orono 117 23 07 NE W SW ,% 270 n. 7-26-1R GPS LOCATION—decimal degrees(to four decimal places). DRILLING METHOD Latitude Longitude ❑Cable Tool O given [I Dual Rotary ❑Auger ,'otary ❑Rotasonic House Number,Street Name,City,and ZIP Code of Well Location ❑Other 4755 Tonka View Lane, Orono 55364 DRILLING FLUID WELL HYDROFRACTURED? ❑Yes I'Wo Show exact location of well/boring in - tion grid with"X." Sketch map of well/boring location. bentonite From ft.To ft. Showing property lines, N roads,buildings,and direction. USE %%Domestic ❑Monitoring ❑Heating/Cooling _ __y____ ❑Noncommunity PWS ❑Environ.Bore Hole ❑Industry/Commercial ❑Community PWS ❑Irrigation ❑Remedial -_-L-.-- -_. �, ❑Elevator ❑Dewatering I=1 w E CASING MATERIAL i arlG HOLE DIAM. T .� Dnve Shoe? ❑Yes ? '' ' ❑Steel ❑Threaded ❑Welded %mire .'lastic ❑ l �f CASING S Diameter Weight Specifications • mop, v� ' n.To 260 ft. lbs./ft. 8 n.To 5�ft. F1 Mile--( � 6 PROPERTY OWNER'S NAME/COMPANY NAME in.To ft. lbs./ft. 2 n.To270 ft. Kim in.To ft. lbs./ft. in.To ft. & Hood Maronde OPEN HOLE Property owner's mailing address if different than well location address indicated above. SCREEN ohr`o,,�1it __MM Make �faon From ft. To ft. same Type stainless stain Diam. 2" Slot/Gauze .(if Length 4/ + 4 t Set between 260 ft.and 270 ft. FITTINGS 2"13' 1 adpr STATIC WATER LEVEL 126 ft. ' elow❑Above land surface Measured fro L late measured 7_26_18 Dry hole ❑Yes leo WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL( elow land surface) 266 ft.after 3 hrs.pumping 40 q.p.m. Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION �ihitewater %Pitless/adapter manufacture Model ❑Casing protection NI2 in.above grade O At-grade ❑Well House ❑Hand Pump GROUT INFORMATIONFO (specify bentonite,cement-sand,neat-cement,concrete,cuttings,or other) Material belt iteFrom • _ 0 To 50ft. ['Ids. kit ags Material cuttings From 50 To_260ft. ❑Yds. ❑Bags HARDNESS OF Material From To ft. ❑Yds. ❑Bags GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO Driven casing seal From To Bags One bag=94 lbs.cement or 50 lbs.bentonite NEAREST KNOWN SOURCE OF CONTAMINATION L %7 topsoil black soft 0 3 Well is 7�-� feet direction fromA p clay brown medium 3 34 Well disinfected upon completion? Ares ❑No sandy clay gray medium 34 733 PUMP clay/gravel gray medium 73 84 ❑Not installed Date installed 7-26-18 clay/sand gray soft 1 84 113 Manufacturer's name Sr�Pfer sand mix soft 113 120 Model Number 7 �f HP 1 Volts 230 fine sand gray mediuminpriiuin 1D . 757 Length of drop pipe 14/ ft. Capacity g.p.m. gravel/sand mix 257 270 Type: 'Submersible ❑L.S.Turbine ❑Reciprocating ❑Jet ❑ ABANDONED WELLS Does property have any not in use and not sealed well(s)? ❑Yes Aflo VARIANCE Was a variance granted from the MDH for this well? ❑Yeso 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. �f , .' >' 7-27-18 er ed R es ati +. .u e Certified Rep.No. Date Rol& Stodola LOCAL COPY 827830 Name of Driller ID#52603 HE-01205-16(Rev.5/16)