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WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. <br /> County Name WELL AND BORING RECORD 643'160 <br /> Hennepin Minnesota Statutes Chapter 103! <br /> Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed <br /> ft. <br /> Orono 117 23 07 234• 2-21-00 <br /> House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD <br /> El Cable 1200 Wildhnrst Trail Orono, lin. 55364 ❑Auger Tool t Ror i taryo Dug <br /> ed <br /> Show exact location of well in section grid with'X". Sketch map of well location. 0 <br /> Showing properly lines, <br /> `' roads and buildings. DRILLING FLUID WELL HYDROFRACTURED? El YES 0 NO <br /> N i. Water <br /> I I �� FROM ft.to ft. <br /> I I <br /> i e <br /> � USE 0 Monitoring 0 Heating/Cooling <br /> 9 t Domestic ❑ Community PWS 0 Industry/Commercial <br /> k ❑ Irrigation 0 Noncommunity PWS 0 Remedial <br /> I I <br /> w - ET <br /> T 0 Environ.Bore Hole <br /> I I `� 0 Dewatering ❑ <br /> r r <br /> I I Q CASING Drive Shoe? 0 Yes cXto HOLE DIAM. <br /> I 1 1/ZMile <br /> 0 Steel <br /> rXPlastic 0 Threaded <br /> ❑ ❑ Welded <br /> l <br /> 3 <br /> s <br /> 1-1 Mile--I <br /> CASING DIAMETER WEIGHT <br /> PROPERTY OWNER'S NAME in.to ft. lbs./ft. in.to ft. <br /> Nike Hollenhorst in.to ft. lbs./ft. in.to_2_34 <br /> Property owner's mailing address if different than well location address indicated above. M.to ft. lbs./ft. in.to ft. <br /> SCREEN OPEN HOLE <br /> MaJohnsQ D from ft.to ft. <br /> Type Statinlens Steel Dia, 2a8' <br /> Slot/Gauze .010 Length <br /> Set between 226 ft.and 234 ft. FITTINGS: 2• X 30"_v/kp <br /> STATIC WATER LEVEL <br /> WELL OWNER'S NAME 90 ttX below 0 above land surface Date measured 2-21-00 <br /> PUMPING LEVEL(below land surface) <br /> Well owner's mailing address if different than property owner's address indicated above. 220 ft. after 2 hrs.pumping 30 air g.p.m. <br /> Ltl HEAD COMPLETION whi terater del <br /> NAL Pitlessadapter manufacturer <br /> ❑ Casing Protection 12 in.above grade <br /> ❑ At-grade(Environmental Wells and Borings ONLY) <br /> GROUTING INFORMATION <br /> Well grouted? a Yes 0 No <br /> GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO Grout Material ❑ Neat cement 0 Bentonite 0 Concrete I High Solids Bentonite <br /> MATERIAL from 0 to 30 ft. 2.5 0 yds. L bags <br /> from to ft. 0 yds. 0 bags <br /> Clay Brown S 0' 18 Ifrom to ft. ❑ yds. 0 bags <br /> Clay Grey S 18' 105 1 <br /> NEAROWN SOURCE OF CONT�►�IN TION <br /> feet c)7 direction T`ecrf type <br /> Well disinfected upon completion? f�'!es 0 No �� <br /> Clay Sand Grey S 105'2201 PUMP <br /> ❑ Not installed Date installed <br /> 2-23-00 <br /> Water Sand Grey S 220'230. <br /> Manufacturer's name Goulds <br /> Model number HP 1 Volts 230 <br /> Length of drop pipe 126' ft. Capacity 12 g.p.m. <br /> Type: fubmersible 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 arNo <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-. a ,a The information contained in this report is true to the best of my knowledge. <br /> E' ED DON STODOLA WELL DRILLING CO. , INC. <br /> Licensee Business Name .-- Lic.• Reg.•••• 27172 <br /> MAR .3 0 2nnn <br /> Li ' rillr.o.oir'Ampo 2-28-00 <br /> CITY Ur Unt3N0 <br /> Authorized Representative S. ature Date <br /> Chuck <br /> 64316 0 Name of Driller Moore 2-21-00 <br /> Date <br /> LOCAL COPY HE-01205-07(Rev.2/99) / <br />