08-25-2020 well & boring construction record

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° 4 ' 3- ` a4xt * �41;. +fy ,N : , ^ * * MINNESOTA UNIQUE WELL WELL 100 BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. County Name WELL AND BORING CONSTRUCTION RECORD 8 4 8 5 3 0 Hennepin Minnesota Statutes,chapter 1031 Township Name Township No. Range No. Section No. Fraction(sm.—r-Ig.) WELL/BORING DEPTH(completed) DATE WORK COMPLETED Orono 117 23 10 SW NI!; NE ,/, 148 t 8-25-20 GPS LOCATION—decimal degrees(to four decimal places). DRILLING METHOD Latitude_ _ Longitude ❑Cable Tool ❑Driven [1 Dual Rotary ❑Auger otary ❑Rotasonic House Number,Street Name,City,and ZIP Code of Well Location ❑Other 1150 Heritage Lane, Orono 55391 DRILLING FLUID a WELL HYDROFRACTURED? ❑Yes 06lo Show exact location of well/borin m sectiongrid with"X." Sk@tch mapof well/borin location. it�nit'_. g From ft.To ft. Showing property lines, r'-, roads,buildings,and direction. USE N i { Domestic ❑Monitoring ❑Heating/Cooling -------,--?-- - --, ❑Noncommunity PWS ❑Irrigation ❑Industry/Commercial ❑Community PWS ❑Dewatering ❑Remedial .--'-----'-----`- --`--- `' ❑Elevator El w E CASING MATERIAL Drive Shoe? ❑Yes �No HOLE DIAM. ' ---"---'--" T , ❑Steel ❑Threaded ❑Welded S• Mile �J fY Plastic ❑ I CASING J�� 3 1 Diameter Weight Specifications �p� I - 1 Mile— I 4in_To:_tin ft. lbs./ft.. in.To 50tt. 61/4 PROPERTY OWNER'S NAME/COMPANY NAME in.To ft. lbs./ft. in.To x w ft. iWest Bay come inc• n.To ft. lbs./ft.OPEN HOLE in.To ft. Property owner's mailing address if different than well location address indicated above. SCREEN Make Johnson From • ft. To ft. 10425 Bluff Rd Type stainless steel Diarf2« Eden Prairie, MN 55377 t Slot/Gauze .015 Length 4, + 4' Set between__}{ __ft.and Rft. FITTINGS 2 3' leader STATIC WATER LEVEL 148 __19D ft. ijokaelow ❑Above land surface Date measured 8-25-20 Dry hole ❑ Yes i No WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) 130 ft.after 2 hrs.pumping 40 g.p.m. V Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION ❑Pitless/adapter manufacturer Model ❑Casing protection ❑12 in.above grade ❑At-grade ❑Well House ❑Hand Pump i GROUT INFORMATION(specify bentonite,cement-sand,neat-cement,concrete,cuttings,or other) Material bentoniteFrom 0 To 50 ft. 3 ❑Yds. XBags Material Cuttings From 50 To 140 ft. ❑Yds. ❑Bags HARDNESS OF Material �Y� From To ft. ❑Yds. ❑Bags GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO Driven casing seal From To Bags - One bag94 lbs.cement or 50 lbs.bentonite NEAREST KNOWN SOURCE OF CONTAMINATION / .,,_,.,� 33 -) ! _ clay/gravel brown medium 0 Well is +5 feet f"'r ) direction from • type clay/fir e'sand gray soft 33 66 Well disinfected upon completion? 1 Yes ❑No et, - :*.5.2 ,J.,-.0- sandy clay gray medium 66 82pPUMP fine sand/silty clay gray soft 82 98 ❑Not installed Date installed sandyclay reddish r� Manufacturer's name [�ro� broWes medium 98 123 Model Number HP Volts fpurse gravel/sand mix medium/ Length of drop pipe ft. Capacity g.p m or] hard 123A 149 Submersible Clay red medium 149 150 Type:DLS ❑L.S.Turbine ❑Reciprocating ❑Jet ,❑ ABANDONED WELL Does property have any not in use and not sealed well(s)? ❑Yes No VARIANCE Was a variance granted from the MDH for this well? ❑Yes $No 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. Dan Stodola Well Drilling 1691 Licensee Business Name /Lic,.so�r�Reegg..No. rti R pre(e`ati ig ature Certified Rep.No. Date LOCAL COPY 8 4 8 5 3 Rob Stodola Name of Driller ID#52603 HE-01205-18(Rev.3/19)