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,, MINNESOTA UNIQUE WELL <br /> tAIELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. <br /> County Name - WELL AND BORING CONSTRUCTION RECORD � .9 • <br /> Minnesota Statutes,chapter 1031 <br /> Hennepin . <br /> Township Name Township No. Range No. Section No. Fraction(sm. Ig.) WELL/BORING DEPTH(completed) DATE WORK COMPLETED <br /> Orono 118 23 27 SW STD: SE/, 170 1/1O/25 <br /> GPS LOCATION—decimal degrees(to four decimal places). DRILLING METHOD <br /> Latitude Longitude .❑Cable Tool i❑Driven III Dual Rotary <br /> ❑Auger ❑Rotary ❑Rotasonic <br /> House Number,Street Name,City,and ZIP Code of Well Locationi ❑Other <br /> 900 Brown Rd No, Long Lake, MN 55356 DRILLING FLUID WELL HYDROFRACTURED? ❑Yes DI.No <br /> Show exact location of well/boring in section grid with"X" Sketch map of well/boring location. Ben t o n i t e Fram ft.To ft. <br /> Showing property lines, <br /> N -7 roads,buildings,and direction. USE •®Domestic ❑Monitoring ❑Heating/Cooling <br /> I i I 1 <br /> _ - _ ❑Noncommunity PWS El Irrigation ❑Industry/Commercial <br />• 9. r <br /> / Community PWS ❑Dewatering ❑Remedial <br /> / ❑y___i_ ___,__ Z l ❑Elevator <br /> W - ET r CASING MATERIAL Drive Shoe? ❑Yes g No HOLE DIAM. <br /> r <br /> * ❑Steel ❑Threaded ❑Welded <br /> 'h Mile . ..n Plastic ❑ <br /> I k.- CASING <br /> ' s Diameter Weight Specifications 8 <br /> 4 /� 50 <br /> 1 1 Mile I in.TO � 0- ft. lbs./ft. in.To 7 <br /> eft. <br /> PROPERTY OWNER'S NAME COMPANY NAME in.To ft. lbs./ft. in.To ft. , <br /> Mike Geelaa in.To ft. lbs./ft. in.To ft. <br /> J .-4.., OPEN HOLE <br /> Property owner's mailing address if different than well location.address indicated above.' <br /> SCREEN • -a k` 6- <br /> Make J.0 • .i From ft. To ft. <br /> ci 6t, •l lsvu.r <br /> t: <br /> Type n i .,1 Diam. L, n , <br /> •a,,:i R. Li <br /> Slot/Gauze Length <br /> Set between 1 6 0 /ft.and 1 U ft, nFJ�TTINGS t 1, a tL <br /> STATIC WATER LEVEL ` "' ft.-fn Below ❑Above land surface <br /> 1/10/25 � <br /> Date measured Dry hole ❑Yes"u No ` <br /> WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) <br /> 155 <br /> ft.after 2 hrs.pumping q.p.m. <br /> Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION monitor <br /> Tn Pitless/adapter manufacturer Model <br /> ❑Casing protection ' N 12 in.above grade ' <br /> ❑At-grade ❑Well House ❑Hand Pump <br /> GROUT INFORMATION(specify bentonite,cement-sand,neat-cement,concrete,cuttings,or other) <br /> 1 cuttings 160 50 <br /> Material., • From r n To t.., ft. ❑Yds. ❑Bags <br /> Material o e n t U u l e F om )u u To v ft. ❑Yds. N Bags <br /> HARDNESS OF Material From To ft. ❑Yds. ❑Bags <br /> GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO Driven casing seal From To Bags One bag=94 lbs.cement <br /> or 50 lbs.bentonite <br /> NEAREST/KNOWN'SOURCE OF CONTAMINATION,lillk F <br /> Clay Brown 23 Well is !�a� feet S4 directionfromL � type <br /> PU Well No isinfected upon completion? ❑ <br /> Clay Gray S 23 66 Yes ❑ <br /> Not installed Date installed 1/1 /25 <br /> ❑ <br /> Clay/Sand Gray S f66 117 Shafer <br /> Manufacturer's name <br /> I 2O <br /> Sand/Gravel Mix S 11 r 170 Model Number 2 HP Volts <br /> t3 1Length of droppipe 1 L 6 ft. Capacity g.p.m. <br /> Type: Submersible ❑L.S.Turbine ❑Reciprocating ❑Jet ❑ <br /> ABANDONED WELLS <br /> Does property have any not in use and not sealed well(s)? ❑Yes 3 No <br /> VARIANCE <br /> Was a variance granted from the MDH for this well? ❑Yes No TN# <br /> WELL CONTRACTOR CERTIFICATION <br /> 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 /> Use a second sheet,if needed. <br /> REMARKS,ELEVATION,SOURCE OF DATA,etc. <br />' \ " --- Don Stodola Well Drilling Co Inc 1691. <br /> f Licensee Business Name Lic.or Reg.No. <br /> i > l 1/16/2 5 <br /> [certified Representative ignature Certified Rep.No. Date <br /> . Rob S,todola <br /> LOCAL COPY 8 7 3 5 9 9 <br /> Name of Driller <br /> ID#52603 HE-01205-18(Rev.3/19) <br />