Well and Boring Construction Record

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MINNESOTA UNIQUE WELL WELL'OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. County Name WELL AND BORING CONSTRUCTION RECORD Hennepin Minnesota Statutes,Chapter 1031 8 2 7 8 0 3 Township Name Township No, Range No. Section No. Fraction(sm.—.Ig.) WELUBORING DEPTH(completed) DATE WORK COMPLETED Orono 117 23 06 SW SEIM 140 ft. 5-3-13 _ GPS LOCATION—decimal degrees(to four decimal places). DRILLING METHOD Latitude Longitude ❑Cable Tool ❑Driven ❑Dual Rotary ❑Auger Rotary ❑Rotasonic House Number,Street Name,City,and ZIP Code of Well Location ��/ ❑Other 765 Lakeview Parkway, Orono 55364 DRILLING FLUID WELL HYDROFRACTURED? ❑Yes 'No Show exact location of well/boring in section grid with"X" Sketch map of well/boring location. water From ft.To ft. Showing property lines, N roads,buildings,and direction. USE ,Domestic ❑Monitoring ❑Heating/Cooling I f _E - Noncommunity N onc ommu PWS CommunityPWSIrrigation ❑ Environ. .Bore Hole ❑ Industry/Commercial dustry/C ommercial Irrigat on Remedial ::_y! ' ❑Elevator ❑Dewatering ❑ T 1"'�__ _^l-�j.L CASING MATERIAL Steel Drive Shoe? ❑Yes ONo Threaded ❑Welded HOLE DIAM.. • Smile I ' , lastI 0 -I -t- -:-- . 1 • I CASING I Diameter 130 Weight Specifications g I--1 Mile I - - _ . in.To ft. lbs./ft. 7` in.To 54. in.To ft. lbs./ft. 6 4 in.To 140ft. PROPERTY OWNER'S NAME/COMPANY NAME Con Homes in.To ft. lbs./ft. in.To ft. W[! SCREEN OPEN HOLE Property owner's mailing address if different than well location address indicated above. Make Johnson From ft. To ft. - Type stainless steel Diam?" f Slot/Gauze .010 Loi th+ 4' I J-7.) 1\J--I-p'--A..... • )-„•-r-a /-1 Set between 1 3() ft.and 140 ft. FITTINGS 2"x3' leader STATIC WATER LEVEL 50 ft.gBelow ❑Above land surface (IT--,-Q--1.--- - \'J .Q_`4, ./, Ai A) .: -_k/ 7 Willie J ' Measured from,t p Of measured 5-3-18 Dry hole 0 Yes [ No WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) 125 ft.after 2 hrs.pumping 40 o.p.m. Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION XPitless/adapter manufacturer[r11r Model- ❑Casing protection yi 2 in.above grade ❑At-grade ❑Well House ❑Hand Pump GROUT INFORMATION(specify bentonite,cement-sand,neat-cement,concrete,cuttings,or other) Material bentoni`Flom 0 To 50 ft. 3 ❑Yds. 'Wags Material cUtting$rom 50 To 130 ft. ❑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 i_ clay brown medium 0 18 Well is .i feet �1 direction from _1-'- type Well disinfected upon completion? Xes ❑No clay gray medium 18 32 PUMP ❑Not installed Date installed -44-16 sandy clay gray medium 32 83 Manufacturers name Schaefer 7r� ,7 Model Number HP 1.5 Volts 230 sand brown medium 83 140 Length of drop pipe 84 ft. Capacity _ _g.p.m. Type:,'Submersible ❑L.S.Turbine ❑Reciprocating ❑Jet ❑ ABANDONED WELLS Does property have any not in use and not sealed well(s)? ❑Yes 5;f to VARIANCE Was a variance granted from the MDH for this well? ❑Yes Xo 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 StodolalWell Drilling Co,. Inc. 1691 Licensee Business Name Lic.or Reg.No. `-tee' �= 7-23-18 tifted'Ftepftative Signature '- Certified Rep.No. Date ROb Stodola LOCAL COPY 8 2 7 8 0 3 Name of Driller ID#52603 HE-01205-16(Rev.5/161