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 827 8 2 3 Hennepin Minnesota Statutes,Chapter 1031 Township Name Township No. Range No. Section No. Fraction(sm.—.Ig.) WELUBORING DEPTH(completed) DATE WORK COMPLETED Orono 117 23 06 NW NW SWC 8-15-18 f1. 149 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 q / ❑Other 465 Lakeview Parkway, Orono 55364 DRILLING FLUID t WELL HYDROFRACTURED? ❑Yes XNo Show exact location of well/boring in section grid with"X." Sketch map of wel ring location. bentonite From ft.To ft. Showing roperty lines, N roads,buildings and direction. USE Domestic El Monitoring ❑Heating/Cooling ` ❑Noncommunity PWS ❑Environ.Bore Hole ❑Industry/Commercial / ❑Community PWS ❑Irrigation ❑Remedial ❑Elevator ❑Dewatering ❑ CASINGERIAL Drive Shoe? ❑Yes No R MAT HOLE DIAM. _ - T ❑Steel ❑Threaded ❑Welded Mile s lastic 1- O CASING ❑ S 9 Diameter Weight Specifications F--1Mlle— I 4 in.To 14n ft. lbs./ft. L$_in.To ft. PROPERTY OWNER'S NAME/COMPANY NAME in.To ft. lbs./ft. 6'2 in.To150 ft. Norton Homes LLC in.To ft. lbs./ft. in.To ft. SCREEN OPEN HOLE Property owner's mailing address if different than well location address indicated above. Johnson Make From 2— ft. To ft. 18215 45th Ave N, Ste D Type stainless steel Diam. Plymouth, MN 55446 SloVGauze .010 Length 4'Y+ 4/ Set between 140 ft.and 149A ft. FITTINGS 2'x3' w/leader STATIC WATER LEVEL 65 ft.,'Below CIAbove land surface Measured from top of late measured 8-15-18 Dry hole ❑ Yes XrNo WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) 133 ft.after 2 hrs.pumping 40 q.p.m. Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION res KPitless/adapter manufacturePhiteWa ter Model Casing protection X12 in.above grade ❑At-grade ❑Well House ❑Hand Pump GROUT INFORMATION(specify bentonite,cement-sand,neat-cement,concrete,cuttings,or other) Material bentDflit,rom 0 To 50 ft. 3]Yds. KBags Material cut t ings From 50 To 140 ft. ❑Yds. ❑Bags HARDNESS OF Material From To ft. _ ❑Yds. ❑Bags GEOLOGICAL MATERIALS COLOR FROM TO MATERIAL bane cement o94 lbs.lbs. Driven casing seal From To Bags One e5lag,b94t NEAREST KNOWN SOURCE OF CONTAMINATION clay L medium 0 • �,r r brown fiedit71f1 14 Well is J� feet direction from._.� type medium Well disinfected upon completion? rgYes ❑No medr clay gray i 14 79 PUMP p 1�l ❑Not installed Date installed 8-21-1 8 sand/ 'avel mix soft 79 100 Manufacturer's name Schaefer fine sand/ Model Number HP 1.5 Volts 230 silty clay gray soft 100 124 Length of drop pipe } ft. Capacity g.p.m. 137 ABANDONED WELLS T ❑L.S.Turbine ❑Reciprocating ❑Jet ❑ sand brown soft 124 a � c3Vel mix medium 137 15d Does property have any not in use and not sealed well(s)? ❑Yes �Tlo VARIANCE Was a variance granted from the MDH for this well? ❑Yes tX'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. Don Stodola Well Drilling Co,. Inc. 1691 Licensee Business Name Lic.or Reg.No. --7,—", ,-/-/' 8-23-18 YC Hie 6epresenta✓v: ignature Certified Rep.No. Date LOCAL COPY 8 2 7 8 2 3 Name of Driller Rob Stodola ID#52603 1-1E-01205-161Rev.5/16)