Well and Boring Construction Record

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t. _ . f • 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 3 9 6 0.6 Township Name Township No. Range No. Section No. Fraction(sm.—.Ig.) WELI/BORING DEPTH(completed) DATE WORK COMP FETED Orono 118 23 33 IF SE SLS 198 i1-29 GPS LOCATION—decimal degrees(to four decimal places). DRILLING METHOD Latitude Longitude ❑Cable Tool ❑Driven ❑Dual Rotary ❑Auger yrRotary ❑Rotasonic House Number,Street Name,City,and ZIP Code of Well Location 0 Other 2590 Watertown Rd, Orono 55346 DRILLING LUID WELL HYDROFRACTURED? ❑Yes PrNo Show exact location of well/boring in secti nd wiYq� X:' etch map of well/boring location. bentonite From ft.To ft. t-N Showing property lines, N li roads,buildings,and direction. USE X Domestic ❑Monitoring ❑Heating/Cooling _ [—I ❑Noncommunity PWS ❑Environ.Bore Hole ❑Industry/Commercial ❑Community PWS ❑Irrigation ❑Remedial ----l---__a_-.-_-1-------__- ❑Elevator ❑Dewatering w�ww..,,,,�ffff❑ w E T CASING MATERIAL Drive Shoe? ❑Yes_$No HOLE DIAM. I ❑Steel ❑Threaded [� elded %Mile SPlastic ❑ B La s+R!ZA CASING T 1 Diameter Weight Specifications 4 —1 Mile--IO in.To 190 ft. lbs./ft. 8 in.To /5y�. �L�A-� cs r— CJS in.To ft. lbs./ft. 6i in.To 20a PROPERTY OWNER'S NAME/COMPANY NAME W Debra elf in.To ft. lbs./ft. Jn.To ft. OPEN HOLE Property owners mailing address if different than well location address indicated above. SCREEN J� Make From ft. To ft. same Type stainless steel Diam. 2" Slot/Gauze .010 Leng4' + 4 Set between .ft.and ft FITTINGS 2NX teader STATIC WATER LEVEL _ — I(� ft.ki Below ❑Above land surface Date measured 11-29-98 Dry hole ❑Yes igNo WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) 180ft.after 2 hrs.pumping 30 q.p.m. Well/boring owners mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION Whitetrater ,Pitless/adapter manufacturer Model ❑Casing protection 0 12 in.above grade ❑At-grade ❑Well House ❑Hand Pump GROUT INFORMATION(specify bentonite,cement-sand,neat-cement,concrete,cuttings,or other) Material bent terom 0 To 50 ft. 3 ❑Yds. ix Bags Material cuttings From 50 To_IYL 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 clay brown medium 0 40 /, Ai brown 40 62 Well is feet direction from' }dam type sand/clayD soft © Well disinfected upon completion? 0 Yes ❑No sand/gravel mix medium 62 102 PUMP clay gray medium 102 110 ❑Not installed Date installed 11-30-18 clay/sand gray medium 110 140 Manufacturer's name Schaefer sandy clay gray medium 140 16z Model Number _ f HP •5 Volts 230 brown medium 162 182 �� reddishModel of drop pipe 147 ft. Capacity g.p.m. sand/gravel mix medium i82 200 Type:'Submersible ❑L.S.Turbine ❑Reciprocating ❑Jet ❑ ABANDONED WELLS Does property have any not in use and not sealed well(s)? ❑Yes Mi No VARIANCE Was a variance granted from the MDH for this well? ❑Yes yl 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 Go,. Inc. 1691 Licensee Business Name Lic.or Reg.No. i-11-19 7‘,1:1.°Hsentative ,-ur_ Certified Rep.No. Date Rob Stodola LOCAL COPY 8 3 9 6 0 6 Name of Driller ID#52603 HE-01205-17(Rev.5/17)