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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 8 2 7 8 2 4 Minnesota Statutes,Chapter 1031 Hennepin Township Name Township No. Range No. Section No. Fraction(sm.--.Ig.) WELUBORING DEPTH(completed) DATE WORK COMPLETED Orono 117 23 06 SW SW. SW1/43 n. [f GPS LOCATION—decimal degrees(to four decimal places). DRILLING METHOD 5 7-9-18 Latitude Longitude ❑CabtgTool !Driven ❑Dual Rotary ❑Aug®r; !Rotary ❑Rotasonic House Number,Street Name,City,and ZIP Code of Well Location ❑Other 4745 Augusta St, Orono 55364 DRILLING FLUID WELL HYDROFRACTURED? ❑Yes o Show exact location of well/boring in section grid with"X." Sketch map of well/bar.• - ion. bentonite From ft.To ft. .o ' .property lines, N road angs,and direction. USE (abomestic ❑Monitoring ❑Heating/Cooling --- --_--?---- --- �❑`Noncommunity PWS ❑Environ.Bore Hole ❑Industry/Commercial /� ❑Community PWS ❑Irrigation ❑Remedial ------;--- ❑Elevator ❑Dewatering ❑ W .; ; E CASING MATERIAL Drive Shoe? El �Vo HOLE DIAM. T ❑Steel ❑Threaded ❑Welded T• t i lastic 'kMde ❑ 1 CASING I�F S Diameter Weight • Specifications Mile--I ! / f (i 4 in.To 145 ft. lbs./ft. 8_in.To -ft. 1 PROPERTY OWNER'S NAME/COMPANY NAME , \/� `- in.To ft. lbs./ft. in.To5_ft. i in.To ft. lbs./ft. in.To ft. Norton TTomes LLC / OPEN HOLE Property owner's mailing address if different than well lociyon address indicated above. SCREEN i Make Johnson From ft. To ft. i . r :,.` Ste D Type ss-tes stainlesti Diem. 2" ;ymouth, *fid 55446 Slot/Gauze .010 Length 4, + 4, Set between ft.and 155 ft. FITTINGS 2M , leader STATIC WATER LEVEL 102 ft.gelow ❑�Abbovve Ian surface Measured fro 7 of well Date measured 7-9-18 Dry hole ❑Yes to WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) 140 ft.after 2 hrs.pumping 30 - q.p.m. Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION �,3 �itless/adapter manufacturer Whitewater Model ❑Casing protection g12 in.above grade ❑At-grade ❑Well House ❑Hand Pump GROUT INFORMATION(specify bentonite,cement-sand,neat-cement,concrete,cuttings,or other) Material-aentFrom 0 To 50 ft. 30 Yds. , tags Material cuttings From 50 To 14-5 ft. ❑Yds. ❑Bags HARDNESS OF Material From To ft. ❑Yds. ❑Bags GEOLOGICAL MATERIALS COLOR FROM TO MATERIAL Driven casing seal From To Bags One bag=94 lbs.cement or 50 lbs.bentonite r_ 28 NEAREST KNOWN SOURCE OF CONTAMINATION clay brown IIt dI ium 0Well is 95 feet N direction from r type Well disinfected upon completion? jgr Yes ❑No clay gray medium 28 39 PUMP 1 O sandy1 ❑Not installed Date installed 12-31-18 clay gray medium 39 81 Manufacturer's name Schaefer �w, p Model Number HP 1.5 Volts 230 sand/gravel mix medium 81 97 Length of drop pipe 126 ft. Capacity g.p.m fine sand gray soft 97 128 Type:�Submersible ❑L.S.Turbine H IOciprocating ❑Jet El ABANDONED WELLS j sand/gravel 1/gravel t'fix medium 128 155 Does property have any not in use and not sealed well(s)? ❑Yes Arlo VARIANCE Was a variance granted from the MDH for this well? ❑Yes XI% 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. !' 1-2-18 No. :-/':// rt e nta Si ature Certified Rep.No. Date LOCAL COPY 8 2 7 8 2 4Rob Stodol a Name of Driller ID#52603 HE-01205-16(Rev.5/16)