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WELLOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. <br /> County Name WELL AND BORING RECORD 639135 <br /> Henna in Minnesota Statutes Chapter 1031 <br /> Township Name Township No. Range No. I Section No. FractionWELL DEPTH(completed) Date Work Completed <br /> Orono 118 23 33 168' n 4-25-00 <br /> House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD <br /> 3020 Watertovn Road Orono, • ❑ Cable Tool F1 Driven Dug <br /> El Auger �iotary 71 Jetted <br /> Show exact location of well in section grid with"X". Sketch map of well location. ❑ <br /> Showing property lines, <br /> roads and buildings. DRILLING FLUID WELL HYDROFRACTURED? ❑YES ❑NO <br /> Bentonite <br /> FROM ft.to ft. <br /> USE ❑ Monitoring ❑ Heating/Cooling <br /> �t L CXomestic El Community PWS <br /> El Irrigation ty ❑ Industry/Commercial <br /> .� ❑ Noncommunity PWS ❑ Remedial <br /> WE ❑ Environ.Bore Hole <br /> i i i i [I Dewatering ❑ <br /> CASING Drive Shoe? ❑ Yes ❑ No HOLE DIAM. <br /> El Steel El Threaded ❑ Welded <br /> EXIastic ❑ <br /> s J b _ <br /> iIMile -� �c ♦ f6/� <br /> 0 <br /> CASING.DIAMETER WEIGHT <br /> PROPERTY OWNER'S NAME 4 in.to 1 60ft. lbs./ft. 7 7/ 3 <br /> Steiner & Koppel t win.to ft. lbs./ft. in.to <br /> Property owner's mailing address if different than well location address indicated above. in.to ft. lbs./ft. in.to ft. <br /> 18340 Minnetonka Blvd SCREEN OPEN HOLE <br /> Deephaven, MN.55391 Make_obn8on from ft.to ft. <br /> Type Stainless Steel Diam. 70 <br /> Slot/Gauze -O is Length Be <br /> Set between eft.and__1_6�11. FITTINGS: <br /> STATIC WATER LEVEL <br /> WELL OWNER'S NAME 90 ft.X below ❑ above land surface Date measuredd— _5_a O <br /> PUMPING LEVEL(below land surface) <br /> Well owner's mailing address if different than property owner's address indicated above. 1,+5 g ft. after 4 hrs.pumping 2 g.p.m. <br /> WELL HEAD COMPLETION <br /> EXitless adapter manufacturer :J-,(� <br /> Model <br /> ❑ Casing Protection ❑X?in.above grade <br /> ❑ At-grade(Environmental Wells and Borings ONLY) <br /> GROUTING INFORMATION <br /> Well grouted? Eres ❑ No <br /> GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO Grout Material ❑ Neat cement ❑ Bentonite ❑ Concrete [High Solids Bentonite <br /> MATERIAL from__to ft. 9 h ❑ yds.X bags <br /> Clay YellOv Soft 0' 20 from to ft. Elyds. ❑ bags <br /> from to ft. ❑ yds. ❑ bags <br /> Clay Gra soft 20 A 5 NEAREST KNOW SOURCE OF CONTAMINATION - 10fC <br /> Y y YJ feet `.3C"'��l.J r direction type <br /> Well disinfected upon completion? X Yes ❑ No <br /> Gravel Colorel Soft 45 70 PUMP <br /> Clay & Gravel ray [Iced. 70 138 ❑ Not installed Date installed 6-29-00 <br /> Manufacturer's name Goulds <br /> Clay & Gravel Brovn Soft 13811481 <br /> Model numberHP 1� volts 230 <br /> Length of drop pipe 105, ft. Capacity 18 - g.p.m. <br /> ..Sand Gray S 148` 168 Type: XSubmersible ❑ L.S.Turbine ❑ Reciprocating ❑ Jet ❑ <br /> ABANDONED WELLS <br /> Does property have any not in use and not sealed well(s)? ❑ Yes KNo <br /> VARIANCE <br /> Was a variance granted from the MDH for this well? ❑ Yes XNo TN# <br /> WELL CONTRACTOR CERTIFICATION <br /> Use a second sheet,i/needed T This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. <br /> REMARKS,ELEVATION,SOURCE OF DATA,etc. The information contained in this report is true to the best of my knowledge. <br /> ON STODOLA WELL DRILLING CO. , INC. <br /> Ll c se Business Nawe - L,g;_orReg.No. 27172 <br /> 9-29-00 <br /> rATithorized _ tiv Signature Date <br /> Duane Matheve 4-25-00 <br /> 6 3 913 5 Name of Driller Date <br /> LOCAL COPY HE-01205.07(Rev.2/99) <br />