07-16-19 Well and Boring Construction Record

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f • •`- MINNESOTA UNIQUE WELL WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING Na Countypiene - ' WELL AND BORING CONSTRUCTION RECORD Minnesota Statutes,chapter 1031 8 3 9 5 8 9 n TownshipmNam Township No. Range No. Section No. Fraction(sm.—.Ig.) WELUBORING DEPTH(completed) DATE WORK COMPLETED 1 din" ,.• 117 '- ` 23 06 SE's 225 n. 7-16-19 GPS LOCATION—"' ecimal degrees(to four decimal places). DRILLING METHOD Latitude \dLongitude ❑Cable Tool ❑ riven ❑Dual Rotary ❑Auger Rotary ❑Rotasonic House Number,Street Name,City,and ZIP Code of Well Location r, ❑Other .....rrr�rfffff 4315 " few �, Orono 55364 DRILLING FLUII WELL HYDROFRACTURED? ❑Yes 1 No Show exact locatiph of well/boring in section grid with"X" Sketch map of well/boring location. bentonite'',_;. Froth' ft.To 01K ft. .' Showing property lines, ` N roads,buildings,and direction. USE Domestic ❑Monitoring ❑Heating/Coaling ;___ ❑Noncommunity PWS ❑Environ.Bore Hole ❑Industry/Commercial ddLCy� So Community PWS ❑Irrigation ❑Remedial Q ee �j X7 ❑Elevator ❑Dewatering ❑ w ! E T "4(`� I `(\ CASING MATERIAL Drive Shoe? ❑Yes ,No HOLE DIAM. -"' I a ❑Steel ❑Threaded ❑Welded f Mile �¢ 'Plastic ❑ ...r-"-T--------- I 1 CASIN a - 1 ,i t` Diameter Weight Specifications s ) 1 Miley in.To 215 ft. lbs./ft. 8 in.To R/!� tt. PROPERTY OWNER'S NAME/COMPANY NAME n.To ft. lbs./ft. *+(`i in.To225ft. Swanson Hoopes in.To ft. lbs./ft. in.To ft. SCREEN OPEN HOLE Property owner's mailing address if different than well location address indicated above. T 1360 Hamel Rd Make Johnson From " ft. To ' ft. C Type stainless Steel Diem. 2 Medina,, MR 55340 Slot/Gauze .010 Length 4S + 41 Set between 215 ft.and 225 ft. FITTINGS ewer f 1 __. STATIC WATER LEVEL 74 ft.x Below ❑Above land surface Date measured 7'1649 ._ Dry hole ❑Yes'No WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) 210 ft.after 2 hrs.pumping 50, q.p.m. Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION • �itless/adapter manufacturer el asing protection 1 12 in.above grade ❑At-grade p Well House ❑Hand Pump /"' GROUT INFORMATION(specify bentonite,cement-sand,neat-cement,concrete,cuttings,or other)� Material ent dteFrom 0 To 50 ft. 3 ❑Yds. Bags Material eating/I From To 2145 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 ;z l 5-*NEAREST KNOWN SOURCE OF CONTAMINATION Q-.—�. clay b medium © 22 Well is r feet direction from `=k•'F type _ti Well disinfected upon completion? A Yes ❑No sandy clay gray medium 22 1(X) PUMP J/; fine sand/ ❑Not installed Date installed /V — /9 sty clay gray sof t 100 Manufacturer's name g �!� mix medium 206 225 Model Number HP /4� Volts ta3cO YCJ4lJV 4G ,Length of drop pipe /6J5 ft. Capacity g.p.m Type: Submersible ❑L.S.Turbine ❑Reciprocating ❑Jet ❑ ABA DONED WELLS Does property have any not in use and not sealed well(s)? ❑YesNo VARIANCE T Was a variance granted from the MDH for this well? ❑Yes XNo 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. 9-26-19 C i presentative ignature Certified Rep.No. Date LOCAL COPY 8 3 9 5 8 9 Name of Driller ' Stodola ID#52603 HE-01205-17(Rev.5/17)