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WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. <br /> County Name WELL AND BORING RECORD 6 2 4 9 6 7 <br /> Hennepin Minnesota Statutes Chapter 1031 <br /> Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed <br /> Orono 118 23 27 202 ' 8-19-99 <br /> House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD <br /> 850 Willow Drive North Orono,Mn. 0 CableueTool 0 Drivenotar0 Dug <br /> ❑ Auger �Rotary 0 Jetted <br /> Show exact location of well in section grid with'X". 55356 Sketch map of well location. ❑ <br /> Showing property lines, <br /> roads and buildings. DRILLING FLUID WELL HYDROFRACTURED? ❑YES 0 NO <br /> " Bentonite <br /> ____ j ___ FROM ft.to ft. <br /> USE 0 Monitoring ❑ Heating/Cooling <br /> Domestic <br /> -I 1 ''. _a <br /> ❑ Irrigation ❑ Community PWS 0 Industry/Commercial <br /> 0 Noncommunity PWS 0 Remedial <br /> IN I E ❑ Environ.Bore Hole ❑ Dewatering 0 <br /> -i r r <br /> /ZMu, CASING Drive Shoe? 0 Yes ❑ No HOLE DIAM. <br /> ____ ❑ Steel 0 Threaded <br /> 0 Welded <br /> N)), x WELL �Plastic 0 <br /> S <br /> 1 Mile <br /> CASING DIAMETER WEIGHT <br /> PROPERTY OWNER'S NAME 4 0.098'198' n. SDR21 lbs./n. 7 71 3(1, <br /> Erotas Building Corp. in.to ft. lbs./ft. V in.202_ft. <br /> Property owner's mailing address if different than well location address indicated above. in.to ft. lbs./ft. in.to ft. <br /> 3436 40th Street NE SCREEN OPEN HOLE <br /> Buffalo, Kn. 55313 Make Johnson from ft.to ft. <br /> Type Stainless Steel Diam._3R <br /> Slot/Gauze ir8 Length 4' <br /> Set between in ft.and 202 ft. FITTINGS: <br /> STATIC WATER LEVEL <br /> WELL OWNER'S NAME 1101 ft. L�+y <br /> below 0 above land surface Date measured 8-19- ri <br /> PUMPING LEVEL(below land surface) <br /> Well owner's mailing address if different than property owner's address indicated above. 1 94 ft. after 2 hrs.pumping 2 5 g.p.m. <br /> WELL HEAD COMPLETION <br /> ❑ Pitless adapter manufacturer Model <br /> ❑ Casing Protection 0 12 in.above grade <br /> ❑ At-grade(Environmental Wells and Borings ONLY) <br /> GROUTING INFORMATION <br /> Well grouted? J Yes ❑ No <br /> HARDNESS OF Grout Material 0 Neat cem t 0 Betgqite ❑ Concrete 11 High Solids Bentonite <br /> GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO <br /> from to 4 v U ft. 0 yds.8 bags <br /> CLay Yel low S 0' 30 I from to ft. El yds. 0 bags <br /> from to ft. ❑ yds. 0 bags <br /> NEARFy�F T KNOWN SOURCE OF CONTAMINATION)l <br /> Clay, Gravel Grey S 30 ' 120' 4OO feet �./604-Ts^i direction ''S--- /421.67– type <br /> Well disinfected upon completion? XYes 0 No <br /> Sand, Gravel Tan S 12012021 PUMP <br /> CINot installed Date installed 11-3-99 <br /> Manufacturer's name Goulds <br /> Model number HP 1•5 Volts 230 <br /> Length of drop pipe 147 ft. Capacity g.p.m. <br /> Type:,'bmersible El L.S.Turbine 0 Reciprocating El Jet 0 <br /> ABANDONED WELLS <br /> Does property have any not in use and not sealed well(s)? El Yes No <br /> VARIANCE <br /> Was a variance granted from the MDH for this well? 0 Yes O No TN# <br /> WELL CONTRACTOR CERTIFICATION <br /> Use a second sheet,if needed 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 /> DON STODOLA WELL DRILLING CO. . INC. <br /> Licensee'usiness N. e ic.or Reg.No. 27172 <br /> Authorized Repregentlltide Signature Date <br /> fred Leiby 8-13-9 <br /> Name of Driller H E-01ate <br /> 205-06(Rev.7/98) <br /> LOCAL COPY 624967 <br />