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MINNF.St7TA IINIt71 IF WFI I <br />WELL OR BORING _OCATION <br />MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. <br />WELL AND BORING CONSTRUCTION RECORDg 4 4 7 81 <br />County Name <br />Hennep in <br />Minnesota Statutes, chapter 1031 <br />Township Name <br />Township No. <br />Range No. <br />Section NqW <br />raction (sm. —. Ig.) <br />WELLIBORING DEPTH (completed) <br />DATE WORK COMPLETED <br />Orono <br />118 <br />23 <br />,/Sr4F SF <br />194 .t. <br />9-24-19 <br />GPS LOCATION — decimal degrees (to four decimal places). <br />DRILLING METHOD <br />Latitude Longitude <br />❑ Cable Toolriven ❑ Dual Rotary <br />.Rotary <br />❑ Auger ❑ Rotasonic <br />❑ Other <br />House Number, Street Name, City, and ZIP Code of Well Location <br />50 Cristofori Cr1 Orono 55359 <br />DRILLING FLUID <br />bentoni <br />WELL HYDROFRACTURED? ❑ Yes Lj No <br />e <br />From ft. To <br />Show exact location <br />of well/boring in section grid w' "X" Sketch map of well/boring location. <br />Showing property lines, <br />USE Domestic ❑Monitoring E]Heating/Cooling <br />N �� roads, buildings, and direction. <br />;___ __i__ <br />__ __ ___;__ <br />❑ Noncommunity PWS ❑ Irrigation E]Industry/Commercial <br />E] Community PWS E] Dewatering E] Remedial <br />--i--- 4-- <br />---� ------ t-- - <br />❑ Elevator <br />W <br />E <br />---, <br />❑s o <br />CASING MATERIALDrive Shoe? ❑ YeThreaded Welded <br />❑ <br />HOLE DIAM. <br />T <br />Mile - <br />I <br />�teel <br />lastic ❑ <br />CASING <br />1 <br />S <br />Diamgte4r ,fprc7J Weight Specifications <br />8 50—i <br />Miley <br />(� <br />in. To ft. lbs./ft. <br />f. in. To. 10 <br />To ft. lbs./ft. <br />in. To ft. <br />PROPERTY OWNER'S NAME/COMPANY NAMEin. <br />Alexa Hansen <br />in. To ft. lbs./ft. <br />in. To ft. <br />h o cgr} OPEN HOLE <br />SCREE ftm <br />Property owner's mailing address if dilferent than well location address indicated above. <br />Make _5tai1es_steel From w ft. To ft. <br />Type 1 Diam. <br />SIOVGauze Length <br />Set betweenft. and ft7 FITTINGS X <br />STATIC WATER LEVEL 82 ft. elow El Above land surface <br />A <br />9-24-19 <br />Date measured Dry hole ❑ Yes LfNo <br />WELL OWNER'S NAME/COMPANY NAME <br />PUMPING LEVEL (below land surface) <br />180 3 30 <br />ft. after hrs. pumping g.p.m. <br />Well/boring owners mailing address if different than property owner's address indicated above. <br />V LHEAD COMPLETION <br />Pi Pilless/adapter manufacturer hVel <br />❑ Casing protection 12 in. above grade <br />❑ At -grade ❑ Well House ❑ Hand Pump <br />GROUT I ORMATION ecify benlonit ement-s neat -cement, rete, cuttings, or oth ) <br />"enton�e i� <br />Malarial tZ From 1:n ❑Yds. Bags <br />Material cutFrom To ft. ❑ Yds. ❑ Bags <br />Material From To ft. E] Yds. ❑ Bags <br />HARDNESS OF <br />GEOLOGICAL MATERIALS <br />COLOR <br />MATERIAL <br />FROM <br />TO <br />Drivencasing sea] From To Onebag=94lbs.cement <br />_Bags <br />or 50 lbs. bentonite <br />KNOI�(JJ SOURCE OF CONTAMINQTJON <br />0 <br />{� <br />claybrown <br />neditma <br />Wallfeet direction from type <br />upon completion? as ❑ No <br />T6pump <br />clay <br />gray <br />medium <br />32cted <br />cla /<_�ravel <br />brown <br />medium <br />43claay7, <br />1alled <br />-ray, mie <br />um <br />Date in- <br />isand cla <br />?r3y <br />soft <br />1 80 <br />9 <br />Manufacturer's name <br />course gravel <br />rix <br />radium <br />92 <br />IM <br />/fine snag <br />clay/fine <br />r1 ray <br />medium <br />103 <br />17' <br />Model Number HP Volts— <br />oltscla <br />Length of drop pipe ft. Capacityg.p.m <br />gravel, course <br />eqnd <br />MMX <br />mdi-Lyn <br />178 <br />19 <br />Type:ubmersible ❑ L.S.Turbine E] Reciprocating E] Jet ❑ <br />ABANDONED WELLS <br />Does property have any not in use and not sealed well(s)? ❑ Yes E4 <br />VARIANCE <br />Was a variance granted from the MDH for this well? [:]Yes Elo TN# <br />WELL CONTRACTOR CERTIFICATION <br />This well was drilled under my supervision and in accordance with Minnesota Rules, chapter 4725. <br />The information contained in this report is true to the best of my knowledge. <br />Use a second <br />sheet, i/ needed. <br />T <br />Don Stodoia tdell Drilling Co,. TnC. 1691 <br />REMARKS, ELEVATION, SOURCE OF DATA, etc. <br />Licensee Business N e or Reg. No. <br />p�Lic. <br />3 M-8-19 <br />C epresentative gibnature Certified Rep. No. Date <br />Rob Stodola <br />LOCAL COPY <br />844781 <br />Name of Driller <br />ID #52603 Ht-Ulzuo-10 (N6v.J/18) <br />