08-22-19 Well & Boring Construction Record

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MINNESOTA UNIQUE WELL WELL OR Bt ,G LOCATION County Name _ MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. WELL AND BORING CONSTRUCTION RECORD ifenne in Minnesota Statutes, chapter 1031 839-595 Township Name Range No. Section No. Fraction (sm. —+ Ig.) WELUBORING DEPTH (completed) DATE WORK COMPLETED �Tb_wnshipNp. Orono L 117 23 02 NE '/,SW 238 GPS LOCATION — decimal degrees (to four decimal places). Latitude Longitude DRILLING METHOD ❑ Cable Tool W1 Driven ❑ Dual Rotary [:] Auger Rotary ❑ Rotasonic ❑ Other House Number, Street Name, City, and ZIP Code of Well Location 1390 Fox St. Orono 391 DRILLING FLUID , ! WELL ye bentonite From HYDROFRACTURED? ❑ Yes o ft. To ft. Show exact location of well oring in section grid N i__ __ __ --_;__ ith "X" Sketch map of well/boring location. Showing property lines. roads, buildings, and direction. USE Domestic ❑Monitoring ❑ Heating/Cooling jF ❑ Noncommunity PWS ❑Environ. Bore Hole ❑Industry/Commercial ___ __ ___ ___-__ ❑ Community PWS ❑ Irrigation ❑ Remedial ❑ Elevator ❑ Dewatering ❑ T � CASING MATERIAL Drive Shoe. Yes ❑ No Steel Threaded E] Welded HOLE DIAM. 'h Mile t ❑ Plastic ❑ __T -- -CASING ---'- '1 S ;---{ I Mile - �fn. To _ 22St. SLfl. � in. To Q 37/0.T.To 23$t. CASING Diameter qq Weight Specifications 4 in. To 225 ft. lbs./ft. in. To ft. lbs./ft. in. To ft. lbs./ft. ra r PROPERTY OWNER'S NAME/COMPANY NAME Elevation Fames SCREE OPEN HOLE From ft. To ft. Property owners mailing address if different than well location address indicated above. 18312 Minnetonka Blvd Wayzata, MM 55391 Make �� Type stainless steel Diam. 2" I' SloVGauze .010 Length49 .j 41 Set between ft. and 29 ft. FITTING ", "! STATIC WATER LEVEL ft. ;KBelowtr❑ Above land surface Date measured — Dry hole ❑ Yes XNo WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL (below land surface) x� 220 ft. after 3 hrs. pumping 40 g.p m Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION ❑ Pitless/adapter manufacturer Model ❑ Casing protection ❑ 12 in. above grade ❑ At -grade ❑ Well House ❑ Hand Pump GROUT INFORMATION (specify bentonite, cement -sand, neat -cement, concrete, cuttings, or other) Material entoeite From 0 To 50 ft. 3 {, ❑ Yds. XBags Material Cutting From 50To 225 ft. ❑ Yds. ❑ Bags Material From To ft. ❑ Yds. ❑ Bags Driven casing seal From To Bags g -One ba 94 lbs. cement or 50 lbs. bentonite GEOLOGICAL MATERIALS COLOR FROM TO sandy clay broom LHARDNESSOF O 23 NEAREST KNOWN SOURCE OF CONTAMINATION 1 4+�3 �,z /J 1'. r'Well is Ji feet f' direction fromclay Well disinfected upon completion?Yes E] No clay/sand gray- gray soft 138 138 141 PUMPsandy 1 Q — Not installed Date installed 0 - Manufacturers name ) a Model Number HP Volts Length of drop pipe �QS ft. Capacity g.p.m clay redd brown soft 141 152 sandy clay n ;;ray tmt1,52 Ireedium C] 18 6 186 200 brown soft 2W 218 Type: XSubmersible ❑ L.S. Turbine ❑ Reciprocating ❑ Jet ❑ ABA DONED WELLS sticky shale C@ toe t]ITI sands -bone/ shale £;Cay hard 224 226 Does property have any not in use and not sealed well(s)? ❑ Yes No VARIANCE sandstone whitee soft 226 238 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, i/needed. - REMARKS, ELEVATION, SOURCE OF DATA, etc. Dan Stodola Well Drilling Co,. Toe. 1691 Licensee Business Name 1- or Reg. No. `tiff 'R presentative Signature Certified Rep. No. Date Rob Stodols LOCAL COPY 839595 Name of Driller ID #52603 HE -01205-17 (Rev. 5/17)