08/28/2020 - well and boring construction record

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- MINNESOTA UNIQUE WELL WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. County Natae WELL AND BORING CONSTRUCTION RECORD8 4 H Jr 4 9Minnesota Statutes,chapter 1031 'tors Din Township Name Township No. Range No. Section No. Fraction(sm.•-Ig.) WELL/BORING DEPTH(completed) DATE WORK COMPLETED Orono 117 `•_ _f 23 '!4 i'''.7 Nr1 11/44 170 n 8-25-?0 GPS LOCATION-decimal degrees(to four decimal places). DRILLING METHOD Latitude _ Longitude Li Cable Tool ❑Driven ❑Dual Rotary ❑Auger Rotary Li Rotasonic House Number,Street Name,City,and ZIP Code of Well Location LI Other DRILLING FLUID WELL HYDROFRACTURED? fl Yes o 3015 Watertown in (pro 5536 a ' Show exact location o well/boring in sec on god wit ketch map of well/boring location. bpntontilt- From ft.To ft. Showing.ro..-rty lines, N • -)ft1road in J n.direction. USE gDomestic III Monitoring ❑Heating/Cooling �. ❑I Noncommunity PWS ❑Irrigation ❑Industry/Commercial . ❑Community PWS ❑Dewatering ❑Remedial ❑Elevator ❑ w - ' - : - ' E �/ t CASING MATERIAL Drive Shoe? LI Yes XTlo HOLE DIAM. r f--- T Steel Threaded ❑Welded S Mile .-_. , ) Plastic YF ❑ ❑T 1 �4 ❑ S (�3' CASING Diameter ` Weight Specifications �/� � 1 Mile---( 1_,.....__ in.To 160 ft. lbs./ft. 8 in.To �/u�ft. PROPERTY OWNER'S NAME/COMPANY NAME in.To ft. lbs./ft. in.To 170ft. Marc & Kari Newell in.To ft. lbs./ft. in.To ft. Property owner's mailing address if different than well location address indicated above. SCREEN OPEN HOLE same Make * From ft. To ft. Type stainless stl Diam. 2* Slot/Gauze 60,15 Length � Set between 1f ft.and 170 ft FITTINGS Al�i leader STATIC WATER LEVEL 94 ft.›Below ❑Above land surface Date measuled 4820 Dry hole ❑Yes to WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) C!� 155 ft.after 2 hrs.pumping 50T q.p.m. Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION t�{.atter KPitless/adapter manufacturer WLModel ❑Casing protection ...I2 in.above grade ❑At-grade ❑Well House ❑Hand Pump GROUT 0 INFORMATION� om(specify bentonites,cement-sand,/ neat-cement,concrete,cuttings,or other) Material t>ent°niterTo 50 ft. 3 ❑Yds. Sttags Material Cllttfi r-, From 50 To 160 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 C �f NEAREST KNOWNNOSOURCE OF CONTAMINATION tt�,�.. clay brown soft 23 Well is �°� feet direction from'['-''tA`�+_, type clay ,dray soft 23 40 Well disinfected upon completion? , Yes ❑No \\\\\\ sandy clay gray medium 40 5 PUMP n clay/sand I gray soft P5 93 ❑Not installed Date installed 10-7-20 gravel/sand dark medium 93 105 Manufacturer's name Schaefer sand brown soft 105 123 Model Number HP 1.5 Volts 230 sandy clay reddish soft123 130 Length of drop pipe 126 ft. Capacity g.p.m sandy clay/gravel gray soft 130 144 Type;,Kubmersible ❑L.S.Turbine ❑Reciprocating ❑Jet ❑ sand/gravel mix medium 144 170 ABANDONED WELLS Does property have any not in use and not sealed well(s)? ❑Yes, o VARIANCE Was a variance granted from the MDH for this well? ❑Yes No 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,. c 1691 Licensee Business Name Lic.or Reg.No. ; 10-27-20 C:''fi-r'epresentati' g ature Certified Rep.No. Date LOCAL COPY 8 4 8 5 4 Rob Stodola Name of Driller ID#52603 HE-01205-18(Rev.3/19)