09/08/2020 - well and boring construction record

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MINNESOTA UNIQUE WELL ' WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. County Name WELL AND BORING CONSTRUCTION RECORD848550 ' ., Minnesota Statutes,chapter 1031 R nn' (n - Township NaMe Township No. Range No. Section No. Fraction(sm.—.Ig.) WELL/BORING DEPTH(completed) DATE WORK COMPLETED Orono 117 23 06 !11-.7 71 SW. 150 h. 9-1-20 GPS LOCATION—decimal degrees(to four decimal places). DRILLING METHOD Latitude Longitude ❑Cable Tool ❑Driven ❑Dual Rotary ❑Auger • XRotary ❑Rotasonic House Number,Street Name,City,and ZIP Code of Well Location ❑Other 4725 Augusta St, Orono 55364 DRILLING FLUID WELL HYDROFRACTURED? _❑Yes f$No Show exact location of well/boring in section grid with"X" Sketch map of well/borin.location. !?n nt0..1 2"rs _ From ft.To ft. N is,buildings,and direction. USE Domestic ❑Monitoring ❑Heating/Cooling f" ❑Noncommunity PWS ❑Irrigation ❑Industry/Commercial ❑Community PWS ❑Dewatering ❑Remedial i I a � ❑Elevator ❑ W I •E ll� CASING MATERIAL Drive Shoe? ❑Yes '�tIlo HOLE DIAM. i T ,„..,,u,,,,,,,,,,,,„ E Threaded ❑WeldedIded h Mile TS-Plastic � CASING Diameter l Weight Specifications ..n 1 Mile I ,� 4 in.To 140 ft. lbs./ft. in.Toft. PROPERTY OWNER'S NAME/COMPANY NAME in.To ft., lbs./ft. �� in.Tol 4Q ft. !Dorton Times ITC in.To ft. lbs./ft. in.To It. Property owner's mailing address if different than well location address indicated above. SCREEN OPEN HOLE 112.15 45th Ave N, Ste T) Make JOhnson From ft. To ft. ' Plymouth, MN 55445 Type stainlAss steel Diam._ 2" SIoUGauze Ari .10 Length i # 41 Set betweel40 ft.and 150 ft. FITTINGS FITTINGS 2"x3 i. Loactoc STATIC WATERQQLEVEL/1 92 ft. Below ❑Above land surface Date measure9'R'20 Dry hole ❑Yes XNo WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) 135 ft.after 2 hrs.pumping 35 q.p.m. I Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION 1 XPitless/adapter manufacturer s'2hitewater Model ❑Casing protection g12 in.above grade ❑At-grade ❑Well House ❑Hanc Pump GROUT INFORMATION(specify bentonite,cement-sand,neat-cement,concrete,cuttings,or other) Material bent OM taFrom 0 To 50 ft. 3 ❑Yds. Bags Material Cut tin s From 50 To 140 ft. ❑Yds. ❑Bags HARDNESS OF Material From To ft. ❑Yds. ❑Bags GEOLOGICAL MATERIALS COLOR FROM TO MATERIAL Driven casing seal From To Bags One bag=94 lbs.cement or 50 lbs.bentonite NEAREST KNOWN SOURCE OF CONTAMINATION • clay brown ledium 01 24 } , - 9 Well is /✓ feet �✓` direction from type clay -gray median 29 43 Well disinfected upon completion? gYes ❑No clay/sand ray soft 43 55 PUMP clay +17'3y 'led uF 55 S0 ❑Not installed Date installed 9-22-20 sand/clay gray soft 80 89 Manufacturer's name Schaefer sand/gravel mix lima i K m R9 97Model Number HP 1.5 Volts '30 fine sand brown soft 97 136 125 sand/gmix Sok t 134.y 1.50 Length of drop pipe ft. Capacity g.p.m 1 Type:4Submersible ❑L.S.Turbine ❑Reciprocating ❑Jet ❑ ABANDONED WELLS Does property have any not in use and not sealed well(s)? ❑Yes "(No 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. Dop Stodola flell Drilling Co,. Inc. 1691 Licensee Business Name Lic.or Reg.No. '-----7" ` r':-' • _ 10-15-20 "ert ed'e.reseht.ive i.".'-ur• ' Certified Rep.No. Date Rob Stodola LOCAL COPY 8 4 855 0 Name of Driller ID#52603 HE-01205-18(Rev.3/19)