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<br /> MINNESOTA UNIQUE WELLS ;;`
<br /> WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO.
<br /> County Name WELL AND BORING CONSTRUCTION RECORD 8485 2 6
<br /> Tnnepin Minnesota Statutes,chapter 1031
<br /> Township Name Township No. Range No. Section No. Fraction(sm.—+Ig.) WELUBORING DEPTH(completed) DATE WORK COMPLETED
<br /> Orono 117 23 06 SE SWy.SE ,A 140 ft 7-16-20
<br /> GPS LOCATION—decimal degrees(to four decimal places). DRILLING METHOD
<br /> Latitude Longitude ❑Cable Toot . ❑Driven ❑Dual Rotary
<br /> ❑Auger otary ❑Rotasonic
<br /> House Number,Street Name,City,and ZIP Code of Well Location ❑Other Lakeview iakeview Pa kway, Orono 55364 RILLING FLUID WELL HYDROFRACTURED? ❑Yes �fJo
<br /> Show exact location of well/boring in section grid with"X.” Sketch map of Kt4H/boring lo.stiiq bentonite From ft.To ft.
<br /> Sh ing property nes,
<br /> N oad�b dings,and dir. USE `Domestic ❑Monitoring ❑Heating/Cooling
<br /> _-__ --- . ❑Noncommunity PWS ❑Irrigation ❑Industry/Commercial
<br /> N ❑Community PWS ❑Dewatering ❑Remedial
<br /> II] ❑
<br /> W ECASING MATERIAL Drive Shoe? III Yes Ago HOLE DIAM.
<br /> i --"--------- - T
<br /> ❑Steel
<br /> ❑Threaded ❑Welded
<br /> ,,.‘
<br /> h Mile lastic ❑rF----
<br /> --- I
<br /> ,", CASING
<br /> S Diameter Weight Specifications c
<br /> I- 1 Mile 4 in.To 130 ft. lbs./ft. 8 in.To 50 ft.
<br /> z_
<br /> PROPERTY OWNER'S NAME/COMPANY NAME in.To ft. lbs./ft. � in.T ' ft.
<br /> in.To ft. lbs./ft. in.To ft.
<br /> Homes omes OPEN HOLE
<br /> Property owner's mailing address if different than well location address indicated above. SCREEN
<br /> A t Make •/Vs[�1 From ft. To ft.
<br /> 1�821�5 45th N Ste D Type stailess steel Dom. 2"
<br /> ry•
<br /> Plmmouth, MN 55446 Slot/Gauze •15 Length 4' + 41
<br /> Set between 130 ft.and 140 ft. FITTINGS 2tx3' LaMar
<br /> STATIC WATER LEVEL 52 ft., Below ❑Above land surface
<br /> Date measured 716—!0 Dry hole ❑Yes$No
<br /> WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface)
<br /> r
<br /> e
<br /> 125 ft.after 2 hrs.pumping__ q.p.m.
<br /> Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION shite ter
<br /> Pitless/adapter manufacturer _ Model
<br /> ❑Casing protection A'12 in.above grade
<br /> ❑At-grade ❑Well House ❑Hand Pump
<br /> GROUT INFORMATION(specify bentonite,cement-sand,neat-cement,concrete,cuttings,or other)
<br /> Materialbent0nite From 500 To 50 ft. 3 ❑Yds. Bags
<br /> Material alt t in ;s From To 130 ft. ❑Yds. ❑Bags
<br /> HARDNESS OF Material From To ft. ❑Yds. ❑Bags
<br /> GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO Driven casing seal From To Bags
<br /> One bag94 lbs.cement
<br /> or 50 lbs.bentonite
<br /> NEAREST KNOWN SOURCE OF CONTAMINATION
<br /> clay breva medium 0 17r
<br /> Well is / r-a _feet___ ✓ C► direction from*• 'Y type
<br /> clay medium 17 4U 6 Well disinfected upon completion? Yes El No
<br /> ,Fjraly 1PUMP
<br /> clay/stand bray medium 46 84 ❑Not installed Date installed
<br /> ,�� 8-4..20
<br /> 1 cuaA (3°t Manufacturer's name Schaefer 6:K '
<br /> brown r 230
<br /> sand soft 84 t 40 Model Number HP 1.5 Volts �
<br /> INJ42
<br /> Length of drop pipe ft. Capacity g.p.m „ ,K-`''
<br /> TypeSubmersible ❑L.S.Turbine ❑Reciprocating ❑Jet ❑ W'
<br /> ABANDONED WELLS
<br /> Does property have any not in use and not sealed well(s)? ❑Yes ArNo
<br /> VARIANCE
<br /> Was a variance granted from the MDH for this well? ❑Yes_lo 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 sheet,if needed.
<br /> REMARKS,ELEVATION,SOURCE OF DATA,etc.
<br /> Don Stodola well Drill.in, Co,. Inc. 1691
<br /> Licensee Business Name Lic.or Reg.No.
<br /> , 8-4-20
<br /> 6
<br /> ertified Represdtrtatfve Signature Certified Rep.No. Date
<br /> 848526 Rob Stodola
<br /> '
<br /> LOCAL COPY 'N.---
<br /> Name of Driller
<br /> ID#52603 -01205-
<br /> 7 (Rev 3119
<br /> ..si)., _ ..
<br /> H
<br /> F
<br /> 8
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