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MINNESOTA UNIQUE WELL <br />WELL OR BORING LOCATION <br />MINNhbU IA ULFAK I MrN I Ur MCHL I n <br />WELL AND BORING CONSTRUCTION RECORD <br />r �� uvn .v ��• <br />F7:8:6 0 8 2 2 <br />County Name <br />Menne in <br />Minnesota Statutes, chapter 103I <br />Township Name <br />Orono <br />Township No. <br />1 <br />Range No. <br />23 <br />Section No. <br />08 <br />Fraction (sm. — Ig.) <br />SW SW SET <br />WELUBORING DEPTH (completed) <br />$� 't. <br />DATE WORK COMPLETED <br />10/22/21 <br />GPS LOCATION — decimal degrees (to four decimal places). <br />Latitude Longitude <br />DRILLING METHOD <br />❑ Cable Tool Driven ❑ Dual Rotary <br />❑ Auger Rotary ❑ Rotasonic <br />❑ Other <br />House Number, Street Name, City, and ZIP Code of Well Location <br />1525 Minnie Ave Mound MN 55364 <br />DRILLING FLUID WELL HYDROFRACTURED? [-]Yes ®No <br />Bentonite From ft. To ft. <br />Show exact <br />location <br />of well/boring in section grid with "X" Sketch map of well/boring location. <br />Showing property lines, <br />N roads, buildings, and direction. <br />Q❑ <br />USE ® Domestic ❑ Monitoring ❑ Heating/Cooling <br />Noncommunity PWS ❑ Irrigation ❑ Industry/Commercial <br />❑Community PWS ❑ Dewatering E]Remedial <br />iF <br />! <br />w <br />_ 11 <br />l� (� <br />E T� <br />❑Elevator <br />EJ�j <br />CASING MATERIAL Drive Shoe? ❑ Yes [NNoH <br />❑ Steel El Threaded ❑Welded <br />OLE DIAM. <br />�'k Me <br />% I <br />s 1 V+OU 4— <br />EXPlastic ❑ <br />A <br />S in. Toy O ft <br />6 • 5 in. Tog 0 ft. <br />in. To ft. <br />' <br />CASING <br />Diameter Weight Specifications <br />4 in. To 80 ft. lbs./ft. <br />in. To ft. lbs./ft. <br />in. To ft. lbs./ft. <br />�- <br />t Mae <br />PROPERTY OWNER'S NAME/COMPANY NAME <br />Mark Duenowe� <br />OPEN HOLE <br />SCREEN <br />Make .�o neon From ft. To ft. <br />Type stainless Diam. <br />Property owner's mailing address if different than well location address indicated above. <br />Slot/Gauze • Length <br />Set between ft. and 89 ft. FITTINGS lead <br />STATIC WATER LEVEL 50 ft. :�] Below ❑ Above land surface <br />Date measured 10/22/21 Dry hole ElYes No <br />WELL OWNER'S NAME/COMPANY NAME <br />PUMPING LEVEL (below land surface) <br />75 ft. after 3 hrs. pumping 40 o.p.m. <br />Well/boring owner's mailing address if different than property owners address indicated above. <br />WELLHEAD COMPLETION � <br />5LPitless/adaptermanufacturer kA:kl L, VLj0 r Model <br />❑ Casing protection �kQ in. above grade <br />❑ At -grade ❑ Well House ❑ Hand Pump <br />GROUT INFORMATION (specify bentonite, cement -sand, neat -cement, concrete, cuttings, or other) <br />Material cut t inglrom 80 ToSOA�ft. E] Yds. ❑ Bags <br />Material e n t on t pRom Toy ft. — ❑ Yds. Pq Bags <br />Material From To ft. ❑ Yds. E] Bags <br />Driven casing seal From To _Bags One bag = 94 obs. cement <br />or 50 lbs. bentonite <br />GEOLOGICAL MATERIALS <br />COLOR <br />HARDNESS OF <br />MATERIAL <br />FROM <br />TO <br />1 <br />v <br />I <br />NEAREST KNOWN SOURCE OF CONTAMINATION . �n <br />Well is v feet direction from stype <br />Well disinfected upon completion? dGes E]No <br />( <br />6 <br />PUMP <br />❑ Not installed Date installedcno—! 1) <br />Manufacturer's name 45 \lX� <br />Model Number HP % Volts �\ <br />/n1► .`tl►�`1 <br />YAC- tJ,/`��i <br />(� <br />1 ' <br />Length of drop pipe tUvJ ft. Capacity 9 -p -m <br />Type: ubmersible ❑ L.S.Turbine ❑ Reciprocating ❑ Jet ❑ <br />ABANDONED WELLS <br />Does property have any not in use and not sealed well(s)? ❑ Yes No <br />VARIANCE <br />Was a variance granted from the MDH for this well? ❑ Yes 00o 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, it needed. <br />Don Stodola Well Drilling Co Inc 1691 <br />REMARKS, ELEVATION, SOURCE OF DATA, etc. <br />Licensee Business Name Lic. or Reg. No. <br />558 10/22/ <br />/Ce1I6. Fepresentative Signature Certified Rep. No. Date <br />Rob Stodola <br />LOCAL COPY <br />860822 <br />Name of Driller <br />H F -!N 9n5-1 R ! R nv.7/ 191 <br />10 #52603 <br />