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MINNESOTA UNIQUE WELL <br /> WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. <br /> County Name WELL AND BORING CONSTRUCTION RECORD 84 4 816 <br /> HennepinMinnesota Statutes,chapter 1031 <br /> Township Name Township No. Range No. Section No. Fraction(sm.—.Ig.) WELL/BORING DEPTH(completed) DATE WORK COMPLETED <br /> Orono 117 23 07 NW nwsE ' 165 ft. <br /> 6-5-20 <br /> GPS LOCATION—decimal degrees(to four decimal places). DRILLING METHOD <br /> Latitude Longitude ❑Cable Tool ❑Driven ❑Dual Rotary <br /> ❑Auger XRotary ❑Rotasonic <br /> House Number,Street Name,City,and ZIP Code of Well Location ❑Other <br /> 1405 Park Dr, Orono 553 L DRILLING FLUID WELL HYDROFRACTURED? ❑Yes o <br /> Show exact location of well/boring in section grid with"X" + Sketch map of well/boring location. bentonite From ft.To ft. <br /> Showing property lines, <br /> -i .1 I E._ it <br /> N { roads,buildings,and direction. USE s'Domestic ❑Monitoring ❑Heating/Cooling <br /> _______?__ _----_ .J❑o Noncommunity PWS ❑Irrigation ❑Industry/Commercial <br /> ❑Community PWS ❑Dewatering ❑Remedial <br /> ---'---- -----f--------- ❑Elevator ❑ <br /> w E CASING MATERIAL Drive Shoe? ❑Yes �Tlo HOLE DIAM. <br /> ❑Steel ❑Threaded ❑Welded <br /> S Mile „Ntlastic ❑ <br /> — CASING <br /> 9 Diameter4 Weight Specifications �/� <br /> {--1 Mile I 10.To 155 ft. lbs./ft. 8 in.To 50 ft. <br /> PROPERTY OWNER'S NAME/COMPANY NAME in.To ft. lbs./ft. in.T 65 ft. <br /> in.To ft. lbs./ft. in.To ft. <br /> Norton Homes OPEN HOLE <br /> Property owner's mailing address if different than well location address indicated above. SCREEJo. S <br /> onM <br /> 18215 45th A'V? N, Ste �} � stainless st From ft. To ft. <br /> N <br /> Plt outh, MN 55446 SIoVGauze ,15 Length 4 9 + 4 5 <br /> ' Set between 1 55 J ft.and 165,_ t.FITTINGS'? Y le <br /> STATIC WATER LEVEL 6ft.,KBelow ❑Above land surface <br /> ' Date measured 6-5-20 Dry hole ❑Yes rielo <br /> WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) <br /> 1 0ft.after hrs.pumping 35 q.p.m. <br /> Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION <br /> gPitless/adapter manufacturerttet Model <br /> ❑Casing protection ,.12 in.above grade <br /> ❑At-grade ❑Well House ❑Hand Pump <br /> GROUT INFORMATION(specifybentonite,cement-sand,neat-cement,concrete,cuttings,or other) <br />. material bentonite,. 0 To 50 ft. 3 ❑Yds. ,�}bags <br /> Material cuttings From 50 To 155 ft. ❑Yds. ❑Bags <br /> HARDNESS OF i 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 brown Idinm - (IL 27 Well is J feet N...% direction from ~t) 'Ttype- <br /> Well disinfected upon completion? 'Yes ❑No �" <br /> clay/sand gray aoft 77 52 PUMP <br /> ❑Not installed Date installed 620 <br /> . <br /> sand (fits) hrnwn soft 52 115 Manufacturer's name Schaefer . <br /> / Model Number HP 1 Volts <br /> 210 <br /> end!c'1 1y ay medium 115 138 Length of drop pipe 105 ft. Capacity g.p.m <br /> Type:gSubmersible ❑L.S.Turbine ❑Reciprocating ❑Jet ❑ <br /> sandy ei ay`grRVP1 r pddi qh ABANDONED WELLS <br /> brown media 138 153 Does property have any not in use and not sealed well(s)? ❑Yes X'No <br /> Sand PIX 'riita 153 165 VARIANCE <br /> Was a variance granted from the MDH for this well? ❑Yes A•Mo 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 /> Ion Stodola Well Drilling Cos. Inc. 1691 <br /> Licensee Business Name Lic.or Reg.No. <br /> Grp 8-3-20 <br /> di led Representative Signature Certified Rep.No. Date <br /> Rob Stodola <br /> LOCAL COPY 8 4 4 816 <br /> Name of Driller <br /> ; ,, ID#52603 HE-01205-18(Rev.3/19) ,_ <br />