06-29-2022 Well & Boring Construction Record

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i MINNESOTA UNIQUE WELL WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. County Name WELL AND BORING CONSTRUCTION RECORD 7 Hennepin Minnesota Statutes,chapter 1031 8 7 6 ! 0 2 Township Name Township No. Range No. Section No. Fraction(sm.—+lg.) WELUBORING DEPTH(completed) DATE WORK COMPLETED " Orono 117 23 06 NH N4 SH 140 n. 6/2 9 GPS LOCATION—decimal degrees(to four decimal places). DRILLING METHOD Latitude Longitude ❑Cable Tool ❑Driven ❑Dual Rotary ❑Auger X Rotary ❑Rotasonic House Number,Street Name,City,and ZIP Code of Well Location ❑Other ' 610 Lakeview Pk „ Orono DRILLING FLUID WELL HYDROFRACTURED? ❑Yes X No Show exact location of well/boring in section grid with"X." Sketch map of well/boring location. SentBentonite From ft.To ft. Showing property lines, roads,buildings,and direction. USE N I tbomestic El ❑Heating/Cooling r ' �`' ❑Noncommunity PWS ❑Irrigation ❑Industry/Commercial ,_ 444yyy ❑Community PWS ❑Dewatering ❑Remedial ❑Elevator ❑ w E I CASING MATERIAL Drive Shoe? ❑Yes [TNo HOLE DIAM. T I $ ❑Steel ❑Threaded ❑Welded h Mile 1 �,,.-•- ( Plastic ❑ 1 ,�,,. CASING — ' s Diameter Weight Specifications ) 1 Mae I E 4x 4 in.To 130 ft. lbs./ft. g in.To 50 ft. , in.To ft. lbs./ft. 6.5 in.Tft. PROPERTY OWNER'S NAME/COMPANY NAME IP , Brandon & laaaendra Galindo in.To ft. lbs./ft. in.To ft. SCREEN OPEN HOLE Property owner's mailing address if different than well location address indicated above. SCREEN +� Make + From ft. To ft. 7517 Cty Rd107 Type : airless Diam. Pequol t Lakes, MN 5 472 Slot/Gauze ` ' Length Set between 1 V ft.and 140 ft. FITTINGS 3 I lead STATIC WATER LEVEL 60 ft. *Below ❑Above land surface Date measured 6/2^�Q/2 Dry hole ❑'Yes 1 No , WELL O'a'/NER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) • PloitooRoues 125 ft.after 2 hrs.pumping 50 g.p.m. Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION 18215 5 t h Ave I Pitless/adapter manufacturer Wh1 t e a t o L Model Plymouth, 55446 ❑Casing protection X 12 in.above grade ❑At-grade ❑Well House ❑Hand Pump .24, ;,,, GROUT INFORMATION(specify bentonite,cement-sand,neat-cement,concrete,cuttings,or other) Material cut t Lng om 130 To 50 ft. ❑Yds. ❑Bags Materialb ton h t eom 50 To 0 ft. 3• ❑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 TOP Soil Black Soft 0 15 Well is 35 feet_ CX. direction from type Well disinfected upon completion? X Yes ❑No Clay brown Soft 15 28 PUMP Not installed Date installed 7/20/22 Clay Gray Soft 28 47 Manufacturer's name Shafer Model Number HP '' Volts 230 Cray Soft 47 77 84 Clay/SandLength of drop pipe ft. Capacity _g.p.m. 5 Type:X Submersible ❑L.S.Turbine ❑Reciprocating ❑Jet ❑ Sand/Gravel Mix Soft 77 8 ABANDONED WELLS Pine Sand Brown Soft 85 128 Does property have any not in use and not sealed well(s)? ❑Yes g No VARIANCE Sand/Gravel Mix Soft 128 140 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 Nell Drilling Co 1691 Licensee Business Name Lic.or Reg.No. '7 ,g;‘ 7, 1: ,f"" _ ...ram . 'Certified Representative Signature Certified Rep.No. Date Rob Stodola 2 LOCAL COPY_ 87 6 -0 Name of Driller ID#52603 HE-01205-18(Rev.3/19)