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• MINNESOTA UNIQUE WELL ' WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. County Name - WELL AND BORING CONSTRUCTION RECORD 5 1 Minnesota Statutes,chapter 1031 Uennepin Township Name Township No. Range No. Section No. Fraction(sm.—.lg.) WELL/BORING DEPTH(completed) DATE WORK COMPLETED Drono 117 23 3 3t; SUET, SW,, 185 t. 12/15/24 GPS LOCATION—decimal degrees(to four decimal places). t DRILLING METHOD Latitude Longitude ❑Cable Tool DI Driven ❑Dual Rotary ❑Auger Rotary ❑Rotasonic House Number,Street Name,City,and ZIP Code of Well Location ❑Other 2285 Webber Hills Rd, -Orono MN 55391 DRILLING FLUID WELLHYDROFRACTURED? ❑Yes +- No Show exact location of well/boring in section grid with"X." Sketch map of well/boring location. Bon t o n i t e ' From ' ft.To ft. Showing property lines, N roads,buildings,and direction. USE ®Domestic ❑Monitoring ❑Heating/Cooling --^ i 1 i l ❑Noncommunity PWS ❑Irrigation ❑Industry/Commercial ❑Community PWS ❑Dewatering ❑Remedial \A Elevator ❑ w , ET CASING MATERIAL Drive Shoe? ❑Yes No HOLE DIAM. ---4---r Ni 5� ❑Steel ❑Threaded ❑Welded '/Mile L_ ©Plastic ❑ I ' s S Diameter Weight Specifications 5 0 I �--1 Mile I in.TO 175 ft. lbs./tt. V in.To R in.To ft. lbs./ft. 6. q•� 1" PROPERTY OWNER'S NAME/COMPANY NAME coin.Td 5 ft. Dennis P?d rSon in.To ft. Ibs./ft. in.To ft. Property owner's mailing address if different than well location address indicated above. SCREEN ,y D s OPEN HOLE Make Jot1n$an From ft. To ft. stainless 4" Type 1 rtrt Diam. . Slot/Gauze "•_°10 Length 8 It Set between 1 /5 ft.and 1 8) ft. FITTINGS i lead STATIC WATER LEVEL 47 ft. Below ❑Above land surface Date measured 12/15/24 Dry hole ❑Yes 1 No . WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface)1 70 ft.after 4 hrs.pumping 30 q.p.m. Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION K Pitless/adapter manufacturer monitor Model ❑Casing protection L]12 in.above grade ❑At-grade ❑Well House ❑Hand Pump GROUT INFORMATION(specify bentonite,cement-sand,neat-cement,concrete,cuttings,or other) Material cut t i ng from 175 To 50 ft. ElYds. ❑Bags Material Dent o n i Fropm 50 To ° ft. 3 ❑Yds. Bags , HARDNESS OF Material From To ft. ❑Yds. ElBags GEOLOGICAL MATERIALS COLOR FROM TO MATERIAL Driven casing seal From To Bags One bag=94 lbs.cement or 50 lbs.bentonite - NEAREST KNOWN SOURCE OF CONTAMINATION (/11-L\_ Cla/Sand Brown. �f 1,1 w �' m 0 2 4 Well is `"� feet direction from : l..}" type I ^!f Well disinfected upon completion? ❑Yes El No Clay/Sand Gray S 24 2 PUMP 12.20.24 y 7 t ❑Not installed Date installed - Brown S 7 2 100 Manufacturer's name Shafer . Sand 1 7 y B ro$r. S 100 13-(} Model Number 105 HP 3/4 Volts 230 Sandy Ci 1 a y/G r V 1 0 Length of drop pipe ft. Capacity g.p.m. Red S 1 59 Type: Submersible ❑L.S.Turbine ❑Reciprocating Ill Jet ❑ Clay/Gravel 130 JABANDONED WELLS C f� Does property have any not in use and not sealed well(s)? ❑Yes g No Clay rab M 159 172 VARIANCE Yellow St 172 185 Was a variance granted from the MDH for this well? ❑Yes No TN# Sand - 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 Well Drilling Co Inc 1691 Licensee Business Name Lic.or Reg.No. ` t �-%- 558 12/20/24 GC&rtified Representative Signature Certified Rep.No. Date LOCAL COPY 8 7 3 5 6 Rob staC�01a 9Name of Driller ID#52603 HE-01205-18(Rev.3/19)