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r c • "'L WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. CountyName WELL AND BORING RECORD 6 7 3 8 8 2 Hennepin Minnesota Statutes Chapter 103! Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed Orono 117 23 7 ,. ,. ,. 335 n House Number,Street Name,City,and Zip Code ot Well Location or Fire Number DRILLING METHOD 1150 Garden Crt� �r0�� 553 4 � CableTool ❑ Driven C] Dug i i Auger �Rotary ❑ Jetted �� Show exact location of well in section grid wi "X". � Sketch ma'of well location. f l � � Showi g property lines, ---_.. _.—_.... --------- � � ro nd buildings. DRILLING FWID WELL HYDROFRACTURED? ❑YES .O N tt � N8C@C _i � i �_ i ! FROM ft.to ft. i _i_ _i_ _i {t ! ;y. USE ❑ Monitoring ❑ Heating/Cooling i i i i � , , ._,____,� � �Domestic ❑ Communiry PWS ❑ Industry/Commercial _i_ _a_ _�_ _i_ t f l Irrigation i i i i q ❑ Noncommunity PWS ❑ Remedial 9 I_7 Environ.Bore Hole ❑ Dewatering ❑ W , � � � ET � . � � _r � V2M��e � � CASING Drive Shoe? ❑ Yes No HOLE DIAM. � _i_ _i_ _i_ �.; �,�, 1 ❑ Steel ❑ Threaded ❑ Welded 1 2 - f �Piastic �! _ i- i i i � _� � . S __. __.__._.�-_`.�._.`":a'� P �-t M�ie� �I �- ._.� CASIN DIAMETER WEIGHT PROPERTY OWNER'S NAME � in.to 331 h 2�� __IbsJft. ��-in.to��3Qgtt. C 1�8�� Cudd �� an in.to ft. _ Ibs./fl. V�4 in.to-7 J J ft. Property owner's mailing address if diBerent than well location address indicated above. ._ in.to_ _ ft. IbsJft. in.to _tt. Z 7) k!a rke t r7 t+ �t e 139 SCRE� OPEN HOLE Minneat�Qil$ t7a� 55405 Make from� ft.to ft. t ! Type �� SLeeI ____Diam. _ • SIOVGauze_ ��1� __ Length �� _ _. Setbetween _ 331___fLand___3��ft. FITTINGS:�~�¢4~ �.i�„ _ r STATIq V6AAfER LEVEL �_��Q s L.V WELL OWNER'S NAME ___ __ __tt.�below ❑ above land surface Date measured PUMPIN(3L16YFL(below land surface) � .7L7 . Well owner's mailing address if different than property owner's address indicated above. _________ft. after____. ______hrs.pumping O g.p.m. �LL HEAD COMPLETION Whf t�ewa t e r Pitless adapter manufacturer_ del ❑ Casing Protection. __ _ �12 in.above grade � ❑ At-grade(Environmental Wells and Borings ONIY) GROUTING INFORMATION Well grouted? �Yes L i No HARDNESS OF Grout Materiat ❑ Neat cem ❑ Bento f�' Concrete High Solids Benronite GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO � °�� from to ft. _ ❑ yds. � bags �� ♦ p from � to��__ft.�st��bags � � C�$y ye 110� ��f t Q �v from_ to _. ft. ❑ yds. ❑ bags r NEAR2ST�KNOYJf�SOURCE OF CONT}�MINATION,_. � :� .� � , �- C�ay gr8y .g01� �� QQ -- � -�� feet %'_J�( ,.( �� 'r'' direction.--� � � type Well disinfected upon completion? �Yes ❑ No �—'4-��%C� a�— eand brown s�it 90 220 PUMP ❑ Not installed Date installed ��v� clay/sand gr8� mediw� Z� 325 Manufacturer'sname -��++�e-�—��--- Model number HP � Volts sand gray soft 2S 335 � __--- __ Length of drop pipe ft. Capaciry g.p.m. Type: Submersible �i LS.Turbine ❑ Reciprocating ❑ Jet ❑ ABANDONED WELLS Does property have any not in use and not sealed well(s)? ❑ Yes �No VARIANCE Was a variance granted from the MDH for this well? (7 Yes �No TNN WE�L CONTRACTOR CERTIFICATION Use a second sheet,if needed This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. The information contained in this report is Vue to the best of my knowledge. REMARKS,ELEVATION,SOURCE OF DATA,etc. Don Stodola Well Drilling Co., inc. 2 272 Licen ee Busines Name Lic.o�Reg.No. � '� 5-29-�2 "Autho rzetl'ReprEsent e�gna �/ /� Date __ Ghuck �foaee _ 3-12-Q2 Name of Driller Date LOCAL COPY 6 7 3 8 8 2 HE-01205-07(Rev.2/99) IC#140-0020