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• <br /> MINNESOTA UNIQUE WELL <br /> WELUBORING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. <br /> County Name WELL AND BORING RECORD 7 4 3 4 4 5 <br /> NIMEMMIBEINUMMI min Minnesota Statutes,Chapter 1031 <br /> Township Name Township No. Range No. Section No. Fraction WELL/BORING DEPTH(completed) DATE WORK COMPLETED <br /> Orono 117 23 07 - 335 ft. 1-5-07 <br /> GPS DRILLING METHOD <br /> LOCATION: Latitude degrees minutes seconds______ <br /> ❑Cable Tool I Driven Li Dug <br /> Longitude degrees minutes seconds ❑Auger X.Rotary ❑Jetted <br /> House Number,Street Name,City,ity,andanZip Code of Well Location or Fire Number ❑ <br /> • <br /> 1530 Orchard Beach Place, Ocean° 55364 DRILLING FLUID WELL HYDROFRACTURED? ❑Yes lewo <br /> Show exact location of well/boring in section grid with"X." Sketch map of well location. bentonite From ft.To ft. <br /> Showing property lines, <br /> N ,/ -7....A,,..„,,,41.. //i�ds,buildings, USE Domestic ❑Monitoring ❑Heating/Cooling <br /> I /(,/ ' `1.,.,�rxldirection. El Noncommunity PWS H Environ.Bore Hole ❑Industry/Commercial <br /> i ❑Community PWS E Irrigation ❑Remedial <br /> ❑Elevator Dewaterin ❑ <br /> - <br /> -i---'--'--- ---- - <br /> feel _Jve Shoe? _ Yes ❑No HOLE DIAM. <br /> W I E T ^Threaded ❑Welded-- I ❑Plastico <br /> V.Mil 1 <br /> 1 J' CASING <br /> r • <br /> Diameter Weight Specifications <br /> S 4 306 8 <br /> I— 1 Mile —I in.to ft. 11 lbs./ft. __ in.to1. 30 ft. <br /> in.to ft. lbs./ft. in.inQto �j`^'ft. <br /> PROPERTY OWNER'S NAME/COMPANY NAME in.to ft. lbs./ft. ___ Via.,to 335 ft. <br /> LY11om SCREEN OPEN HQ335 <br /> Property owner's mailing address if different than well location address indicated above. Make From ft.To ft. <br /> 842 Ivy Lane Type Diam. <br /> MN 55123 Slot/Gauze Length <br /> Set between ft.and ft. FITTINGS <br /> STATIC VAER LEVEL <br /> elow Above land surface Date measured 1-5-47 <br /> PUMPVEL(below land surfaces <br /> WELUBORING OWNER'S NAME/COMPANY NAME70 <br /> ft.after hrs.pumping g.p.m. <br /> ;ILL HEAD COMPLETION <br /> Well/boring owner's mailing address if different than property owner's address indicated above. 'itless Adapter Manufacturer Model <br /> ❑Casing Protection X12 in.above grade <br /> ❑At-grade(Environmental Well and Boring ONLY) <br /> GROUTING INFORMATION <br /> Well grouted? 1'es ❑No ,,��(( <br /> Grout materials ❑Neat cemententonitekVoncrete ❑Other <br /> From To ft. �d'#, bags <br /> net <br /> From To ft. +tads+ ❑Bags <br /> GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO From To ft. ❑Yds. ❑Bags <br /> MATERIAL <br /> NEAREST KNOWN SOURCE OF CONTAMINATION <br /> clay yellow medium 0 23 feet "� direction/ �` <br /> Well disinfected upon completion? 'YYes El No - <br /> PUMP <br /> fine sand/clay gray soft 23 194 _ ! .01 <br /> fine <br /> ry ❑Not installed Date installed <br /> fine sand gray soft 190 2.30 Manufacturer's name �~` <br /> 230 pModel Number yr�r1 y HP i�� Volts .2 3 <br /> fine sand/clay green/brown soft 298 Length of drop pipe r ft. Capacity g.p.m. <br /> 7,i`yr;Y Type '6ubmersible O L.S.Turbine ❑Reciprocating ❑Jet ❑ <br /> sandstone/shale 1 Ly <br /> yellow r , 306 WELLS <br /> Does property have any not in use and not sealed well(s)? 0 Yes 11\lo <br /> sanstone gray herd 306 335 VARIANCE y <br /> Was a variance granted from the MDH for this well? LI YesJOTJo TN# <br /> WELL CONTRACTOR CERTIFICATION I <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. Don Stodola Well Drilling Co., Inc. 1691V71 <br /> Licensee Business N e Lic.or Reg.No. <br /> //. , 71:ate- 41Ir ' ' <br /> th a Representative Slit ature Date <br /> 7 4 3 4 4 5 <br /> Jim Kohis __ <br /> Name of Driller <br /> LOCAL COPY HE-01205-09(Rev.9/05) <br /> IC 140-0020 <br />