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WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. <br /> County Name WELL AND BORING RECORD 660554 <br /> Hennepin Minnesota Statutes Chapter 1031 <br /> Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed <br /> Orono 117 23 051. 212 n 5-30-02 <br /> House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD <br /> 684 Tonkava Rd. ❑ Auger Orono 553 ❑ Cable Tool [:1Rotary ❑ Dug <br /> ❑ Jetted <br /> Show exact location of well in section grid with"X". _ Sketch map of well location. ❑ <br /> 94owigp.)roperty lines, <br /> roads a d buildings. DRILLING FLU WELL HYDROFRACTURED? ❑YES O <br /> N bentonite <br /> i FROM ft.to ft. <br /> USE ❑ Monitoring ❑ Heating/Cooling <br /> Domestic <br /> El Irrigation El Community PWS ❑ Industry/Commercial <br /> E t El Environ.Bore Hole ❑ Noncommunity PWS El Remedial <br /> w E -a s ry El Dewatering ❑ <br /> CASING Drive Shoe? ❑ Yes No HOLE DIAM. <br /> Steel ❑ Threaded ❑ Welded <br /> Plastic ❑ <br /> CASING DIAMETER WEIGHT <br /> PROOPPROPERTYOWNERS NAME iI 4 in.to 204 ft. 1,99 lbs./ft. 8 in.to 0 <br /> Denali du s t on HoInc.Inc• in.to ft. lbs./ft. in.to 2 <br /> Property owner's mailing address if different than well location address indicated above. in.to ft. lbs./ft. _in.to ft. <br /> 2600 Christian Crt SCREEAIv n OPEN HOLE <br /> 6haska s NN 55318 Make' from ft.to ft. <br /> Type stainlssfs steel Diam. _ <br /> R <br /> SIottGauze 01 n Length r 4 <br /> Set between I <br /> � ft.and�ft. FITTING 2* • <br /> STATIC�JER LEVEL <br /> WELL <br /> / 6 <br /> WELL OWNER'S NAME VV ft.11 below ❑ above land surface Date measured 5-30-01 <br /> PU��}pI(�G�LEVEL(below land surface) <br /> Well owner's mailing address if different than property owner's address indicated above. 100 ft. after 3 hrs.pumping 15 g.p.m. <br /> QV/ELL HEAD COMPLETION whf tura ter <br /> ,A Pitless adapter manufacturer Model <br /> ❑ Casing Protection 12 in.above grade <br /> ❑ At-grade(Environmental Wells and Barings ONLY) <br /> GROUTING INFORMATION <br /> Well grouted? 1J Yes ❑ No <br /> HARDNESS OF Grout Material ❑ Neat ce�g nt ❑ Benton t ❑ Concrete �Hi h Solids Bentonite I <br /> GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO from q/V to � ft. 2.1 ❑ yds.V bags <br /> /� p <br /> from '10 204 ft. natural ft&V bags <br /> cls !Drown and 0 1$ from to ft. ❑ yds. ❑ bags <br /> NEA�T_KNQWN SOURCE OF CON2p11 I 101, <br /> cls rown oft is 38 ' feet Y N� _ <br /> � <br /> r direction� ` e t type <br /> Well disinfected upon completion? Yes ❑ No <br /> clsy _�ray 50ft 38 120 PUMP <br /> /� ❑ Not installed Date installed 7•-501 <br /> sand (fine) Lown Oft 120 195 Manufacturer'snameaermotor <br /> Model number 02657 HP A Volts <br /> sand/ vel kray soft 195 212 Length of drop pipe 147 ft. Capacity g.p, . <br /> Type/Submersible ❑ L.S.Turbine ❑ Reciprocating ❑Jet ❑ <br /> ABANDONED WELLS �/ <br /> Does property have any not in use and not sealed well(s)? ❑ Yes 27 No <br /> VARIANCE <br /> Was a variance granted from the MDH for this well? ❑ Yes )(No TN# <br /> WELL CONTRACTOR CERTIFICATION <br /> Use a second sheet,i/needed This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. <br /> REMARKS,ELEVATION,SOURCE OF DATA,etc. The information contained in this report is true to the best of my knowledge. <br /> Don Stodola Well Drilling co., Inc. 2� 72 <br /> L" nsee B ess fjfa Lic.or Reg.No. <br /> 7-13-01 <br /> Authorized-Representative Signature Date <br /> Chuck Moore 5-30-01 <br /> Name of Driller Date <br /> LOCALCOPY1660554 � _ <br /> HE-01 205-07(Rev.Mill) <br /> IC#140-0020 <br />