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MINNESOTA UNIOUE WELL WELL ORB, i ING LOCATION MINNESOTA DEPARTMENT OF HEALTH WELL AND BORING STRUCTION RECORD Minnesota Sta utes, chapter 1031 AND BORING NO. 839605 County Name Pin Township Name Township Name Orono Township No. 117 7 Range No. 23 Section No. 11 Fraction (sm. — Ig.) NNW �W , WELUBORING DEPTH (completed) 245 n. DATE WORK COMPLETED 12-30-18 GPS LOCATION — decimal degrees (to four decimal places). Latitude Longitude DRILLING METHOD ❑ Cable Tool Driven ❑ Dual Rotary ❑Auger Rotary. E] Rotasonic ❑ gjlter � * House Number, Street Name. City, and ZIP Code of Well Location 1300 Bracket t s Point Rid. Orono 55391 DRILLING FLUID WELL HYDROFRACTURED? ❑ Yes No bentonite From ft. To Show exact location y❑ of well/boring in section grid Sketch map of well/boring location. Showing property lines, road ings, and direction. N . USE Domestic ❑Monitoring ❑Heating/Cooling Noncommunity PWS ❑Environ. Bore Hole ❑ Industry/Commercial J'' �� ❑ Community PWS ❑ Irrigation ❑ Remedial ❑ Elevator ❑ Dewatering ❑ w -- ' , -- TS — iMiie� E --- "'; ' T 'h Mlle — � � CASING MATERIAL Drive Shoe? Yes E]No Steel Threaded ❑ Welded ❑ Plastic ❑ HOLE DIAM. ^ L in. To Stft. 6k in. To 1941. 37 To 24'Tt. IP CASING Diameter AL Weight Specifications 4 in. To 194 ft. lbs./ft. in. To k. lbs./ft. in. To ft. lbs./ft. PRPROPERTY OWNER'S NAMEICOMPANY NAME Welch Forsman SCREEN OPEN HOLE y q� From �# ft. To 245 It Property owner's mailing address if different than well location address indicated above. 6026 Pillabnry Ave S Minneapolis, M 55449 Make Type Length _ Slot/Gauze Length Set between ft. and ft. FITTINGS STATIC WATER LEVEL 38 ft. Below ❑ Above land surface o Dale measurts�q—31-18 Dry hole ❑ Yes XNo WELL OWNER'S NAMEICOMPANY NAME PUMPING LEVEL (below land surface) 120 ft. after 4 his. pumping 50 o.P.m. Wellfboring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION Pitless/adapter manufacturer L Model ❑ Casing protection 2 in. above grade [-]At-grade[:]Well House ❑ Hand Pump GROUT INFORMATION (specify bentonite, cement -sand, neat -cement, concrete, cuttings, or other) Material bentonite From 0 To50-- ft. 4 ❑ Yds. XBags Material L`�i tti ngs From--J(L—To194 ft. ❑ Yds. ❑ Bags Material —From—To—ft. E) Yds. E] Bags Driven casing seal From To Bags One bag = 94 lbs, cement or 50 lbs. bentonite GEOLOGICAL MATERIALS COLOR HARDNESS OF MATERIAL FROM TO NEAREST KNOWN SOURCE OF CONTAMINATION sand/cla mix soft 0 13 "'�— !' Well is ! 1aJ feet direction from '' Well disinfected upon completion? kes ❑ No��~' clay clay/sand iiffto gray SO13 medium 25 25 36 PUMP / ❑ Not installed Date installed // Manufacturers name Model Number HP � Volts a?30 Length of drop pipe—� ft. Capacity g.p.m sandy clay sand/clay gray gray —medium— soft 50 93 sandy clay shale/sandstone gray green medium hard 190 192 Sandstone rown ahard! medlium 192 245 Type: E] Submersible ❑ L.S. Turbine ❑ Reciprocating ❑ Jet ❑ ABANDONED WELLS Does property have any not in use and not sealed well(s)? ❑ Yes XNo VARIANCE Was a variance granted from the MDH for this well? ❑ Yes TN# 1XNo 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. ♦ �+,. Don Stodola Well Drilling Co• , Inc • 1691 Use a second sheet, if needed. REMARKS, ELEVATION, SOURCE OF DATA, etc. � e= �. L `J "" Licensee Business N me Lic. or Reg. No. AN 0 3 2020 ! " 9-26-19 "rtifW Rbpresenta1J4`SfgnrLr(r Certified Rep. No. Date Rob Stodol8 LOCAL COPY , 83,9605 Name of Driller IU #b'2(jW