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s <br /> MINNESOTA UNIQUE WELL <br /> WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. <br /> County Name WELL AND BORING CONSTRUCTION RECORD 8 5 7 3 9 <br /> Minnesota Statutes,chapter 1031 <br /> Hennepin <br /> Township Name Township No. Range No. Section No. Fraction.(sm.—.Ig.) WELL/BORING DEPTH(completed) DATE WORK COMPLETED <br /> Orono 117 23 03 WJ 11'iiN v 205 ft. 6/18/21 <br /> GPS LOCATION—decimal degrees(to four decimal places). DRILLING METHOD <br /> Latitude Longitude ❑Cable Tool ❑Driven ❑Dual Rotary <br /> ❑Auger it Rotary ❑Rotasonic <br /> House Number,Street Name,City,and ZIP Code of Well Location ❑Other <br /> 2250 Longview Cir, Orono DRILLING FLUID WELL HYDROFRACTURED? ❑Yes ®No <br /> Show exact location of well/boring in section grid with"X." Sketch map of well/boring location. Bentonite From ft.To ft. <br /> Showing property lines, <br /> roads uildings,and direction. USE <br /> N Qi) i.� Domestic ❑Monitoring ❑Heating/Cooling <br /> .__�_______-_ i .+. -- ` --- ❑Noncommunity PWS ❑Irrigation ❑Industry/Commercial <br /> ❑Community PWS El Dewatering ❑Remedial <br /> i--- ---- - - >'-- ._._ ----T-T JJ} ❑Elevator ❑ <br /> S -- <br /> w E T CASING MATERIAL❑Steel Drive Shoe? ❑Yes ®No HOLE DIAM. <br /> r---- .-- I • .. ❑Threaded ❑Welded <br /> 'I We - X Plastic ❑ <br /> -r- -------------- 1 <br /> CASING <br /> ' s Diameter Weight Specifications <br /> :x' <br /> 1 Mile_ I in.To 197 k. lbs./ft. y 8 in.To 5A ft. <br /> PROPERTY OWNER'S NAME/COMPANY NAME in.To ft. lbs./ft. 6*Sin.T209 ft. <br /> in.To ft. lbs./ft. in.To ft. <br /> 'Tim Grit tner SCREEN OPEN HOLE <br /> Property owner's mil' gyt address if different than well location address indicated above. <br /> �i£tt AS EIDOY�I j <br /> Make � From ft. To ft. <br /> Type Sta ess Diam. ` 2w <br /> ' Slot/Gauze * � Length S �� -`� <br /> Set between ft.and ft. FITTINGS dial <br /> ky, STATIC WATER LEVEL g b /5 ft. ®Below ❑Above land surface <br /> Date measured 6/18/21 Dry hole ❑Yes *No <br /> WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) <br /> 190ft.after 2 hrs.pumping 50 g.p.m. <br /> Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION <br /> ❑Pitless/adapter manufacturer i Model <br /> ❑Casing protection ❑12 in.above grade <br /> ❑At-grade ❑Well House ❑Hand Pump .I <br /> GROUT INFORMATION(specify bentonite,cement-sand,neat-cement,concrete,cuttings,or other) <br /> Material eating8 From 197 To 50 ft. ❑Yds. ❑Bags <br /> Material t�toniteFrom 50 To 0 ft. 3 ❑Yds. X Bags <br /> HARDNESS OF Maters From To ft. i ❑Yds. ❑Bags <br /> GEOLOGICAL MATERIALS COLOR FROM TO <br /> MATERIAL . Drw4ncasing seal From To Bags = <br /> One bag94 lbs.cement <br /> or 50 lbs.bentonite <br /> 0 NEAREST KNOWN SOURCE OF CONTAMINATION <br /> ctay brown. 8 25 Well is ‘2kS feet P4 direction from 1} <br /> i rtype <br /> 25 81 Well disinfected upon completion? XJ Yes El No <br /> clay gray in PUMP <br /> l ❑Not installed Date installed \C\ \D-\ <br /> clay/sand gray in 81 159 Manufacturer's name <br /> Model Number HP Volts <br /> ,ravel/clay gray tn/;h 150 174 ` l <br /> t Length of drop pipe l ' ft. Capacity g.p.m <br /> Ci$y "ray in 174 197 Type:Submersible ❑L.S.Turbine ❑Reciprocating ❑Jet ❑ <br /> ! ABANDONED WELLS <br /> Sand yellow 9 f 97 209 Does property have any not in use and not sealed well(s)? ❑Yes ❑No <br /> i 9VARIANCE <br /> Was a variance granted from the MDH for this well? ❑Yes. 0 No TN# <br /> WELL CONTRACTOR CERTIFICATION <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. <br /> Don Stodola Well Drilling 1691 <br /> Licensee Business Name Lic.or Reg.No. <br /> /'rt �, lir 6/18/21 <br /> C p esentativ• ignature Certified Rep.No. Date <br /> Rob St°dole <br /> LOCAL COPY 8 5 7 03 9 <br /> Name of Driller <br /> 0162603 - HE-01205-181Rev.3/19) <br />