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�: . . _ , _ _ . . , _,.... , <br /> __ , ....� . . ..�., <br /> _ , <br /> WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. <br /> County Name WELL RECORD 5 2 0 2 0 6 <br /> Hennepf n Minnesota Statutes Chapter 1031 <br /> Township Name Township No. - Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed <br /> Orono I1$N 23W 27 D� ,,SW,,, SW ,,, E 1.87 tt 2/26/93 <br /> Numerical Street Address and City of Well Lceation - n ir Numb�rr �--,-'. DRILLING METHOD <br /> �" � � - � ❑ Cable Tool ❑ Dnven � Dug <br /> 23�0 6th AV�. N. �" ' '- -- ❑ n�9e� C�Rotary O Jetted <br /> Show exact location of well in section grid with"X". ekh�map of well location. ❑ <br /> � ��j LSbwiing property lines, <br /> N roads and buildings DRILLING FLUID <br /> � � � � B�roi� quf k gel <br /> --r- 7- -1 -1- <br /> � � <br /> ,USE ❑ Heating/Cooling <br /> � � i � C��Domestic ❑ Monitoring <br /> --a- -�- - �- ❑ Industry/Commercial <br /> yy i I E . � ❑ Irrigation ❑ Public <br /> � � T ❑ Test Well ❑ Dewatering � Remedial <br /> _1_ _1_ _'_ __ I ❑ <br /> , ; , '��Y 2 8 �-g�3 <br /> f-mi. CASING Drive Shce? ❑ Yes C�.No HOLE DIAM. <br /> __I_ ' ♦ <br /> � �- ; -r- I ❑ Steel ❑ Threaded ❑ Welded <br /> �—,m�i�.� <br /> 1 r��st� ❑ <br /> CASING DIAMEfER WEIGHT <br /> PROPERTY OWNER'S NAME � in.to 1$2 tt. � _�} Ibs./ft. �in.to�Q_ft. <br /> Mikai Hendersen Hom�s Inc. �^.�� ". 'bs."�. ���.�o�. <br /> Mailing address ii dii(erent than property address indicated above. in.to R. Ibs./ft. in.to ft. <br /> SCREEN OPEN HOLE <br /> Make�TOttriS�ri from ft.to ft. <br /> Type �*�irs�s acrva�-.�.`��zc••c�Diam. 7 M <br /> SIoVGauze Leng[h <br /> Set between ft.and ft. FITTING : � <br /> STATIC WATER LEVEL <br /> GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO ��Q ft. �.�5ebw ❑ above�and suAace Date measured 2�2 6 <br /> MATERIAL be <br /> PUMPING LEVEL(bebw land surface) <br /> y@�.�.(3W (�.'3�y �rown SOf� � 3� � ft. after 1 hrs.pumping 3� g.p.m. <br /> WELL HEAD COMPLETION <br /> C�.r'I V �r a y 5 O�� 3 6 1�2 L�Pitless adapter manufacturer Mode� �u .��z__ <br /> ❑ Casing Protection ❑ 12 in.above grade <br /> C�-a� � Sa�'}.C! ``,�raY sOft 142 I /9 GROUTINGINFORMATION <br /> Well grouted? �Yes ❑ No <br /> 3$TI ty.t bz own S O f t'. �Z 9 1��] Grout Material f�Neat cement ❑ Benronite <br /> from_3Q_to_�_R �_ ❑ yds.��ags <br /> from_l._$Z to_3 Q_ft. ❑ yds. ❑ bags <br /> from to ft. ❑ yds. ❑ bags <br /> NEAREST KNOWN SOURCE OF CONTAMINATION <br /> feet directio���_type <br /> ��'''�� g2 <br /> Well disin�ec ed upon completion? �`7es U No <br /> PUMP <br /> ❑ Not installed Date installed 3/1/9 3 <br /> Manutadurersname A�rmotor <br /> Model number HP�� Volls�'7 tl <br /> Length of drop pipe Z�� ft. Capacity �� g.p.m. <br /> Pressure Tank Capaciry <br /> Type:�] Submersible ❑ L.S.Turbine ❑ Reciprocating ❑Jet ❑ <br /> ABANDONED WELLS <br /> Dces property have any not in use and not sealed well(s)? ❑ Yes ',,(� No <br /> WELL CONTRACTOR CERTIFICATION <br /> This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. <br /> The infortnation contained in this report is irue to the best of my knowfedge. <br /> Useasecondsheet,ilneeded Leut�hrzer We12 TIZC. ZQ�ZrJ <br /> REMARKS,ELEVATION,SOURCE OF DATA,etc. Licensee Busirress Name �ic.or Reg.No. <br /> � c,.�.__ �^ <br /> nl D <br /> K�en Schmieg 3/17/93 <br /> Name o/Driller Date <br /> E LOCAL COPY 5 2 0 2 0 6 HE-01205-04(Rev.5/92) <br />