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* � � MINNESOTA UNIQUE WELL WELUBORING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. County Name WELL AND BORING RECORD 7 4 3 4 2 5 � �� n Minnesota Statutes,Chapter f031 Township Name Township No. Range No. Section No. Fraction WELUBORING DEPTH(completed) DATE WORK COMPLETED Orano I� I18 23 32 �� < ��. 20Q � I1-2-06 GPS DRILLING METHOD LOCATION: Latitude degrees minutes seconds . � '.Cable Tool � 'Driven I I Dug Longitude degrees minutes seconds �:Auger �otary I ��.Jetted House Number,Street Name,City,and Zip Code of Well Location or Fire Number � -------- ----- 355 Stubbs Bs d N Ora�o 55356 DRILLI1NG,.F,�LUID.�j WELL HYDROFRACTURED? I I Yes o Show exact location of well/boring in section grid with"X." Sket map of well location. �;l�Di�t� __ � owing property lines, From ft.To ft. N roads,buildings, USE .Domes�ic �..,Monitoring I I Heating/Cooling and direction. � :Noncommunity PWS _;Environ.Bore Hole I I Industry/Commercial -"'""" ""`- --`-- ---`- --.Community PWS �.�_Irrigation ❑Remedial � .Elevator ':Dewatering ❑ '� --'----"--� -"�-"--""'"- CASING MATERIAL Drive Shoe? I_I Yes No HOLE DIAM. � ' W � ; ; � E T � "Threaded '�. I Welded ,, , , �teel '� � � � � I � --�--'-"'-- --�----'- lastic ;. : , � � '/z Mile ; I i I i I CASING : --�-----'-- --^-- '--r- � 1 Diameter Weight Specifications S R [� t/�q p �}/�} F�—t Mile� �Y� �"^ ,� _ ,., t��'� �) � � 'T in.to l7G ft. �� Ibs./ft. �u�� C� in.to _7Vft. �{yV-��-� �`' _in.to ft. IbsJft. ___ �in.to��ft. - PROPERTY OWNER'S NAME/COMPANY NAME - in.to____ ft. Ibs./ft. _ in.to ft. �'�"� �� SCREEN�j�$� OPEN HOLE Property owner's mailing address if�,,,erent�..,..�aei�,.,�ation address indicated above. Make��Qt�i_ From___ _ft.To ft. Type .__.. _ Diam. ___ )t .. ^ � Slot/Gauze •� 0 Length � �"� Set between��ft.and ft. FITTINGS��_ � STATIC WATER LEVEL �f�� .. 1�3__ ft.�Below Above land surface Date measu��1V PUMPING LEVEL(below land surface) q WELL/BORING OWNER'S NAME/COMPANY NAME __��1_ ,ft.after Z hrs.pumping„____„L� g.p.m. � WELL HEAD COMPLETION ��aCeC � Well/boring owner's mailing address if different than property owner's address indicated above. pitless Adapter Manufadurer _ �M del____ _ , I�.Casing Protection _____________ yY12 in.above grade I.I qt-grade(Environmental Well and Boring ONLY) GROUTING INFORMATION�( Well grouted? /`Yes �. .No Grou�materials . Neat cemenj/A�Bentonite ' I Concrete I '��+�Other � From �1 To� ft. J � :Yds. ..Y�'Bags � From_�To_��ft. ��s� C:Bags ` GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO From To ft. ❑Yds. ❑Bags MATERIAL NEAREST KNOWN SOURCE OF CONTAMINATION � 7� �.s _.y , Y�, �� . �� feet . directian ��i"��type Well disinfected upon completion? J Yes f�..l No y� PUMP * `�t� �' �� .J Not installed Date installed i�l� �� t �e � Manufacturer's name ��t�r y CJ Model Number HP Volts �� I br�4�'i �f t 'i Length of drop pipe �`t� ft. Capacity__ g.p.m. Type;�Submersible =]LS.Turbine �l Reciprocating I i Je[ L; ABANDONED WELLS � � Does property have any not in use and not sealed well(s)? I J Yes �' No VARIANCE Was a variance granted from the MDH for this well? ��.Yes�!-`No TN# 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. Use a second sheet,i/needed. aN(i Stodala We12 Drilling co�� 1�a ib� REMARKS,ELEVATION,SOURCE OF DATA,eta ' -t� _.-__... - — �� - --.._. . _----- .. Licensee Business Nam Lic.or Reg.No. I L"C7"llC7 Au iz resentative Signa ure Date �k M�ore LOCAL COPY �� /� � � Name of Driller `'� � HE-01205-09(Rev.9/O5) IC 140-0020