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! �y <br /> WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. <br /> County Name WELL AND BORING RECORD Q <br /> In Minnesota Statutes,Chapter 1031 L C <br /> Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed <br /> 0=111M 116 23 32 / / y 170 n 9-20-O4 <br /> GPS DRILLING METHOD <br /> LOCATION: Latitude degrees minutes seconds <br /> Longitude degrees minutes seconds ❑Cable Tool ❑Driven ❑Dug <br /> R ❑ <br /> House Number,Street Name,City, <br /> Auger otary Jetted <br /> ,and Zip Code of Well Location or Fire Number [I E] <br /> OX <br /> 3220 Watertown Rd,, Orono DRILLING FLUID WELL HYDROFRACTURED? ❑Yes X <br /> No <br /> Show exact location of well in section grid with"X". Sketch map of well IOC64N Oratec FROM ft.TO ft. <br /> Showing property <br /> N roads and bui i USE ❑monitoring ❑Heating/Cooling <br /> Domestic ❑Environ.Bore Hole ❑Industry/Commercial <br /> Noncommunity PWS ❑Irrigation ❑Remedial <br /> --'----- --L—---`-- `� ❑Community PWS Dewatering ❑ <br /> CASING <br /> w ; e T Drive Shoe? E]Yes No OLE H DIAM. <br /> ___---_________ ❑Steel ❑Threaded 11 Welded <br /> 'h Mile Plastic ❑ <br /> 1 CASING DIAMETER WEIGHT <br /> s <br /> in.to 162 ftM <br /> . LIN lbs./ft. in.to_ t. <br /> —1 Mile 4 <br /> n.to ft. lbs./ft. in.l0 M. <br /> PROPERTY O�WNER'SNAME/COMPANY NAME in.to ft. lbs./ft. in.to ft. <br /> ru�r! FineFlomm SCREEN OPEN HOLE <br /> Property owner's mailing address if different than well location address indicated above. Make__Jobn$M FROM ft. TO ft. <br /> 1844 Wayzata Blvd, B= 815 Type ,aln esti Diam. 2" <br /> Long Lake M 55356 Slot/Gauze Length <br /> Set between j70• ft.and_jf)2_ ft. FITTINGS <br /> STATIC-NfATER LEVEL <br /> ft. below El above land surface Date measured <br /> WELL OWNER'S NAME/COMPANY NAME �� <br /> PUMPING LEVEL(below land surface)n ft.after------M hrs.pumping 35 g.p.m. <br /> WELL HEAD COMPLETION �/�` <br /> Well owner's mailing address if different than property owners address indicated above. Pitless adapter manufacturer�_�C , <br /> Casing Protection �12 in.above grade <br /> ❑At-grade(Environmental Wells and Boring ONLY) <br /> GROUTING INFORMATION <br /> Well grouted Yes ❑No <br /> Grout material Neat cement ❑Bentonite ❑Concrete XHigh Solids Bentonite <br /> from _to 30 ft. - I ❑yds. )(bags <br /> HARDNESS OF from 0 to 167 ft. -an ❑bags <br /> GEOLOGICAL MATERIALS COLOR FROM TO from to ft. <br /> MATERIAL ❑yds. [I bags <br /> NEAREST KNOWN,SOURCE OF CONTAMINATION �}.. <br /> Clap yellow �!r O �q /t 1 ✓ feet l i J direction i.�` ��- type <br /> g!� p �1/� A /f• Well disinfected upon completion Yes ❑No <br /> clay gra soft 12 100 PUMP <br /> / <br /> y� ❑Not installed Date installed <br /> gravel colored soft= 100 116 Manufacturer's name <br /> clay <br /> Model number HP ���Volts <br /> clay 'gra ,�1um 116 150 Length of drop pipe rL/L� ft. Capacity <br /> 9—Type: Submersible L]L.S.Turbine ❑Reciprocating ❑Jet L]water1and brown soft 50 170 ABA DONEDWELLS <br /> Does property have any not in use and not sealed well(s) ❑Yes No <br /> VARIANCE <br /> Was a variance granted from the MDH for this well? ❑YesNo 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. TSOn ltedola Well Drillings. Inc• 27172 <br /> LicensdBlusineame Llc.or Reg.No. <br /> Au Date <br /> Chuck pWre <br /> LOCAL COPY � 711481 Name ofDriller HE-01205-08(Rev.5/02) <br /> IC 140-0020 <br />