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WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. <br /> County Name WELL AND BORING RECORD 6 8 6 5 6 2 <br /> Hennepin Minnesota Statutes Chapter 1031 <br /> Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed <br /> Orono 117 23 07 148 n 10-11-02 <br /> House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD <br /> 1074 Wildhurst Trl, Orono 55364 0 Cable Tool 0 Driven El Dug <br /> ❑Auger 5erotary El Jetted <br /> Show exact location of well in section grid with"X". Sketch map of well lo .ion. 0 <br /> Showing prop-Ctiods.•.buildings. DRILLING FLUID WELL HYDROFRACTURED? (DYES <br /> N i <br /> --4/-7- water FROM ft.to ft. <br /> USE 0 Monitoring <br /> 0 CommunityPWS 0 Heating/Cooling <br /> 1 omeslic 0 Industry/Commercial <br /> u Yr V ❑ Irrigation <br /> !l ❑ Environ.Bore Hole ❑ Noncommunity PWS ❑ Remedial <br /> W e C 0 Dewatering 0 <br /> - i --� �y�, _ s.-e-.4 l t CASING Drive Shoe? 0 Yes j�}�'No HOLE DIAM. <br /> L ❑ Steel 0 Threaded0 0 Welded <br /> S <br /> I---1 Mn. <br /> CASING DIAMETER WEIGHT <br /> PROPERTY OWNER'S NAME 4 in.to-1-4A_ft. lbs./ft. 6 in.to_'0. <br /> in.to ft. - lbs./ft. in.tot. <br /> Jnhn Thomas CnatnisfF'+S4 Frames TOc. <br /> Property owner's mailing address if different than well location address indicated above. _ in.to ft. lbs./ft. in.to ft. <br /> 1161 Wayzata Blvd, 0218 SCREEN OPEN HOLE <br /> yU Make Johnson from ft.to ft. <br /> Wayzata, MN 55391 Type stainless stl Diam. �» <br /> Slot/Gauze •010 Length ,,, t 4, <br /> Set between 14Q ft.and ft. FITTINGS: 2 w x3o„ w/kp <br /> STATIC WATER LEVEL G <br /> WELL OWNER'S NAME 25 ft.j>k•llelow ❑ above land surface Date measured 10-11-02 <br /> PUMPING LEVEL(below land surface) <br /> Well owner's mailing address if different than property owner's address indicated above. 136 ft. after 1 hrs.pumping 60 g.p.m. <br /> WELL M <br /> Pitless adapterHEADCOmanufacturerPLETION vhf t eva t e r Model <br /> r jr'j c.: El Casing Protection t2 in.above grade <br /> $ .) <br /> 0 At-grade(Environmental Wells and Borings ONLY) /` <br /> GROUTING INFORMATION <br /> (:1f Y Luis iii., Well grouted? Yes 0 No <br /> HARDNEgg jy' <br /> ba Grout Material 0 Neat cement 0 Bentonite 0 Concrete igh Solids Bentonite <br /> GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO <br /> from to_30_ft. ❑ yds. *bags <br /> from 30 to4_40_ft. natural Cfls11 bags <br /> fill black soft 0 10 from to ft. ❑ yds. 0 bags <br /> NEAREST KNOWN SOURCE OF CONTAMINATION <br /> peat black soft 10 20 feet 4-4J direction type_, <br /> Well disinfected upon completion? fYes 0 No _ + a <br /> sand gray soft 20 30 PUMP <br /> ❑ Not installed Date installed 1-7-03 <br /> clay gray soft 30 135 Manufacturer's name Aermotor <br /> graysoft 148 Model number HP 1•5 Volts 23$ - <br /> sand <br /> 135Length of drop pipe 63 ft. Capacity •7 g.p.m. <br /> Type: '6a/tubmersible 0 L.S.Turbine ❑ Reciprocating 0 Jet 0 <br /> ABANDONED WELLS <br /> Does property have any not in use and not sealed well(s)? 0 Yes XIClo <br /> VARIANCE <br /> Was a variance granted from the MDH for this well? 0 Yes >10No TN# <br /> WELL CONTRACTOR CERTIFICATION <br /> Use a second sheet,if needed This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. <br /> REMARKS,ELEVATION,SOURCE OF DATA,etc. The information contained in this report is true to the best of my knowledge. <br /> Don So <br /> ul •o].ae W,�ll D llin Lsorce5,lb. Ina. 2717. <br /> 77"/9 �� �� 1-10-0 <br /> Authored Represent.,ve Signa ure Date <br /> Chuck Moore 10-11-02 <br /> 6 8 6 5 6 2 Name of Driller Date <br /> LOCAL COPY HE-01205-07(Rev.2/99) <br />