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MINNESOTA UNIQUE WELL <br /> WELUBORING LOCATION it MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. <br /> County Name WELL AND BORING RECORD <br /> Th73 9139..oepin Minnesota S jtptes,Chapter 1037 <br /> Towriship Name Township No. Range No. Section No. Fraction WELUBORING DEPTH(completed) DATE WORK COMPLETED <br /> Orono 117 23 02 ,/, ,/, ,/, 245 ft. 5-10-06 <br /> GPS DRILLING METHOD <br /> LOCATION: Latitude degrees minutes seconds <br /> ❑Cable Tool ❑Driven ❑Dug <br /> Longitude degrees minutes seconds ❑Auger 1otary CI Jetted <br /> House Number,Street Name,City,and Zip Code of Well <br /> Location or Fire Number ❑ <br /> 1230 Woodhill Ave, Orono 55391 DFjILLI C�[FF8LII to ;& WELL HYDROFRACTURED? El Yes Xlo <br /> Show exact location of well/boring in section grid with"X." Sketch map of well location. D� From ft.To ft. <br /> Showing property lines, USE Domestic ❑Monitoring CI Heating/Cooling <br /> N roads,buildings, <br /> I and direction. ❑Noncommunity PWS ❑Environ.Bore Hole El Industry/Commercial <br /> ""T""' ❑Community PWS ❑Irrigation ❑Remedial <br /> 1 ICI <br /> MA'yElevator ❑Dewatering ❑ <br /> ------' I e� CASING ERIAL Drip Shoe?y�SYes ❑No HOLE DIAM. <br /> W 1 i E T Steel Threaded ❑Welded <br /> l <br /> ❑Plastic ❑ <br /> /:Mile <br /> CASING <br /> 1 Diameter Weight Specifications <br /> S � � \ 4 214 11 8 30 <br /> 1 Mile I IJ+JL? C � in.to ft. lbs./ft. in.to-n-4 r"ft. <br /> in.to ft. lbs./ft. in.inpto qft. <br /> PROPERTY OWNER'S <br /> N]A�MEE/COMPANY NAME in.to ft. lbs./ft. 37 W,to 245 ft. <br /> Michael/Judy d SCREEN OPEN Hj4 245 <br /> Property owner's mailing address if different than well location address indicated above. Make From ft.To ft. <br /> same as above Type Diam. <br /> Slot/Gauze Length <br /> Set between ft.and ft. FITTINGS <br /> STATIC�IQIATER LEVEL �1 <br /> 7 ftelow ❑Above land surface Date measured <br /> PUMPING LEVEL(below land surface) <br /> WELUBORING OWNER'S NAME/COMPANY NAME <br /> 180 ft.after 3 hrs.pumping 50 g.p.m. <br /> W LL HEAD COMPLETION <br /> Well/boring owner's mailing address if different than property owner's address indicated above. ,pitless Adapter Manufacturer o el <br /> ❑Casing Protection *2 in.above grade <br /> ❑At-grade(Environmental Well and Boring ONLY) <br /> GROUTING INFORMATION <br /> Well grouted? Xes ❑No <br /> Grout materials ❑Neat cementptentorwlar� l Concrete lther <br /> From cement <br /> To .71/ ft. jOtY4is. -Kegs <br /> From To Palma' f s. ❑Bags <br /> GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO From To ft. ❑Yds. ❑Bags <br /> MATERIAL <br /> NEAREST KNOWN SOURCE OF CONTAMINATION <br /> /(TI <br /> clay yellow soft 0 12 feet ," direction -- - -- type <br /> Well disinfected upon completion? es ❑No <br /> sand brown soft 12 38 PUMP _ <br /> 60 <br /> CI Not installed Date installed '/ G <br /> clay gray soft 38 90 Manufacturer's name <br /> 90 Model Number / HP /Ka Volts `�? <br /> G <br /> gravel gray medium 110 Length of drop pipe /V I ft. Capacity g.p.m. <br /> Type: ubmersible ❑L.S.Turbine ❑Reciprocating ❑Jet ❑ <br /> clay/rocksgray medium 110 155 ABANDONED WELLS <br /> Does property have any not in use and not sealed well(s)? ❑Yes,t to - <br /> clay/sand gray medium 155 214 VARIANCE <br /> hard <br /> a variance granted from the MDH for this well? ❑Yes Jo TN# <br /> sandstone <br /> brown 214 245 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. Stodola ELEVATION,SOURCE OF DATA,etc. Don Inc.Well Drilling Co., 27172 <br /> Licensee Business Name Lic.or Reg.No. <br /> /tea-a(, <br /> ri epe native Signagr749 Date <br /> Chuck Moore <br /> LOCAL COPY <br /> 739139 Name of Driller : <br /> HE-01205-09(Rev.9/05) <br /> IC 140-0020 <br />