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....._..�.__. , ... .._ . .. . _ � � � � � WELL LOCA�ION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. County Name Henne in WELL AND BORING RECORD 6 2 4 9 0 8 �� p Minnesota Statutes Chapter f031 '"�� Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed Orono lls 23 32 �,, ,. ,,, 23Z' � 4-21-99 House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD 47b0 BS side Road Oroac� NN. 5356 � CableTool ❑ Driven ❑ Dug Y � ❑ Auger �] Rotary ❑ Jetted � Show exact location of well in section grid with"X". Sketch map of well location. ❑ Showing property lines, roads and buildings. DRILLING FLUID WELL HYDROFRACTURED? ❑YES ❑NO N , , , , Bentonite FROM n.�o h. -,- -,- -,-- -,- - ; / � . ; USE ❑ Monitoring ❑ Heating/Cooling i i i i ._i,��i � -. i-� <'� f�� i�. i �,Domestic ❑ Communit PWS " _i_ _�_ _�._ _i_ � ❑ Irrigation Y ❑ Indusiry/Commercial i i i i --. ❑ Noncommunity PWS ❑ Remedial w i I I I E T l7 Environ.Bore Hole ❑ Dewatering ❑ i i i i �/2IM.ia 'J''�� CASING Drive Shoe? �Yes ❑ No HOLE DIAM. _i i _i_ _i_ � ( � �Steel �Threaded ❑ Welded � _�_ � � �,�,_,. x � ❑ Plastic ❑ �—,Mae—� jU' �� CASING DIAMETER WEIGHT PROPERTY OWNER'S NAME __�in.to__��tt. l� Ibs./ft. in.to ft. Diversified Con�truction ��.�o n. �bs.�h. �;�.,o��. Property owner's mailing address if diNerent than well location address indicated above. in.to ft. Ibs./ft. ��, 7O 1 O AXy 7 SCREEN OPEN�fHO�fL�Ef �f9 9 F 3�r• L�uls Parl�/ 17t�.�✓al�6t7 Make��r1 from LLI ft.toLJi ft. Type Diam. SIoUGauze Length Set between ft.and ft. FITTINGS: ST4T1G�p//�TER LEVEL ��1�n WELL OWNER'S NAME 1�'� h� below ❑ above land surtace Date measured � PU�P�f�yG LEVEL(below land surface� � 30 a i r Well owner's mailing address if different than property owner's address indicated above. �� ft. after � hrs.pumping g.p.m. ��:s+ �LL HEAD COMPLETION Pitless adapter manufacturer Whi tewater Model ❑ Casing Protection L�12 in.above grade . ��tiAt-grade(Environmental Wells and Borings ONLY) �GROUTING INFORMATION Well grouted? �Yes ❑ No HARDNESS OF Grout Material ❑ Neat cement ❑ Bentonite ❑ Concrete �(1 High Solids Bentonite GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO from Q to 3O ft. 3 ❑ yds. �bags trom to ft. ❑ yds. ❑ bags C18 7@Il M 3 0• 2? r�om �o x. ❑ yds. ❑ bags NEAREST KNOWN SOURCE OF CONTAMINATION Cla Gre S `� 1 3� `—` � feet y;'�% �� direction - ' ' /*.. rype Well disinfected upon completion? Ll►Yes ❑ No Sand Gre S 35• 190 PUMP ❑ Not installed Date installed 6�Z��7 Cl$ S$n(� BrQ'Kn [K 90� Z 1 5 Manufacturer's name ��d Jacket Model number HP��Vfolts 230 Shale sa�f�8�+0 @ �ed B ��n M 1 5� ZZS Length of drop pipe �'��* R. Capacity 1` g.p.m. �f� Type: C'rSubmersible ❑ L.S.Turbine ❑ Reciprocating ❑ Jet O Sandstone Cir� ite H i�� Z qgANDONEDWELLS P Does property have any not in use and not sealed well(s)? ❑ Yes LPNo VARIANCE Was a variance granted from the MDH for this well? ❑ Yes C�'No TN# W�LL CONTRACTOR CERTIFICATION Use a second sheet,if needed This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. REMARKS,ELEVATION,SOURCE OF DATA,etc. The information contained in this report is true to the best of my knowledge. D�N S'PODULA WBLL DRILLZAtG CO3 , IAte. Licen e Busines am ic.or Reg.No. 2?1 7 Z �,�,,,� 9-13-99 \ Authorized Representative Signature Date C�iuck Maor� 4-21-99 Name of Driller Date LOCAL COPY 6 2 4 9 0 8 „E_o,2o5_�,Re�.,,�8,