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WELL LOCATION <br />Cooijty Narr Hennepin <br />MINNESOTA DEPARTMENT OP HEALTH <br />WELL RECORD <br />Minnesota Statutes Chapter 1031 <br />MINNESOTA UNIQUE WEU NO. <br />536243 ’’ <br />Township Name <br />Orono <br />Township No Range No S«lK)n No.Fraction WELL DEPTH (complelw))Dale Work Completed <br />117 23 C3 7. 7. 7.K.1'2-1 [1-94 <br />Numerical Street Aridress and City of Well Location <br />2240 Abingdon Way Qruno, Nn. <br />or Fire Number <br />Show exact location of well in section grid with *X* <br />N <br />*-r- <br />• <br />--1-- <br />1 <br />. a . <br />1 <br />• <br />-l- <br />1 <br />1 <br />1 <br />1 <br />..a..f <br />1••-I-•.• <br />..1. <br />••I <br />t Sketch map of wen location <br />Showing property lines, <br />roads and buildings <br />DRILLING METHOD <br />□ Cable Tool <br />□ Auger□ _____ <br />□ Driven <br />a Rotary <br />□ Dug <br />□ Jetted <br />DRILLINGFI <br />c <br />T <br />'<• m <br />1 <br />.USE <br />X! Domestic <br />□ irrigation <br />n Tost Well <br />□ Monitoring <br />□ Public <br />□ Dewatering <br />D Heating/Cooling <br />□ Industry/Commercial <br />□ Remedial <br />□ _________ <br />CASING <br />^ Steel <br />n Plastic <br />Drive Shoe? ^ Yes <br />□ Threaded <br />□ ___ <br />n No <br />n <br />PROPERTY OWNER'S NAME <br />Tony Eic^ CXjrpsny <br />Mailing address if different than property address indicated above <br />4100 Berkshire Lano <br />Plymc4it_h, fto.S5446 <br />CASING DIAMETER <br />__4__„ <br />___________m to „ <br />___________m to _ <br />WEIGHT <br />L.ft <br />— ft <br />_.»t . t)S /Tt. <br />SCREEN <br />Make “Jonnscji <br />Stalhli^^rSteel <br />HOLE DIAM <br />y//m.toi_.fl. <br />3n tol <br />__in. to _ <br />OPEN HOLE <br />__ft.to_ <br />Type _________D«m. <br />SloVGauze_________li)____________________Length______ <br />Set between ‘ti:j_ft and_li4.__ft FITTINGS:. <br />GEOLOGICAL MATERIALS COLOR HARDNESS OF <br />MATERIAL FROM <br />STATIC LEVEL <br />. ft. . IQielow n above land surface Date measured. <br />2-15-91 <br />Clay S Sonri (;•PUMPING LEVEL (below land 8u.-face) <br />__________________ft after______, hrs pumping __gpm. <br />Sand WELL HEAD COMPLETION <br />^ j Pitless adapter manufacturer „ <br />’ Casing Protection__________ <br />Wtiitewuter Model <br />„X] 12m above grade <br />GROUTING INFORMATION <br />Woligrouted? X ves □ No <br />Grout Material r: Neat cement rXBentonite <br />from___to_________ft. <br />from._________to ______ _ ft. <br />from ___ to ft <br />_ □ yds. CX^ <br />□ yds. □ bags <br />__n yds. n bags <br />w '1^ ^ <br />NEAREST KNOWN SOURCE OF C .^TAMINATION^ <br />/QO^_____feet_____________________^direction <br />Well dismlocted upon completion? R Yes j No <br />Date installed <br />PUMP <br />; 1 Not installed <br />Manufacturers name <br />Model number __ <br />Length of drop pipe <br />Pressure Tank Capacity <br />Type X: Submersible i ] L.S Turbme 11 Reciprocating i j Jet □ <br />j-2y-yA ‘ <br />■TTLii^i. S Wblling <br />HP 230 <br />Ti30l »g'cT _gp.m. <br />■ — <br />-1. <br />ABANDONED WELLS <br />Does properly have any not in use and not sealed well(s)'» ! ) Yes <br />Use a second sheet, it needed <br />WELL CONTRACTOR CERTIFICATION <br />This well was drilled under my supennsion and m accordance with Minnesota Rules. Chapter 4725. <br />The information contained m this report is true to the best of my knowledge <br />DON S'lYJDCa./^ WELL ERILTilNG 00., INC. 27172 <br />REMARKS. ELEVATION. SOURCE OF DATA, elc Licensee Business Name <br />Name ol DnUet <br />LOCAL COPY 536243 <br />°r-i3-94 <br />HE-01205-04 (Rev. S/92)