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WELL LOCATION MINdNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. <br />County Name WELL AND BORING RECORD 596669 <br />Hennepin Minnesota Statutes Chapter 1031 <br />Township Name Townshi No Ran No Secton No Fraction WELL DEPTH (comvlete4) Date Work Completed <br />Orono 11� �? )6 2001 a 10-15-97 <br />HITm r. Street Ndmo, City, and Zip Code of Well Location or Fire Number DRILLING METHOD <br />t 'ernda le Road North oro n, Mn. Cable Tool Driven ❑ Dug <br />Auger I :Aolary n Jetted <br />Show exact location of well rn section god with'%' Sketch map of well location <br />rt lines. <br />roads an s DRILLING FLUID WELL HYDROFRACTJRED'r YES J440 <br />N Benronj. <br />FROM n. to ft <br />USE Domestic Mondnrmg •, HeetklpK,boWlp <br />_ _ _ _ _ V ❑ hrlpaaon ; Community PWS IndustrylIC4nitnerCW <br />w ❑ Test Well watering y PWS : Remedial <br />` CASING Drrvd Shoe? Yes Xo HOLE DIAM. <br />_ _ - - _ _ L - ❑Steel ; ; Threaded Welded <br />1 Y <br />5LL [7 Plastic ❑ __-_----- <br />CASING,DIAMETER 1 C, 2 WGT 1 • 9 a 3 <br />PROPERTY OWNER'S NAME 4 �, b 7_ M. _ Ibsfi. p lb <br />Lauer Hones ----fn.b_ —ff. _ bsA1. —r�4-_-26 <br />Property owners mailing address it different than well'ocaton address indicated above. in. to _ fl. ... IDs.AL m. to __. _. ft <br />'%UJ rerndale Road N. SCREEN _— en OPEN HOLE <br />Wayzata, MN.55391 Make from_. _ _ Ilb__ ft <br />Type 9� Steel own. <br />SWIRu=e -__- I U // �I Lwgth IS <br />Selbetween _„__192 M.alw 200-hTTI . FINGs.2____"- 3" <br />STATIC WATER LEVEL <br />WELL OWNER'S NAME �) t' <br />ft Qi below U abbVa Wad e1M1aCe Date measured 7 �-��.= 1 <br />PUMPING ALEVEL (below land surface) <br />Well owner's mailing address if dalerenl than property, owner's address indicated above _ - �.'l�h. after �_._ _ - his pumping y, +. _ _ g p m <br />WELL HEAD COMPLETION <br />A Nmessadapisrmanufactwer-Whi_tewater _ Model _ <br />❑ Casing Protection i4 12 in above grade <br />r) At -grade (Environmental Wells and Borings ONLY) <br />GROUTING INFORMATION <br />Well grouted? X'. Yes No <br />HARDNESS OF Grout Material Neat cem t Benl . Concrete Solids Bentonee <br />GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO °oV - X <br />Iron _._b R _ ❑ yds bags <br />Irom _ to IL ._ ❑ - be <br />Topsoil Brown S :) 1 21 from _ b fL — ❑ yds hags <br />NEAR t��SOURCE OF CO AMIN T N — <br />Clay S.,nd Brown S 2' 25 i� feet dirMlon`Sf T� <br />Walldlwlected upon completion? A Yet ❑ No <br />Clay brown S 25 6b pump 1-2-98 <br />17 Nol installed Date installed <br />Clay Rocx!, Grey S 60 130 Manufacturers nartJe6�Goulds <br />Model number -_--_ HP L J V <br />Send Grev M 13(} tUu 1'75 - --- -- <br />- Length d drop p" n Cap" y.p.m. <br />Type: 9 Subw4r$W ❑ L S Turbine Reciprocahrg ❑ Jet ❑ <br />— -- ABANDONED WELLS Does property have any not m use and not sealed welds)? ElYes Aft. <br />VARIANCE <br />Was a variance grar ;ed from the MOH for this wain Yes i ' 4. <br />WELL CONTRACTOR CERTIFICATION <br />Use a eeodrd slaw. it needed This well was drilled under my supervision and in accordance with Minnesota Rules Chapter 4725 <br />The information contained in Ihis report is true to the best of my knowledge <br />REMARKS, ELEVATION, SOURCE OF DATA, etc. (jUN STODC)T-A.. WLLI, MILLING CO. INC . <br />, <br />Lbansaw AraMwaa Name LAc. a Ap. No L 7 l .' <br />APR 1 .3 1997 tChuck mocre <br />sp.iafun, <br />Name rN.Mller ..____. faa _. . <br />LOCAL COPY F59 6 6 6 9 1 NE-M 28546(Nw. Win) <br />KP <br />