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. �__. MINNESOTA UNIQUE WELL WELL O�i BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORWG NQ ,. County Name WELL AND BORING RECORD 7 g 19 8 8 - Minnesota Statutes,Chapter 103I F, Township Name Township No. Range No. Section No. Fraction WELUBORING DEPTH(completed) DATE WORK COMPLETED ,, ,, 331 n &-20-12 GPS DRILLING METHOD LOCATION: Latitude _ degrees __ minutes _ _ seconds Longitude __ degrees _ minutes _ _ seconds � 'Cable Tool �Driven ❑Auger �lotary � House Number.Street Name,City,and ZIP Code of Well Location Fire Number ❑Other ' IZ7O r�lif�� LrEG�C �� viaA7V S� • DRILLING FLUID WELL HYDROFRACTURED? ❑Yes o s Show exact location of well/boring in section grid with"X" Sketch map of well/boring lo 171�i��te From ft.To ft. Showing prope n — N roads,buildings, dir c�. USE �(jomestic '. .Monitoring ❑Heating/Cooling � __j___ __._____�__ ___l__ � �Noncommunity PWS I�Emiron.Bore Hole ❑Indushy/Commercial t ! ! ! ! Communiry PWS ❑Irrigation ❑Remedial ; , � � � � --=-----=------;-- ---`-- 1 ❑Elevator ❑Dewatering ❑ � " `N ; ; ; ; E� CASING MATERIAL rive Shoe? �Yes ❑No HOLE DIAM. , . , � � ` -�'-�---'- -� -' �teel �Threaded ❑Welded ' 'h Miie � �_plastic ❑ ; ; : : 1 � --.--- --r--s--.-- --.-- � : ; ; ; ; CASING Diameter Weight Specifications �-7 Mile--� ��, � in.To �7Z7 ft. Ibs./ft. 8t �_in.To_5� ft. PROPERTY OWNER'S NAME/COMPANY NAME � ____in.To___._ ft. Ibs./ft. _ �4 Qin.T��7 ft F �1.� ��'1� . in.To_. ._ _ft. IbsJft ��M To��_.ft SCREEN_ OPEN HOLE Property owner's mailing address if different than well location address indicated above. - — � Make �_ From ft. To ft. Type atainlesa �tl Diam. _ _ _ _ SIoVGauze _(��O Length_��__} [�t Set between ft.and ft. FITTINGS • 1 STATIC WATER LEVEL Measured from �-e� �� ft.[�'Below ❑Above land surface Date measured__��1� WELL OWNER'S NAME/COMPANY NAME PUMPWG LEVEL(below land surface) 27� ft.after �+ hrs pumping � q.p.m. Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION ys��At�r = Pitless/adapter manufacturer��Z ____ _._._ Model r ❑Casing protection �12 in.above grade ❑At-grade ❑Well House i_J Hand Pump GROUTING INFORMATION(specify bentonite,cement-sand,neat-cement,concrete,cuttings,or other) Matenal_��t�From V To__ JQft. � ❑Yds. �Bags Matenal�{$[liCtli 13�rj,_�To__�i�ft. ❑Yds. ❑Bags HARDNESS OF Matenal _ From To_____ft. ❑Yds. ❑Bags GEOLOGICALMATERIALS COLOR MATERIAL FROM TO Dnvencasingseal From To _ Bags NEAREST KNOWN SOURCE OF CONTAMINATION �''1 / J <_� `—� � �� / /�.�' feet r direction .�Y� ��t�-�✓ type � � �� Well disinfected upon completion? rLy Yes ❑No � PUMP :'� ❑Not installed Date ir.stalled _ _ ��`+l� =- �Y ��Y 8�Y �ft 30 240 3rh��er - - — ` Manufacturer's name ��!�� Cc � A� �� Model Number _ HP I.S Volts .2�_. � L +� Length of drop pipe 1,0� ft. Capacity __._____g.p.m a�iR1E'�� yeil�o�v y�yyj� x� `j�'� Type: Submersible ❑LS.Turbine ❑Reciprocating ❑Jet [, ___ _,_ ABANDONED WELLS �$�� te �� 3L1 �3�, Does property have any not in use and not sealed well(s)? ❑Yes �o VARIANCE Was a variance granted from the MDH for this well? ❑Yes o TN# WELL CONTRACTOR CERTIFICATION This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. The information contained in this report is true to the best of my knowledge. Use a second sheet,if needed. REMARKS.ELEVATION,SOURCE OF DATA,etc. � �t�� R_•' T �s �� \�V 1�1C; : _. -- -- — -- -- --.. __ __—___ _. _. _ . , FL[� d .. 2013 Licensee Business Name y Lic or Reg No. C�i � CITY OF ORONO ,:�" ,,, � �' 1(}-25-IZ - ert � epresentative Si ature � Certified Rep.No. Date Rd�! St4f�0�.e LOCALCOPY 7 g �g�g Name of Driller IC 140-0020 � �� HE-01205-13(Rev.11/10)