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� <br /> WELL L�ATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIOUE WELL NO. <br /> '_ . CountyName WELL AND BORING RECORD 6 2 4 9 0 9 <br /> �. <br /> ' H@IIA@p�ll Minnesofa Statutes Chapter 103/ <br /> Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date WoAc Completed :_ - <br /> 0='OIIO 217 23 08 ,�. ,�. ,�. 272• n 4-29-� <br /> House Number,Street Name,City,and Zip Code of Wetl Location or Fre Number DRILLING METHOD <br /> 3286 Northahore Drive Orono, Mn. 5539 � CableTool C� Driven ❑ Dug <br /> ❑ Auger {9 Rotary ❑Jeried <br /> Show e�cacl bcation of welt in section grid with'X'. Sketch map of well lacation. ❑ <br /> Showing property lines, <br /> roads and bulidings. DRILLING FLUID WELL HYDROFRACTURED? ❑YES C NO <br /> i � N � , Bentonf te FROM ft.to ft. <br /> -i -�- -i- -� <br /> USE ❑ Monitoring O Heating�Cooling <br /> i i i i �7 Domestic <br /> �V _J_ _4_ _L ❑ Community PWS ❑ Industry/Commercial <br /> ❑ �RI �IWI <br /> � � � � F�, � ❑ Noncommunity PWS p Remedial <br /> w E �v O Environ.Bore Hole <br /> � i � i T � O Dewatering ❑ <br /> -r -�- -r- -r <br /> � � � � yz� CASIN� Drive Shoe? Yes ❑ No HOLE DIAM. <br /> _i_ _1_ _L_ _�_ I Steel �Threaded ❑Welded <br /> 1 � Plastic ❑ <br /> s <br /> f-_'"'''°—� <br /> CASING DIAMETER WEIGHT <br /> PROPERTY OWNER'S NAME Robert Waade S.- Associat 84 �n.to 247 ft, l i �bs,m � 'i��30 n <br /> in.to ft. Ibs./ft. �in.t�pit. <br /> Property owners mailing address'rf different than well location address indicated above. in.to tt. IbsJft. 3 �ap Z 2 <br /> SCREEN OPENHO�E�7 27�f <br /> � ..�.�� Make �� from tt.to � ft. <br /> TYPe Diam. <br /> 5240 Nolan Drive SIoUGauze Length <br /> Mfnnetonka, MN. 55343-4123 set►�nNee� tt.and tt. FITTINGS: <br /> STATIC WATER LEVEL <br /> WELL OWNER'S NAME 45 ft.�below ❑above land suAace Date measured 4�29-9 <br /> PUMPING LEVEL(below land eurtace) <br /> Well owner's mailing address if di(terent than property owner's address indicated above. 1 ZO ft. after � hrs.pumping 60a i r g.p.m. <br /> �WELLHEADCOMPLETION �itevater <br /> ] Pitleas adapter manufacturer Model <br /> ❑ Casing Protection � 12 in.above grade <br /> O At-grade(Environmental Welis and Borings ON�Y) <br /> GROUTING INFORMATION <br /> Well grouted4 C�Yes � No <br /> HARDNESS OF Grout Material ❑ Neatca ment ❑ Bentonite ❑ Concrete �Hi h Solids BentonKe <br /> GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO n 9 <br /> from v to 3 0 ft, ���ds�] bags <br /> �!laY B�,'Ow�r ,,S 0� i � , hom to ft. ❑ yds. ❑ bags <br /> ��om to n. ❑ yds. ❑ bags <br /> S�ACl BI�OYI� S I 8� 6 �NEAR BT SOURCE OF CONAT/�/MINATION�',/l �� t G <br /> � reec f+��/�j,• airection rype <br /> Well disiMected upon completion? � Yes ❑ No <br /> Ciay Grep S 63� 95� <br /> PUMP 7��,�99 <br /> 5and Grep S 95' 10 �� Nol instelled o���ue <br /> Manufadurers name <br /> Clap xocks (s�,'@II A 1�0� Z3 •Model number 01 6�268 HP�Volts 23� <br /> � <br /> Length of drop pipe tt. Capacity 1 8 g.p.m. <br /> Shale Sandeto e �it S 235• L4 �Type:-D Submersible ❑ L.S.Turbine ❑ Reciprocatfng ❑Jet ❑ <br /> ABANDONED WELLS �G <br /> Sandatone Grey Kh te M ��� ��^ Does property have any not in use and not sealed well(s)? ❑ Yes TJ No <br /> � <br /> VARIANCE <br /> Was a variance granted from the MDH for this well? O Yes � No TNM <br /> WEIL CONTRACTOR CERTIFICATION <br /> Use a second aheet,i/needed This weil was drilled under my supervision and in axordance wilh Minnesota Rules,Chapter 4725. <br /> REMARKS,ELEVATION,SOURCE OF DATA,BtC. The infortnation contained in this report is true to Me best ot my knowledge. <br /> ld STODOLA XELL DRILLING CO. . INC. <br /> Licensee Busineu Name ' or Reg.No. <br /> 2-29-00 <br /> Aufhorized Repre ve Signature Date <br /> Chnek Moore 4-29-99 <br /> 6�4 9 0 9 N��,�"„�, o8`B <br /> LOCAL COPY HE-o,zos-oe cRe�.��ee� <br />