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WELL LOCATION '` MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. <br /> County Name WELL AND BORING RECORD 621588 <br /> Henna .l n � , va`` Minnesota Statutes Chapter 1031 <br /> Township Name Township No. Range No. Section N;..y Q ction WELL DEPTH(completed) ft. <br /> Date Work Completed <br /> Orono 117 23 4U� SW,, SW SE. lib 11/6/00 <br /> House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD <br /> 790 S Old Crystal iiay onRd, Oro ❑ AugTool ❑Doter ❑ <br /> ❑ Auger EKTool <br /> 0 Jetted <br /> Show exact location of well in section grid with"X". Nyr. Sketch map of well location. 0 <br /> Showing property lines, <br /> roads and buildings. DRILLING FLUID WELL HYDROFRACTURED? ❑YES CKNO <br /> N Water <br /> W,--k FROM ft.to ft. <br /> ---- Oe I( USE 0 Monitoring 0 Heating/Cooling <br /> I '"Tht.4 domestic ❑ Community PWS 0 Industry/Commercial <br /> OMMOMIN0 Irrigation <br /> -I i 0 Noncommunity PWS 0 Remedial <br /> w r -- 0 Test Well <br /> r 1/2" CASING Drive Shoe? 0 Yes XNo HOLE DIAM. <br /> ____ r ) ❑ Steel 0 Threaded 0 Welded <br /> W CPlastic 0 <br /> s (.X <br /> 1 Mile <br /> CASING DIAMETER WEIGHT <br /> PROPERTY OWNER'S NAME 4 in.to 16 b ft. _lbs./ft. 8 into ��3773C�ft... <br /> Artnur Blair in.to ft. lbs./ft. 64 in.toJZyr. <br /> Property owner's mailing address if different than well location address indicated above. in.to ft. _lbs./ft. in.to ft. <br /> SCREEN tY OPEN HOLE <br /> Make Bigfoot from ft.to ft. <br /> Type SiO n04.Sing Diam. t* <br /> Slot/Gauze 116 1.3of Length <br /> Set between ft.and ft. FITTINGS: <br /> STAT C,WATER LEVEL � <br /> WELL OWNER'S NAME J �[ <br /> _ ft. L'below 0 above land surface Date measured 11/3/00 <br /> PUMPIIyG((,J,F�EL(below land surface) 50 <br /> Well owner's mailing address if different than property owner's address indicated above. jj ft. after hrs.pumping g.p.m. <br /> ��YpLL HEAD COMPLETION Wni tewater <br /> L'Pitless adapter manufacturer Model <br /> ❑ Casing Protection _- GA in.above grade <br /> ❑ At-grade(Environmental Wells and Borings ONLY) <br /> GROUTING INFORMATION <br /> Well grouted? ❑ 'es 0 No <br /> HARDNESS OF Grout Material 0 NBentyEite ❑ Concrete (High Solids Bentonite <br /> GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO atereat cement 1933 <br /> from to ft. 0 yds. Cbags <br /> from to ft. 0 yds. 0 bags <br /> 1til,:3O1 1 lilac: Soft 0 3 from to ft. 0 yds. ❑ bags <br /> NEA T KNOWN SOURCE Q.FyCONMI <br /> T NATION <br /> Clay Brown Med 3 15 <br /> feet "'fir direction Sewes L1 RA <br /> Well disinfected upon completion? X Yes 0 No <br /> S, /Sandy Clay Blue Het 15 d4 PUMP 1 /tTl t�V <br /> 0 <br /> ❑ Not installed Date installed <br /> Saady Clay Brawn Soft. 64 98Sta-rite <br /> Manufacturer's name <br /> Med Model number HP j/4 Volts 230 <br /> Sc1 i1 C' Mix ✓ O iA r;j 98 126 Length of drop pipe 80 ft. Capacity 10 g.p.m. <br /> Type: (Aubmersible ❑ L.S.Turbine 0 Reciprocating 0 Jet 0 <br /> ABANDONED WELLS ' <br /> Does property have any not in use and not sealed well(s)? 0 Yes Cid/go . <br /> VARIANCE <br /> Was a variance granted from the MDH for this well? ❑ Yes L'XNo <br /> WELL CONTRACTOR CERTIFICATION <br /> Use a second sheet,if needed This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. <br /> REMARKS,ELEVATION,SOURCE OF DATA,etc. The information contained in this report is true to the best of my knowledge. <br /> RES Well Drilling 27276 <br /> Licensee Business Name Lic.or Reg.No. <br /> //j l: 1 ,..._ : / ` 7-<=/oi <br /> Authorized Representative Signature Date <br /> Robert E Stodola, Jr <br /> Name of Driller Date <br /> LOCAL COPY 621588 HE-01205-06(Rev.9/97) <br />