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i'WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. <br /> County Name WELL RECORD 548509 <br /> F1.Ennepin Minnesota Statutes Chapter 1031 <br /> Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed <br /> Lrf�rk. 117 _ C:'9 130 12-9- .: <br /> '/. . <br /> Numerical Street Address and City of Well Location or Fire Number DRILLING METHOD <br /> 825 Glc:( Crystal. bay Road, Uronr,Mt 55391 ❑ Cable Tool ❑ Driven ❑ Dug <br /> ❑ Auger :❑ Rotary ❑ Jetted <br /> Show exact location of well in section grid with'X". Sketch map of well location. ❑ <br /> Showing property lines, <br /> N1 roads and buildings. DRILLING FLUID <br /> -_r__y_ _1-_1_ 4tot- <br /> ° �L <br /> t i x .USE ❑ Heating/Cooling <br /> Ci.Domestic ❑ Monitoring <br /> iii <br /> W ' I E "f ❑ Irrigation ❑ Public ❑ Industry/Commercial <br /> ' T '�'� ❑ Test Well ❑ Dewatering ❑ Remedial <br /> I <br /> ""^" KJ CASING Drive Shoe? ❑ Yes ❑ No HOLE DIAM. <br /> --I- - - ---i-- I 0 Steel ❑ Threaded ❑ Welded <br /> 1 [�}-Plastic ❑ <br /> 1--i no, <br /> CASING DIAMETER WEIGHT <br /> PROPERTY OWNER'S NAME L?. 1 IC: SDR-21 / 7/8 30 <br /> n.to ft. lbs./ft. in.to ft. <br /> Yerigan Construction in.to ft. lbs./ft. 6 1iry'r1_i-c <br /> Mailing address if different than property address indicated above. in.to ft. lbs./ft. in.to ft. <br /> Rt. 4 Box 385 SCREEN OPEN HOLE <br /> Isanti, 14n. 550 4CJ Make �Lf1Ll:{II from ft.to ft. <br /> Type -St ainle s Steel Diam. 415 <br /> Slot/Gauze l+, Length 1 t..i <br /> Set between 126 ft.and 130 ft. FITTINGS: <br /> STATIC WATER LEVEL <br /> GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO ii')} U4 <br /> MATERIAL _ ft. below ❑ above land surface Date measured 1 G-�-�_ <br /> PUMPING LEVEL(below land surface) <br /> Sand & Clay c 1 1('C° ft. after hrs.pumping g.p.m. <br /> 4/ELL HEAD COMPLETION <br /> `Sand 1 t)l ' 1 tl� tit Pitless adapter manufacturer Whitewater Model <br /> ❑ Casing Protection 12 in.above grade <br /> GROUTING INFORMATION <br /> Well grouted? R Yes ❑ No <br /> Grout Material ❑ Neat cement X Bentonite <br /> from U to 30 ft. 2 0 yds. bags <br /> from to ft. 0 yds. 0 bags <br /> from to ft. ❑ yds. ❑ bags <br /> NEARE/ST KNOWN SOURCE OF CONTAMINATION <br /> 1 0C type <br /> jt../6.4- 7 f`i direction SePr" ,' <br /> Well disinfected upon completion? 'I Yes ❑ No <br /> PUMP <br /> .-' -ti.. <br /> ❑ Not installed Date installed 't <br /> Manufacturer's name 0 1 1. :1.. & r°,ri:1 f 31i i:i: <br /> Model number %:(FYj fi t I:4('1 HP I`.. Volts 1, -i) <br /> Length of drop pipe ft. Capacity '' g.p.m. <br /> Pressure Tank Capacity . _r:t't ::^l lcn Gal t'i ni Zect <br /> Type: L7 Submersible ❑ L.S.Turbine ❑ Reciprocating ❑ Jet 0 <br /> ABANDONED WELLS <br /> Does property have any not in use and not sealed well(s)? ❑ Yes X No <br /> WELL CONTRACTOR CERTIFICATION <br /> This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. <br /> The information contained in this report is true to the best of my knowledge. <br /> Use a second sheet,if needed DON S°'L SI= 'S JF` DRILLING CD., INC. 27172 <br /> REMARKS,ELEVATION,SOURCE OF DATA,etc. Licensee Business Name �. Lic.or Reg.No. <br /> 1 L-9-9v <br /> . ' • A h zP ed Represents a gnature Date <br /> F.P. McMahon 12-9-94 <br /> Name of Driller Date <br /> MAS 1 1995 <br /> LOCAL COPY 5 4 85 0 9 HE-01205-04(Rev.5/92) <br /> ( - <br />