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• <br /> MINNESOTA UNIQUE WELL <br /> WEJBORIf. LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. <br /> County Name WELL AND BORING RECORD 743419 <br /> � � Minnesota Statutes,Chapter 1031 <br /> Township Name Township No. Range No. Section No. Fraction WELLBORING DEPTH(completed) DATE WORK COMPLETED <br /> Orow 118 23 35 'i '/. '/. 150 ft. 1013-06 <br /> GPS DRILLING METHOD <br /> LOCATION: Latitude degrees minutes seconds <br /> ❑Cable Tool Driven ❑Dug <br /> Longitude degree§" minutes_ seconds_ ❑Auger *riven <br /> ❑Jetted <br /> House Number,Street Name,City,and Zip Code of Well Location or Fire Number ❑ ,; <br /> 1000 Old Long 'lake Rd, Orono 55391DRILLING LUI t5 WELL HYDROFRACTURED? ❑Yes to <br /> Show exact location of well/boring in section grid with"X." Sketch map of well location. From ft.To ft. <br /> Showing property lines, USEmestic ❑Monitoring ❑Heating/Cooling <br /> N t { .ads,buildings, 9/ 9 <br /> ; ; i '' and direction. ❑Noncommunity PWS ❑Environ.Bore Hole 0 Industry/Commercial <br /> j --' ❑Community PWS ❑Irrigation Remedial <br /> ❑Elevator ❑Dewatering ❑ <br /> T ill <br /> CASING MATERIAL Drive Shoe? ❑Yes ;o HOLE DIAM. <br /> W 1 1 E T ❑Steel ❑Threaded ❑Welded <br /> Plastic ❑ <br /> I i '/:Mile <br /> CASING <br /> 1 Diameter Weight Specifications <br /> I--1 Mile--I ,s, ' , 4 (_" 4 in.to• i � ft. 2�' lbs./ft. Mat 8 in.to ft. <br /> in.to ft. lbs/ft in.to lig)ft. <br /> PROPERTY OWNER'S NAME/COMPANY NAME in.to ft. lbs./ft. in.to ft. <br /> Strong Arm Constrzustion SCREEN juhneen OPEN HOLE <br /> Pro%rty owner's mailing address if different than well location address indicated above. Make From ft.To ft. <br /> 6583 15hStX11, ! 1160 sal mi <br /> Type Diam. <br /> 1e VSt 1 0 55124 Slot/Gauze •O O �a� Length 4� *- t <br /> l� ii�l J ,i►�3 f ri Set between 150 ,fL and 141 ft. FITTINGS rem. witp <br /> STATI ATER LEVEL <br /> 14)6 ft.Xelow ❑Above land surface Date measured lT' ' <br /> PUN=LEVEL(below land surface . <br /> WELLBORING OWNER'S NAME/COMPANY NAME170 +� <br /> ft.after 1,-a5 hrs.pumping '30 g.p.m. <br /> W LL HEAD COMPLETION <br /> Well/boring owner's mailing address if different than property owner's address indicated above. Xpitless Adapter Manufacturer -"�"�* o✓del <br /> ❑Casing:protection-: ' X2 in,attove grade <br /> ❑At-grade(Environmental Well and Boring ONLY) <br /> .„_•"' - GROUTING INFORMATION <br /> Well grouted? Yes ❑No oar[ , <br /> Grout materials ❑ V Neat cement plenton Concrete ❑Ot <br /> From To +� ft. ❑Y s fags <br /> From To I#2 ft.' ❑Bags <br /> HARDNESS OF <br /> GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO From To ft. ❑Yds. ❑Bags <br /> �4// <br /> NEAREST KNOWN SOURCE OF CONTAMINATION <br /> f Ili�,�,,,y,,,�` brow moth= 0 6 ' feet direction 0....444- <br /> Well disinfected upon completion?X/es ❑No fi +9 <br /> PUMP f <br /> claysoft 6 18 ❑Not installed Date installed / - 18"<34 <br /> /,�,�li brown <br /> y Manufacturer's name '-'. <br /> grewel/ii7LsModel Number HP Volts <br /> a <br /> clay gray medium 48 90 Length of drop pipe` ic) ft. Capacity g.p.m. <br /> # <br /> Type 6ubmersible ❑L.S.Turbine ❑Reciprocating ❑Jet ❑ <br /> ;tf l soft 900 <br /> 1 ABANDONED WELLS <br /> Does property have any not in use and not sealed well(s)? ❑Yes,$o <br /> VARIANCE <br /> Was a variance granted from the MDH for this well? ❑Yes TN# <br /> WELL CONTRACTOR CERTIFICATION !� <br /> This well was drilled under my supervision ant;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. <br /> REMARKS,ELEVATION,SOURCE OF DATA,DECEIVED Dort Std Well Drilling Co. Inc. 1691 <br /> Licensee Business Name Lic.or Reg.No. <br /> J <br /> DEC 312007 `, 3-/m c7 <br /> Aut ''ed ,.. .sen••,eSI.na iiir Date <br /> CITY OF ORONO On& Mere <br /> LOCAL COPY <br /> 7 4 3 419 Name of Driller <br /> HE-01205-09(Rev.9/05) <br /> IC 140-0020 <br />