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* — - <br /> WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. <br /> County Name WELL AND BORING RECORD 677 8 6 <br /> Hennepin Minnesota Statutes Chapter 103/ <br /> Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed <br /> n. <br /> Orono 118 23 31 335 9-30-02 <br /> House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD <br /> 420 Orchard Park R4, Orono 55356 CI Aug Tool 0 Driven 0 Dug <br /> 111 Auger Rotary 0 Jetted <br /> Show exact location of well in sectio\ nd <br /> Sketch map of well location. El <br /> Showing property lines, <br /> roads abuildings. DRILLING FLUID - WELL HYDROFRACTURED? ❑YES OHIO <br /> N ' .. bentonite FROM ft.to ft. <br /> { USE ❑ Commung ❑ I dust /Comm(/ omestic ❑ Community PWS ❑ Indust /Commercial <br /> ❑ Irrigation ❑ Noncommunity PWS ❑ Remedial <br /> w I E ❑ Environ.Bore Hole ❑ Dewatering ❑ <br /> YI CASING Drive Shoe? es 0 No HOLE DIAM. <br /> / <br /> KSteel ?threaded 0 Welded <br /> / ❑ Plastic 0 <br /> S <br /> I—I M,Iei <br /> CASING DIAMETER WEIGHT <br /> PROPERTY OWNERS NAME 4 in.to_252_ft. 31 lbs./ft. 8 in.to.30 ft. <br /> LDK Builders ZInc. in.to ft. lbs./ft. 63/4_in.t ft. <br /> Property owner's mailing address if different than well location address indicated above. ____._ _ in.to ft. lbs./ft. 3 7 ti8to..33.5. <br /> 21370 John Mills Dr, Ste 101 SCREEN ___ OPEN HOLE (! OJ <br /> P.O. Box 67 Make from 252 ft.to 335 ft. <br /> Type Diam. <br /> Rogers, MN 55374 <br /> 1 SloUoUGauze Length <br /> Set between ft.and ft. FITTINGS: <br /> STATIC WATER LEVEL <br /> WELL OWNER'S NAME 118 ft.Xbelow ❑ above land surface Date measured 9-3002 <br /> PUMPING LEVEL(below land surface) <br /> Well owner's mailing address if different than property owner's address indicated above. 250 ft. after 3 hrs.pumping 35 g.p.m. <br /> WELL HEAD COMPLETION <br /> ❑ Pitless adapter manufacturer 111h11 t eve t A r Model <br /> ❑ Casing Protection 0 12 in.above grade <br /> ❑ At-grade(Environmental Wells and Borings ONLY) <br /> + SGROUTING INFORMATION <br /> Well grouted? ? Yes ❑ No <br /> HARDNESS OF Grout Material ❑ Neat cement 0 Bentonite 0 Concrete Hi h Solids Bentonite <br /> GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO 30g <br /> * from to [ <br /> ft. 3 ❑ yds. bags <br /> clayyellow hard 28 from 30-_to 252 ft. na�fi4s1❑ bags <br /> from to ft. 0 yds. ❑ bags <br /> NEAREST KNOWN SOURCE OF CONTAMINATION <br /> clay gray soft 28 110 f•'J feet direction j`•.1a•-�. type <br /> Well disinfected upon completion? 'res 0 No <br /> sandigravel gray soft 110 160 PUMP <br /> O Not installed Date installed 10-18-02 <br /> clay/rocks gray medium 160 252 Manufacturer's name Aermotor <br /> sandstone gray hard 252 335 Model number HP 1.5 Volts 230 <br /> Length of drop pipe 147 ft. Capacity g.p.m. <br /> Type: ❑ Submersible 0 L.S.Turbine ❑ Reciprocating 0 Jet 0 <br /> ABANDONED WELLS <br /> Does property have any not in use and not sealed well(s)? 0 Yes o <br /> - • VARIANCE <br /> Was a variance granted from the MDH for this well? 0 Yes ,o TN# <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 /> t • • • • • - Dril -27172 <br /> • Li - see Busin ss Name lc.or Re .No. <br /> / AzedRepresat,-Sigfl. <br /> LV re `� ' 12-4-02—02 <br /> Chuck Moore 9-30-02 <br /> °..A 77870 Name of Driller Date <br /> g/� <br /> ro <br /> LOCAL COPY HE-01205-07(Rev.2/99) <br /> IC#140-0020 <br />