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WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO.
County Name WELL RECORD 5 2 0 2 0 6
Hennepf n Minnesota Statutes Chapter 1031
Township Name Township No. - Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed
Orono I1$N 23W 27 D� ,,SW,,, SW ,,, E 1.87 tt 2/26/93
Numerical Street Address and City of Well Lceation - n ir Numb�rr �--,-'. DRILLING METHOD
�" � � - � ❑ Cable Tool ❑ Dnven � Dug
23�0 6th AV�. N. �" ' '- -- ❑ n�9e� C�Rotary O Jetted
Show exact location of well in section grid with"X". ekh�map of well location. ❑
� ��j LSbwiing property lines,
N roads and buildings DRILLING FLUID
� � � � B�roi� quf k gel
--r- 7- -1 -1-
� �
,USE ❑ Heating/Cooling
� � i � C��Domestic ❑ Monitoring
--a- -�- - �- ❑ Industry/Commercial
yy i I E . � ❑ Irrigation ❑ Public
� � T ❑ Test Well ❑ Dewatering � Remedial
_1_ _1_ _'_ __ I ❑
, ; , '��Y 2 8 �-g�3
f-mi. CASING Drive Shce? ❑ Yes C�.No HOLE DIAM.
__I_ ' ♦
� �- ; -r- I ❑ Steel ❑ Threaded ❑ Welded
�—,m�i�.�
1 r��st� ❑
CASING DIAMEfER WEIGHT
PROPERTY OWNER'S NAME � in.to 1$2 tt. � _�} Ibs./ft. �in.to�Q_ft.
Mikai Hendersen Hom�s Inc. �^.�� ". 'bs."�. ���.�o�.
Mailing address ii dii(erent than property address indicated above. in.to R. Ibs./ft. in.to ft.
SCREEN OPEN HOLE
Make�TOttriS�ri from ft.to ft.
Type �*�irs�s acrva�-.�.`��zc••c�Diam. 7 M
SIoVGauze Leng[h
Set between ft.and ft. FITTING : �
STATIC WATER LEVEL
GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO ��Q ft. �.�5ebw ❑ above�and suAace Date measured 2�2 6
MATERIAL be
PUMPING LEVEL(bebw land surface)
y@�.�.(3W (�.'3�y �rown SOf� � 3� � ft. after 1 hrs.pumping 3� g.p.m.
WELL HEAD COMPLETION
C�.r'I V �r a y 5 O�� 3 6 1�2 L�Pitless adapter manufacturer Mode� �u .��z__
❑ Casing Protection ❑ 12 in.above grade
C�-a� � Sa�'}.C! ``,�raY sOft 142 I /9 GROUTINGINFORMATION
Well grouted? �Yes ❑ No
3$TI ty.t bz own S O f t'. �Z 9 1��] Grout Material f�Neat cement ❑ Benronite
from_3Q_to_�_R �_ ❑ yds.��ags
from_l._$Z to_3 Q_ft. ❑ yds. ❑ bags
from to ft. ❑ yds. ❑ bags
NEAREST KNOWN SOURCE OF CONTAMINATION
feet directio���_type
��'''�� g2
Well disin�ec ed upon completion? �`7es U No
PUMP
❑ Not installed Date installed 3/1/9 3
Manutadurersname A�rmotor
Model number HP�� Volls�'7 tl
Length of drop pipe Z�� ft. Capacity �� g.p.m.
Pressure Tank Capaciry
Type:�] Submersible ❑ L.S.Turbine ❑ Reciprocating ❑Jet ❑
ABANDONED WELLS
Dces property have any not in use and not sealed well(s)? ❑ Yes ',,(� No
WELL CONTRACTOR CERTIFICATION
This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725.
The infortnation contained in this report is irue to the best of my knowfedge.
Useasecondsheet,ilneeded Leut�hrzer We12 TIZC. ZQ�ZrJ
REMARKS,ELEVATION,SOURCE OF DATA,etc. Licensee Busirress Name �ic.or Reg.No.
� c,.�.__ �^
nl D
K�en Schmieg 3/17/93
Name o/Driller Date
E LOCAL COPY 5 2 0 2 0 6 HE-01205-04(Rev.5/92)