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W^LL LOCAt»ON <br />County Name <br />Hennepin <br />Tcwmahip Name <br />Qrono Towp^l <br />MINNESOTA DEPARTMENT OF HEALTH <br />WELL RECORD <br />Minnesota Statutes Chapter 1031 <br />MINNESOTA UNIQUE WELL NO. <br />548550 <br />Range No <br />23 <br />Section Na <br />Nwnef^ Street Address and City of WefI Location <br />25b ScAjth Brcwn Road, Orcno, tti. 5 <br />Shota exact tocaUon of laeU In sectioo gnd with 'X‘. <br />N <br />Fraction <br />24-0008 <br />or Fire Number5356 <br />•11I <br />1 <br />-f- <br />1 <br />1 <br />- A - <br />1 <br />1 <br />.A. <br />1 <br />1 1 <br />a <br />1 <br />1 V <br />I 1 • <br />1 V <br />..J....j,.1 . <br />1 1 <br />t 1 <br />9 •¥1- -J- <br />1 <br />s <br />P «. <br />1 <br />—b -— r- <br />i ••1 <br />L <br />T <br />II <br />i <br />mi. <br />Sketch map of well location <br />StKxaing property lines. <br />roa<» artd buildings. <br />O <br />3 <br />I MtJf <br />PROPERTY OWNER S NAME <br />Yerigan Crostruction <br />Mailing addrees if different than property address irKficaled above. <br />Rt. 4 Bok 385 <br />Isanti, Ml. 55040 <br />QEOLOOICAL MATERIALS <br />day <br />Clay <br />Sand, Gravel <br />Clay <br />COLOR <br />Yellow <br />Grey <br />Mix <br />Grey <br />Sand, Gravel Mix <br />HARDNESS OF <br />MATERIAL <br />S <br />FROM <br />O’ <br />'ir. I <br />22 <br />107 <br />WELL DEPTH (cofnpletw)) <br />15^ <br />DRILLING METHOD <br />□ Cable Tool <br />□ Auger <br />□ ____ <br />Date Work Completed <br />12-21-94 <br />□ Orrven <br />□jfotary <br />□ Dug <br />□ Jetted <br />DRILLING FLUID <br />.USE <br />(X Domestic <br />□ Irrigation <br />□ Test Well <br />□ Monitoring <br />□ Public <br />□ Dewatering <br />n Heatmg^Cooling <br />□ Industry/Commeroal <br />□ Remedial <br />□ _________ <br />CASINO <br />dC Steel <br />□ Plastic <br />Drive Shoe? □ Yes □ No <br />□ Threaded U Welded <br />□ _______________ <br />—m—'*sag.-2r <br />___________In. to__________ft ____________ <br />___________into__________ft. ____________ <br />______ft. ____m. to <br />. IbsJR. <br />ibsTfl. <br />bsJft. <br />SCREEN^______ <br />Mtk. HcMerd <br />Time <br />HOLED! AM. <br />7 7/8 30 <br />___in. to____ “ <br />ir..lo <br />OPEN HOLE <br />from___-ftto. <br />Slot/Qauze_ <br />Set between <br />.Diam. . <br />.Length. <br />_ft and -1 gg ft. FITTINGS: <br />STATIC WATER LEVEL <br />__________________ft. below □ above land surface Dale measured ^ <br />PUMPING LEVEL (below land surface) <br />______140 ft after _______1 hrs. pumping .gpm. <br />WELL HEAD COMPLETION <br />91 Pitlets adapter manufecturer <br />□ Casmg Protection _____________________________ <br />Model <br />X12 n. above grade <br />GROUTING INFORMATION <br />WeH grouted? RVes □ No <br />from 0 to 30 n.2 □ yds. bags <br />from to ft.□ yds. □ bags <br />from to ft._ □ yds. □ bags <br />Sandy, Clay Red 107 137 <br />NEAREST3^j^NO^ SOURCE OF CON^INATION <br />Sand^ <br />Wek disinfected upon completion? CKXes □ No <br />cny <br />Rerl c? <br />Use s aecond 8h09t. it needed <br />REMARKS, ELEVATION. SOURCE OF DATA. <br />137’15«; ■» <br />□ Nolinslaaed <br />Manufacturer's name. <br />Model number <br />1-26-95 <br />*W8|gr^ <br />3N102-12 <br />Lerigth of drop pipe <br />Pressure Tank Capacity <br />S4 <br />ClnyLuli McilJc^ C^ff^Cf02“ <br />Volts <br />12 <br />^3U <br />.gpm. <br />Type i1^tA>mersible □ LS. Ti^bine □ Reciprocating □Jet □ <br />ABANDONED WELLS <br />Dues properly have any not in use and not sealed weli(s)? □ Yes K No <br />WELL CONTRACTOR CERTIFICATION <br />This weu was dniled under my supervision and in accordance with Minnesota Rules. Chapter 4725. <br />The mformation contained m this report is true to the best of my Knowledge. <br />DUN STODOIA WELL DRIULING O).^ DC* 27172 <br />Licensee Business Name Lie. or Reg. No <br />12-21-94 <br />Auttxmied Repreeentattve Snafjre <br />Fred Leity <br />Dale <br />12-21-94 <br />NameorOnau <br />LOCAL COPY 548550 <br />Date <br />HE^12tXMM (Rev. 5/92) <br />miN