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WELL LOCATION <br />County Name 1 <br />MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO <br />WELL RECORD 546835 <br />Minnesota Statutes Chapter 1031 <br />Township Name <br />Township No I Range No <br />Seciron No <br />Fraction <br />WELL DEPTH Icom"W) <br />k <br />Date Wok Completed <br />0 <br />118N 23W <br />I 35 <br />SEr•SW NE <br />183 <br />6/16/94 <br />Nunencal Street Address and City of Well Location <br />or Fire Numrier <br />DRILLING METHOD <br />Cable Tool <br />❑ Ddven U Dap <br />c <br />ono Lake Rd . <br />A ger <br />SRonry o Janes <br />Show exact location of well in section , 1 with 'K' <br />Sketch map of well location <br />Showing property Imes. <br />k roads and buildings DRILLING FLUID <br />T ;_ Baroid qulk gel <br />l 1 l USE <br />� pomostrc <br />r I E litigation <br />T Test Well <br />PROPERTY OWNER'S NAME <br />[fix. �1 rC Y{G1 A VV{�O r i{r•V . <br />Melling address if different than property address xtdoeated above <br />CASING Drive Shoe? <br />1.Stsel xThreaded <br />Plastic <br />D HMtrngtCoolmg <br />Monitoring <br />o it« ❑ Industry/Commercial <br />DD Remedial <br />ewslenng <br />D <br />(yes No ------- HOLE DIAM� <br />Welded <br />CASING, DIAMETER 1 7 3 WEIGHT 1 1 8 30,,R <br />/F in IL _ aJl1. n l01 3 <br />_ In. b into <br />_—in. to, _. IL ------------- -b-M ntoft <br />SCREEI�T� OPEN HOLE <br />Make JJIIII1�77AA��IIII _ ".b—_ h. <br />Type a a nTeso steel__D„ ill _ <br />SIw/ammisi , 18 slot _ ---Lerplh--lQ--f t <br />Set between _ ". Ilasd _ft. FITTINGS:. - - 3 t --iXt ., <br />— STATIC W-kTER LEVEL 1 <br />GEOLOGICAL MATERIALS I COLOR IHARDNEESS RIAL OF I FROM TO _ _ 8 _ ft ' t6ebw above land surface Doe measured V-_6 <br />Sand L gravel <br />clay & sand <br />sand i{ clay <br />sand <br />brown <br />soft <br />0 <br />,;ray <br />soft <br />28 <br />-ray <br />soft <br />94 <br />gray I soft 116.3 <br />Use a second ahtef. if to~ <br />REMARKS. ELEVATION. SOURCE OF DATA. etc <br />'JAN 10 1996 <br />PUMPING LEVEL (below land surface) <br />21 <br />ft after 1 _ hrs Pumping - — ----- 50 ---g.p.m <br />WELL HEAD COMPLETION <br />monitor <br />pS 45 <br />%e <br />NPitleaaadapter manufacture, <br />Moasl <br />. Casing Protection <br />I 12 n. above graft <br />1 6 <br />GROUTING INFORMATION <br />wen grcn,:e0 ''i' yes NO <br />1 8 <br />1 <br />Grout Material Neal cement T`Oentonile <br />from to _ h <br />yds " bega <br />from _-_ -- b —_ ft <br />_ ` " Wsbags <br />from _ b -- --__ ft <br />i ; yda r begs <br />NEAREST KNOWN SOURCE OF CONTAMINATION <br />_ 30-___-_-- .feet west <br />Well dlaofteli upon Completion? ryes . - No <br />direction ~cause ,ype <br />PUMP <br />Nol nstelled Da __ <br />Manufacturers name run os <br />Model-umoet HP <br />Length of drop pipe _. iR ` IL Capawy <br />_ <br />Voa{. 220 <br />1ai- - -gp_m <br />Pressure Tank Capacity <br />Type Aubrndrs-0le • L S Turbine -. Reciprocating <br />- Jet -.—.—_ <br />ABANDONED WELLS <br />` <br />yes J% <br />Does property have any not inuse and not sealed weilisl' <br />WELL CONTRACTOR CERTIFICATION <br />This well was drilled under my sumneision and in accordance with Minnesota Rules. Chapter 4725 <br />The intormation contained n this report is True to the best of my <br />Leuthner Well INc. <br />knowledge <br />10125 <br />Liminsee Bus nest Name <br />Lrc GrAss Nd <br />/ <br />red Rtpresenla!'veSignature <br />nick Leuthuc) r <br />11/4/94 <br />Name of Driller <br />I._OCAL C( Y 4 6 8'45 HE-01205-04 (11 SM) <br />