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� WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. CountyName WELL AND BORING RECORD � g� � � 7 Hecx�epin Minnesota Statufes Chapter 1031 Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Compteted Orono 118 Z3 3b ,, ,, �, 226 � 6-20-43 GPS DRILLING METHOD LOCATION: Latitude degrees minules seconds .. ._ Longitude degrees minutes seconds �r_I Cable Tool J nven __Dug _]Auger �otary ,_.Jetted House Number.Street Name.City,and Zip Code of Well Location or Fire Number ��'�. �� WS �� i�� Ococw 55331 DRILLING FLUID WELL HYDROFRACTURED? ��,_;Yes � No Shop exact location of well in section grid with"X". Sketch map of �cation. �$te� FROM_ ft.TO ft. Showing op lines, N roads nd ildings USE 1 Monitoring 'Heating/Cooling ; . , ,.� �yr pomestic i�J Environ.Bore Hole _Industry/Commercial �'Commun y PWSWS `-_Irrigation I_j Remedial _ Y Dewatering ❑ -'''"'--'--- --`-- --"`"- ASING y( OLE DIAM W � E `� � � �� Drive Shoe? _ �Yes F�`�No H � � ; .'� �� , [�Steel i�Threaded =Welded -� -,--- --- -� -�-- T � _ � �.' Plastic i_.� '/Mile ¢ � '\ ------ ------ ------ ---=-- 1 �-- z � CASING DIAMETER WEIGHT S � �____in.to�,_jq _ fc L•lil Ibs./ft �in.to_._�t. �--1 Mlle—j � '. '. �,,.,_.) .,C�(.. E f �'-��'� . in.to__ ft. Ibs./ft. �in.to..�bft. PROPERTY OWNER'S NAME/COMPANY NAMP. ' in.to ft Ibs./ft. in.to ft. ~111111II11T1�Ba'7t 1SE11S SCREEN OPEN HOLE Propertv�wner's mailing address if differect tiian�:vell location address indicatad abovc Make�(� FROM ft. TO ft. —_.----�-- S8�1P_ a.S above Type__��$��& ,$��_ Diam._ _ �N_ SIoUGauze Length � Set between ��d it. FITTING� � STATIC WATE EL ��____ft. - below .above land surface Date measured � PUMPING LEVEL(below land surface) WELL OWNER'S NAME/COMPANY NAME � ��__ ft.after_ _ _�,��__hrs.pumping _�� g.p.m. WELL HEAD COMPLETION Well owner's mailing address if different than property owners address indicated above. �p�tless adapter manufacturer_ �t�$te� Model _ Casing Protection_ �12 in.above grade ❑At-grade(Environmental Wells and Boring ONLY) GROUTING INFORMATION Well grouted �Yes [i No Grout material ❑Neat cement �` �Bentonite . �Concrete�High Solids Bentonite from_�__.�to_�_. it. _�.. �__]yds. '�bags from�_to�&_(L �.�8�_��i� �. �,bags .�� GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO from to ft __yds. � �bags MATERIAL — — —--- - -- ' NEAREST KNOWN SOURCE OF CONTAMINATION Z.'�8�1 yellau� $�yt Q �2 ��'' feet .�._, f� direction ��_:.J�` �..: type Well disinfected upon completion Yes �No �$y �v .�Ost � � PUMP ) 1 C�A�-1fg �Not installed Date installed_ 0'��i�{{'�1��_ _ ___._._ `►i��/�� Q� ��.t� M1 1ffA Manufacturer's name __ ____. _.___—._.___ - p Ii�C�li 7lJ 1�\J Model number __ HP��._.._ Volts�.__.. �" $�� bt�j'1 j�1� '�7V 226 Length of drop pipe.__�+�(__ __ft. Capacity ________ g.p.m. Type: �Submersible f��.L.S.Turbine ��,Reciprocating ❑Jet ❑ ABA DONED WELLS Does property have any not in use and not sealed well(s) ^Yes �.No VARIANCE Was a variance granted from the MDH for this well? Lj Yes � No TN# WELL CONTRACTOR CERTIFICATION This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. IThe information contained in this report is true to the best of my knowledge. Use a second sheet,il needed REMARKS,ELEVATION,SOURCE OF DATA,etc. �(3 t�}`t(��. �11.D i 11 illP � t__ •f 11'lA____ ��:'. �iR:� L{_;-Fi. Licensee Busin2ss Name Lic.or Aeg.No- i 7�� ---- - - - — "---- — . __ __.---- - - epr'esent tive Si t e Date t�Ck 1'�cOre fr'20"t13 ('� (1 O �� Name of Driller Dare LOCAL COPY �;�d p HE-01205-OB(Ra¢SPo2) IC 140-0020