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MAR-22-2611 11 : 12 AM LEUTHHER WELL IHC 952 447 2592 P. 61
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<br /> MINNES0 NIa E WELL
<br /> . AND •
<br /> eOAINa�uo,
<br /> MINNESOTA DEPAYt'TM N7 OF HEALTH
<br /> WELL AND B INC3 RECORD 031 1
<br /> 7 5 8`2
<br /> WELL OR BORING LOCATION Chapter C
<br /> Minnesota Stalun+r p !•;
<br /> ,I.i; DATE WOFfN..MPL6TED .. ,
<br /> tNELl790nIN• OCf•TH loo ) i"
<br /> action No, 4Q � y
<br /> • Rance o. 6 r f /Jr" r
<br /> J DRILL c f'
<br /> V0 �_ I I�Driven h,Dug
<br /> seconds Jeuod
<br /> OPS df101aa min�iao Cablo Toot
<br /> Latitude C clary Z
<br /> LOCATION: degrees � minulas �-- seconds _. �ALUM '� _
<br /> IAnguuda C. -
<br /> DRILLING FLUID WELL.HVDROFRACTURED7 J Yea '
<br /> Houma umber.Sir 'd NEM,City,end Zip Code mf Wwll Location
<br /> No
<br /> /f From K.To.._-- '
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<br /> ;mien g d h°X1'
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<br /> Sketch map of buildiwellfongs,
<br /> ooRtloone, Ij Monitoring [I Hemin®ICooling
<br /> r not location o plJ' ' ;, Showing property Ir r oomr■dc
<br /> 5r roads,building),anddirection. E nd�str IOommeMlel'
<br /> E]Nonaommunhy OWf3 D.environ.Oar.Holo �� y
<br /> ���� r El community PWS
<br /> C Irrigatienviroan Li Ramedlal i;,
<br /> U Elsvntor 1 Detealenna
<br /> HOLE DIAM.
<br /> w��� CABI. MATERIAL Drive Shoe? j Ya. C�No "�i 'I
<br /> � ', U pteel U Thradeo ���)Welded
<br /> IIII T b tale L�- /
<br /> ENE= I." CrSINt3 - r.—
<br /> Wolght Specifications D amat:r / to 1' t.
<br /> SI
<br /> In,to ) r3 It. _�—.—Jbedlt .
<br /> I �� , In.IO_,/
<br /> ��-1 Mud �����' �' ��In.to _It. Ibe,Al.
<br /> lbs". In.to . Il.
<br /> PROPERTY OWNCP's NAMO1COnnW+NV NAME: _In.to It. - .. '.I• i I
<br /> ' 1 OPEN HOLE i:••!;,., is
<br /> 40 A SCREEN I••'../1::.....•HI;I'I.': I
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<br /> Pf•• War's • n9 eddnes 1 d rant than viol location QOdfaea Indicated abo•a Moko � '•'
<br /> Qlam.
<br /> TyPa Length l,.s
<br /> Siol/0 wan
<br /> Eat between IL and R. FITTINOB._� ' ••
<br /> 'Measur+oi trom__. I ."Ilaplai
<br /> VATIC WATER L .'L II,;'h'I!I;"Ilii)
<br /> It.n Bolan ❑Abcwe land surface Date mefleUrdl_.—
<br /> „-'�i�lilii;
<br /> PUMPING LEVCL(below land surfed)) 1 i,
<br /> v:pLL O NER'8 NAMGIGOMPANY NAME has d�^tbjn9°'___ —g-p.m.
<br /> It.alter
<br /> .� WELL�EADCOM-LETI•N .� Moder /r'. .!
<br /> orin0 OWnaf'i mailing adOrBaa II dltlerenl than property a^'nor's address Indicated above, Itlossradapt■r reanuhlcturer it�,.p �'.
<br /> rVS 1Lf� 'I ,'I'I.
<br /> ____,... --:-.• [,J 12In.eoovl ,' y`I II'
<br /> casing Protection • I'I„', IIS
<br /> ❑At sand)(Environmental Wall and BOrin ONLY)
<br /> .. Q-r TIN.INFORMATION �II ;.! I II 1d1LII
<br /> Well grouted jt'laa 0 No .,:!�I i.iil
<br /> afoul materiels J Neal cement entonlle E concrete L�Odler ,
<br /> From Tb II. ❑Yds. ace
<br /> From To It, - ❑Yds. . Sags
<br /> — W MAT E IA OF FROM 70 To It, f Yoe, r]'Sega
<br /> GEOLOGICAL MATERIALS COLOR MAS BRIAL From , .
<br /> I Pr NEAREST KNOWN SOURCE OR CONTAMINATION p
<br /> i • i N / J / fat ,`'1_ direction y `elfsp C•-- type
<br /> enell OIaIn1BMd upon ccme I]plellon9 L Wo
<br /> PUMP 'I:
<br /> NIMMF211/11Va 12111111111 Nol stalled time In' lad —L�- i
<br /> MenuheeuroPe namedrir f1111W11171111 •�• Model Numbor /� HP�r' —yplte_� Length of drop pipe rte"—._ +L Capocilw_.-- o.D.lh.
<br /> Type;g Submersible ❑L.S,Turbine ❑Reoiprocaonq ❑Jet '❑ ,i
<br /> ABANDONED WCLLB —
<br /> „I •
<br /> Dobe property have any not In ue.and not naiad w■Ilia)7 t 11 Yes ' o i
<br /> VARIANCE I''
<br /> was a ens.)grontod from the MOH Lor this Wwii9 I,I vee �•No TNd� '
<br /> ') WELL CONTRACTOR CERTIFICATION S 'll
<br /> This well well drilled under my aupervlalon and In a000rdenao with Mlnnasola Rules.,fJhi'�'a
<br /> aprer d
<br /> The Information contained In Ws report is true to the beet of my knowledge.
<br /> U99 a second sheaf,11 needed.
<br /> REMAPKs.ELeVATION,80UROE OI DATA,aro. �� � � ` �
<br /> Ian a DuBlnon Na .�Llo.or Rag,No.
<br /> ..1T' 0.4.
<br /> III e• -e• =sen a vi Signature -d Rap.No. Date
<br /> ;i, II• S
<br /> LOCAL COPY 1 7 5 8 2 2 2 i�.ergeeti-!� �_ ;i
<br /> • Name or Driller l.
<br /> pC.alme•1'
<br /> I IC T+-0020
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