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ESOTA UNIQUE <br /> MINNESOTA DEPARTMENT OF HEALTH MW AND BORING NO. <br /> WELL Gil BORING LOCATION WELL <br /> County Name WELL AND BORING RECORD 7 7 0 015 <br /> pin Minnesota Statutes,Chapter 1031 <br /> Henne <br /> Township Narpe Township No. Range No. Section No. Fraction WELL/BORING DEPTH(completed) DATE WORK COMPLETED <br /> Orono 117 23 03 SW SE SWC 208 ' 6-23-09 <br /> GPS DRILLING METHOD <br /> LOCATION: Latitude degrees _ minutes seconds <br /> Longitude degrees minutes seconds ❑Cable Tool ❑Driven ❑Dug <br /> ❑Augerotary ❑Jetted <br /> House Number,Street Name,City,and Zip Code of Well Location or Fire Number ❑ <br /> 2095 5 <br /> 53si <br /> DRILLING FLUID WELL HYDROFRACTURED? ❑Yes k100 <br /> Show exact location of welVboring in section grid with"X." Sketch map of well/boring location. bentonite From ft.To ft. <br /> Showing property lines, <br /> N roads,buildings,and direction. USE <br /> 1 omestic ❑Monitoring ❑Heating/Cooling <br /> __ -_ ❑Noncommunity PWS ❑Environ.Bore Hole ❑Industry/Commercial <br /> �� 4 i ❑Community PWS ❑Irrigation ❑Remedial <br /> -i- F-- ;- rl ,` , ❑Elevator ❑Dewatering <br /> w ; E ` CASING MATERIAL ❑ HOLE DIAM. <br /> Drive Shoe? ❑Yes fflo <br /> ; r T <br /> c,::7"./ ❑Steel ❑Threaded ❑Welded <br /> 'h Miley ❑ <br /> i I Il astic <br /> CASING <br /> s ' Diameter Weight Specifications <br /> ) 1 Mile in.to _ft. 1.9>s./ft. mots _8_in.to 50. <br /> PROPERTY OWNER'S NAME/COMPANY NAME in.to N. lbs./ft. _6%_ <br /> in.to . <br /> �{..� in.to ft. lbs./ft. in.to ft. <br /> ThrIMMOUIVOn SWAM SCREEN OPEN HOLE <br /> Property owner's mailing address if different than well location address indicated above. <br /> Make Johnson From ft. To ft. <br /> same as above Type_ertaitilestriDiam. 2« <br /> Slot/Gauze .11'131 <br /> M© Length�i t y? <br /> Set between q.01 tt.and ft. FITTING _ <br /> STATIC WATER�L�FEL Measured rom p <br /> ft.Neelow ❑Above land surface Date measured 60.23..09 <br /> WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) <br /> 196 ft.after 1.5 hrs.pumping 5fl q.p.m. <br /> WelVboring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION <br /> Pitless/adapter manufacturer t 3` ,1 N '--..,Model <br /> ❑Casing Protection r�12 in.above grade <br /> ❑At-grade(Environmental Well and Boring ONLY) <br /> GROUTING INFORMATION <br /> Well grouted RYes ❑No <br /> Grout materials ❑Neat cement RBentonite ❑Concrete ❑Other <br /> From_To 50 ft. 4 ❑Yds. ArBags <br /> GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO From To_ _ft.� f f s. ❑Bags <br /> MATERIAL From To ft. ❑Yds. ❑Bags <br /> NEAREST KNOWN SOURCE OF CONTAMINATION <br /> clay brawn sof I 16 - J. feet C_ direction t a--' type <br /> Well disinfected upon completion? IRYes ❑No <br /> clay aray soft 16 50 PUMP <br /> r <br /> ❑Not installed Date installed ll " -,1 7U- <- <br /> s ' : .i- • •:.0 -• a I''1Y Manufacturer's name r,1,r,."-, <br /> 6r <br /> ay Model Number HP / Volts /.'if) <br /> clay/rocks fray 1!edd�.t m 100 180 Length of drop pipe /)40 ft. Capacity g.p.m. <br /> Type:[Submersible ❑L.S.Turbine ❑Reciprocating ❑Jet ❑ <br /> clay red medium 180 195 <br /> ABANDONED WELLS <br /> Does property have any not in use and not sealed well(s)? ❑Yes �No <br /> sand gray soft 195 208 VARIANCE <br /> Was a variance granted from the MDH for this well? ❑Yes XNo TN# <br /> WELL CONTRACTOR CERTIFICATION <br /> This well was drilled under my supervision and In accordance with Minnesota Rules,Chapter 4725. <br /> The information contained in this report is true to the best of my knowledge. <br /> Use a second sheet,if needed. <br /> REMARKS,ELEVATION,SOURCE OF DATA,etc. <br /> Don Stodola Well Drilling C o,. Inc. 1991 <br /> Licensee Business Name Lic.or Reg.No. <br /> • /f <br /> epresentative Signature Certified R ..No. Date <br /> Cljatie Moore <br /> LOCAL COPY 7 7 0 0 15 Name of Driller <br /> IC 140-0020 HE-01205-11(Rev.3/07) <br />