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ulAr lG IAICI I him <br />WELL LOCATION <br />MINNEWA DEPARTMOfT OF HM 11 <br />- _-- - <br />5 613367 <br />4 <br />WELL RECORD <br />caffl" �,,, <br />' ric nenl1, <br />MinnesohStatutesCtwter1031 f7Ty� <br />c <br />Tswrwv Name <br />ToWWV No, <br />Range No. <br />Section No. <br />Fract,on <br />WELL DEPTH (Calf ed) ( n <br />DW Work <br />C1r(:T� <br />I V/ <br />Ntarrrteal Snsr Address and car or Was LOMW <br />or Fre Number <br />DRILLING METHOD <br />Z iO, ircrin: <br />�;j1. t <br />❑ Cabe Toa ❑ Dr,t ❑ Dug <br />_ <br />❑ Auger ❑ Flo" ❑ Jslyd <br />❑ — <br />Stow exact Iorof was in wetion grid wth 'X'. '. SMakShf�mwW of wMI bWbW. <br />DRILLING FLUID <br />N roadebua <br />1 . <br />' <br />- - - t - ,1 ; - <br />.USE n Domestic ❑ Monlwr,r,y - ° "duis"l Orrwri <br />° IndlletrylCorrrrrerolel <br />w E <br />,, <br />❑ a,ga,bn ❑ Pubic <br />RsnrWrd <br />❑ Teel WN ❑ Oewaserng 0 <br />_1. _i 1_ <br />T <br />CASING Drive 91fos7 ❑ VM ❑ No <br />HOLE DIAM. <br />1 , <br />• <br />� <br />-�- - -'j -r• ; <br />O SMN O Threaded ❑ WeWed <br />CL Plwlic (71 <br />H 1 r'or I <br />CASING DIAMETER WEIGHT <br />n. Ib <br />PROPERTY OWNER'S NAME <br />aGll�' Wier) I CTI pU 1Y <br />in. Io n. <br />in. to n. _ Ib&A. <br />_ in. to _ n. <br />Meng address I d weer elan Paperer address indlcard above. <br />SCREEN OPEN HOLE <br />1(;l, Perrsnire Lv-ne <br />1'irmth, Ki. a .f, <br />IH'w.fit]t`xI ftm <br />Type +J.f1lP_S�; �.L�'H'1 - Dlrn, t <br />SwxIdum jyr! 7l: Langtn 4 <br />eel flst.reen �, TTn. and n. FnTINGS: ---f+L--*AL— <br />STATIC WATER LEVEL <br />`MATEIAL_ <br />OF <br />WOLOOICAL MATERIALS <br />COLOR <br />qSS <br />FROM <br />TO <br />n. p bebw ❑ ebore ww aurfam Der meeeuee 6-0-- J <br />PIIMPIIG LEVEL (mow and surraoe) <br />Clay <br />Yeli(A-' <br />k;, <br />1 , t <br />/ <br />, <br />174 n. atw 1 hers. purrpap <br />WILL HEAD COMPLETION <br />clav <br />Grev <br />1 `�' <br />t; :' <br />olvr.r■e.pH.rn,rxeacn,r.r hli 't t �,r r.r Hoar <br />❑ Casing mcaschm p 12 in. above Weds <br />Grev <br />:, <br />r,5' <br />1'Z( <br />O"OUT"a INFORMAT,DN <br />Was growdT M Yes o No <br />Grout VAWIM ❑ Neal ON Him )y sr+Horrr <br />1LQ <br />1of. <br />"m C to >1 n. O yds. IM begs <br />flan to n. ❑ yds. ❑ Image <br />from to _ n. ❑ yde. ❑ bps <br />NEAREST KNOYYq SOURCE OF CONTAMINATION <br />SEP; �� <br />?!�'- l..l 6.4s>- dr.utwn exp• <br />WN dekMecled upon corrprlan7 fq Yee O No <br />PUMP <br />❑ Not nelsMd OMe <br />L !r <br />MenAetvses rwrr <br />Moder number 1 SC :• t 1 HIS 1 Vdr <br />Lerlgal d dray ppe i f �; r h. cap" <br />Pnwun Tarar Capseelr : `. i _ -' f T'r I <br />Type: m Subnws6r ❑ L.S. Turbo* ❑ RedPoc+hp ❑ JM ❑ <br />ABANDONED WELLS <br />Doss property have stw nal n uw "not sealed w9f(s)7 ❑ Vw M No <br />WELL CONTRACTOR CERTIFICATION <br />Ttra wN wY drlae0 under my Wpervem and n wwrdrrta wllh Mkrmata Rules, Chipfer 4725. <br />The nbrmtllon oelea wd in Oft report u true to On bell of my krawledgs. <br />Cy YJ SV -0,141 Sv�'LU DRlIyrl;vi; LU. g Its:. <br />UIe a seenno In..r. err rweded <br />REMARKS, ELEVATION, SOURCE OF DATA, em. <br />Jug <br />_ trwreae Br/srMss IvarrM O1 No. ]r• % <br />h-5-95 <br />lz � z <br />S9 -t— Derr <br />L L <br />i'LI:It� 1A'1. J. <br />Wamw or Driller DIM <br />HE-01205-e4(R".S092) <br />LOCAL COPY <br />5 613 3 6 <br />W &O <br />