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SWGauze 1U/ 1U L-10 -- <br />Set between _.._ 186 h. and s 5 n. FrMNG8: 11w --- <br />STATIC WATER LEVEL <br />'GEOLOGICAL MATERIALS I COLOR HAMA EESS RIALOF FROM TO - - _ n .X below CJ above land surface Dete rnea-wed 1-13-9 <br />ChAy Blc-ck S <br />Clay Yellcm S <br />Clay Grey S <br />&uxi-gavel I rian I51W <br />Use a second sheet, if needed <br />REMAF :S. ELEVATION. SOURCE OF DATA, etc <br />LOCAL COPY <br />PUMPING LEVEL (below lend surface) <br />AW n. an- 1 his. pumping - 3� _ i P.m. <br />WELL HEAD COMPLETION <br />': WnWss adapter manufacturer _ t- j--VAn-t jinkr_ Model <br />Casing Protection. - _-_-_ `�e2m above grade <br />1 b HL r GROUTING INFORMATION <br />Well grouted? x Yes No <br />Griot Material i Neat cement rentonile <br />from _L i-- to---2L'ft. — 2 ❑ yds. X bags <br />from. -- _ lo— n. _ _.._._—. U yds. ❑ bags <br />from to It. ❑ yds. ❑ begs <br />NEARES KNOWN SOURCE OF CONTAMINATION <br />----feel S.O/MIf rL _ diectbn �7z- /- p %At: rype <br />Well disinfected upon completion? XJ Yes ❑ No <br />PUMP f.. �i C /� <br />IJ Nol inh stalled Date installed 2-15-75 <br />Manufacturers name AQ, ,,or --_ <br />Model number FIN 02603 HP 1.5 Vdk i til <br />Length of drop pipe . 1 9-p In <br />Pressure Tank Capacity <br />Type xl Submersible r' L.S. Turbine ❑ Recomcating ❑ Jet ❑ <br />ABANDONED WELLS <br />Does property have any not in use and not sealed welds)' : Yes : KNO <br />WELL CONTRACTOR CERTIFICATION <br />This well was dnlled under my supervision aro in accordance with Minnesota Rules. Chapter 4725 <br />The information contained in this report is true to the best of my knowledge <br />DON :l fUD01A WELL Mn Li% LO. E 1N.. 2-117;' <br />Lmnsse Bwklgs Name Lx: or t. No. <br />Arifhonred Representetmr gnefurs 011111111, <br />Fred LieLhy 1-13-95 <br />Name of Dnaer Date <br />548551 <br />HE -0120504 (Rev. S192) <br />! <br />MINNESOTA UNIQUE WELL NO. <br />WELL LOCATION <br />MINNESOTA <br />DEPARTMENT OF HEALTH <br />WELL <br />RECORD <br />County Name <br />t1elul�'L�ln <br />5 4 8 5 51 <br />Minnesota Statutes Chapter 1031 <br />Township Name <br />Township No <br />Range No <br />Sedan No <br />Frettan <br />WELL DEPTH (completetl) <br />Date Work Completed <br />Urcrx: <br />11 ; <br />.._ <br />r14 <br />19� <br />n <br />Numerical Street Address and City of Well Lormim <br />or Fire Number <br />DRILLING METHOD <br />28,111 Wintry: ide W. <br />Ca-'.;I:li, %len. <br />Cable Tool <br />El Dug <br />Ona <br />: AugerR <br />❑ <br />Show exact location of well,n ion grid wilh'X' <br />Sketch map of well location <br />Stowing Property lines. <br />roads <br />a° buildings <br />DRILLING FLUID <br />r <br />X w� <br />r <br />.USE <br />- Ll HeaUngrCoohrg <br />t t <br />I� Domestic <br />: Monitoring <br />- ❑ Industry Commercial <br />ty <br />i <br />i <br />E <br />Irngahon <br />I Public ❑ Remedial <br />-,- -1- <br />- - -- <br />T <br />1 <br />' Test Well <br />Dewatering <br />❑ - - <br />I <br />CASING Drive Show <br />i Yes C; No <br />HOLE OIAM. <br />r <br />i. ', Steel Threaded f-: Welded <br />1 <br />rkplastic Li <br />_-- .-- <br />1` <br />CASING RIAMETER <br />�O <br />WEIGHT <br />PROPERTY OWNER'S NAME <br />M. to n. <br />-441-21 win. <br />7 7/ <br />lbtiy E idea C�xry kvly <br />__� _ <br />- ---- _ in. to n. <br />-6-1y(4-196 <br />Aaawkq eddresa a drnerent than property address indicated above <br />in. to —_ _ n. <br />bath. <br />_ In. to _ h. <br />410' _: BerkshirC, Luc- <br />SCREEN <br />gi&th <br />OPEN HOLE <br />Pl Jl]u1a Ml. ✓J446 <br />Make �d <br />from <br />Jam- <br />Type qt-Ain1ASA .gtPAP1 <br />DWn. <br />SWGauze 1U/ 1U L-10 -- <br />Set between _.._ 186 h. and s 5 n. FrMNG8: 11w --- <br />STATIC WATER LEVEL <br />'GEOLOGICAL MATERIALS I COLOR HAMA EESS RIALOF FROM TO - - _ n .X below CJ above land surface Dete rnea-wed 1-13-9 <br />ChAy Blc-ck S <br />Clay Yellcm S <br />Clay Grey S <br />&uxi-gavel I rian I51W <br />Use a second sheet, if needed <br />REMAF :S. ELEVATION. SOURCE OF DATA, etc <br />LOCAL COPY <br />PUMPING LEVEL (below lend surface) <br />AW n. an- 1 his. pumping - 3� _ i P.m. <br />WELL HEAD COMPLETION <br />': WnWss adapter manufacturer _ t- j--VAn-t jinkr_ Model <br />Casing Protection. - _-_-_ `�e2m above grade <br />1 b HL r GROUTING INFORMATION <br />Well grouted? x Yes No <br />Griot Material i Neat cement rentonile <br />from _L i-- to---2L'ft. — 2 ❑ yds. X bags <br />from. -- _ lo— n. _ _.._._—. U yds. ❑ bags <br />from to It. ❑ yds. ❑ begs <br />NEARES KNOWN SOURCE OF CONTAMINATION <br />----feel S.O/MIf rL _ diectbn �7z- /- p %At: rype <br />Well disinfected upon completion? XJ Yes ❑ No <br />PUMP f.. �i C /� <br />IJ Nol inh stalled Date installed 2-15-75 <br />Manufacturers name AQ, ,,or --_ <br />Model number FIN 02603 HP 1.5 Vdk i til <br />Length of drop pipe . 1 9-p In <br />Pressure Tank Capacity <br />Type xl Submersible r' L.S. Turbine ❑ Recomcating ❑ Jet ❑ <br />ABANDONED WELLS <br />Does property have any not in use and not sealed welds)' : Yes : KNO <br />WELL CONTRACTOR CERTIFICATION <br />This well was dnlled under my supervision aro in accordance with Minnesota Rules. Chapter 4725 <br />The information contained in this report is true to the best of my knowledge <br />DON :l fUD01A WELL Mn Li% LO. E 1N.. 2-117;' <br />Lmnsse Bwklgs Name Lx: or t. No. <br />Arifhonred Representetmr gnefurs 011111111, <br />Fred LieLhy 1-13-95 <br />Name of Dnaer Date <br />548551 <br />HE -0120504 (Rev. S192) <br />! <br />