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WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. <br /> CountyName WELL RECORD � ,� � � � 3 <br /> H�nnepin Minnesota Statutes Chapter 1031 `- �- <br /> Township Name Township No. � Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed <br /> Orono 117N 23W 4 SW SW NW lZg n 7/13/93 <br /> Numerical Sireet Address and City of Well Location or Fire Number DRILLING METHOD <br /> 1 10 LE?cl� S�. ❑ CableTool ❑ Driven ❑ 0�9 <br /> C Auger p..Rotary ❑ Jetted <br /> Show exact location of well in section grid with"X". Sk@}�h pf well location. ❑ <br /> _---�-"` 5'��g property lines, <br /> N t � "'r Of ,fclatls and buildings. DRILLING FLUID <br /> � � , � ,^{o _;' Baroi� quik c�el <br /> --r--7- -1 -1- 4'; . _. —_.`_' <br /> i � i i t` _ ,USE ❑ Heating/Cooling <br /> a_ _�_ �_ �_ �omestic ❑ Moniroring ❑ Industry/Commercial <br /> yy �i � i E ❑ Irrigation ❑ Public <br />�-••�- _1_ _�_ __ __ T ❑ Test Well ❑ Dewatering O Remedial <br /> � � � fl mi. <br /> � CASING Drive Shoe? ❑ Yes L�No HOLE DIAM. <br /> � --�- i- � -r- � ❑ Steel ❑ Threaded ❑ Welded <br /> 1 C.�s�Plastic ❑ <br /> �-1 milr O�� 2 � �.993 <br /> CASING DIAMETER WEIGHT <br /> PROPERTY OWNER'S NAME � in.to �14 ft. 1 •g Ibs./ft. � in.to 3� ft <br /> Mark Gronberg �� to n. �bs.�h. 1 ��.to119�. <br /> Mailing address if ditterent than property address indicated above. in.to ft. Ibs./ft. in.to ft. <br /> SCREEN OPEN HOLE <br /> Make j ayco from fl.to fl. <br /> � Type Z��$t j,C Diam. � <br /> SIOUGauze ��.___�_��L Length_� C�� <br /> Set between ft.and ft. FITTINGS: ,,,�- <br /> STATIC WATER LEVEL <br /> GEOLOGICALMATERIALS COLOR HARDNESSOF FROM TO 80 7�13 <br /> MATERIAL h�� below ❑ above land surface Date measured <br /> PUMPING LEVEL(below land surface) <br /> yellaw C.'�.c3� brO�dT1 SOft � ig .�? ft aft� hrs.pumping z0 g.p.m. <br /> WELL HEAD COMPLETION <br /> clay �ray $Q�t Z9 63 1�7 Pitlessadaptermanufacturer 1��'l�t�l1$t@rModel SU �'rJ� <br /> ❑ Casing Protection ❑ 12 in.above grade <br /> ''ga2�� �rL�� '�'Of t v� 77 GROUTING INFORMATION <br /> Well grouted? l�Yes ❑ No <br /> C�.a�7 y r a y .r"a O f'fi 7�] 1�� Grout Material q[Neat cement ❑ Bentonite <br /> from 3� to � ft. � ❑ yds.L3iI bags <br /> sar�c3 bZ'owtl soft I03 119 '�°`"—�--�-`°��`� ❑ vds. ❑ bags <br /> from to R. ❑ yds. ❑ bags <br /> NEAREST KNOWN SOUFiCE OF CONTAMINATION <br /> 3� feet P_c'lSt direction hALCe rype <br /> Well disinfected upon completion? p�s ❑ No <br /> PUMP ry f�C/n� <br /> !/ V � <br /> ❑ Not installed Date installed <br /> Manufacturer'sname Aermotor <br /> Modelnumber HP 3 4 vons 220 <br /> Length of drop pipe 1 Q� ft. Capacity 10 g.p.m. <br /> Pressure Tank Capacity <br /> Type: C7`i$ubmersible ❑ L.S.Turbine ❑ Reciprocating ❑ Jet ❑ <br /> ABANDONED WELLS <br /> j Does property have any not in use and not sealed well(s)? [] Yes QQJo <br /> 7 <br /> � WELL CONTRACTOR CERTIFICATION <br /> i <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 ihe best of my knowledge. <br /> Leut��n�r idell Inc. Z0125 <br /> Use a second sheet,if needed <br /> REMARKS,ELEVATION,SOURCE OF DATA,eta Licensee Business Name Lic.or Reg.No. <br /> �f � / / <br /> �'��e�.-����v---�A '�-�L..—�/� '/�'��� <br /> A thor¢ed Representah ignature �Dat� <br /> � Ken Schmieg 9/21j93 <br /> Name ol Driller Date <br /> # <br /> LOCAL COPY � 2 6 6-� � HE-01205-04(Rev.5/92) <br />