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<br /> MINNESOTA UNIQUE WELL
<br /> WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO.
<br /> co,,,,�YNa�„e WELL AND B�RING RECORD � ; � n r�
<br /> Henne pin Minnesota Statutes,Chapter 103/ � � '•` � �
<br /> Township Name Township No. Range No. Section No. Fraction WELUBORING DEPTH(completed) DATE WORK COMPLETED ,
<br /> 5
<br /> Orono 118N 3W 35 S),�V SW S�, 298 feet f� July 12, 2011
<br /> GPS DRILLING METHOD
<br /> LOCATION: Latitude N degrees 44 minutes 5g seconds 45.t�6 ,
<br /> Longitude __ g �� i..:CableTool -'I Driven _''�..Dug "�
<br /> W de rees _ 93 minutes 33� seconds 04.14 r�Auger �Rotary �-_Jetted
<br /> House Number,Street Name,City,and Zip Code of Well Location or Fire Number ii �
<br /> 1190 Lyman Avenue, Wayzata 55391 DRILLING F�UID WELL HYDROFRACTURED? �J Yes �'No �
<br /> Show exact location of well/boring in section grid with"X:' Sketch map of well/boring location. Be11tOTllte From ft.To tt.
<br /> Showing property lines, -
<br /> roads,buildings,and direction. USE
<br /> :�� � ��No communi pyyg �Monitoring ❑Heating/Cooling �
<br /> __j___ _;__ ___�_____;_ [] 'ty Environ.Bore Hole ,_�.Industry/Commercial :'
<br /> -�^•'""""�"-""� ❑Community PWS _ _Irrigation 'L,Remedial
<br /> --'--- --;--- ---`-- ---�-- `���"', ! ''Elevator �..Dewatering �..�
<br /> `! -w
<br /> > w ; ; ; ; E �. � CASWG MATERIAL Drive Shoe? �'Yes ❑No HOLE DIAM.
<br /> ° --,-- --- ---� .-- T
<br /> ��� �Steel �Threaded ;.'Welded
<br /> �: , , 'f Mlle � � � - �
<br /> : , , � _ Plastic .---_- - n�.
<br /> � �-- �-- --• :- `_... ;
<br /> l
<br /> � CASING
<br /> � ��"`^...,,,,,_ Diameter Welght Specifications
<br /> , S `'�� 4 � to 268 n 10.791bsJft. —_+�� _ �;� ,268 �
<br /> � i 1 M�ile—� �°: �' � :(,.
<br /> .. ."_ _ _ —. . —
<br /> Y
<br /> - PROPERTY OWNER'S NAME/COMPANY NAME in.to__. . �� ft. _ _._Ibs./ft. _ __._ in.ro__ ft.
<br /> Brian & Julia Palmer ��.ro— ft. 1es.�h. �� �� h
<br /> SCREEN OPEN HOLE �
<br /> Property owner's mailing address if differen�than well location address indicated above. - - ------
<br /> 520 Indian Mound Street, #3B Make_ Maass __ F,om rt. To____ n.
<br /> � Wayzata, MN 55391 Type �anc�hlocke�,.l o�am. :
<br /> �� SIoUGauze.__��1111e�S2.I11�11(S1tL0]].e Length �2 ' X 16V�� 1� 1 ��
<br /> �. Set between Z�G ft.and G7V __fl FITTINGS 1�-paCl�er�2 1� r1Ser�
<br /> ! Phone: (952)475-3220 STATIC WATER LEVEL
<br /> Measured from���_7ft�, above
<br /> �_6__ ft.� �Below �Above land surface Date measured�//-L,_1-1 1_
<br /> WELL OWNERS NAME/COMPANY NAME PUMPING LEVEL(below land surface)
<br /> '•�� Sa.111e 23 S ft.after 1 7 hrs.pumping -_-_GO___ __ g.p.m. �t
<br /> ," WelUboring owner's mailing address if different than properry owner's address indicated above. WELLHEAD COMPLETION 1� C� Ylr1V ��
<br /> '��� itless/adaptermanufacturer___ Baner Model.__ `�naYYJ s
<br /> _
<br /> �asing Protection _._ __ �2 in.above grade
<br /> � ]Arigrade(Environmental Well and Boring ONLY)
<br /> GROUTING7�I,N�F,,,O�RMATION [� ^� p 1
<br /> Well gi"Vi'LIaTldYes � �.f�19� G6p 1 5 �/
<br /> Grout teria s Neat ceme Bentonit I Concrete ��. er__ �
<br /> �en�onite � � � 9b � �P� _/
<br /> From To __ fL _. . _ _Yds. �Bags
<br /> GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO From .To_ . ft. _. _.._ j�Yds. �, �Bags
<br /> MATERIAL From To ft. � Yds. '', J Bags
<br /> :� Clay BrOWIl M 0 -34 NEARECST KNOWN SOURCE OF COcNTAMINATION r
<br /> _ J0+ feet J�_. direction `�ept1C �Pe
<br /> Rocks/Clay Grey M 161 16g Well disinfected upon completion? es ' No
<br /> PUMP 1
<br /> � / Notinstalled Dateinstalled____ iUly 2S� 2�11 '�
<br /> Sticky Clay Grey M 204 237 - - - —
<br /> Manutacturer's name �JrU17CifOS
<br /> n 16550-38 HP 5 �o„S 230/3phase
<br /> Shale Tan M-H 253 25g ""°de'"�`"be' - _ --
<br /> 1 , ,� A 1L
<br /> Length of drop pipe 1 �4 X 2`f6� _ft. Capacity 1 V _ g.p.m
<br /> Shale Red Lvi-r1 ZVO Zp4 Type. ubmersible LS.Turbine I Reciprocating �Jet �J
<br /> ABANDONED WELLS
<br /> Shale/Sandstone 1 aIl H 296 337 Does property have any not in use and not sealed well(s)? Yes o
<br /> VARIANCE
<br /> Was a variance granted from the MDH for this well? �J Yes o 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 repor�is true to the best of my knowledge.
<br /> Use a second sheet,il needed.
<br /> REMARKS,ELEVATION,SOURCE OF DATA,eta C-163
<br /> E.H. Renner & Sons, Inc. 1431 `'
<br /> _ __—__ _ —
<br /> Licensee Business Name Lic.or Reg.No. ��
<br /> Elevation: 970 ft MSGS Quad: A105 :.,..--,_.�
<br /> Open hole collapsed. Maass sandblocker screen was 467 10/07/11
<br /> 111Stalled. Certdied Rep s�n a i a�ure ��erhfied Rep.No. Date
<br /> LOCAL COPY
<br /> 7 7�0 6 2 Ed Renner
<br /> Name of Driller
<br /> � IC 140-0020 HE01205-12(Rev.12/08)
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