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, <br /> r ' 1 . <br /> WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. <br /> County Name WELL RECORD 5 3 6 2 7 5 <br /> ilennepin <br /> ! Minnesota Statutes Chapter 1031 <br /> Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed <br /> ft <br /> Orono 118 23 35 34,0012 'i. 205 7--.; s <br /> Numerical Street Address and City of Well Location or Fire Number DRILLING METHOD CITY OF _.-.,, <br /> rr�� <br /> �`�,�,,,, �T <br /> 0 Cable Tool 0 Driven 0(vow D <br /> 1225 � Dr, , M 0 Auger X Rotary ^•• <br /> Show exact location of well in section grid with"X". Sketch map of well location. 1=1L=' —. F I't/Ac <br /> Showing property lines, ..- ' <br /> N roads and buildings. DRILLING FLUID <br /> 111111111111 <br /> W ®�� -• USE g 0 HeatIndustry/Coling <br /> ommercial Domestic 0 Monitoring ❑ Industry/Commercial <br /> Irrigation ❑ Public DEC ❑ ial <br /> ���� T ` rt} 0 Test Well 0 Dewatering ❑2e� 1994 <br /> �IM�® II j CASING Steel Drive Thoe?headedf Yes ❑ No 0 Welded HOLE DIAM. <br /> 1 t,},,.,,,,„.,,,,,,$� ❑ Plastic ❑ <br /> I---i mil, <br /> A it4' .. , CASING DIAMETER WEIGHT <br /> PROPERTY OWNER'S NAME _ s_in.to 195 ft. lbs./ft. / neto 30ft. <br /> Charles Cudd Ccs in.to ft. lbs./ft. i <br /> 6 y �fd.t0205ft. <br /> Mailing address if different than prop rty a ress indicated above. in.to ft. lbs./ft. li'n..to .l ft. <br /> 1842 Wooddale Dr SCREEN OPEN HOLE <br /> Woodbury, J i Make from_195 ft.to 205ft. <br /> wrv�J".vaaa..}r MN 55125Type N/A Diam. • <br /> Slot/Gauze Length <br /> Set between ft.and ft. FITTINGS: <br /> HARDNESS OF STATIC WATER LEVEL <br /> GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO 75 ft.X below ❑ above land surface Date measured <br /> PUMPING LEVEL(below land surface) <br /> Clay Soft 0ft. after hrs.pumping g.p.m. <br /> 195 WELL HEAD COMPLETION <br /> ,hale & Sandstone 11 - 195 205 al Pitless adapter manufacturer Yd hit t r Model <br /> N. LJUJ <br /> 0 Casing Protection k 12 in.above grade <br /> GROUTING INFORMATION <br /> Well grouted? X Yes 0 No <br /> Grout Material ❑ Neat cement i Bentonite <br /> from a to 30 ft. 0 yds.yy❑ bags <br /> from to ft. 2 0 yds. Q bags <br /> from to ft. 0 yds. ❑ bags <br /> NEAREST KNOWN SOURCE OF CONTAMINATION , <br /> feet L,cl 7 direction 4'rJ iC type <br /> Well disinfected upon completion? 0 Yes ❑ No <br /> PUMP <br /> ❑ Not installed Date installed 8-3-94 <br /> Manufacturer's name Red Jacket <br /> Model number I Bc HP ! Volts <br /> Length of drop pipe <br /> •}105 41a <br /> Capacity 10 4 q30 g.p.m. <br /> Pressure Tank Capacity � � <br /> Typeie Submersible 0 L.S.TurbiP 01,2fpraopi* er <br /> ABANDONED WELLS <br /> Does property have any not in use and not sealed well(s)? 0 Yes iti No <br /> WELL CONTRACTOR CERTIFICATION <br /> 4-1 <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. ' ' RI!Ikk rl m '�!- - *1 +: s•kir-;' <br /> • ( <br /> i.r ,, __--- �`. , 8-17244 <br /> Authorized Representative Signature Date <br /> F.P. McMinn 7-20-94 <br /> Name of Driller Date <br /> LOCAL COPY 5 3 6 2 7 5 HE-01205-04(Rev.5/92) <br />