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WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH \- MINNESOTA UNIQUE WELL NO. County Name WELL AND BORING RECORD 664 8 5 2 SIERBURNE Minnesota Statutes Chapter 1031 Township Name Township No. Range No Section No saloon WELL DEPTH(completed) Date Work Completed Elk RIver 33 26 35 .. 341 n 7-20;01 Nouse Number,Street Namejty,and Zlp Code of Well Localion or Fire Number DRILLING METHOD 18513 Twin Lakes Rd El Cable Tool A Driven U Dug I 1 Auger I Rotary n Jetted Show exact location of well in section grid with'X'. Sketch map of well location. Li _..—_ _.... ... . ..__ Showing properly lines. t roads and buildings. DRILLING FLUID WELL HYDROFRACTUREO? C YES U NO N �� �� I H 0 FROM__.. _. n.le_.._ n. SEWER I USE Monitonng ;]Heating/Cooling Q. �� I 0 Domestic Communty PWS ❑Induslry/CommerGal COYER J irrigation ❑ Noncommunity PWS ❑ Remedial w��t 2.12..1 l Envlron.Dom Hole O pewatenng ❑ __ _. .—.. ry v2“... CASING Drive Shoe? 3 Yes ❑No HOLE DIAM. 0 111111111111111111 DCSteel ❑ Threaded ] welded II Plastic L' --- S \ I— ,YN { CASING DIAMETER WEIGHT PROPERTY OWNER'S NAME 18 in to 240 n. ____ Ibslh. in.to___ ft. CITY OF ELK RIVER in to�0 n _Ibsm. — n.to_n. Property owners mailing address it different man well location address indicated above. _ _. in.to n. ___,__ _lbsitt. __.in.to n. 322. VI I N G. AV E. SCREEN stainless OPEN HOLE Make Johnson from T n.to _n. ELK 1\1yk11,, PAN 5'.530 Type v=_Slot — Dlam a2i SbUGauze -.030 _ _._Length _,. Set between 240 _f.and 340 n. FITTINGS: IT Packer _ STATIC WATER LEVEL WELL OWNER'S NAME 12 __h. below ❑above land surface Date measured 7-20-01 CITY OF ELK RIVER PUMPING LEVEL(below land surface) 1 Well owner's mailing address it different man property owner's address Indicated above. DEAL h. after 2 _.._hrs.pumping_]S00 g.p.m. SA 01E. WELL HEAD COMPLETION ❑ Rheas adapter manufacturer_ Model U CaSing Protection _. X1 12 in.above grade ❑At-grade(Environmental Wells and Borings ONLY) GROUTING INFORMATION Well grouted?gym[Yes ❑No GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO Grout Material XXNeat cement 0 Bentariitell 0 Concrete n High Solids s eenton MATERIAL from_ 0 to_23fl_.e. _ ❑ yds.U bags from to n. _ ❑ yds. ❑ bags Sand Brn S 0 10 from to ft _ ❑ yds. ❑ bags Sand. Si Gravel with NEAREST KNOWN SOURCE OF CONTAMINATION 100 feet West din—von storm clay lenses Brn S 70 Well disinfected upon completion? es ❑ No Clay & Gravel Brn S 70 75 PUMP K Not installed - Date installed._ _.... Sandy Clay Brn S 75 140 Manufacturers name _ . _. Model number__... -._.• HP_.__._ Volts— . Sand Brn S 140 150 Length of drop tape_ _ _...._ ft. Capacity_.._ g.p.m• Type: ❑Submereble ❑ L.S.Turbine n Reciprocally ❑Jet 0 Sandy Clay Brn S 150 159 ABANDONED WELLS Brn Does property have any not in use and not sealed well(s)? ❑ Yes X No SandStone&Shale Green S-M .. 159 180 VARIANCE ^ •I 1 Sandstone & Shale Tan Red Gwen S-M 1 80 200 Was a variance granted horn Me MOH for this walls 0 Yes X Na TNe WELL CONTRACTOR CERTIFICATION - Use a .t Y This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. REMARKS,ELEVATION r-o SCE O ► ;.r •► The inlonnation contained in Ws report is true to the best of my knowledge. r ••i DE t Mark J. Traut Wells, Inc. 71536 sits Lit.orRsg. r Authorized•- a� / aV At r Tony[ Fd .. _._ ' / _Name of Driller r Dale MINN. DEPT. OF HEALTH COPY 664 8 5 2 HE•01205-07(Rev. ) IC#140-0020