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04/25/01 WED 15:27 FAX 612 425 7153 TILLER CORY. •y. SL\Ut t,\uutittx wjUu..) <br /> WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. <br /> IN <br /> I <br /> County Name <br /> SNiFRSURME WELL AND BORING RECORD 5 7 8 9 3 7 <br /> Meleesole Statutes Chaplin'1031 <br /> - <br /> Tawnsnip Name Township NO. Range NO. Socrron No. I Erection WELL DEPTH(completed) ,, <br /> Date Work Competed <br /> le ELK RIVER . 33N 26W 3 SW. SE SW 168 JAN 20, 1998 <br /> House Number,Street Name,City,and ZIO Code al Wel Location Or Fre Number DRILLING METHOD <br /> O Coble Tool Cl Driven O Dug <br /> NW OF INTERSECT. - US169 & 2218T AVE ❑ Auger �[ROt.ry ❑Jolted <br /> Shaw..act location of well n section pro With'X'. Sketch map el well location Cl STllll l f 1 10T01T Win <br /> n <br /> 8h oans end b'tailings. <br /> I <br /> 144 <br /> roads uW Du ldings. DRILLING FLUID <br /> N ,� BENTONITE DRILL FLUID <br /> r USE 0 inp 0 Heating/Coating <br /> ❑ Dom.tk <br /> Dms1:3 Community PWS R Induetrylcomme <br /> raal <br /> t � 44.0e t1 <br /> Te �l fl NOnconvnuney PWS G Remedial <br /> fTw -r-- r 77'77 <br /> CAS■+GDrive Shoe? r1 Yes XNO U <br /> HOLE DIAM. <br /> y(sl.et X Threadedn Welded <br /> ' �- 1 ❑Plastic It <br /> I ~— i CASINO DIAMETER WEIGHT <br /> PROPERTY OWNER'S NAME 1 4 m to T f�.1 n 19 79 bsM. l•In.to ]1 h. <br /> COMMERCIAL ASPHALT I <br /> In.to ft -- twin N 3/1,to l Tfl k <br /> In.lo Ib,Jtl. In b IL <br /> I <br /> Property owner's mailing eedteame <br /> e If drent lion well location addressInlKatetl shove. <br /> SCREEN OPEN HOLE <br /> 10633 - 89TH AVENUE N Move MIDIMIDIh from n.to k <br /> Ty <br /> MAPLE GROVE, MN 55369 pe s orm N/3• <br /> SIotfG.eze 15 #■t L.ngth <br /> I <br /> , Set between 161' ti,and III k FITTINGS: Inn II <br /> STATIC WATER LEVEL <br /> WELL OWNER'S NAME 65 Rx below ❑sows land surteoe Dale measured 1-20-98 <br /> -. SANE - PUMPING LEVEL(below Mall Newel <br /> Welt owner's mailing ea .e If ON 't <br /> 1tueth.r+progeny owner's adckesa,ndtceled Bows. AFNR_ s, alto. bre.ourroatg 75, g.p.m. <br /> WELL HEAD COMPLETION <br /> XPWs.daerenulaekrer gineMOS ----i[i�4# <br /> 1116 <br /> O Casing Protection_ pt 12 In..bow grade <br /> C M-grade(Etwhonmwitul Wels.nd Bcnnpm ONLY) <br /> GROUTING INFORMATION <br /> Well grouted? Yea ONO <br /> GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO Grout Materiel ❑ Neal cemom C Bentonite ❑Concrete X High Bolide B.rnwt.. <br /> I <br /> MATERIAL - .ipmPOm__0_ro__I h. —3— O Yds.*brio <br /> /�G� �1�� /�R* from b I. ❑ yds.❑ begs <br /> - RA Cell _mow ss_ a 85 wool l h. O yds.0 begs <br /> NEAREST KNOWN SOURCE OF CONTAMINATION <br /> I <br /> dls159+ feel N remotion PBTVPTF NM_HNA-_ N 8 5 1 Q�, wdisinfected upon comptekon? "(YeeCINo SNs'PTYC <br /> PUMP <br /> SAND AROwld 1l -140 17S. 0 Nol installed Date Installed 1,1)--111 - <br /> Manvfedureh nem° i+eUNDFOC <br /> Model number LAU$5 jHP s Vulls 4$p <br /> Limo,of drop pipe 2• X 120 h. C •Y 40 g P.m, <br /> Pressure Tank C.pecty WM 25 2 X 85 <br /> GAL <br /> Type: Dr eubm ewarie C)L S.Turbine 0 Ricpracating 0.1.1 0 <br /> ABANDONED WELLS <br /> Does property harm any rat 1n use end not sealed weals)? a Y. %Ne <br /> RI <br /> VAANCE 7� <br /> Was a',anemia premed from the NOR for pile well? ❑Yea Y No <br /> WELL CONTRACTOR CERTIFICATION I� <br /> Lbs a second fleet,If needed This well w.s draed under my supervision and In accordance with Mlmesote Rues.Chapter 4725. <br /> The Information contorted In this report Is atm le tie beat O1 my knowledge, <br /> REMARKS,ELEVATION,SOURCE OF DATA,etc. <br /> M.G.S. QUAD NUMBER 137D <br /> r E R & LIC.a Rig.N7101 c _ <br /> ELEVATION 980' +/- 5' e <br /> I <br /> n.vres.enf.we SOgnstrues 5-018-98 <br /> VICTOR FRAUGHT 5-18-98 <br /> iNIPORTANT FIL Wf PROPERTY PAPERS <br /> 578937 '°'Odder Dew <br /> WELLI. <br /> OWNER COP`! He-01206 46(Ravi 1/■■) <br /> I <br />