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MINNESOTA DEPARTMENT OF HEALTH Update Date 2003/10/10 <br />Unique No. 00127221 WELL AND BORING RECORD <br />Entry pate 1g1381t)4J17 <br />County Name Sherburne Minnesota Statlrtes Chapter 1031 <br />Well Depth Depth Completed Date Well Completed <br />Township Name Township Range Dir Section Subsection ft 190 ft 1977/10/27 <br />~ ~ W 28 ADDDDA 190 <br />Weil Name BAUFIELD, MARY Drilling Method Non-specified Rotary <br />Drilling Fluid Well Hydrofractured? ^ Yes ^ No <br />Contact's Name BAUFIELD, MARY ft <br />From ft. to <br />11948192ND NW AV <br />GEOLOGICAL MATERIAL COLOR HARDNESS FROM TO <br />SAND BROW 0 ~ <br />CLAY BLUE ~ 1`~ <br />WATER SAND BROW 150 190 <br />USGS Quad: Elk River Elevation: 965 <br />Aquifer: QBAA Att Id: <br />Report Copy _ <br />Use Domestic <br />Casing Drive Shce? ^ Yes ^ N Hole Diameter <br />Casing Diameter Weightpbsftt) <br />4 in_ to 185 ft <br />Screen Y ~ Open Hole From ft. to ft• <br />Make JOHNSON Type L <br />Diameter Slot Length Set Fitting <br />2 ft. to ft <br />Date 1977/10!27 <br />Static Water Level 70 ft. from Land surface <br />PUMPING LEVEL (below land surface) <br />80 ft. after 3 hrs. pumping 30 9•P•m• <br />Well Head Completion <br />PiUess adapter mfr Model <br />Casing Protection ^ 12 in. above grade <br />^ At-grade(Environmental Wells and Borings ONLY) <br />No <br />Grouting Information Well grouted? 0 Yes <br />Material From To (ft.- Arnourmt(Yds/bags) <br />Y <br />Nearest Known Source of Contamination <br />ft, direction. ~ <br />Well disinfected upon completion? 0 Yes ^ No <br />pump ^ Not Installed Date Installed Y <br />Mfr name AERMOTOR <br />Model HP 0.75 Volts <br />Drop Pipe Length 72 ft. Capacity 9•P-m <br />Type S <br />Any not in use and not sealed well(s) on property? ^ Yes ^ No <br />Was a variance granted from the MDH for this Well? ^ Yes ^ No <br />Weil CONTRACTOR CERTIFICATION Lic. Or Reg. No. 27056 <br />License Business Name <br />Name of Driller ~D r~~ <br />