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<br />~ <br /> <br />WELL LOCATION <br />County Nal1)e <br />AnOKa <br /> <br />-=;;~ row;;~o, I ;~;o. I s;~on No. <br /> <br />House Number, Street Name, City, and Zip Code of Well Location <br />5161 - 156fh Lane.NW <br /> <br />MINNESOTA DEPARTMENT OF HEALTH <br />WELL AND BORING flECORD <br />Minnesota StaMas Chapter 1031 <br /> <br />MINNESOTA UN/QUE WELL NO. <br /> <br />1'6~67811 <br /> <br />Fraction <br /> <br />WELL DEPTH (completed) <br />210 feet <br /> <br />n. \ Date Work Completed <br />October 24, 2001 <br /> <br />NE"NW NE'I. <br />or Fire Number <br /> <br />DRilLING METHOD <br />o Cable Tool <br />o Auger <br />o <br /> <br />DRIWNG FLUIP <br /> <br />Bentonite <br /> <br />o Driven <br />~Rotary <br /> <br />o Dug <br />o JeUed <br /> <br />w <br /> <br />N <br />-.' <br />-:- -~- -:- -;- <br /> <br />I I I I <br />_I- _.J_ .-1._ _l- <br />I I .1 I <br /> <br />I T.I I <br />-1- -"1- -T- -, <br />I I I I <br /> <br /> <br />+ -~- -t- -:- <br />s <br />1.....~ <br /> <br />Sketch map of well location. <br />() Showing property Unes, <br />I ../~ I rads and ~uhdings" <br />, ~ . <br />I <br /> <br />.1.1'U1~12S.f <br /> <br />. <br />.....! , <br /> <br />USE. _~ <br />)II:l Domestic <br />o IrrigaRon <br />o Environ. Bore Hole <br /> <br />Show exact location of well in section grid with 'X'. <br /> <br />_Al r <br />'. <br />--..- <br /> <br />CASING <br />~teel <br />o Plastic <br /> <br />I WELL HVDROFRACTURED? <br /> <br />I FROM. ft, to <br /> <br />o Monitoring D' Heating/Coofing <br />o CommunitY pWS . 0 Industry/Commercial <br />o Noncommunity PWS 0 Remedial <br />o Dewatering 0 <br /> <br />DOve Shoe? )I Yes 0 No <br />)('Threaded 0 Welded <br />o <br /> <br />DYES ~O <br />It. <br /> <br />ET <br /> <br />'12.... <br /> <br />1 <br /> <br />HOLE D1AM. <br /> <br />PROPERlY OWNER'S NAME <br /> <br />1l\A"~1''''' --... · <br />Property owne(s mailing address if differt>nt.than wen'locatio!) addiessIndicated above: <br /> <br />," CASING DIAMETER <br />4 in. to 125 I\. <br />In. to . It. <br />~_In.to .____fl <br /> <br />WEIGHT <br /> <br />10.79 <br /> <br />IbsJlt. <br />Ibs.lfl. <br />IbsJlt.. <br /> <br />-tln.to~1\. <br />4in.to~1\. <br />~in.t~~fl <br /> <br />5161 - 156fh Lane NW <br />Ramsey, MN 55303 <br /> <br />SCREEN <br /> <br />Make <br /> <br />Type <br />Slot/Gauze <br />Set between <br /> <br />I OPEN HOLE <br />from 124 <br />Diem.' <br />length <br />I\. FITTINGS: <br /> <br />flto 210 It. <br /> <br />Phone: (763)323-470Z <br /> <br />It. and <br /> <br />WELL OWNER'S NAME <br /> <br />Same <br /> <br />Well owner's mailing address if different than property owner's address ind~ted above. <br /> <br />STATIC WATER LEVEL ' <br />30 . I\.J(helow 0 above land SlJrface . Date 'measured 10-24-01 <br /> <br />PUMPING LEVJ=L (below land surface) <br />, . Air It.'after <br /> <br />hrs. pumping . <br /> <br />30 <br /> <br /><I.p.m. <br /> <br />Clay <br /> <br />Brown <br /> <br />S <br /> <br />o <br /> <br />30 <br /> <br />WELL HEAD COMPLETION . ak <br />J& PiUess adapter manufacturer .' B er <br />o Casing Protection <br />o At-grade (Environmental Wells and Borings ONLY) <br />GROUTING INFORMATION <br />Wen grouted? "f(ves D. No <br />Grout Malerial 0 Neat cement 0 Bentonlle 0 Concrete <br />from 0 to~1\. <br /> <br />from to-,----I\. <br />from to It. <br /> <br />NEARES. T K.bIRWN SOURCE OF CONTAMIN~ON th <br />'U+ feet .' au dire<<tion <br /> <br />WeD disinfeCted upon completion? )( Ves 0 No <br /> <br />Model Snappy <br />)(12 in. above grade <br /> <br />GEOLOGICAL MATERIALS <br /> <br />COLOR <br /> <br />HARDNESS OF FRO. M <br />MATERIAL <br /> <br />TO <br /> <br />)( High Solids Bentonite <br />3 0 ydS.;ttJ bags <br />D' yds. 0 bags <br />o yds. 0 bags <br /> <br />Sand <br /> <br />Brown <br /> <br />S <br /> <br />30 <br /> <br />80 <br /> <br />Septic <br /> <br />~pe <br /> <br />Rubble <br /> <br />Lt. Green <br /> <br />S <br /> <br />80' <br /> <br />124 <br /> <br />PUMP <br /> <br />"~ap.~n.e.S~e. . ,. <br /> <br />Lt. Green <br /> <br />M <br /> <br />124.. 210 <br /> <br />o Not installed Date installed <br />t";an~~ac~...r'S nl!fl'i~' Gnmdfos <br />M~~e1~U~ber 22SQE10C-190 HP <br />1W'PVC X 6<\, <br /> <br />02/05/02 <br /> <br />. <br /> <br />1 <br /> <br />Volts 230 <br />22 <br /> <br />g.p.m. <br /> <br />Length.of drop pipe <br />Type: )( Submersible <br /> <br />Capacity <br /> <br />. 0 LS, Turbine 0 Reciprocating 0 Jet 0 <br />ABANDONED WELLS . <br />Does property have any not in use and not sealed well(s)? 0 Ves 1(No <br /> <br />. <br /> <br />VARIANCe <br />Was a variance granted from the MDH for iIlis well? 0 Ves lJ(No TNIt <br /> <br />WELL CONTRACTOR CERTIFICATION <br /> <br />Use a second sheet. if needed <br />REMARKS, ELEVATION, SOURCE OF DATA. etc. <br /> <br />Q2-306 <br /> <br />This weU 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 /> <br />E.H. Renner & Sans, Inc. 71015 <br />----. . <br /> <br />~"*" C.' L:: ~..~". 03121/02 <br /> <br /> <br />Authorized Representative Signature Date . <br /> <br />Victor Praught 03/21/02 <br /> <br />, <br />, . <br /> <br />~evati9n: 880 ft. MSGS Quad: 136C <br />. ...A.eplacement Well. Reused owner's pitless <br />Adapter and. extended 1" .polyethylene <br />water pipe. Well Rite JR 15 tame <br /> <br />MINN. DEPT. OF HEALrH COpy I <br /> <br />Name of Driller <br /> <br />Date <br /> <br />i <br />i <br />. I <br />! <br /> <br />62"6781 <br /> <br />HE-0120S-06 (!'lev. 7/98) <br />::s5 <br /> <br />,.:.. <br />