Well info - Laserfiche WebLink

Home Browse Search

WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. � CountyName WELL AND BORING RECORD 6 5 5 0 5 5 Minnesota Statutes Chapter 103! Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed i. . �T� n Z2�28��0 House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD ❑ Cable Tool �iven C7 Dug ❑ Auger Rotary ❑ Jened Show exact location of well in section grid with"X". Sketch map of well location. i.�l � �� Showing property lines, -----.._--------------�—�----------- �� roads and buildings. DRILLING FLUID WELL HYDROFRACTURED? ❑YES �fJO " �� vater , , � , FROM n.�o n. ,- -;- -;- -, � USE J ❑ Monitoring ❑ Heating/Cooling , i i i �,ySi Domestic ❑ Communi PWS f7 Irrigation Ty ❑ Indusiry/Commercial i i i i � [,.� ❑ Noncommunity PWS ❑ Remedial w I ' I I E r � C� Environ.Bore Hole ❑ Dewatering ❑ -r --�- -r- -r i i i i � CASING Drive Shoe? ❑ Yes o HOLE DIAM. /2Mne _i _i_ _L_ _i_ I ^ ��L �Steel ❑ Threaded ❑ Welded � � � � 1 U ,r, Plastic ❑ S �t Mile-� CASING DIAMETER WEIGHT PROPERTY OWNER'S NAME � in.to_��fl. Ibs./ft. �in.to�' tlj in.to fl. Ibs./ft. in.to Property owner's mailing address if di rent[han well location address indicated above. in,to ft. Ibs./ft �in.to� SS�C SS above SCRE�jJ�t.�_a�r�_ OPEN HOLE MakeJ T from ft.to ft. Type St81IZ�Q88 .��e�l__ Diam-•/ SIoUGauze f1 /� y� �t •V�St.---------------.--Length '� Setbetween ��'� ft.and_�.T_�__ft. FITTINGS:7��(3�~_.�,�� - STATIC WATER LEVEL WELL OWNER'S NAME �5 ft.�elow ❑ above land surtace Date measured�'��._� O - PUMPING LEVEL(below land surface) Well owner's mailing address if different than property owner's address indicated above. _ r� ft. after___ hrs.pumping_ g.p.m. --�-}H----- �--------- ---� �L HEAD COMPLETION - Pdless adapter manufacturer vh i t e�t e r Model ❑ Casing Protection___ _�2 in.above grade ❑ At-grade(Environmental Wells and Borings ONLY) GROUTING INFORMATIQN � Well grouted? ➢e�Yes G No GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO Grout Material ❑ Neat cement '�l Bentonite ❑ Concrete �High Solids Bentonite MATERIAL from to ❑ yds.�bags � ��t --�— from_._ to ft. s. ❑ bags cla ellow ffiediw� 1 � ��'� �S#��'i'21 from_ to ft. ❑ yds. ❑ bags NEAR/ES-T KNOWN SOURCE OF CONTAMINATION�J � C18 TS8 30f� �, 9 ---tC�� _feet �C'Jdt I�`'� direction �� j � type Well disinfected upon completion? j�Yes ❑ No ��.'+�(-�J j�/F(,.. saud (fine) bro�n sof t 9 22 PUMP ❑ Not installed Date installed�__4"'u,1 ' ��8 brown mediun� 42 25 ManufacturePsname v��_____. _ 10�Se/CQar$� Modelnumber ___ HP.7(�_____ VOIts23V sandstone Nhite ��ft Z6 L7 Lengthofdroppipe L9 ft. Capacity ___ _ ___g.p.m. �T Type:�Submersible ❑ LS.Turbine ❑ Reciprocating ❑ Jet ❑ _ ABANDONED WELLS Does property have any not in use and not sealed well(s)? ❑ Yes �No VARIANCE Was a variance granted from the MDH for this well? [, Yes �o TN#_. �� � WELL CONTRACTOR CERTIFICATION Use a second sheet,il needed This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. � The information contained in this report is true to the best of my knowledge. REMARKS,ELEVATION,SOURCE OF DATA,etc. � ° Stodola �lell Dril2ing Co,� Inc.. _.27 72 �: � Licensee$usiness Name Lic.or Reg.No. �� -: � " '� 2-12-�OI : ; �"� ' - � � .�._ _ -� ,., . . --- _ — uthorize prese hv Signature Date Chuck Moore IZ-28-�1 Name o/Orillei Date LOCAL COPY 6� 5 0 5 5 HE-01205-07(Rev.4/99)