Well info - Laserfiche WebLink

Home Browse Search

. , _ -� . .�a �. . �. -�x. MINNESOTA UN/QUE WELL = WELL OR�30f,ill`J�LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. r � Counry Name WELL AND BORING RECORD 7 g 19 9 9 Minnesota Statutes,Chapter f037 To n Township No. Range No. Section No. Fraction WELUBORING DEPTH(completed) DATE WORK COMPLETED � �.17 �� ! �+ �� v, �� n �. � GPS DRILLING METHOD LOCATION: Latitude degrees minutes seconds Longitude degrees minutes seconds �'Cable Tool ❑Driven J Auger �Rotary House Number,Sireei Name,City,and ZIP Code of Well Location Fire Number ��Other 6495 B� �� E�1 {#cano 55�59 DRILLING FLUID WELL HYDROFRACTURED? ❑Yes o Show exact location of well/boring in section grid with"X." Sketch map of well/boring location. �R+=�u�e From.. ft.To ft. Showing property lines, --- : N road ,buil 'ngs.and direction. USE �omestic ❑Monitoring ❑Heating/Cooling ' I � � I '`.F_;�X �;,J,...� . __..__ . _�_ __.__ �_]Noncommunity PWS ❑Environ.Bore Hole ❑Industry/Commercial ; � � � � �� [..]Community PWS ❑Irrigation , ❑Remedial ' --'-----�-- --`—--`— [ !Elevator �Dewatering � ❑ ? `N , , ; ; E " ASW ERIA rive Shoe? �Yes �,� No HOLE DIAM. C GMAT L p � --�-----�------�-----�-- � : s I I I I T � ,�Steel �Threaded ❑V�Ielded :� , , , , '!�Mile �' --�---—�--- --�----�- ❑Plastic [ : �� CASING � � S � � � ,(�, Diameter Weight Specifications �J� Q ��Mite� � in.To�� ft. Ibs./ft. v in.To �O ft '' PROPERTY OWNER�S NAMErCOMPANY NAME in.To_.._. . tt. Ibs./ft. "� in.Ta�+�ft ._ ' -��-----...__,_ in.To ft. Ibs./ft To ft t - �C�� TS lOC� �S �QC• OPEN HOLE Property owner's mailing address if different than well location addr s i`icated above. SCREEN _ 14S RS�.LW�y St C�I Make t� __ __ From ft. To ft. ��t� 1� 55357 Type__ Dia� ! SIoUGauze��(� _____ Length_�t Set between ""'ft.and ft. FITTINGS " STATIC WATE L � Measured rom � ft.�{Below ❑Above land surface Date measured WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) ft.after hrs.pumping_ g.p.m. Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION �Pitless/adapter manufacturer ��a�`�� Model ❑Casing protection �12 in.above grade ❑At-grade �J Well House ❑Hand Pump GROUTING INFORMATION(specify bentonite,cement-sand,neat-cement,concrete,cuttings,or other) Matenal_ om To ft ❑Yds. �_�Bags �� Matenal��To�ft. ❑Yds. U Bags HARDNESS OF Material . __ From To ft. ❑Yds. ❑Bags GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO Dnven casing seal From To _Bags NEAREST KNOWN SOURCE OF CONTAMINATION C�� iJLi7�YII �l� �� .- feet � '� direction �— type Well disinfected upon completian? �Yes ❑No � ; Ci$ j'$ �(}�� PUMP ; L Not installed Date installed__ Z�-13 ' �` 1 � �� Manufacturer's name '�� __ ' * l`��.,,�J / Model Number HP__}.�.�__Volis � Ca �� i'L� Len th of dro i e__ ZV(7 ft. Ca acit m - 9 PPP P Y 9P C�8 ' �� Type:�Submersible ❑LS.Turbine ❑Reciprocating ❑Jet ❑ ABANDONED WELLS �itel ° Y�—t� Does property have any not in use and not sealed well(s)? ❑Yes I_�jCNo acaiA�a � VARIANCE * ,�� Was a variance granted from the MDH for this we117 ❑Yes �No TN# 1 WELL CONTRACTOR CERTIFICATION This well was drilled under my supervision and in accordance with fvlinnesota Rules,Chapter 4725. The information contained in this report is true to the best of my knowledge. Use a second sheet,il needed. REMARKS,ELEVATION,SOURCE OF DATA,etc. CE�yED DcMi Sttxta►18 WeII Ih'illisi� Co., I�. !&91 J�� Licensee Business Name Lic.or Reg.No. 212Q13 "..--� . _- . �,. C�N O�'p ' � �--�t—��_ � ��0 C resen i e Siy�6fur Certified Rep.No. Date LOCAL COPY 7 919 9 9 - �` '-�� Name of Driller IC 140-0020 HE-01205-13(Rev.11/10)