Laserfiche WebLink
tiT�Th�.OF'MINNI-S(7TA Uk�.l'AHIMlNTOI�Hk:ALTH y <br /> 1. L(1('ATI(1N()I�WI�.LL Ff/NNFSOTA UNIQUE WE(.L NO. <br /> i,,,,,,,YN,�„• WATERWELLRECOR� 403800 <br /> � .� .. In.ware,sample <br /> Minnriota SfeN�cf/SM1 A.lII�.fIX <br /> T��wnship Name Township Numher It�n�c Numher y�c�i�in N�. 1-rai�l��n 3. YROYF;RTY OWNk:R5 NAMt <br /> f�fl� ��.� o� �� o� '� � � '6� '' ��+'�.1� �f��+�l�fl3! � <br /> I)Islan�'e and It- 11�in fn�m Hn�J Inlrrsecli��ns��r Slnei AJJress an0 C'�1Y o(W<II Lac�ion Addry{ jrE�L'j �i�/�6 O� J .e f� T � <br /> ` ,q <br /> _'a�a.�^��i � <br /> Snnw ea�it Lrcaliun o(ywrll in ucli�in rriJ wilh"X." Ske1cA map o!well I�calion. a.WlLL DEPTH(complet<d) Date of Completion <br /> ' n AJJilinn Name ��6 f,. �'�+^��'(j� <br /> _ L' __ '`- "ti <br /> ii � s ��c,nir�oo� a❑ee.rrse �On��.�� ioOn�e <br /> N - - -�- -�-I- , - E e�,Kk N�m�n <br /> x❑N��m,wr��u s❑ntr e❑a�rea n❑ <br /> ' - - '' -` ��. ��N��tarY 6�Jelled 9OYnwer Aueer <br /> - - �- --�- - -�-- 1 <br /> Lol Num�er 6. USE <br /> I�liimestic 4❑Yu�lie$u00�Y 7[�Induslry <br /> S <br /> F—1 IRtZI ]�Irriguti��n 5❑Municipal B�Commerti�l <br /> 1. lORMATIONLO(: �•p�pH HAltl>NFSSO! F�HUM TO <br /> 1()NMqTIVN J�Tr�t Wrll 6❑Air('��ndi�ionini 9❑ <br /> q 7.CASING Hti1GHT:AboveJBelow HOLE DIAM <br /> '�'�C1 '�� � �(� Bl�ck a❑ThrcadrJ <br /> i' <br /> 30(;alv. S�WelAed Sur(ace !t. <br /> {wia� � ���� � � ,1G7 P�eStIC 6❑ Drive Shoe? Yes_ No x <br /> . ��� in.lo ��� ft. Weight ���� Ibs./ft. —fn.�l�ft. <br /> � {[ y����'� Li�W'�►ia � �• in.lo f�. WeigM Ibs./(1. —in.lo_(t. ..f <br /> � in.to ft. W<iRhl Ibs.�ft. �n.lo_(t. <br /> j• ���r �����j �� =g e.SCRtEj`{�� r open ole . _; <br /> Meke� y (rom !t.to ft. ,i <br /> II�[iR� i��i�l�i� 1�7 +31J TYV� Sir �'{s1�4� Dis. ';: <br /> SI�1/Gauze y �� Length � <br /> �tWee�s� ��� f'ITTINGS: <br /> ;?� �.`�.�� +!{} '� n.,�a «. <br /> ft.and fi. <br /> 9. STATIC WATlR LEVEL �'�� <br /> ��i18 G�. �i4� �� �^� • <br /> � J� �neli�w ❑annve Date Measu��� <br /> — land surface f <br /> _ 1����� r�� ���� �� �� 10.YUMPINGLk;VEL(telowlanOsurface) <br /> 1�ai <br /> O;f{T.i <br /> (I.afler hrs.pumpin6 =� B.p.m. <br /> �_���n� w��� � � !� f�.afler hrs.pumpinH B.p.m. <br /> �F i � <br /> 11.Wt;LLHEAUCOMYLF:TION <br /> — � i'Q.P�uess aaepier,manuracwrer moee� <br /> Q'b1L� �1 ��� 7❑Bas ment u((sei !❑A��east 12"above Rrade <br /> pOiA4 <br /> _ 12.WELL GROUTED? <br /> �3�.� C�� ���i �.�.� �C7v� ❑r,o <br /> — �❑rvr��c�m<��� aOer�i���n� �O <br /> �s�.+�rw't �� Y)� Grout matenal <<om «.cu.Yas. <br /> +3Y4�/. w.• <br /> 13.NEAREST 60URCES OF P06SIBLE CONTAMINATION <br /> �_roe� a�««�o� �rve <br /> Well disinfected uDon comple��on? Yes� N��❑ <br /> 10. PUMP <br /> oa«m:�su�e '3�.3i�.�4: ❑Na��„:�.u<a <br /> r:4�.�...�_w,.-... t}r <br /> � ('� Manufacluret's Name j�A�� <br /> � S �(� '�, � Model Number HY�_Volts 6sj3L�_ <br /> � i:� Length of drop piPe �� ft.capacitY 1� B.p.m. <br /> _J Material of droD p�pe �Y� <br /> S+K <br /> � � 2 2 �i� irve:��❑suhm�•rcintr �❑L.S.Turbine s�ftec�vroc�i�ng <br /> ' 3�1e� 4�('en�rifugul 6❑ <br /> , . ' t �r. <br /> 1 <br /> s s eet �� 16.WATERWELLCONTRACTOR'SCERTIFICATION <br /> I5.AEMARKS,ELEVATION,SOUR <br /> a ��y_� 'Ihis well was drilled under my jurisCiction and this report is true to � <br /> "����+.,,,� Ihe besl of my knowledge and�elief. <br /> .�'j�'e�,�nss j�+�1.1 f`.n 2,�,5�31a. <br /> Licenree Butineir Name Licenx No. <br /> naa.essFi1�1� 41S�V'��, '�,�_�$�� �L' ��e'Y��i �`,f� <br /> s�aoea� . � , w�e �#-"�s-��$ <br /> Auf�orized Represenfalive <br /> �.�3J�� :i£E°M@�31� n,« �*„`��'�:1 <br /> Name of Drdler <br /> I��AL C�PY 4 0 3 8 D 0 sna son+ <br /> 7/76 30M <br /> 7/78 30M <br /> HE-012o5-ot 2/82 tOM <br />