well info - Laserfiche WebLink

Home Browse Search

i Y � MINNESOTA DEPARTMENT OF HEALTH MIN AND BORIN'�G NO. ELL WELL OR B�i :�vu LOCATION co�ntY N,,�„ WELL AND BORING RECORD 7 g 2 0 21 �n Minnesota Statutes,Chapter 1031 Township Name Township No. Range No. Section No. Fraction WELLJBORING DEPTH(completed) DATE WORK COMPLETED t�ca�o !17 23 d5 �i 1� N�� 195 n (r25-I3 GPS DRILLING METHOD ` LOCATION: Latitude degrees minutes seconds Longitude degrees minutes __ seconds ❑Cable Tool ❑Driven ❑Auger �iotary House Number.Street Name,City,and ZIP Code of Well Location Fire Number ;�Other �Zl� GLa[7CWi Is1Z� � tkac�o 5y3 DRILLING FLUID WELL HYDROFRACTURED? ❑Yes . o - Show exact location of well/boring in section grid with"X" Sketch map of well/boring loca n. ��t��it� �� `; Showing property li s, From ft.To ft. N roads.buildings,and direc n. USE �Domestic ❑Monitoring ❑Heating/Cooling __._____�__ ___�_____l_ �_�Noncommunity PWS ❑Erniron.Bore Hole ❑Industry/Commercial , `�Community PWS ❑Irrigation ❑Remedial ` --i-----;--- --F-- ---i-- ']Elevator ❑Dewatering ❑ �� `/d , , , � E T _ CASING MATERIAL ' � HOLE DIAM. , , , , ; -� Drive Shoe? L;Yes �Vo ' -. --�--- —�--- --�-----%-- �'Steel ❑Threaded ❑Welded . � � � i Mile � lastic ,� `, � --:--- --T-- ---�-- ---.-- 1 � ; ; ; ; CASING S Diamett�er Weight Specifications �—iM,ie—� . �� u�� " in.To��" ft. Ibs./ft. � in.To�Oft Fl jL�� PROPERTY OWtNER'S NAMEiCOMPANY NAME � in.To ft. Ibs./ft. � in.To ft �1� �� 1�lla in.To ft. Ibs./fl. in.To fl Property owner's mailing address if different than well location address indicated above. SCREEN� OPEN HOLE � I5050 23rc1 Ane N Make_ From ft. To ft. 1. f /�7 ' ��ti�+ � JS'f'i/ TYPe— �� $$ Diam. ;. n � —_ SIoUGauze •�V Lengih `f T� : Set between___�7_ft.and 195 tt. FITTINGS � � STATIC WATER LEVEL Measured from 97 ft. elow ❑Above land surface Date measured WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) �,.�� ft.after__.� _ hrs.pumping 3� g.p.m. Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION �t �Pitless/adapter manufacturer 3[llt�t�r Model _ �Casing protection___ __ ,�2 in.above grade ❑At-grade I !Well House ❑Hand Pump � GROUTING W FORMATION(specify bentonite,cement-sand,neat-cement,concrete,cuttings,or other) Matenal "—"��'Fromr O To__ �ft. � ❑Yds. ,(�ags Material �� j �To �ft. ❑Yds. ❑Bags HARDNESS OF Material From To_ ft. ❑Yds. ❑Bags GEOLOGICALMATERIALS COLOA MATERIAL FROM TO Drivencasingseal From To _Bags NEAREST KNOWN SOURCE OF CONTAMINATION ' C� �� f� � � feet � direction � �«:.Sl..� niyRle Well disinfected upon completion? �Yes �, J No � ,$'�� PUMP ��y� ❑Not installed Date installed_______ ��,______ �'+��/ �1 varied �� Manufacturer's name .�I�c�QL'� � Model Number HP � Volts �� Length of drop pipe �7 - ft. Capacity g.p.m Type: ubmersible I�L.S.Turbine ❑Reciprocating ❑Jet ❑ ABANDONED WELLS Does property have any not in use and not sealed well(s)? ❑Yes �IVo VARIANCE _..... , Was a variance granted from the MDH for this well? r J Yes o TN# WELL CONTRACTOR CERTIFICATION This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. The information contained in this report is hue to the best of my knowledge. Use a second sheet,ii needed. REMARKS,ELEVATION,SOURCE OF DATA,etc. don Stcadoia well Dtillic�g Co,. inc. 1691 - -——--__- - - _-_ ___ -_ Licensee Business N e Lic.or Reg.No. ! �. 9-12-13 esentative 9 gnatur Certified Rep.Na Date _.: ' LOCAL COPY 7 9 2 O 2 1 _ �� r�-- — _ _ Name of Driller IC 140-0020 HE-01205-13(Rev.11/10) �