Laserfiche WebLink
STATE OF MINNESOTA DEPARTMENT OF HEALTH <br /> �� WATER WELL RECORD M/NNESOTA UNIpUE WELL NO. ������ <br /> County Name Jor Wafer SaMplr <br /> F�i1f�k�£.i� Mihnesofa Slafrfes 156A.01-.08 <br /> Township Name� ownship Number Range Number Section No. Fraction 4.WELL DEPTH(compktedl Date of Completion <br /> i N E y, '/� '/� <br /> � ��.T.'`v'.'_i.:� �.1�.5 � ~..� W �..t,t � l;i tt. ' t'+'� <br /> �-�1°<-.� <br /> tiumerical Stree[Addtess and City of Well Loca[ion or Distance from Road In[ersection. 5.DRILLING METHOD <br /> O CableTool O Reverse ❑Driven ❑p�g <br /> G'��i1.,� {?�1Z r'�ZT�'33Ik? IVC?�C..�T t ��'OT1G� M1Y2T1. <br /> ow ncaa Ixation d well in section grid with"X." Sketch map d well laatan. ❑HollowNod ❑Air O Bored O <br /> N <br /> � � _i i_ Addi[ion Name �L7 Rotary ❑Je[ted ❑Power'Auger <br /> -� � � � 6.DR[LLING FLUID <br /> � � � Icek Number <br /> •-+- --- �- �- 7.USE <br /> W � i � E <br /> _1_ _1_ _'_ __ �Domestic ❑Monitoring ❑Heat Pump <br /> I '. � � r Lot Number ❑Irrigatan {]Public ❑Industry <br /> h mr. <br /> ' � i ❑Test Well C]Municipal ❑Commercial <br /> -i- �- - -r- j ❑AirConditioning ❑ <br /> �-���e'—� 8.CASING HOLE DIAM. <br /> HEIGHT:Above/Below <br /> 2.PROPERTY OWNER'S NAME Mailing Address if differen[[han property address (�81ack <br /> �Threadcd <br /> indicated above. Surtace (t. <br /> �iil2 +�$Gk.l�itAfi: U.:sTI:=`�.t'. I�"all�. t'�2�.�i1i�; OGalv. ❑Weldea <br /> Drive Shce? Yes�� No— <br /> !t3111. ��11Z3.Z� 1.3�3ilfV 4:� • - _ O Plastic p If 4 t� <br /> �:X ::.'; � ,q <br /> ���; z:i.= ;ir�, - �."?=- 1= in.to��[t. Weight�IbsJ(t. —�n. t���ft. <br /> 3. FORMATION LOG COLOR HARDNESS OF FROM� TO in.to fL Weight IbsJft. �n. to_lt. <br /> FORMATION <br /> in.to ft. Weight Ibs./ft. �n. to�t. <br /> �;���y t; ��-: 9.SCREEN Or�openhole <br /> Make ���1��1 from ft.to. ft. <br /> _ ^ f� Tyce �''i�:�1]"1� _ C: :i -. .� Dlam. ;,'r�� <br /> ,' <br />`, SIoVGauze �-� Length ��� <br /> 1�t FITTINGS: <br /> Set between 1#1 ft.an�J-4� tt. <br /> 10.STATIC WATER LE�BL <br /> ,6=�-' ft.�'3 below ❑above Date Measured 1-�-==i r-�i <br /> land surface <br /> ll.PUMP[NG LEVEL(below land surtace) <br /> ��'-�'� ft.after +- hrs.pumping -�+' g.p.m. <br /> - (l.after hrs.pumping g.p.m. <br /> 12.HEAD WELI,COMPLET[ON <br /> -' w��Pi[less adapter manufacturer'�1����F ��f-Fr Model <br /> ❑Basement o(tset ,�At least 12"above ground <br /> ❑Plastic casing protection <br /> 13.WELLGROUTED? �Q'es ❑No <br />� : <br />�,.,�� ❑Neat Cement O Bentonite � ��ui`i.�1 t���C:1L s;L <br />'r' <br /> Grout material from to tt.cu.yds. <br /> i : <br /> o-".' <br /> r: �. <br /> 14. NEAREST SOURCES OF POSSIBLE CONTAM(NATION <br />�� feet direction �ype <br /> Well disinfec[ed upon mmpletion? f,�Yes ❑No <br /> 15. PIJMP �-� <br /> �-1..'���1 ; <br /> Da[e installed ❑Not installed � � <br /> Manufacturer's name ��F'-'p'� <br />� " Model number HP �- Volts��� - <br /> E <br /> I,ength ot drop pipe "� fL Capacity �� g.p.m. <br /> Material of drop pipe �p�,��,\7� <br /> Type��O Submersible ❑L.S.Turbine L]Reciproca[ing <br /> ❑Jet ❑Centrifugal ❑ <br /> I6. ABANDONED WELLS <br /> Unused well on Vroperty? ❑Yes .lL7 No <br /> Use a second aheel,ij needed �ed ❑ Permanent ❑ Temporary ❑ Not sealed <br /> 17. REMARKS,EIEVATION,SOURCE OF DATA,etc. <br /> 18.WATER WELL CONTRACTOR CERTIFICATION <br /> This well was drilled under my jurisdiction and[his report is true lo the hest of my <br /> knowledge and belief. <br /> lli;Fv Si(.��i,¢<�, Vv�;1+L: F�Fti'ILLING UG.. ii�K:. ;r.�17� <br /> Licensee Brsineu Narae License No. <br /> Address ��-=,?'i:) �3..:.'ii�%+�,:.�':�' ?i ���t:3 i !`iT3. ,��;.�tt'� <br /> �.�._. / <br /> Si nt4f`"'� ,�.:...,,..�.�f-��./��at: . f Datr �_.'�a?.r�� <br /> 8 � <br /> Au[horized Idepresenfntlue <br /> j'�• - y''C.-`TivY.'._... 9—�.._.�i1 <br /> DatP - <br /> Name of Dril(er <br /> 5/74 30M <br /> LOCAL COPY � 6 g� � 7 ���s� <br /> �,�8 30M <br /> HE-01205-03(Rev.9/88) p�82�p�„� <br />