HomeMy WebLinkAboutwell info 1.LOCATION OF WEMI County WATER WELL RECORD MINNESOTA UNIQUE WELL NO. 434017
I /� O 1�]
Cnty Name
Miwwem/a SfwJrfq .w Wile►Sewrpls L} L{ 1
156A.01-.08 r
ownshnp Name, ownsh,p Numbswange Number Section No. I Fraction 4.WELL DEPTh,completedl Date of Compktor
117 '4 or 37
Distance and Director from Road Interswiian or Street Address and City of Well Location 5.DRILLING METHOD
10 Cable tool 413 Reverse 70 Driven 100 Dug
Show exact location of well in section grid with"X." Sketch map of well location. 20 Hollow rod 50 Air 80 Bored 110
N
1 , Addition Name 30 Rotary 60 Jetted 90 Power iauger
6.DRILLING FLUID,.,
:,et tont
._�_ _1_ �_ �_
Block umber
W , t E 7. USE
fM Domestic 40 Monitoring 80 Heat Pump
1 T Lot Number 20 Irrigation 50 Public 90 Industry
If mi.
n 30 Test Well 60 Municipal IOD Commercial
7O Air Conditioning 110
1 mile 8.CASING HOLE DIAM.
2.PROPERTY OWNER'S NAME _ r 10 Black 40 Threaded HEIGHT:Abryre/Bebw
1-77
ptCl!rOr=tel `• 20 Galy. SO WeldedSurface tt.
<:: � L. [ Drive Shoe? Yes_No
Address -30 Plastic 60 =� �:
d
in.to 125 ft. Weight - ' IbsJft. - -;n. J-2 It
3. FORMATION LOG COLOR HARDNESS Of
FORMATION FROM TO in.to Wi
ft. Weight lbs./ft. n. to--Jt,
in.to ft. Weight lbs./ft. in. to---Jt
•.,�E7 ..r! �r e -�� 9.SCREENS Or openhok
r� Make .J�3�'il1I3E}a'2. from rt.to. ft.
race .`� -3 Type t2'iu3�35 �Lwe Dis...
Slot/Gauze `J :� Qt Le 1 Z
ravel .est -v Set between 3`•5 ft.and 130 ft. r S :, C�$f��`-i INGS:
f 10.STATICrWATER LEVEL
♦' i
.� v :•rave l ---ray '�`� 1J3 a ft.Obelow Oabove Date Measured
land surface
^^ :t 7 11. PUMPING LEVEL(below land surfatt)
• ZI
ft.after firs.pumping 9.p-m.
ft.after hrs.pumping g.p.m.
ravel �.Tlrne Lact _.. >t :30 12.HEAD WELL COMPLETION
10 Pitless adapter.manufacturer model
20 Basement offset 30 At&east 12"above ground
40 Plastic casing protection
13.WELL GROUTED?
ZYes O No
K]Neat Cement ?0 Bentonite 30
Grout materialy�� from to 7 .ft.cu.y�l�..._..,.__
-iGSi lfY�'�Lw sir ..� �.".✓
10__CL �•
:a.ii hili •e D— I 7 •I rS: •
14. NEAREST SOURCES'3 °3 OF POSSIBLE CONTAMINATION
3 '.ter ^>"
feet �� direction type
Well disinfected upon completion? :]Yes 0 No
15.PUMP -
r=1 t7
Date installed O Not installed
Manufacturer's name
r e�
Model number HP ca Volts_-^-''
IVLength of drop pipe �� i ft.
,.i capacity �b g.p.m.
Material of drop pipe i.-il t nizeds
Type:tG)Submersible 30 L.S.Turbine 50 Reciprocating
20 jet 40 Centrifugal 60
16. EXISTING WELLS
Unused well to property? O Yes O No
Use a second shed.i/weeded Abandoned O Permanent O Temporary 0 Not sealed
17.REMARKS.ELEVATION,SOURCE OF DATA,etc.
18.WATER WELL CONTRACTORS CERTIFICATION
This well was drilled under my jurisdiction and this report is true to the best of my
knowledge and belief. t 715
Lwswree Bwsiwess Nowa License No.
Address 511!
i Itmt Imple l
Signed - i. Da
Authorized Representative
Date
Name of Driller
WATER WELL 4 3 4 017 717'
7/70 30M
7178 9UM
CONTRACTOR COPY HE-01206.02(Rev.10/85) 2/82 101A