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HomeMy WebLinkAboutWater Well Record STATE OF MINNESOTA DEPARTMENT OF HEALTH t.LOCATION OF WELL1 WATER WELL RECORD MINNESOTA UNIQUE WELL NO - 1113 County Name for Water Sample T Minnesota Statutes 156A.01-.08 Township Name Township Number I Range Number I Section No. I Fraction 4.WELL DEPTH(completed) Date of Completion t72 UZX? U78 o23W. ° 33 lei'' SW,W, - 13* 'n. 10J25/90 Numerical Street Address and City of Well Location or Distance from Road IntersectitYn. 5r DRILLING METHOD 2725 W Wayzata zatidBlv -` , M 55356 53 5` ❑Cable'lool ❑Reverse ❑Driven ❑Dug Show exact location of well in section grid with"X ' Sketch map of wepll location. ❑Hollow Rod ❑Air ❑Bored ❑ N yy I � t i Addition Name i7 Rotary ❑Jetted JtPower Auger ti.'DRILLING FLUID ` NOM l ' t I Block Number ^,, g `-'°� --+- -=- - - well Y `,8 3. 7. USF. WE t � I � ❑Domestic &&onitoring.� ❑Heat Pump ( Lot Num tx•r ❑Irrigation ❑Public ❑Industry mi. ❑Test Well {]Municipal ❑Commercial ❑Air Conditioning ❑ t 1 ri.CASING HOLE DIAM. 2.PROPERTY OWNER'S NAME Mailing Address if different than property address lack HEIGHT:Above/Ji �1 ❑Threaded Tom. indicated above. Surface 2 it vei Capital, • ❑PlastGaIv $Welded `W. Wl �e� W. r� y,� Blvd. DriveYShce? Yes_No� V VCv 356 -❑Plastic ❑ �'"'� � `�� 2 _ in.to ft. Wdight lbs./ft. Win. t, t. 3. FORMATION LOG COLOR HARDNESS OF FROM TO in.to ft. Weight lbs./ft. in. tort. FORMATION A 2 in.to ft. Weight lbs./ft. in. tort. ' to soil V blackSCRE I Or open hole from ft.to. ft. ake clad gray 2 13 Type get s Ste-A- Diam. Slot/Gauze 30 Length �� . FITTINGS: "I_4 Set between 3 ft.and 33 ft. Y -- 10. STA IC WATER LEVEL fl.Xbelow ❑above e. Date Measured land surface 11. PUMPING LEVEL(below land surface) ft.after hrs.4umping 2 g.p.no. ft.after hrs.pumping g.p.m. I2.HEAD WELL COMPLETION ❑Pitless adapter manufacturer Model '❑Basement,offset K.41 least 12"above ground ❑Plastic casing protection I3.WELL GROUTED? X Yes ❑No Teat Cement ❑Bentonite 13' - .r yam., Grout material 1>/i 2 bin from © to 2 ft.cu.yds. 2 14. NEAREST SOURCES OF POSSIBLE CONTAMINATION feet direction -tp pe Well disinfected upon completion? ❑Yes IgNo 15. PUMP yy Date installed I Not installed Manufacturer's name - Model number HP Volts- Length of drop pipe ft. Capacity _.-.- ppm. Material of drop pipe -- Type: ❑Submersible ❑L.S.Turbine 0 Reciprocating 11 jet ❑Centrifugal ❑ - 16. ABANDONED WELLS Unused well on property? ❑Yes $No Use a second sheet,if needed Sealed ❑ Permanent ❑ Temporary ❑ Not sealed REMARKS,ELEVATION,SOURCE OF DATA,etc. tri.WATER WELL CONTRACTOR CERTIFICATION This well was drilled under my jurisdiction and this report is true to the best of my knowledge and belief. Stns tell Drillbig CO. 27194 Licensee Business Name license No. •- Address 59 " Signed Authorized Representative _ rrT4'7bna"m late:!-- 3_q1 Name of DHIler LOCAL COPY 1471113 7/7430M 7/76 30M 7/76 30M HE-01205-03(Rev.9/88) 2/62 10M STATE OF MINNESOTA DEPARTMENT OF HEALTH 1.LOCATION OF WEL WATER WELL RECORD YINNESOTA UNIQUE WELL NO. 7 i 114 County Name /or Water Sample Haulepin Minnesota Statutes 156A.01..08 Township Name Township Number Range Number Section ction No. Fraction 4.WELL DEPTH(completed) Date of Completion Or MR o Z3iaT or 33 Nd Staff NEI/, 14 ft. 1(}_2'9-90 Numerical Street Address and City of Well Location or Distance �Tfrom LL,Road intersection. �t 5.-DRILLING METHOD 2725 W. Way=t€i Blvd.. Long Lake, M 55356 ❑Cable Tool ❑Reverse ❑Driven ❑Dug Show exact location of well in section grid with"X." Sketch map of well location- ❑Hollow Rod ❑Air ❑Bored ❑ N YY�� i i Addition Name i Mkotary ❑Jetted APower Auger --r---�- -1 -1- � 6.DRILLING FLUID t t Block Number W ' I E Well Y aw - ' T " -1- --- -- -_ I ❑Domestic �Mom-toring ❑Heat Pump I Lot Number ❑Irrigation ❑Public ❑Industry *+r ' - ❑Test Well ❑Municipal ❑Commercial --t- -�- -; -r- I ❑Air Conditioning ❑ 1 1 I —� "F 8.CASING HOLE DIAM. mile HEIGHT:Above/ ❑Threaded 2.PROPERTY OWNER'S NAME Mailing Address if different than property address KBlack indicated above' Surface 2 ft. a capitiat rnc. 2765 W., -WTYla't a J.ZVd. 't Plastic ❑ Drive Shoe? Yes_No_X p p 1CM Lake, ';•N 5 p 55 in.to 4 ft. Weight lbs./ft. _n. to-14it. 3. FORMATION LOG COLORHARDNESS OFFORMATION FROM TO in.to t. it. Weight lbs./(t.� —in. to in.to ft. Weight lbs./ft. Win. tort. TU;? sol & fill BLICk @ 3 s.SCREENOr open hole Make from-ft.to. ft. �.a Clay a'eM 3 14 Iylx Si.inai ew Stere] w Dfam. 109 Slut/Gauze Length FITTINGS: 4t between 4 ft.and �� ft. 10. STfC JIV IR LEVEL �! jjr fLabelow ❑above Date Measured land surface 11. PUMPING LEVEL(below land surface) ft.after 1 hrs.pumping 2 g.p.m. ft.after hrs.pumping -__— g.p.m. 12. HEAD WELL COMPLETION ❑Pitless adapter manufacturer Model .10 Basement,offset JtAt least 12"aboveground ❑Plastic casing protection 11 WELL GROUTED? KYes ❑No Neat Cement ❑Bentonite ❑ 1 bw Grout material from ID to- ft.cu.yds.-- 14. NEAREST SOURCES OF POSSIBLE CONTAMINATION feet direction type Well disinfected upon completion? ❑Yes XNo 15. PUMP Date installed $Not installed w Manufacturer's name Model number HP Volts __. Length of drop pipe ft. Capacity g.p.m. Material of drop pipe Type: ❑Submersible ❑L.S.Turbine ❑Reciprocating ❑Jet ❑Centrifugal ❑ -- - 16.ABANDONED WELLS Unused well on property? ❑Yes 'A No Use a second sheet,iJ needed homed ❑ Permanent ❑ Temporary ❑ Not sealed 17.REMARKS,ELEVATION,SOURCE OF DATA,etc. 18.WATER WELL CONTRACTOR CERTIFICATION This well was drilled under my jurisdiction and this report is true to the best of my knowledge and belief. y� s Td1 al Deli um Co. 27194 Licensee Business Name License No. Address 6240 . 12 liaple plain 144 55359 Signed Date l-�: 91 Authorized Representative Randv Jchronn Date1^ �y Name of Driller 6/74 30M LOCAL COPY 1471114 7/7830M 7/78 30M HE-01205-03(Rev.9/88) 2/82 10M STATE OF MINNESOTA DEPARTMENT OF HEALTH I.LOCATION OF WELL WATER WELL RECORD MINNESOTA UNIQUE WELL NO. �] County Name for Wafer Sample r Minnesota Statutes 156A.01-.08 1115 Township Name •L�� Township Number Range Number Section No. Frraac�tiion gyp 4.WELL DEPTH(completed) D�Completion�p �{�_�� 11iii o W 33 AA / W ice'/ h. 10-30-'FV Numerical Street Address and City of Well Location or Distance Jism Road Intersectiob. 57DRILLING METHOD '^ 2725 v. ta Blvd.' Lmg Luba- M 55M ❑Cable"fool ❑Reverse ❑Driven ❑Dug Show exact location of well in section'grid with-X.- ^7 Sketch map of well location. ❑Hollow Rod ❑Air ❑Bored ❑ ____ N I t t Addition Name -. M•. JERotary ❑Jetted JtPower Auger -r'-�- - -1_ 6-DRILLING FLUID Block Numb W E Number we � -�y' 7wUSE w t f- ❑Domestic Xonitoring ❑Heat Pum pT ❑Industry mi. Lot Number 0 Irrigation 0 Public ❑Test Well �❑Municipal ❑Commercial ❑Air Conditioning ❑ �—I mile 8.CASING HOLE DIAM. 2.PROPERTY OWNER'S NAME Mailing Address if different than property address lack HEIGHT:Above2 _ ❑Threaded 19. Surface- ft. �., indg¢ o�� a� t $1 . -p Galv. YWelded 276 • l Drive Shoe? Yes—No-X VCT Com#fial.� I=& 1� Lake, P- 55356 b Plastic ❑ p � 2_m.to 4 ft. Weigh lbs./ft. flan t,11ft. 3. FORMATION LOG COLOK HARDNESS OF FROM TU in.to ft. Weight lbs./ft. Win. tort. FORMATION in.to ft. Weight lbs./ft. _in. tort. rrbp sail fill $l&* 0 3 9.SCREEN Or�open hole Make J7Wm-10i1 from ft.to., tt. q >f Clay Green 3 14 Type $bmf . Diam.' 2 Slot/Gauze Length IB - " FITTINGS: *t between 4 ft.and 14 ft. 10. STATJ WATER LEVEL q ftX below ❑above ,,: Date Measured land surface 11. PUMPING LEVEL(below land surface) .. ft.after hrs.pypiping 2 g.p.m. ft.after hrs.pumping g.p.m. 12.HEAD WELL COMPLETION ❑Pitless adapter manufacturer Model "❑Basement,offset JtAt least 12"aboveground 4 O Plastic casing protection 13.WELL GROUTED? ZYes ❑No ...X.Neal Cement �,❑�Bentonite ❑ Grout material I �y,""".'�- from 0 to—_3—_ft.cu.yds 14. NEAREST SOURCES OF POSSIBLE CONTAMINATION feet direction type Well disinfected upon completion? ❑Yes RNo 15. PUMP Date installed KNot installed Manufacturer's name - Model number HP Volts Length of drop pipe ft. Capacity Material of drop pipe -- Type: ❑Submersible ❑L.S.Turbine 0 Reciprocating ❑Jet ❑Centrifugal 0 - 16. ABANDONED WELLS Unused well on property? ❑Yes ANo Use a second sheet,iJ needed fed ❑ Permanent ❑ Temporary ❑ Not sealed 17.REMARKS,ELEVATION,SOURCE OF DATA,etc. 18.WATER WELL CONTRACTOR CERTIFICATION This well was drilled under my jurisdiction and this report is true to the best of my knowledge and belief. Stevens Wel I Drii l 1 m Co. 27194 Lirensee Business Name License No. Address 6240Plain, ...1T rr 9 -' " 1-23-91 X13 ned tt Date n..,,,� Authorized Representuliue� �l�7 J Date 1—Z-3-71 Na me of Driller 5/74 30M LOCAL COPY 1471115 7/7830M 7/78 0M 1 HE-01205-03(Rev.9/88) 2/82 IoM