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Home My WebLink AboutWell Records WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. County Name WELL RECORD 522181 f-//i I/7 , i , ,,,..-7 Minnesota Statutes Chapter 1031 Township Name Township No. • Rang No7 Section No. Fraction WELL DEPTH(completed) Date Work Completed 9 /�.)N ) 1 1 7 i J7 M/ I1/ 5(1:- -� tf ft. ( :f Numerical Street Address and City of Well Location or Fire Number DRILLING METHOD t 1 3 / (...,,, /.4,,,54- 7"/ ❑ Cable Tool ❑ Driven ❑ Dug ❑ Auger fq Rotary ❑ Jetted Show exact location of well in section grid with"X". Sketch map of well location. 0 Showing property lines, N roads and buildings. DRILLING FLUID I ,__i_ l..r./ , • i i i, USE ❑ Heating/Cooling E L Domestic 0 Monitoring ), 17Industry/Commercial w i i I , E 0 Irrigation 0 Public ❑ Remedial 1_ 1 0 Test Well 0 Dewatering ❑ CASING Drive Shoe? 0 Yes ❑ No HOLE DIAM. --:- --- ---,-- 1 '''/A ❑ Steel ❑Threaded 0 Welded • I--1 milr Plastic ❑ CASING DIAMETER WEIGHT PROPERTY OWNER'S NAME `'/ in.to ?V i ft. 1 . r r_ lbs./ft. d" in.to ( ft. j-0 1'+✓1 C G//f/ 4-• y in.to ft. lbsift. in.to -f/MC Mailing address if different than property address indicated above. in.to ft. lbs./ft. in.to ft. SCREEN OPEN HOLE Make •If. • from ft.to ft. Type "L Diam. - Slot/Gauze _e, 5"/..,4-• Length ' Set between ._ l ft.and `I G• ft. FITTINGS: - ! STATIC WATER LEVEL GEOLOGICAL MATERIALS COLOR H IRDNE ISLSS OF FROM TO 10)6 ft.A below 0 above land surface Date measured PUMPING LEVELf (below land surface) • t: ft. after hrs.pumping /rt.,' -_ / - 1 �. I I� P P 9g.p.m. WELL HEAD COMPLETION .c 1 ,/ (/' -/.,J O?I .5 4v Pitless adapter manufacturer (.ft) %.„/e/ Model 0 Casing Protection 0 12 in.above grade '. t '//(; •" 1 .i a f, - � GROUTING INFORMATION Well grouted? ill Yes 0 No 1, -r t' I ,//Cr CLI J)y Grout Material 52 Neat cement ❑ Bentonite from .C' to (-- ft. 0 yds. ❑ bags from to ft. 0 yds. ❑ bags j- from to ft. ❑ yds. ❑ bags NEAREST KNOWN SOURCE OF CONTAMINATION feet y- h direction -' "' " type Well disinfected upon completion? X Yes 0 No PUMP ❑ Not installed Date installed 2 ,I( / Manufacturer's name I- t r..-c/ Model number HP / Volts 9 1 Length of drop pipe I ',/ ft. Capacity /•-2 g.p.m. Pressure Tank Capacity Type: yz Submersible 0 L.S.Turbine ❑ Reciprocating ❑Jet 0 ABANDONED WELLS Does property have any not In use and not sealed well(s)? 0 Yes Ef..No 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 true to the best of my knowledge. Use a second sheet,if needed ,6?, r. (:). -. % 'l 0/,',/ . , 1 ] 7 c REMARKS,ELEVATION,SOURCE OF DATA,etc. Lice1nseeBusiness Name Lic.or Reg.No. ,1. t / ,.-", r,. 1 r� , ( _ X1,4.__, U i, j -.9-ci 2 Authorized Representative Signature Date Y9 1-f ) 1 A)) i hi d V 2 '1 7 i-t i. fk'". - • Name of Driller Date LOCAL COPY 522181 HE-01205-04(Rev.5/92) WELL OR BORING LOCATION M71nnl7:a Well and Boring H 29229 MINNESOTA DEPARTMENT OF HEALTH SealinggNo. County NameWELL AND BORING SEALING RECORD Minnesota Unique No. r Minnesota Statutes,Chapter 1031 or W-series No. 11(,i-) •14 --1 (Leave blank d not known) --— Township -- Township Name Township No. Range No. Section No. Fraction(sm. •1g.) Date Sealed Approximate Date Well C)f );' I f / .J I 1 :, or Boring Constructed l4 14 4 Numerical Street Address or Fire Number and City of Well or Boring Location I I : 1 !/j r/1/hi -- -r--, Depth Before Sealing ft. Original Depth - ft. Show exact location of well or boring Sketch map of well or boring Static Water Level ❑Accurate in section grid with"X". location,showing property lines. roads.and buildings. ❑Approximate N i --� Single Aquifer El Multiaquifer ft. below above land surface 4 • ->- CASING TYPE W E t -, i Steel 0 Plastic 0 Tile ❑Other r smile i t . S Screen from -" to ft. Open Hole from to ft. N--r mile OBSTRUCTION/DEBRIS/FILL ❑Obstruction ❑Debris 0 Fill PROPERTY OWNER'S NAME J- ?r' (' 1/, — Type of debris/obstruction Mailing Address if different than property address indicated above. Obstruction/Debris/Fill removed? ❑Yes l'No PUMP q Removed 0 Not Present ❑ Other CASING GEOLOGICAL MATERIAL COLOR HARDNESS OF FROM TO FORMATION Diameter Depth Set in oversize hole? Annular space initially grouted? If not known,indicate estimated formation log from nearby well or boring. 4f in.from (_) to • ' ft. ❑Yes 0 No 0 Yes 0 No 0 Unknown in.from to ft. El Yes 0 No 0 Yes 0 No 0 Unknown in.from to ft. El Yes El No ❑Yes 0 No 0 Unknown METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: [3(No Annular Space Exists 0 Annular space grouted with tremie pipe ❑Casing Perforation/Removal in.from to ft. 0 Perforated 0 Removed in.from to ft. 0 Perforated ❑Removed Type of perforator _ El Other GROUTING MATERIAL '',��; II Grouting material O- • 1 i• (ifrom -- ' to h ft. I.1cf1yards ( r! bags from to ft. yards bags REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING from to ft. yards bags from to ft. yards bags • UNSEALED WELLS AND BORINGS Other unsealed well or boring on property? y(Yes 0 No LICENSED OR REGISTERED CONTRACTOR CERTIFICATION I 1 This well or boring was sealed in accordance with Minnesota Rules,Chapter 4725.The information contained in this report is . r ,� 1 4 true to the best of my knowledge. CorYtractor Business Name License or Registration No. . 1 Authorized Representative Signature f',:.-: Date LOCAL COPY H 29229 :.---, .l229f r , ,, Name of Person Sea,fmg Well or Boring HE-01434-01 - -- – 71irlinlA Well and Boring 2 9 2 2 8 WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH SealinggNo. H County Name WELL AND BORING SEALING RECORD Minnesota Unique No. �) Minnesota Statutes.Chapter 1031 or W-series No. 1 ' r ,.,-?.'7) r'y (Leave blank I not known) Township Name Township No. Range No. Section No. Fraction(sm. •Ig.) Date Sealed Approximate Date Well C_ i•-: Y '1 1 _ -., or Boring Constructed / d 114 il4 1/4 Numerical Street Address or Fire Number and City of Well or Boring Location / r; J 1 (-A-4,1 ti„.. 5.1. j / t Depth Before Sealing �%�l' - ft. Original Depth It. Show exact location of well or boring Sketch map of well or boring Static Water Level ❑Accurate in section grid with"X". location.showing property lines. roads.and buildings. EkApproximate N 1 ---- 4 CI Aquifer Multiaquifer /'� Ift. X- below above land surface 1 4, CASING TYPE W ; I • 1 r 1 (it Steel CI Plastic ❑Tile 0 Other 1 • x mile S Screen from ' -� to ' ft. Open Hole from to ft. N--1 mile-NH OBSTRUCTION/DEBRIS/FILL ❑.Obstruction ❑Debris ❑Fill PROPERTY OWNER'S NAME t j-()/ . C{ '/ ><,,,s^ J Type of debris/obstruction Mailing Address if different than property address indicated above. T5‘,< No removed? CI Yes u/No PUMP \ ❑Removed ®,.,Not Present 0 Other CASING GEOLOGICAL MATERIAL COLOR HARDNESS OF FROM TO FORMATION Diameter Depth Set in oversize hole? Annular space initially grouted? If not known,indicate estimated formation log from nearby well or boring. / in.from ' to ft. ❑Yes 0 No 0 Yes ❑No 0 Unknown in.from to ft. ❑Yes 0 No ❑Yes 0 No 0 Unknown in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: tto Annular Space Exists ❑Annular space grouted with tremie pipe ❑Casing Perforation/Removal in.from to ft. 0 Perforated 0 Removed in.from to ft. 0 Perforated ❑Removed ----- --- Type of perforator ❑Other GROUTING MATERIAL Grouting material from .r` T l to ' ft. '' yards . . bags from to ft. yards bags REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING , 7 - ?j j , / from to ft. yards bags from to ft. yards bags i UNSEALED WELLS AND BORINGS 1 Other unsealed well or boring on property? E'Yes 0 No 1)� LICENSED OR REGISTERED CONTRACTOR CERTIFICATION • I This well or boring was sealed in accordance with Minnesota Rules,Chapter 4725.The information contained in this report is true to the best of my knowledge. 1 1 • Contractor Business Name .f1cepse or Registration No. �, fs• Authorized Representative Signature ' _ Date • LOCAL COPY H 29228 Name of Person Sealing Well or Boring ' HE-01434-01 •