HomeMy WebLinkAbout1988 - water well record STATE OF MINNESOTA DEPARTMENT OF HEALTH •
11.LOCATION OF WELL] WATER WELL RECORD MINNESOTA UNIQUE WELL NO. 4 3 ('71
a M Minnesota Statutes 156A.01..08 W"'"-6aayk v...
15SA.01.08 S
'Township Name Township Number Range Number Section No. Fraction 4.WELL DEPTH(ixxnpleto., Date of Completion
:oto II�} 4 2.+ a -?-.:_.` r t��►': y 1::. ft. 12/11/57
S W
-Pistance and Direction from Road Intersection or Street Address and City of Well Location 5.DRILLING METHOD
'\ 2'1400 (}i
C) L6 f`ie€«,.8 t , lO Cable tool 40 Reverse 70 Driven 100 Dug
JAM exact location we in section grid with"X." Sketch map of well locator= *3 Hollow rod 50 Air 80 Bored 110
- __Addition_ !flame---
J 6.DRIL Rotary
60 Jetted 90 Power;auger
N
11111111111t b✓r .te
W ®111111 E Block Number �---�-
7. USE
11101111111 Tome
i lb Domestic 40 Monitoring e0 Heat Pump
14Lot Number 20 tion 50 Public 9O Industry
1111111111111/11 m.
3O lest Well 60 Municipal 100 Commercial-
70 Air Conditioning 110
I---1,.ik 8._CASING HOLE DIAM.
2.PROPERTY OWNERS NAMEHEIGHT:Ahave/BeIow
.►#
q ID Black 40 Threaded 2
I1'•I martiuson Surface it.
!!j.vr 20 Galv. 50 Welded ..
Address 1 i _. 1"ark r I: f t
r r.^ 30 Plastic 60 t i;
in.to ft. Weight lbs./ft. �~ n. toh
_ .
3. FORMATION LOG COLOR HARDN FROM TO in.to ft Weight lbs./ft. _in. to—h.
FORMATION
t.T.-t� i
i HiQi..Q, in.to ft. Weight lbs./it. ten. to—Jt.
`�}',F%ti L.I C t-+a •,`„t -. 9.SCRE N Or open hole
from ft.to. ft.
Make relr
c1$va sity+ six pe11 / Mal. I : q.. Type t3�!13@ steel Disi : Xio' .
€f
Slot/GauzeIMBt
•i 1 X _ j,,,e4Z 'RTINGS:
',rley,a sne nix (int! Rte;,a 2..f.-., I I L° Set between ft.and ft. r W�`)
3, S ! i. ran ice'r
t I7� I 10.STATIC WATER LEVEL 121/1/C7`_//f/C7
of tc": sari n' L a f =- ft.0 below ❑above Date Measured
land surface
nT�It81 I1. PUMPING LEVEL(below fay¢surface)
S� ft.after hrs.pumping 2.p.m.
ft.atter hrs.pumping . g.p.m.
12.HEAD WELL COMPLETION 6,---its. SP:C4 4e:
10 Pitless adapter.manufacturer model
20 Basement offset 30 At least 12'.above ground
40 Plastic casing protection
,t1,3.WELL GROUTED?
4 '❑Yes 0No
r
10 Neat Cement c itie 30_ _. 17 r
Grout material _from_ to ft.cu.yds.
14 NEAREST SOURCES.rOF POSSIBLE CONTAMINATION
C teen '� direction SeWer _tyer
Well disinfected upon completion? kl Yec 0 No
1fl j 15 PUMP t
Date installed_ Irj15f — 0 Not installed
t I Manufactur.,•s name ** j2�g 7{t f
Model number -t:12511 HP 3+/4 -Volts 23C'
Length of drop pipe— 10151 _.ft capacity 12.1_ _g.p.m
Material of drop pipe GYvan
anee
1 Type:TIP Submersible 30 L.S.Turbine 50 Reciprocating
20 Jet 40 Centrifugal 60
16. EXISTING WELLS
Unused well on property? 0 Yes 0 No
Use a second sheaf,it needed Abandoned 0 Permanent 0 Temporary 0 Not sealed
17. REMARKS,ELEVATION,SOURCE OF DATA.etc
18. WATER WELL CONTRACTORS CERTIFICATION
This welt was drilled under my Jurisdiction and this report is true to the best of my
knowledge and belief.L t
: r9atr a Il li ♦ 7w. � �.
LI
I Licensee Hrsi Na we Lamer,Na.
Address f a �'
Signed ._ 1. . Authorised Representative :. ���'}/
fi/11110arse fc_a.i%aat.Zt Date 't!..lirtA
Name of Driller
WAIEK WELL •
6iie30/4
3oaa
CONTRACTOR COPY
439711 7/7g �
HE-01206.0¢(kev.10/85) 2/62 1004
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