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HomeMy WebLinkAboutWell info� STATE OF MINNESOTA DEPARTMENT OF HEALTH � A WATER WELL RECORD M/NNESOTA UNlQUE WELL NO. �����^ i Cwnry N�n , � Minnesoto Sfotutes 156A.Od,08 I�Woter Snmpk � � Toanship Name� Tow�n+s�h*i�p,N�um Rayn�ge Number Secti.oten�No. Fraction 4.WELL DEP1'H(mmpleted) s Date of Completion ' .ii,�'<.1 � +G�7'it� W �&+� �rY' �� ��i� �/+ .1.� ft. ���� I� Dietance and�D�irectiun fran Road Intersection m Street Address and City of Well I.acation � G METHOD � •�-� ,�.' �W ��^7�o6ii �� � 0 4O Reverse 7O Qriven 100 Du8 � � ow exact locatianN well in sectinn grid with"X:' - Sketch map of well 1 0 11i�F ��red 1t� i � � � � i Addition ame � otary v 9O Power�auger i --r� -1- -1 -1- 6• G Ulp I � � � � { I � � Blak Num6er � i ' W•-�- '�- �- �- E ZU I � lp ' 'oring 8O Heat Pump _.L_ 1_ � � � � � �k mr. 1'°t Number 2O Irtigation 9O Industry '' � � 3p Il Mu iapal I�Commercial �' --�- i- � —r- I 7OAi Conditioning 11� � � � 1 i r �1��_� 8.CASING HOLE DIAM. 2.PROPER7Y OWNER'S NAM1E HEIGHT:AbovelBelow 1�Blazk 4f]Threaded i 4;�'■ � �`�� Surface �at. I „�P„� � �Galv. 5p Welded �� L� Drive Shce? Yes—No— �.�� �$,��' a� ���'�� 30Ptasyc ��c�� �.�� cf_ .�F� I � in.w ft. Weight Ibs✓ft. �n. to—tt. � s I 3. FORMATION LOG COLOR HA����F FROM TO in.to ft. Weight lbs./ft. �n. [� h k FORMATION p in.to ft. Weight IbsJft. �n tu—ft. � � � 1 ��� � � 9.SC Or oP�hole I f fm+�+ ft.to. ft. I 'x� � M� � � ai. .. _ T� II�s.��— I � M SIoVGauu �S�h � ��� • � � Set between^ ft.and it. FI'fTINGS: i �� � � �; 10.STA�t�WA7'ER LE�L ', I� �`� �� �� � � h.O below O abtwe Date Measured �: land surface � �I �r,.,� ✓ 11.PIIMPING LEVEL(below land surface) � p �.'�+iii# �l '��'.� � „ ��- �� �� ft.after hra.Pumpi� �� &P.m. I �,rj � ft.ahei hre.pumping g.p.m. � i � ��; � �'� _ �� ����: :� 12�IEAD WELL COMPLETION � 1T�Pitless adapter.manufacturer male� I �, � ,�, �' �� � �,�}� 2O Bea�nent offset 3O At least 12"above ground I G 40 I�lastic casi�protection � 13.WELL GROUTED? �Yes ❑No ' I 10 Neat Cement 2C7 Bentonite 3O i Grout material from to R cu.yds i T— I i ` 14.NEARFST SOUItCES OF POSSIBLE CONTAMINATION feet directi±o�n ,,... � wen a�9�r����Piec�r "L%Yes ❑No � 15.PiJMP � i Date installed �, ❑Not irretalled � � Manufacturer's name � � Madel m�m6er HP�Vol�s i IeoSth of droP P1Pe � k. , caPecity &P.m. j � Materiae�l of dmP P�Pe � � I Type:lII'Submeraible 3O L.S.Turbihe 50 Reciprawting 2C7 Jet 4O Centrifugal � i• t6.EXISTING WELLS �p j � Unused well an prapertY? G'Yea ❑No I Use o setond sheel,iJ needed � � l7.REMARKS,F.I.EVATION,SOURCE OF DATA,eu. Abando� �Permanent O Temporary O Not sealed • I8.�PATER WELL CONTRACTORS CERTff[CATION � This well was drilled u�er mq jurisdiction and this report is true to the 6est of my knowledge and 6eliet. I �. ����� '� �. ��� � �e a��No,� u��ro. F ,�` � " . �� _ _ �` ` .�� ���� i - � a ;� ., $ ; � �„�.t;;?,--:.s.�_<�` � � S�� �a,c„c �'�,�-�,� pa�p ���"�� i Authorized Representati�e � - e�� � Name of Ikiller DarP �'��•'�� ' LOCAL C�OPY 4 4�7 7 2 7;�� � �,�� F�-0120502(Rev.lOB5) 2/82 tOM ' STATE OF MINNE50TA DEPMTlENT OF HEALTH ABANDOlffD MELI. RECQRD 1, loufloN 0►rtll MINNESOTA UNIpIE MELL NO. (laew b1�eY 11 ne! knern) tonney aeeM Hennepin fannhlo M�p Townfhip NueAe� R�nq� Mumb�r S�etlon Ne. /r�etfen �. YELL OEPTH (coebl�ted) O�t� f��leA � [ � yeI y . Oro� 117N s� 23W y' 1 NW NE SW 122 fe. 2-21-89 • Nuw►lul Stn�t Addr�tt �nd Cltr ef M�11 LOc�Non or D 0� �1/ knma�) Int�rstcNoa C eo1 1(]Rer�n� 7�OHwn 1(�]d�q 1215 Arbor Stxeet� Czystal Ba 55323 � � aoa ���� ep e�..e i�p SAow ��ut teatlon o1 retl ps� t �J�tt�d �Oa�n�Auqe� (fe s�etlen qrid•1tN 't•) Sk�eeA e� 11 leuelan � e. oes s N wet et�e Q res � eo _ � _ _ : ..; , c e n� naewe(]re• ❑Me 11 oEstruettont ca��ee ea • • ' ;_ , .emo�ee, coee.ee MnN M _ � ' . . .I- • - E � �roro �e�t�nq. . .. � : . � 1. �E �ft1e Moniterinq �Haet Loep � � � � � �� ti'c• �) 'fl • � • . . � 2t]Irrlqettaa SD OnAl1e �Industry ..�. . ..... _.� . .... �]Teft Y�11 ��m�e+v� �q]eo�e.e+.► �—1 .ifi— � 70 Af� CondlHoMnq 11� 2. PIlQ7ERTf OWNER'S NAME l4f11nq Addreif It 411ferent tMn 9. CASING(S) oro�trty �Adnfs InAfc�t�d �Eove I�91sek �t�n.e.e �[] C. H. ���,� 2[�6alv. St]M�1ded �Ole�ttc �St�lnles� Steal NANGN[SS OF 3 1n, te /t. 7. FOR1q�10l1 lOG COLOB /ORR�TION F4�1 TO �f net knmm. lndie�te loreutlen leq Irom nev ti11 er �n�rb�all. te. te It. 9. SCREEN 'I'O1JS01�. b�C�C 0 2 �Sereened wl l lrae__ft. te_ It. (It known) Gravel r�ivt� � 2 6 �O�n Nole r.em_re, ea_ re. Clay P.�.1 � 6 22 10. STATIt YATER LEIIEL Cla lue 22 90 47 rc.�eeier p+ee.. 2�,21-89 Y ��ne sa�ae o�te ►be�uree SarLd & ravel rown 90 98 ��. �«�o ca+v�trtoe Clay & gravel lue� 1^oWn 98 122 1�Pltle�a AdiOte� �p re�e e��+ee �8asement ethee �"�r, I 7Q Y�11 olt 16. A[MAAKS, ELEYIITION. SGURtt Oi OI1T� - CASIN6S REMDYED, C1131MfiS CERf01GiE0. ETC. 12. GflOUTIMG INFORlNiIGl1 1�Ueet Ceewnt 2Q Bantoelt� � Well log taken fro�[► n� well drilled 2/8/89 Gront mNrt�l 7 bags +� 0 ce127se. ��. res.2 Uni.que well # 448772 — — u. ME�NEST SWRCES OF CONiAMINATl011 _ reee etnetlon type Yell dlstnfeeted eetere ie�itngt []Yes 11. OUNO �Reenved �Not P�eaent Trpe: 1[I Submerslbla �1.4. Tnrbine �Aeclprotatlnq 2�Jet �tent�lfuq�l 6(] 1S. E�tSTIN6 MELIS (Fl�n� fk�teh loutlons o1 ebendonaA end � �et1��wlit te re�qr4� sxNon or on seek.) Other ueuf�d M11(�) en prop��tr1 �tet �Ilo AAandorteds ❑Penun�nt ❑T�orery (]Not �eeled 11. MATER MELL CGNTMCTQAS CERTIF1C1111011 TMs rell vaf sealed rmder my JuNsdletlan end tMs report • 1s t►ne to tAe �st of ary knowledqe end be11a1. Stevens Well Drill' Co. 27194 llcy�e),1n eif !1� �. Llcense Na. l�L4U �aero..r�aple Plain, NAi 55 59 Siqned Oete � D�t� FFICIA�AWIOWI[0 Y[Ll 4LCORD (14y M uf�d Ior �roarty TnAthr) 11�M o1 Or111�► nrpairr�urr. rrra �rtrs �