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HomeMy WebLinkAboutWell info � - STATF:()V-MINN1�:1()TA �E�.I'AHTMlNTOI�Ht:AITH 1. ln('ATI()N()I�WF�LL Q c�����r N•�,.•� � W A T E R W E L L R E C 0 R 0 �IINNESOTA UN/ ue wer.c No. � ,.Wor�,samP,� 4 0 3 7 6�� Minnetofa S!e lultl/SM1 A.fl/�.f�N T��wnxhip Name T�wnship Numher Nan{e Numher Secllnn N�. I�r���ti��n J. YROYk;RTY OWNER5 NAMt N f �, �, y, Q'.L"{3�b �.�.� � s` � '�w $ �' � �#' �4►'L't��Y't � u�.r��e,�a n� �c���rt����RnaJ InlrrSrcliuns ut Slrcel AJJrtss and C11y o(WNI Loctlion naa.e:s 1.�Q �da31" r A 3� t� � Sl+ow ea�c�li�<��ion of well in src�iun gri�wilh"X." Sketc�map of well Incation. 4.Wk:LL DEPTH c N (ompleted) Date of Complelion � ' AJJi�i�m Name �,��)p+y _ L' '�' ' -'_1- - 4v-Y fl. ��� � � I i S. r i❑e�nir��,�a a❑Ke.e�u ��n,�.�� io❑o�g N - . - - �- - , , + � r G tll��ck NumAn • a :❑H�m,�w.,,a sOn�, e❑e�,«a ii❑ - ' '� '- '� ��M.. J�K"t�rY 6❑letled 9�Yow<r Auger ' ' ' � Lo1 NumAer 6. USF. . _'i_ ' __'' _- _'',__ < , . "akilo��mrv�� a❑v�nro s�vvq a��oa�,vr $ �1�1LZt-� 2�Irrigu�ii�n 5❑Municipal B�C�mmercial I. FONMATIONL04 C'OLOH HAH11Nf'SSOF FHOM TO FOHMATIUN J�Te�I Well 6OAir(lindilinnin` 9� 7. CASING HEIGHT: Above/Below HOLE DIAM '�� '�� $ � � � I❑Black a❑T�rraded 2�(:alv. SOWelded Surfatt ft. '�'� �++�� � � .i� �]Plastic 6� Drive Shoe? Yes_ No� � �in.to ��� ft. Weighl�»� Iba./tt. �In.t����ft. ��� ��� � . �� ��✓ in.to ft. WeiBht Ihs./(t. —in.[o_It. In.fo fl. WeiRht Iba./fl. _in.Io_(t. �� ��V �� �^ 8. SCRk:F;N ��� ropen ole ,J trom (t.�o ft. Make ' 32+�f� � �}�'1 �j3� TYVe � Dii. Lti.L i�. wJ ..f J' � Slnt/Gauze �� Leng�h �t ��j� F'ITTINGS: e" Sel between ��L ft.and ��(t. #��.'rt� ��Y. & 1� C �'� �.�t� «.a�a ��. /� 9.STATIC WATk'.R LEVk:L � `� � � 6� fl.�helnw ❑ahove DeleMeasurcd �+��� " - — — land surface �� ��� �1�� �t..� I0. VUMNING LEV F,L(Gelow land surface) �f +T 4 J�yy ft.af�er �rs.Oumpin6 1L7�.1 B�V�m� ��� �� �� ff.affer hrs.pumpin8 B.p.m. 11.WELLHEAUCOMYLETION y�!8�� �Q Pitless aCap[er,manufac[urer ���r�RS����tlel `��' ���� �� ,�� 3❑dasemenl offsel 3��+��east 12"above gretle 12.WELL GROUTED? ❑Vr� yONo — I�Neal('emenl l�drnlnni�r J❑ Grout material Iro Lo R..Cu.YAs. 13.NEAREST SOURCE6 OF P065IHLE CONTAMINATION �feel direction tyDe WeII disinfec�ed upon comple��on? Ve Nn❑ l4. PUMP Date ins�lei� ❑Nof inslalled ... ManufactureiS Name �y�, ����Q,� MOAeI Number HP�Volls� � Length of drop P�Pe � ft.cap.ci�y � e.p.m. Material of drop p�pe a+��� Tyve: tl's�Suhmersinlr 3�L.S.Turbine 5�lteclprocnling 3�lei 4�C'rnirifugal 6❑ Usensecondsheet,ifneeded �6.WATERWELLCONTRACTORSCERTIFICATION 15.HEMARKS,ELEVATION.SOURCE OF DATA,etc. This well was drilled urtder my jurisdiction and Ihis report is irue lo ihe best of my knowledge and belief. '�i��� ��.�.� �3 r��'�.�► Liceruee Buainexr Name Lfcmx Na naeRu l�?,`c�.�� i�—�t'' ��, �.�i��� ��r'1�31y �t �����k . Siened Date . Authorized Represeniative ��...L-i3ttJ.� ..7.��L� Date �"n�7'�U',� - Name of Driller 5/74:AM L��A` C°PY 4 0 3 7 6 4 7/7630M 7i76 30M HE-01205-0! 2B2 10M :� StATE OF MINNESOtA DEPARt1�Nt OF HEALtN ABAND01'�D NE1L RECORD � �, �a�r�oN o► wu� MtNNESOtA UNIpIE MEII N0. , � (�••w A1�nR �r �oe k�o�1 r.����r Ns^� F�enne in Tnvnihlp N�me To�ns�1D Nuwber N�a9! Nu�Dfr S�cttOn No. f��tttee �. MELL DEPTH (CaqlK�d) Dat! Sul�d N E � � e1 � nX6n� ���. 11/LV Sr 23W Nr O 20 re. 7/19/90 NvM�erlul Str�tt Addr�tt �nd Clty oI M�11 10ut1en or 01at�nC• frow IlO�d S. O�IlUN6 NETHOD (11 lnovn) ` In�ersectlon ID Gsl� tool �Mqr11 7[]Orlv�n 1�Duq r, 1440 Baldq�tr Park Road, Orono, MN 55356 �(J�>>� Roe S[�A1r �]eo�.e i�p � �[j Roa�y eQ a.ec.e 9Q re».� Auq�r � Sho.t exact loc�t$n of wll - (jn eecti�`n 9r1d wltn 'x") Skttc� ��p of w�ll 1euHon 6. OSStRUCT10N5 N Metl abserutt�d Q 1'es � ho L ._ ` Obstructlonf rMov�A Q Tff []Ne If oDstructlons cannot be , , ' � nmoved, eontut MOH ptfort se111nq. w - - - - • • -I- - E ' � 7. USE . � . _ T Lj�Ooerftle {]MeMterinq (Q Hat leo0 - ' ' ' y..i. : , . � 2Q Irriq�NOn SQ OuD11t � induftry �]T�it Y�11 l�Mun1NDa1 IQ]Cen�nercl�l S 7[]�1r CendltloMnq 11� �--1 w!i 2. D0.0CERTY OVNER'S NAME Malllnq J1ddr�tt fI dllferent th�n e. CASING(5) ,� prop�rtr �ddnff tndluted �Sov� 1[]1UcR �{]flin�d�d 7[] Gordon Tanke 2�Galr, �M�1d�E x]I1�sNe l�StNnlesf Stal N�aoNess o� 2 t�, te 16 �c. 7. iORMAt10N LOG COIOR fORW1ilON iNOM TO I� �ot knorn, 1ndltat� �nnea N on leq Iro� n�w wll er nl�rby wil. 1n. te �t. 9. SCIIEEN �SCr�M�A Mll rro.��t. te�p re. (If known) �Opin NOl! fro�_ ft. te_ ft. 10. St�TI[ YAiEII LEYEL 4 ►c.(�e��oM Q+ee�� ' 7/19/90 Und furhet O�t� Me�surld IL MELLNEAD GOMlETION l�N tlesf Ad�ptlr (]feund lurl�d �]eas�.ient e�I��t !,� �?�� ho�e �p w•i� o�e 16. NEMM1NKS, ELEVIITION. SOUNCE Oi OAT11 - CASINGS REMOYEO. CASIN6S IE�f01UTED, fTG. lt. CROUitN6 iNFORIMTION ��..e e.�.�e �]e.�co�ic• �] 6rout �ttN�l � baq �ro�Q,to�Q �t. cu. yes i 1]. NE�REST SWRCES Of GONTIININlI1ION fe�t dlretHen �YD� Yell dlsinfeet�d Mfor� s��llnql ❑ tes ' 11. PUMP �Rewared ❑Not Orlsent , �9g� Trpt: I[1 SuDee►s1s1� �]l.S. turbin� �Rec�p�ocettnq J A N 2 3 ��.� ��.�t�,f�,., � 1S. EklSTINC MEILS (►l��s� �k�tcA loc�ttons of �e�ndoned �nd �tN w wlllf in �MNrkf ffttl0n or on D�c4.) Oth�r u�uf�d w�ll(s) en pro�rtyt ❑1N �No AE�ndon�d: [���nwe�nt �Tl�por�rr (]Not f��led ►), MATER MEII CONTfGCTORS CERi1FICA110N TM s well .�s f��ltd under � �urlfdte H on end this reDort ts tw� to tM Mtt ef � tnowl�Aq� �nd M11N. Stevens Wel� Drillin Co. 27194 "�����'�i'Yiwa 12 Wes�`•�s• no. Addr�ft� e P n, MN 5 5 ' sio�.e o.e� 7 24 90 ��• 1 e Rivers o,e. fFlCl�l AlAMDONED �Ell RECOAD (N�r M uf�d for Irop�rtr ?r�nf/�r) N�� e/ Drill�r IMPCRTAI�ft rlla MI!'S DRSD �