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Home My WebLink AboutWell info , _ , � ��, �,� WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. CountyName WELL AND BORING RECORD 615 2 �. 3 ��yp�rj@�}''j,A Minnesota Statutes Chapter f03! Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed �L°OCIq 1l� �� J w ,Sil�,�. t�11' v. y�? n ll��}��d House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD .i5ii�i id3 Sf t$�B �i+�+ud C�roAa 'S53 rt ❑ cab�e Too� ❑ Driven r� 0�9 Y ❑ Auger O�otary ❑ Jetted Show exact location of well in section grid with"X". �� Sketch map of well location. ❑ .__ Showing property lines, roads and buildings. DRILLING FLUID WELL HYDROFRACTURED? ❑YES [�JO N � , � , >C ��ter FROM n �o h. -,- -,- -,-- -,- USE ❑ Monitoring ❑ Heating/Cooling i i i i �Qomestic ❑ Communit PWS -�- -�- -�- -�- ❑ Irrigation Y ❑ Industry/Commercial . i i i i ❑ Noncommunity PWS ❑ Remedial w E T ❑ Test Well i � i i ❑ Dewatering ❑ i -, i _r 'ZIM.ie CASING DriveShoe? ❑ Yes ❑ No HOLEDIAM. ��. _i_ _ �_ _i _ _i_ I � Steel ❑ Threaded ❑ Welded ""'r � � � � � fr'" � PIBS[iC ❑ S � I �1 Mile-� � • CASING DIAMETER WEIGNT PROPERTY OWNER'S NAME � in.to��ft. �`CY"tl Ibs./ft. �in.to�Ot. ��y �� t __ in.to tt. IbsJft. �.3r in.to__�t. -�i Property owner's mailing address if different than well location address indicated above. in.to ft. Ibs./ft. __in.to ft. SCREEN_ OPEN HOLE Make �a�'�'j�_ from ft.to ft. Type pU�[` Diam._�a SIoUGauze_ ?Ll Length 7 t Set between �._j�ft.and �� R. FITTINGS: STATIC WATER LEVEL WELL OWNER'S NAME •$aQ ft. �below ❑ above land surface Date measured PUMPING LEVEL(below land surface) Well owner's mailing address if different than property owner's address indicated above. L��ft. after ,3 hrs.pumping Si%t g.p.m. _ WELL HEAD COMPLETION S �titlessadaptermanufacturer �rii�r��atr�� Model �J' �5�'4 ❑ Casing Protection ❑ 12 in.above grade ❑ At-grade(Environmental Wells and Borings ONLY) GROUTING INFORMATION Well grouted? C,f�'es ❑ No GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO Grout Material ❑ Neat cement �Bentonite ❑ Concrete ❑ High Solids Bentonite MATERIAL from��to_�_ft. � Cj�yds. ❑ bags from_________to ft. ❑ yds. ❑ bags �`�a ��OWj1 �t�'�• Y j� from _to ft. ❑ yds. ❑ bags NEAREST KNOWN SOURCE OF CONTAMINATION g�,��y Cj�� jyju�,a ��st1. ,Y;; %'y ',�" � feet _ I's�t1 directiont3�."MiEeC j3lii�t� / Well disinfected upon completion? �Yes ❑ No SC3AC3. � �T.AV�Cs'.L �l�X PlBGTi�J PUMP ❑ Not installed Date installed j.��!�� Manufacturer'sname �J�.d��`rt2 Model number HP .�. Z Volts J�..'jV Length of drop pipe 'b� ft. Capacity l� g.p.m. Type: �i.Submersible ❑ L.S.Turbine ❑ Reciprocating ❑ Jet ❑ ABANDONED WELLS Does property have any not in use and not sealed well(s)? ❑ Yes �No VARIANCE Was a variance granted from the MDH for this well? ❑ Yes I]jjJo � WELL CONTRACTOR CERTIFICATION Use a second sheet,il needed - This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. REMARKS,ELEVATION,SOURCE OF DATA,etc. The information contained in this report is true to the best of my knowledge. �cs w�all �rillin�} 2727�i Licensee Business Name Lic.or Reg.No. �;. ? - Authonzed�Representativ nature �"��' Dat btoic�ert �. �tociala: �r. i.tl�j/�t� Name ol Driller HE 01205-06(Rev.9/97) LOCAL COPY � � �j�1 � � _ _, ,..-- . , t _ _�« :.::-�._.-_-..;—� � „ e.�� -,� � � _., , . . . :� MIELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH M�nnesota Well and Bonng i�-14 7 6 9 3� WELL AND BORING SEALING RECORD sea''�9"° ,H Counry Name M�nnesota Unique No. — ��Y3218�iiA Mmnesota Stafutes,Chapter 7031 or W-series No. � ILeave Wank�I nut krwwn� Township Name Township No. Range No Section No. Fracuon�sm.-►Ig.) Date Sealed Date Well or Boring Constmctetl Urono it7 23 5 ti H 1/�/yQ Numerical Street Address or Fire Number and Gry of Well or Bonng Loca6on 35b� �arsl�� OrO�Q Dep�hBeforeSealing 14� fl OnginalDepth j'40 � Show exact loca6on ol N•ell or bonng A ^ Sketch map ol well or bonng AOUIFER(S) STATIC WATER LEVEL in section gnd with'X'. j\ ) � location, showing property �Single Aywfer ❑ Mul�laqwfer � V lines,roads,and buildings. N WELUBORING �Measure0 ❑ Esumated �Water Supply Well ❑Monit.Well �,,.�.,.^ ❑ Env.Bore Hole ❑Other _ 4Q fl �bebrv ❑abore yand si�rkaoe � � � i W - - -i-- -�-- --�-- E ` CASING TYPE(S) -�-- ---- -;-- --�-- � �Steel ❑Plastic ❑Tile �Other i � � � ;�mde ��, —�- -�-- -�-- --i-- � . '�,. ,----�. CASING :"�� _ .� Diameter Depth Set m oversize hole? AnnuaYar�oare rrlia�y goded� S �� y �„�� ! F 4 in.from� to j•3f? R. ❑Yes �No ❑Yes ❑No ❑lMrow�w� i � PROPERTV OWNER'S NAME in.from to ft. ❑ Yes ❑No ❑Yes ❑I�b ❑lM°nw� Property owner's mailirg address if diflerent than wel�location address indicated above. in.from to tt. ❑ Yes ❑No ❑M� ❑� ❑�� SCREEWOPEN HOLE Screen from i�b to �4V ft. Open Hole from b ft. OBSTRUCTIONS WELL OWNER'S NAME Rods/Drop Pipe ❑Check Valve(s) ❑ Debris ❑ Fill ❑No Obstnctim WeM owneYs meip addrass N dillerent than propeny owner's atldress inAicated above. Type Of ObstruC�ionS(DeScribe)��,j�t �1� �e r+ Obstructions removed? [�Yes ❑ No Describe PUMP TyPe��i (iEOlOfi1CAL NATERUL COLOFi HARDNESS OF FROM TO � Removed ❑ Nol Present ❑ Other FORMATION B aot krqwn,irWicete eatimated formatbn log hom near�y well or boring. METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OF1 CASNC AI�BOIE MOLE � No Annular Space Ezi�s ❑ Annular space grouted with tremie pipe ❑ Casing PeAoratioNRertroval in.from to fl. ❑ �a1ed ❑ Rennred in.from to ft. ❑ �b� ❑ �nr'ed Type of perforator p Omer GROUTING MATERIAyS) GroutinqMaterial �'artland fram 1�U to V R ya�ds j b�ys ��«� �o R � � norn ro R �ds e�pc from to R �dc 6� RENARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING OTHER WELLS AND BORINGS Other unsealed and unused well or boring on property? ❑Yes []Wo How msy� LICENSED OR REGISTEREO CONTAACTOR CERTIFICATION This well or boring was sealed in accorde�ce wilh Minnesota Rules,Chapter 4725.The iionnion aa�ird"n�is rapoA s � true to the best of my knowledge. �t�S t�r�ll �rillin� 27�7� conrracro.6usirress Nerrre Lisur o.wq'sr�on aa � " ,�� .�- _-i`� � ��`�� AuMorized Representadve Sig�ature tT��`t�� C� LOCAL COPY H 1�f' I �.,J� Neme ol Person SeaN^9 WeM a Bonng HE-01434-03 �R