HomeMy WebLinkAbout06-29-1988 Water Well RecordCT►K ,tF ul\\FCAT► DFPAVTUF\T OF IIFAI.'I'H
C1.0CATION OF WE WATER WELL RECORD AIlVVESOTA UNIQUE HELL SO.
argty Name
�. gar if at" Sample 442431
Alina is 5141.1e; 156A.01 ..ON
ownsh-p Plamet[Township
Numbtt
117t: a
Ran'gey�N.'umber Srctim No.
23'►�1 a Ia
Fraction,,T,+ .'YET
JU 40 'A,7il 'A
J. WELL DEPTH Imm�te=t
11
DatS otC�Q�
ML��
W
It.
D,auesce and Direct= frorn Road Intersimlion or Street Address and Lily of Well lecatiun
5. DRILLING METHOD
10 Cable tool 40 Reverse 70 Driven 1ti3 this
20 Hollow rod 50 Air so Hored Ito—
Shm exact localm ofwell to section grid with "%" - Sketch map d .,It taatnn.
M
y�[
I
Addition Nae
Addition
Notary 613ktted 90 Power Auger
6. DRILLING
iM 6 kxk umber
7. UXSE
�_ i_ s_
10 Domestic {O Monitoring !r]Heat Pump
1 Lot Number
201rrisation so Public 901ndustry
6'mi
30 Test Well 60 Municipal t00 Commercial
—�— �— —r I
1
70 Air Conditioning t10
. 1y
a.p--a
H. CASING
HEIGHT: Above/Belowi„w
10 buck 40 Threaded
Surface—Kit.
20 Gaty.
HOLE pAyA.
2. PROPERTY OWNERS NAME �.,� ����pp /
1" � / L 0�
Address �5 � .St.
50 Welded
Drive Shoe? Yes_ No_
'
nay, 1►�+1,55323
214 1.99
8 222
_Crystal
_
m. to it. Weight lWit.
in. to U. Weight Ibslft.
in. to It. Wright lbt.fl.
in. to—Jt.
_Jas to—fl.
In. Io ft.
3. FORMATION LOG
COLOR
HARDNESS O)
FORMATIO.
FROM
TO
Tp__�*
jQ�j
Blacko k
V
I
9. SCREENfohnsm Or'openhok
corm fl. its ft.
Make s
Clay
Tan
I
S
Type3 n Dia._
SIdlGaurr LrMh—VVF'ITT�awf�GS:
MAY
YC IW
3
♦�• 7'
Set brtween It. and f1.3 X 4 x — packer
t
C;3ay
ss���
Bim
Utz
I9
�ft�..•
205
10, S6%,3C WATER LI*L 6-28-88
i4
WI
I,.Ohelow Oabme Date Measured
lard surface
�'`
a��19 dstme
i�n'le
205
�S�rf
222
11. PUMPING LEVEL 1Dcbw land surface) 1 n»
�W
ft. after hes. pumping s.D.m•
it, after hes. pumping Spin,
{� HEAD WELL COMPLETION
117 ihliess adapter. manufacturer model
20 Liasement offset 30 At Last 12" above ground
40 Pb%tic casing I'rolechr
3. WELL GROUTED?
[I Y- O No
R7 Not Cement 20 Bentonite 30 ID 30
Grout material from to It. cu. )ds
IJ. NEAREST SOURCES OF POSSIBLE CONTAMINATION
feet d.mi.2 type
Well disinfected upon completion? O Yrs O No
Is. PUMP 6-30-08
Date installed O Not installed
Manufaciurer i name
liz
hladrl number IIP Ydt-
i0o 12
Length of drop Pie PW It. opacity s.p.m.
Material of drop pile
Type 1: 10 Suhmrtsible 313 LS. Turbine !U Recilaoating
_
20 Jet 10 Centrifugal 60
16. EXISTING WELLS x
Unused well - proper&? IIYe, O No
Uua
sAerl, if rvnled
Abandoned OX Permanent O Temporary O Not seakd
,etc.
17. REMARKS, ELEVATION, SOURCE OF DATA, etc.
18. WATER WELL CONTRACTORS CERTIFICATION
This well oras drilled under my jurisdiction and this report is true to the hest of my
krrowl,dge and belief.
Saf.im WeU }ril� 27174
6M'1 ''32 W bU%" Platnsse ASS353
Add
j
Srgned Date
Authoeired Rrprrsmiativr
i
wi`i = Date
LOCAL COPY
4 a 2 4 31
Name of Driller
Si71J0M
71 3
77700M
LIE01205M (Rev. lOiiiS) 2192 101a