HomeMy WebLinkAbout1995-09-19 Water Well RecordWELL LOCATION
MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO.
WELL RECORD 01
County
ou ny Name
lir ru K>nin
56 1 87
MirUtesofa Sratufes ChVfer 1031
Township Name
Township No.
Renpa No.
Section No.
Fttacdolt
WELL DEPTH (completed)Date
Work Completed
Orc'no
1 1 ;
23
04
14d:' n
- , -
Numerical SU" Address and City of Wall Location
or Fire Number
DRILLING METHOD
C /t'�. C401Mt-.1yj 1jcil2 bri-,,e Lmig Iake_,T
1.
❑ Cable Tod :1 DnVen C.: Dig
❑ Auger Il Rotary L] Jelled
:7 - - --- - — -- - ---
Show exact location of well in sedan pend with 'X', Skelcn map d well location
55356 Showing kala.
property
N roads and buldngs
DRILLING FLUID
' ' X
USE
la Domestic n Monitoring He" im
I l
W l E
rI Implion ❑ Puck ) IndutrytCo
I 1
RemoryeCorrmnercial
L] Test Well D Dewatarnp ..1 RemedW
n
e'
CASING Dnve $fnoa7 c rn I-: No
HOLE DIAM.
• /
I
11
t - -i -d
L, Si" :J Threaded 11 Welded
1 miss,
Fj Plastic—_ --
CASINO DIAMETER WEIGHT
` — n. ro 13N
PFIOPERTY OWNER'S NAME rc � -t i r lackm (lxT til
_ . y
--- in. to -- n' - - - - ---- - -- - _.. lbs rtt
– -__-. -- in. to h. "J"
-- --
_ on. to — h.
M&WV address 0 dot WI than property address indicated above.
4 1 i,A , Bert'.::rdre Line
SCREEN OPEN HOLE
I'Ijq!IC;Ut,'1 Flt 1.:. ` � 1 r- h
_
1i1 1 - on
Make from
a
Type st r:1i11C�::: :i1 LE1 Dam. _-_ 4
« 4 --
Set between _ ' y t. and �'� it. FITTINGS:
GEOLOGICAL MATERIALS
COLOR
HARDNESS OF
MATERIAL
FROM
TO
STATIC WATER LEVEL
L -- R. Al below 'I above lard surface Dile meesured
,-IV & a il1c l
;.
r
1 '
PUMPING LEVEL (below land surface)
R. after -- -- Ms. puntpeq p.p.m.
&Intl
�.
1:.I
1::
WELL HEAD COMPLETION
Ciwele.sadaptormenufactla« i*:earit_er Moa.I --
❑ camp Prowlon 2 in. above grade -
GROUTING INFORMATION
We' prolMd9 Yee ❑ No
Grout Mahal ❑ Neal cement 4111anics
u
from-'- .w. to it_. R J ❑ )`s.* beg
from _ to n. ❑ yds. ❑ baps
from to n. ❑ yds. ❑ blip.
NEAREST KNOWN SOURCE OF CONTAMINATION
-N- -._ 7 dkecUon ,SCS NPe
Waa awit.aw upon complertm? R res ❑ No
PUMP
❑ Not e+ataaed Dan installed 10-3-" _
Manufacturersname
Model number HIP1 _ S_ 5 - -- Vofb 730
Langth d drop pipe - tiv�S -- - R CapecM - 7�7-- 9.p.m.
Pressure Tait Capacity
Type: n Submersale ❑ L�. x�e��tnp ' I Jet --- - ---- —
ABANDONED WELLS
Does property have any not m use and not sealed well(s)' :; res 9. No
-
WELL CONTRACTOR CERTIFICATION
Tris well was o lied _ndar my supervision and in accordance with Minnesota Rules. Chapter 4725.
The mformab on contained in On report q true to ft beet of my knowledpe.
Use a second sneer ,f needed
UGN :, A DLU, hl" MUTAIG CU., IANC.. 71 i -
REMARKS. ELEVATION, SOURCE OF DATA. etc.
LkenewBluaeraarNanre 1.4 or PAW No.
Owe
F.P. McMahui 9-119-9
Name or Drme, pipe —
HE -0b 2OS•04(Rev. SM)
LOCAL COPY
.387