HomeMy WebLinkAbout1990-10-25 Water Well RecordHejinepin
STATE Of MINNESOTA DEFATTMENT OF HEALTH
WATEH WELL RECORD MisshSOTA vstQVt weu so.
r Sh/Mla I56A 0I 08 /Of WtUr Samtit 467082
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TowMhip Number Ilange Number Section No Fraction 4 WELL DEPTH loompleted)bateof CamplelionNwVi 14 W
W ------------------!L . 1 QQ
4750 Creekvood Terrace
Shem cuct lontian cl wcirtn Mciion grid with "X "Stoch map ol writ knlion
••r-4--i--f-
T I
■ ^ -
-i--i-■f
■t --i--i-1"r*
□ Hollow Rod □ Air □ BorM n
□ Jetted □ Power Auger
6 DRILUNG FLUID
7
CieomeaiK □ Monitonng □ Heat Pump
□ Imgainn □ Public □ Industry
□ Test Well □ Municipal □ Commercial
t PROFERTY OWNER'S NAME
Roben Corporation
FORMATION LOG
yellow clay
clay
gravel & clay
sand
Mailing Aiidress if diffrieni than propcny address
indicated above.
2765 Kelly Ave.
COLOR rrmFirri^T*:
brown
gray
gray
brown
FOmAnON
soft
soft
soft
soft
FROM
148
□ CaUeTool □ Reverse □ Driveti □ Di«
8 CASING
□ BUch
□ Citv.
D Threwded
□ WcUed
*"‘•"4 °151
--------------------in. to_________
. in. to.
. in. to.
HEIGHT: Abovc/Below
Surface--------------------------It.
Dnve Shoe? Ye-___No____
We«ht_____________Ifcayl
We«ht
We«ht
. IboVlt.
. IbiVfl.
HOUDIAM.
Jn. to_____ft.
Ja to_____It.
9. SCREEN
Johnson Or open hole
tram________.ft. l&
stainless steel
12 slot Leiigth.5 ft.
Set between .. ft. and.
hrrtNcs;
3 ft. extension
10. STATIC WATER LEVEL—um (t.O below □ above
land surface
Date Measured 10/25
11. PUMPING LEVEL (below land surface)
-----------------------It. after ______ hra. pumping .
-----------------------ft. after______________hne pumping .
■ P-m.
gpjn.
12. HEAD WEa COMPLETION
Qfitless adapter manufacturer___________________
□ Basement offset □ At least 12" above ground
□ Plastic casing protection_________
JX WELLCROir-'
□ Neal Cement
Grout material _
□ No
. ft cu. yda-
eg
14 NEAREST SOURCES OF POSSIBLE CONTAMINATION
---------------feel__________direction ________________
Well dmnfrcird upon rompielion’ C|(ea □ No
Vtr outottiAtH. tf rnidml
'■0
|UMP
installed _
iifacturer's i Aeraotor
.□NMinatalled
Model I
Steel
CapacityLength of drop pipe —
MalensI of drop pipe
Type: % Submersible □ LS. Turbine □ Redprocaling
□ Jet □ Centrifugal □___________________________
hiIJl.
12
.Volta 230
16. ABANIXINED WELLS
Unused well on property? □ Yes dDio
Seided □ Permanent □ Temporary □ Not sealed
17. REMARKS. ELEVATION. SOURCE OF DATA. etc.
18. WATEP WELL CONTRACTOR CERTIFICATION
This well was drilled under my junsdiciion and ihu report n true to the best of my
knowledge and talirf.
Leuthner Well Inc. 10125
Addres
Litrmtt Buitmas Somt Limit No
.Box 159, Victorias Mn 55386
P .., VcH..
Ken S^hjrft^
LOCAL. COPY 46/U82
Namoq/DttUtr
HE4UB549(llev. WEB)
nsr./ '/■ // /H
10/27/90
■ Date______________
S/74 30M
7/76 aOM
7/76 S6M
VM 18M