HomeMy WebLinkAbout1994-05-31 Water Well Record;WL )CATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO.
County..ameHamwin WELL RECORD 536272
Minnesota Statutes Chapter 1031
Township Name Township No Range No Section No Frad*. WELL DEPTH (completed) Date Work Completed
117 23 66 41-0073 47 I 7I-'
1
Numencal SIr40111 Address and City of Well Location or Fire Number DRILLING METHOD
030 EZ=n Street Orcm, Mtn. Cabe Tool ❑ Driven Dug
Auger RoWy Jetted
Show exact location of well in section grid wrth'X' Sketch map of well localan
Showing property Imes.
M roads and buildings DRILLING FLUID
os=Ii
EEO
WEE®
I_ I mrk
PROPERTY OWNER'S NAME
Matting address 0 different than property address mOratad stove
``22075 Hra�.: wtts Fbad
►7lsU / Nn. 55 _�31
GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM
MATERIAL
ClayS C
Sand S 1101
Use a second
REMARKS. ELEVATPOW15bURIP WbAtA, etc
SEP 21 1994
.USE DomesticMtxtd .: HeabngiCoohng
°`"n IndustryrCommercral
. Irrigation ❑ Public Remedial
Test Well rl Dewalenng
` L CASING Drive Shoe? " Yes NO HOLE DIAM
Steel Threaded Welded
r 3LPlastK
CASING DIAMETER WEIGHT
4 at. to 128 ". —Want. _7_�8ro 30It
ig Homes Lx
_— n. to _.. R .. - -- baA. on. to "
SCREEta:_a__-_-_ - _ OPEN HOLE
Make - __ from _ ft to. -_ _ -_-- __-"
Type StdiY11(�S St mi Dam
slovGa _ _ 1 L 1 U Length
Set between _ 1 �_)a 1 ". Ytd If FITTINGS: 4 a
STATIC WAT//Si�LEVEL
TO _ If ,a below ❑ above land surface Date measured '1-
PUMPING LEVEL (below land surface)
h aher - -- - hrs pumping - - - - g p m.
WELL HEAD COMPLETION
13l ' qt PRless adapter manufacturer _ _ — Model -- _
Casing Protection_---_----_---- ------_-__ ? 12in.above grade
GROUTING INFORMATION
Well grouted? X: Yes : No
Grout Material ' : Neal cement ,ZBanlmft
from— _ (�-- to —3 _ 3 __-- ❑ yasXJ bags
from to__ — ". —_-_-- ;; yda '7 bags
from to _._ it '1 yds ".; begs
NEAREST KNOWN SOURCE OF CONTAMIN TIO42 y
7�'' - feet wS - direction 5 y►ra type
Well disinfected upon completion? X Yes No
PUMP
Not installed Dale installed
Manufacturers name
Model number - HP Voft --
Length of drop pipe _. - n Capacty
Pressure Tank Capacity T_ _
Type Submersible rJ L S Turbine Reciprocating Jet
ABANDONED WELLS
Does property nave any not in use and not sealed well(sl' Yes X No
WELL CONTRACTOR CERTIFICATION
This well was drilled under my supennsion and in accordance wdh Minnesota Rules Chapter 4725
The �inf�ormation contained inntthis
srreport
t's true 10 the blest Of M know)adyp�ey. _ _
N�.Ia� 57GD" alf�We/ irR.IIaLxIW 66. � 1a C. L / 1 I L
Lrr ensee Brusress Name Lie a Ray. No
5-31-94
Auenorrzed Rep+esen! ve SgnaNre iD4s
F.P, hdMahm 5-31-94
LOCAL COPY 1513 6 ' _" 7 21 HE-0 1205-04 (Rev. 5"