HomeMy WebLinkAbout1988-11-30 Abandoned Well RecordSTATE OF MINNESOTA DEPARTMENT OF HEALTH
ABAXDO0_wD WELL RECORD
I.•LaAtwo—OF WELL
MINNESOTA UNIQUE WEL! NO.
:lease blank it not known!
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Townshi
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Number
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Section No.
Frattsell a.
WELL OE -TM � Date sealed
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4 4 of
Numerical Street Address and City of Yell LOu on Or Oi stance frpm goad 5.
TRILLING METHOD Ilf known)
Inc non
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i
�MI'I! i
JIVV (f� s
10 Cable toot 40 Reverse 70 Dri ,fn 100 Dug
2[J Notlw Rod S[]Air �6ored tl(.j jit
Shw *.act location Or Wa11
10 Rotary 60 Jetted 90 Dower Auger
(in section grid with "X'i
Sketch map of Well locution 6,
Oa 7;iUCTIOnS
_ L _
_
_
.'
0
Wall •bstructtd 0 Yes No
Obs t rbc ti ant re=vtd 0 IN []No If obstructions Cannot be
a
COn tact MOM
'
Wayed.
Lore Waling,
j j
USE
DOMft iC 40 Mom ltOrl ng go Neat MOOD
Irrigation So Publ1C 90 Industry
Test Wall 60 whlc Ipal IC10 Corrc I a I
1 w1.
70Air Conditioning 110 i
2. PROPEATI OWNER'S NAME
Wliing Address +• different than
e.
f
NG(S)
property addnff +ndiuted ADOyt
Black 40 T11readed 70
'
Gals. S❑ welded
30 Plastic 60 Stainless Steel
HARDNESS OF
O. FORMATION LOG COLOR FORM TiOM FROM
If not known, indicate forgtion log from nw well or nearby well.
16. REMARKS, ELEVATION. SOURCE OF DATA . CASINGS REMOVED, CASINGS
FFtCIAL AWDONED WELL RECORD Kay Wa used for Property TrAntfer:
ZJUICWA&rs IIEJ NITn 04=
r0 In. to ft.
In, to ft.
9. SCREEN
0 SC roomed Wall from _ ft. to ft.
(fI known)
. 0 Open Hole from ft. to ft.
110. STA(IC WATER LEVEL
f It. 0 below abort
land fu rlsce Data Measured
III. JELLMEAD COMPLETION
!' 10 Pitlest Adapter Q Found Furled
I esit mnt offset 50
yell Pit
I12. GROUTiN6 INFORMATION I
IVNfat Ctrnt 70MY, to" Ito I
G1/out eaterlal r,n [ j t0� Cu. ydR�
13. ejAREST SOURCES OF COVIAMi NATION
feet _jjRWZ_ directloM r` -r
cell dlsinfocted before__ tooling? res Ts-�
;a. DUMP Aetp red �t Prf t
,Yoe INISubse Ibit U L.S. Turbine Rec,orocatinq
f
70 Jet 40 Centrifugal 60
!
�15. EXISTING WELLS (Please sketch locations Of atandonen and !
attire Wa11s In remerkt sect 0 0, 0n flack.) '
Othfr muted Wa11(a) On pro ptrtyT 0 Yes No
Abandoned: I] Permanent 0 Temporary No felled j
17. WATER WELL CONTRACTORS CERTIFICATION --��
This weft was Pealed under ey jurisdiction and this report
11 l ue to the belt Of *y thowledge And eel'ef.
_ ICfnfet Bufiness Name Llcentf No.
e �
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Data
Now of Driller