HomeMy WebLinkAbout1991-01-09 Water Well RecordSTATE OF MERIESOTA DEPARTIEIIT OF HEALTH
UP 9W
Casaay
WATER WELL RECORD MINNESOTA UNIQUE WELL NO.
fie; u K: r ;1n
Miaa..b sUAda ,16A. o, �.75 IN wet" s.
469550
Tassaltup Now.
her
Number
Srctson No
Frw m
a. WELL DEPTH icaapirtedi
an
11:1 v
t'
SAi -4 Wl 14 SU-AT7,_
al Serrate Addness and City
or theu Loesimn or Distance from Roil Irsterseection
S DRILLING METHOD
1t). :itr:'-'.L,
Uruv_,, Mina. ��! — •
OCOWTool ORnww
Ohollow, kod OAir
ODrivers ODq
0Owed O
sawenactlocationIall
well in Instant" wmh"x." map of well leconsin.
I e
I I
Addition Name
dliRa+ry OJetted
O Pbwv Auger
W r t E
1 t ' I umber r
Y• v
y address
2. PROPERTY OWNER'S NAME Mailing Address if different than propert
indicated above.
k3ute 3 4 BOX 3S
D0,111 Yeri'.4;111 lC>lL:t !ll('�? .NI Iucintl, f$1. r7LINi
J. FORMATION r.s.s.
LOG COLOR .�.._0
�l
'i ftJQ bAm O aA»e Date Measured I�� fia+ir--
land surface
I1. PUMPING IEVFL ibrk w land surfarrl
y fl. after li hn pumping Li� i p.w.
11. after hrs pumping spa.
12. HEAD WELL COMPLETION
&PHtlessadspier manufacturer t Madr
❑ basement offset Ai At kast 12' abre ground
❑ Pla" w casing protection
17. WELL GROUTED? CkYes O No
O Neat Cement O 6entowte
Grout materwl . from to Itat. ptY_
la. NEAREST SOURCES OF POSSIPLE CONTAMINATION
feet director
Well disinketed upon completion? )oYn ONO
ttiye
15 PUMP
[Ate installed ., —� —`a
O Na , 0
Manufanureis name scr
-
, ;^
Model number HP
Vale. `e•
Length of drop ppr 14 1 It. Lapscrty
Material of drop lips, l tt Gai , _
S Rsa.
TypeV SuMue able O LS. Turbine O Reciprmsfuss
Olet ❑ Centrifugal O
16. ABANDONED WELT S
Unused well on property? O Yes gkNo
Usr a srraa/
sbnrt. r w"
sealed ❑ Perwwten1 O Tewplany O NO gram
17. REMARKS. ELEVATION. SOURCE OF DATA. etc.
is. WATER WELL CONTRACTOR CERTWWATION
This well was drilled under my runub"wn will this ripe is true
to the bend of gay
k owleds and edict
Lrraaw wsivm Mar
Lirsar Na
Addrasit -e.h Ht eft.L,�,/�.C�. �`I/' ;./i�ii3
.�` i4:,
-
Authoesid ftpo nor
}'_ Y_ Mf±4jr1. Ar
Nsmr aJ arm"
LOCAL COPY
gtya1101
RAl
4695501
�EiIRMn �Ml
7„gat
g,Y