HomeMy WebLinkAbout1989-07-11 Water Well Recordiggrompi^
STATt OF M0INESOTA DTPARTMENT Of HEALTH
WAT EH WELL RECORD VMQVB WEU SO
Mmmaott Statuin I56A 01 at /mtA'ttrSm 458116
y' rStatMic* md lAmtwfi from RomI InMMion'Sk ittwtl Addm* and City a('wHI Urilioo( 1270 Ftwich Creak ^ive, Otyxyo, Hinn.
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Addiino Namr
Btecfe Number
Lot Number
ShetebiMp of <*e<l lo^lion
V
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1 nommr owNEN-s NAME JGim laurant.
^9f0-FcaBc^ Creeac'Qicivie
Ifaysatat Him.
Sl POEMATIONLOC
Sand
««>• TO
c 30
Clay 30 24b
Shale & Sandetena 243 314
Sandstone 324 332
S DRILLING METHUO
IDCablr tout
rtel
.O Rotary
40 Rome
SO Air
GOjHitil
70 Omen IQO Dug
lOBared ||0_____
EOnmier augrr
6 DRtlXING FLUID
7 U^
lO DumeMK
^Olmgaiun
30 Tern Well
40 Monilani^
SOPuUir
COMumapul
70 Air CondHioniigi
n Heat Pump
90 InduMry
IQO Cmtirnemal
no_______
IJ^ING
lOMack
X
d Threaded
20Galv SOWrliM
aom-'* mi24
____________in. 10___________fl.
____________in. 10___________ll.
____________in. to___________ft
HEIGHT; Above/Befow
Surface X .ft.
Drn« Shoe?
WeiMH . Iba>ft.
WnMH
We#it
k./ft.
.Iba/fl.
HOLCDIAM.
/2a.
.Jn. to
9 scRMBansw Or open hole
lenm . ll. la .ft.
Type Dm--------82.
Sha/Gauae.324.I'i'i
Set hetween .. ll. and..ft
10. Sllftc WATER lJIl
_________________ll. O below O abovY
HttMS?
—7==n
TrniiWGuvlSS^
12 IkAOWEUCC
. ll. alier.
.ll. after.
Mirlacei
_____hra. pumping
DMrMcaaiired.
------20-
M4
g-pjn.
rOMPLETW
T. manidamgrer ^------------------
aOAiicaai 12" dU« ground
40 PlaUir eating pratcnnil---------------
10 Piileu adapter, i
20 Baicmcni ofliel
■X WELL GROUTED?
O Yet ONo
lO Ncai Cemenl 20 Bmianile
Grout matenal__________________
X Matural lAcktill
30__________________________________
. from.. ft. cu. yda.
14 NEAREST SOURCES OF POSSmU CONTAMINATION
---------------leel ---------------dirtcinX
Well ditiniccied upon cMn|delioii.> OVet ONo
TI^IP
Dale UMialled_____
Vk a teraad lAmf. if amM
.•«^»<jieii..scw«»ii»T*,«..
\\! Sff 2 51939 " '
; I I
iiyi
lOCAl COPY 458116
Kturer’t i
.□NmmaiMW
Model number 4b5p*-.HP.Vohm.
Ijrrigth of drop pipe
MalerialX drop pipe
capacity.-RPM-
Type lOSubmerublr JOL.S. Turbme SO Rtaprocatmg
20Jrt 40 Cminlugal 60---------------------------------------------
16 EXISTING WELLS
Unumd well on properly? O Vet
□ Pmnanent O Temporary O Not iraM
X
ONo
IS. WATER WELL CONTRACTORS CERTinCATION
Thia wail waa drilled under my lunadictian and ihia itpori m Uue lo ihe beat of my
ftygWtoiA i«LL amijm co., zk. 172
------15Tnf llqtMy I 7, WtiWg KUmAl^?345-
Addrema.-7=n=«9
ihonaM Repreteniaiita
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Name of Dealer
.Omc.
KE«l20S4eiRev lOAB)
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