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HomeMy WebLinkAboutwell info tiTAT4:Oh�MINNI�:S()TA UF'.1'AN7'M'cNTOI�HF:ALTH I. Lnl'ATI<)N UI�WI LL FIlNNFSOTA UN/QUF WEl.L NO. �^� r !"� �` � y'R, ������rN,��. WATER WELL RECORO .�ea�w in ,�.Wa,�.Sam,�� .�.�°:: _� k�� 4 Minnefr)!a Sfa N feJ I SM1 A.fl l�.(�N Tnwnsnlp Name Tnwnship Numher Nan{e NumAer tiecll�in N�. I�r�cli�in J. NROYlRTY R'S NAMF; N ' g 'G v. v. - 31"j °s' � w �# �,iT'!'y ::a. :�.1�i 2 � I)�atance and Ilkecl�iin(rum N�uJ inlrrsecli��nc�ir Slrcel A�Jress anJ C'i�y of Well Lo<�lion Ad rtsf ��y,.y}�,,,.�.3� �� w•sa,� a�. CPys�ai .�Zt• - d:—_ S��w ear��4�c��ion nf uw<II in xea'lion BriJ wilh"%." � Sk<Ich ma0 of well Inca�i�n. 4.Wk:LL DEPTH(<ompleted) Date of Comple�bn � n AJJili�in Name � i"'�� '�� ft. T,�.vI�+.7 _l ' _ ` _ti _ � � ; �d�ii���d�$ �fi1Z0! s M - � - �- -I- - E i❑c�nir�„��i aOree.r�x �❑n��.�o io❑��e � , -�' � ni�Kk r+�mne. a ` 2OHi�1lnwn�J SOAir 8❑B�red 11❑ _ _ _ '' _� ;fl�. � J� 6�1NIed 9❑Y��wet Au`ef ' ' ' � I l01 Num�er 6. USE '_1_ ' __'' _- '__'-' � �[ � � S � 1 7 II�Jlhimeslic a�Yuhlic SuOV�Y ��Induslry r--1 eri.T�—�—� a❑trr�eor��� s❑m����co�i aOc�mme�c�.� 7. FORMATION LO(: ��p�pH HARISNl:SS Ot' F�HOM TO i[)XMATIUN JOTrst Well 6❑Air('��ndili��nin� 9❑ 7.CASING HEIGHT:ACove/Below HOLE DIAM (S7�ti. },� � � �t+ I�Black 40ThreadrU Yi� �? � ��c.i�. s❑woiara s�.m« # n. G�' � �ra0� �3.,�� �� �� �� �❑Plastic a�V o.�ve snoe+ Vm_ No� �n.to�fl. WeiBh� Ibf./ft. —in.lo_fl. � � � � ��� in.to ft. weiBht Ibs.�fl. —in.to_ft. m.to h. wzlRm �na.�h. in.a_ft. s�� f �� � r/��}_ ��� �� B. SCRk:EN�'� bff1H r open ole � �v�r pVii from fl.�o tt. Make t+`+� 11i'E � 'V +�'� TY7< �Y�iiiiie� V Y� Dia. �vv y,' Slot/Gauze � Lmgth « F'ITTINGS: �,yri.�1 / � O�� � � �t� Sel between ��� Tt.and �� � fl. � iU ♦ ( _ ft.and (1. �raisli' cl�ry br�n �sd 2 t 5 �,�Li "'°' " 9. STATIC WATk;R LEVF;L — — 7� yy��, � llLlrelnw ❑ahnve Date Measured ���� � land surface i 10.PUMYING LF:VEL(below land su�(ace) [y �� ft.af�er � hrs.pumpin6 �Y g.p.m. ft.a(ter hrs.pumping g.p.m. I1y.^V�(F�:LLHEAUCOMNLk:TION �►LJv��i�•sz�a,v�.•, zOea:emeo�orr:r� �On�ira��ia�•an���r praJe 17. Well grouted? �Yex ❑No Cu.Yds. I�Neut('emi•nt 2�Bent��nite �❑ Depth: lrom � � (t.to -�f1. from �+/ ft.to f�. IJ. Nearest sources of possible conlamination leet dircction type well disinfected upon complet�on? Vesn Ni,❑ 10. PUMP i oa,�,�,,.���, 7%2618 3 ❑�o���_,.,��a Manuf�cturcl{Y,N�ame 5,���s ���•� Model�eT' �S �~.• HY.�J`4 Volis Length of drop pipe "� ti.capacilY B.p.m. Material qo(,�dro, p D�oe Type: ALJSunmercinle ��L.S.Turbine S�Reclprocaling � l�le� 40C'rnlriNgal 6❑ 16. wATERwELLCONTRACTORSCERTIFICATION 'fTis well was drilled under my jurisdiction and Ihit reDorl is tru<to the best o(my knowledge and belief. �Bu a � • L/crnx N s Ute a tecond aheet.fI nerded. - I5. NF�.MANKS.F'LlVATION,SOUItC't;OlUATA,eIt. �� 1�� � x,y+�, ��� � g��q���]"('Ji q�– �9�I „LA.l LPV lAi7C:L ewi2 Signed Date Authorixed Represenlative � �jl� ��� Date�� me of DrJlu �ac�a co�� " �, � 1 � �� 5/74 30M � ('�� 7/76 30M 7/78 30M