HomeMy WebLinkAboutwell info WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO.
CounryName WELL RECORD � ��� � �
��X �e/iCl� i n Minnesota Statutes Chapter f 031
Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date of Completion
Qrnno II8N 23W 21 NE,,,NK,,.SW ,,, 267 n 21/6/92
Numerical Street Address or Fire Number and City of Well Loration DRILLING METHOD
936 Cox farm Road Long Lake, f�l 55356 �� CableTool �- o���e� � 0�9
I Auger � Rotary C Jetted
Show exact locatian of well in section gnd with"X". Sketch map of well location.
Showing property lines,
N roads and buildings. DRILLING FLUID
--�- �- -j -i- water
i i � USE
'-+- --- �- �- ffi Domestic � Monitoring f�; Heating/Cooling
� ' 1
W � � ET C Irrigation I; Public _: Industry/Commercial
-� -1- -;- �- I C Test Well Dewatering f7
� f-mi.
� , CASING Drive Shoe? I Yes � No HOLE DIAM.
i
--i- �� —�� [1 Steel ' Threaded - Welded
� � Plastic � glue
�m;le�
CASING DIAMETER WEIGHT
PROPERTY OWNER'S NAME in.to
j 52 n. ibs.m. ���.ro1�Z n.
Ja�es F. Nanson ��._� tt. Ibs./ft. in.to_tt.
Mailing address if different than property address indicated above. in.to fl. Ibs./ft. in.to ft.
SCREEN OPEN HOLE
Make �C� from ft.to ft.
Type Diam.
SIoUGauze c S 0� Length
Set belween V ft.and lfi7 ft. FITTINGS:
HARDNESS OF STATIC WATER LEVEL
FORMATION LOG COLOR FORMATION FROM TO l��j ft. �� below � above land surtace Date measured 1� 6 �2
PUMPING LEVEL(below land surface) C
Tapsoi 1 bl ack 0 4 n. afte� hrs.pumping J� a!a i r q.p.m.
WELL HEAD COMPLETION
Cl ay ro�� 4, 1 C� �Pitless adapter manufacturer ���5 Model �
� Casing Protection
4�a f+a 15 32 GROUTING INFORMATION
Well grouted? � Yes ❑ No
Grout Material � Neat cement ;i Benronite
Cla & ravel ra 32 86 ,�om 0 to 3� n. � YdS. L bags
from to ft. ❑ yds. ❑ bags
SE��"� � �"�ye� �t� �� 92 from to ft. '� yds. ❑ bags
NEAREST SOURCE OF POSSIBLE CONTAMINATION
L�a & ravel ra (�,�1 t �2 !Q� feet direction type
Well disinfected upon completion? �Yes � No
b�C� Q r{3v�� rown �ul i PUMP
C7 Not installed Date installed
c.,,.jp * Manufadurer'sname Go�tlds
JCF#U Ot ravel 1 aC� �'Q� Model number HP___1__�,�`�Volts���'�
Length of drop pipe 3 46 ft. Capacity I$ g.p.m.
Boul der 1 ack wh i e �2 2 Pressure Tank Capaciry �i
Type: � Submersible L I L.S.Turbine I' Reciprocating - Jet �
ti�a � sand rOUVI� RIU� � �2� � AgqNDONEDWELLS
e,, ,�i p� Not in use and not sealed well on property? C 1 Yes � No
JO��i R ravei 1 ti � WELL CONTRACTOR CERTIFICATION
This well was drilled under my jurisdication and in accordance with Minnesota Rules,Chapter 4725.
The information contained in this report is true to the best of my knowledge.
Use a second sheet�needed Stevens Wel t Qri 11 i ng Ca.,I nc. 27194
REMARKS,ELEVATION,SOURCE OF DATA,etc. Liaensee Business Na , Lic.orReg.No.
i�r� � 11/9/92
Authonzed Representative Siganture Date
�ae Stevens II/9192
Name o/Driller Date �
LOCAL COPY � � Q � � � HE-01205-03(Rev.9/91)