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Home My WebLink Aboutwell info: . �. .�, . . � , Y� .,._.r ; - , WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. CountyName WELL AND BORING RECORD 615 2 0 6 H C:i]l16 jJ 1�2 Minnesota Statutes Chapter 103/ Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed or€�nc� 117 23 � W SE t�E I11 n y j25/��3 ��. ��. ��. House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD �8s� (.+r.G��3��if.,,�� Av� ❑ CableTool ❑ Driven ❑ Dug ❑ Auger �Rotary ❑ Jetted Show exact location of well in section grid with"X". Sketch map of well location. ❑ Showing property lines, roads and ilding . DRILLING FLUID WELL HYDROFAACTURED? ❑YES C�10 " �� wat�X i i � i FROM ft.to ft. -i i i i USE ❑ Monitoring ❑ Heating/Cooling � i i i i ^�C � �[Domestic —I— —J_ _�_ _I_ L ❑ Irrigation � Community PWS ❑ Industry/Commercial I I I 1 �7 ❑ Noncommunity PWS ❑ Remedial w e� ❑ Test well i � i i ❑ Dewatering ❑ i , r -r '/zM_ie � � CASWG Drive Shoe? ❑ Yes No HOLE DIAM. _i_ _ i_ _i_ _i_ � .�` U ❑ Steel ❑ Threaded ❑ Welded i i i i i �Plastic ❑ S ` - �1 Mile-� y � CASING DIAMETER WEIGHT PROPERTY OWNER'S NAME � in.ro lflb n. 2dV Ibs./ft. �_in.to_��t. i'��Z�3�a .��rt3C33Z _in.to ft. Ibs./ft. _�in.to.�j,_J�. Property owner's mailing address if different than well location address indicated above. in.to R. Ibs./ft. in,to fl. SCREEN OPEN HOLE Make J$'��'0 from ft.to ft. Type pV�r Diam. � SIoUGauze [�9 2 t Length Set between �.V 6 ft.and +I 1 ft. FITTINGS: STATIC WATER LEVEL , WELL OWNER'S NAME _ �� ft. �elow ❑ above land surface Date measured PUMPING LEVEL(below land surface) 9 Well owner's mailing address if diKerent than property owner's address indicated above. �� ft. after J hrs.pumping 40 g.p.m. WELL HEAD COMPLETION C�Pitlessadaptermanufacturer �t�i��'�ter Model �� ❑ Casing Protection ❑ 12 in.above grade ❑ At-grade(Environmental Wells and Borings ONLY) GROUTING INFORMATION Well grouted? �Yes ❑ No GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO Grout Materia� ❑ Neat cement C�eentonite ❑ Concrete ❑ High Solids Bentonite MATEFiIAL from �0 to 7 n. 3 ❑ yds. OXbags from to ft. ❑ yds. ❑ bags cl,$ �13�A ln��• from to ft. ❑ yds. ❑ bags NEAREST KNOWN SOURCE OF CONTAMINATION t:j,di/ �}l.U� ��4'C�• � �� teet �`+��t direction "�"��r ��t�e` ' Well disinfected upon completion? O�es ❑ No .. �anc� b yr�vel mix m��•/ 7 11 PUMP ❑ Not installed Date installed 9/�4/9€� Manufacturer'sname 5��a'�x,C� Model number HP 1 �olts Length of drop pipe 8� ft. Capacity �.� g.p.m. Type: �.Submersible ❑ L.S.Turbine ❑ Reciprocating ❑ Jet ❑ ABANDONED WELLS , Does property have any not in use and not sealed well(s)? ❑ Yes �No VARIANCE Was a variance granted from the MDH for this well? ❑ Yes Q[No WELL CONTRACTOR CERTIFICATION Use a second sheeG il needed This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. REMARKS,ELEVATION,SOURCE OF DATA,etc.._ The information contained in this report is true ro the best of my knowledge. 8$S Well Drlllln�7 27276 (� � Licena�e Business Name Lic.or Reg.No. ' � �7�>`` � � � 9 _ . �_ Authorized Representative Sig ture ate , _ 8�ber� �. S�s�dolar Jr. �/2�/98 �iii�i �� Name of Driller HE 01205-06(Rev.9/97) LOCAL COPY �15 2 0 6 � '-- . � � .=:z . - �.,. . . , , .. �.. f... :.. -.,,,.... wELI OR BOR�NG LOCATION MINNESOTA DEPARTMENT OF HFALTH M�nnesota Well and Bonng rH l4 5 414 � ry WELL AND BORING SEALING RECORD Sealing No. Coun Name Minneso;a Unique No. � H�nr��in Minnesota Statutes,Chapier 1031 or W-series No. � (Leave Dlank A nol known) Township Name Township No. Range No. Section No. Frac6on(sm.-►Ig.) Date Sealed Date Well or Boring ConstructeA flr�ne� i17 23 5 � „ 9/24/9F� Numencal Street Address or Pire Number and Ciry of Well or Bonng Lceation 2 q� Cj��y�1 fL?� pV Q Depth Before Seal�ng o� _N Original Depih 85 fl Show exact loca6on of w�ell or borirg Sketch map ot well or bonng ApU1FER�S) STATIC WATER LEVEL in section gnd with'X'. bcation, showing property ingle Aqurfer ❑ Mul�iaquAer lines,roads,and bwldi s. N WELUBORING �Aeasured ❑ Estimated �y []QNater Supply Well ❑Monit.Well r T � � � �.ti,. ; ' � ; w� t y` ❑ Env.Bo�e Hole ❑Other _ �� ry. �J pe� ❑apove land su�ace W --�- -�-- -'-- -'-- E �c�`' - CASING TVPE�S) -�-- -i-- -i-- -�-- � ^ '�1 [�Steel ❑ Plasfic ❑Tile �Other � , � um ' —�- -�-- -�-- -�-- � �� `�. CASING � Diameter De ih Set in oversize hde7 ? S � �� P Annualar space Irntially grouted �(r—r rrw� /f `. 1 in.from� to� fl. ❑Yes ;]No ❑�es ❑No ❑Unknown I �� PHOPERTV OWNER'S NAME in.irom to R. ❑ Yes ❑No ❑Yes ❑No ❑Unknown Hark L� r�on Propeity owners mailing aAdress A dillerent Man well locatwn address inA�cated above. in.irom to ft. ❑ Yes ❑No ❑V� ❑No ❑Unknown SCREEWOPEN HOLE Screen from�1 � to �J fl. Open Hole from to R. OBSTRUCTIONS WELL OWNER'S NAME Rods/Drop Pipe ❑Check Valve(s) ❑Debris ❑ Fill ❑No Obstrudpn WeN owr�eYs mairg aAEress il dAb�errt then properry owners adlrass irWicated above. Type of Obstructions(Describe) �i� d Tid j 2 t Obstructions removed? �Yes ❑ No Describe PUMP Tr�^i et GEOLOOICAL MATERIAL COLOR HAHDNESS OF FROM TO �Removed ❑ Not Present ❑ Other FORMATION tl ral knorm,inditale e�tls01o1mauon bp from neaiby well or boring. METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE MOLE: �No Annular Space Exits �r�1 t ❑ Annular space grouted with tremie pipe ❑ Casing PertoratioNRemoval in.from to ft. ❑ PeAwated ❑ Rertioved in.trom to ft. ❑ PeAaa�ed ❑ Renwved Type oi peAorator ❑ omer GROUTING MATERIAL(S) GroutlngMatenal ��'��'d�u trom � to V 1t. yards � bags trom to tl. yards bags from ta .. . R. yarida bags from to__ tt. yards begs REMARKS,SOINiCE OF DATA,DIFFICULTES RI SEALING OTHER WELLS AND BORINGS Other unsealed and unused well or boring on property? ❑Yes_.�Mo How many? UCENSED OR REGISTERED CONTRACTOR CERTiFICATION This well or bonng was sealed in accordance wiM Minnesota Rules,Chapte'r'1725. The�Aortr�atim�ed in Mis repoA ie true to the best of my knowledge. _ �ES Well �riliiei� 17�76 Conhacror Business Name L�or Rep'sYrabon�'. r---=� �•. `� � � • y�" rif %- _ A ed Represenfative igneture OWs Jaa�es L�a -,� LOCAL COPY H 14 5 414 ��oI Person Seali�Well or Bonng HE-0143403 2/97 R