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HomeMy WebLinkAboutwell info STAT� OF 1�Ii�N�S�i'A �EPAR7T�`i'i OF �!c!�?7r� AF�:�MDO?!ED }dF1L �iECQ�t� i 4�u�toa� ov we�� . !�?�vMESOT� IJNIQUE WEII N0. .`__.� (leav� Gitn'< tf not kno�n) � ] �Lavnty Nawe �-- Henne in I 'o��:ms�1A kacu TornsMp Nun�r R�nge NuwDar Sectton Na. Praction � 4. :;iLL �EP7H (cz+.�l�'.,��) Date sealed � fi y h or k Crano 117 s'' 23 � 18 NE r1E SW 53 ``'' 1/19/90 i;�,c•r_r�icel SLrRet AdCress anC City of bleil Loca'tan or plltan:t frw� Rna4 5. DR1LLIiaG riETii�� �if kac,rnj lntarsactton l�f Cabie t�al 0[,'R�vers�c 7[]Qriven 1�Dug .�J' no i lw �wd 5["j A1 r E(]Btired 11(] One DeerinQ Island �'6�'"'- `"�'"�""—"""'�—� a'�Roiary 6[��stted �Porar Auqer S:os enect loutton of well (irt sec.tort grid rlih 'X') Sketcn .up of wil loteNea 6. 08;TRUCTIOkS '�� � ; - _ M '- -` 1:e11 obstru:ted Q Yes �] No _ � _ Qb;SructSon; r�teova4[�Yts �No If obstructlons cannot be � moved, contact !@N , , � � - - - - • • -I- ` - E betorc i��11ny. : � �X � i � � 7. USE ...... _... .._ - - � ' ' y R. 1Q Dw.rsitt �PonlYoring �Heat LooD •� I 2�]Irrigation �]Publit 90 lndustry .i..,_.,,�._._._•- � �'i TNsf k•sll !�75unicip�l !C[�Coesercfal I J � a-----1 .sL---+ � 7['•Atr Cundttinniny 11[� Z ."ROP�FfY OYHER'S NAME IL111ng kddress 1f �Sfferont than�J ��ING{S) �,�l� proprrty �ddress lndicated a0ert 1�Blatk 6�Thrnad�d 7Q � Scherber Propertie p,0. Box �3 �,�7e�i,�. st���_ia�a Excelsior, MN 55331 �'a Pi�3.+c �]s-�+�i:sa se�s� ' Y~._ HRRDNE55 OF ..'�"._,.___—'_- _"� tn. ia� ft. 3. �ORMIIiIOA lOG CCLOR FOiiYJ1T16M FACi! i0 - �-- It not known, indfute fonnation log froa naur veil or nearDy rell. ��. 1n, to _,� 1t. ..�...___� .. �.� . ^� 9.�SCREEII _.�......_.__.�._�._ .�..._ . _�_.+._. . _ _ __� fF�]Sereanid c.;il f;�s tt. to tt. . ._,..._.,,. ,�._.� � � (I` kno,�) � � (�0»� l�sl�s 9:_n.` ti. to_� ft. _ �_�.. _ _. ._— .,�_ ...�_ .,�_ i ,,v� - '_- 10. :;iA7IC41�TER I_:tifL ft. � bola� ��SovR �� � � � ��12nA surfact Date Measured 1 19� �-.• �.�„ ._.:_ �� r„� 11. 1tELLKE�O CG".�L�'fI0:1 lj,]Pititts :_.�pWr �Feand Buried i � i------ ��� __.._,. __�- �83s.uxnt offse2 �.., ..�.__...._.__..� 3�]idell P1L 16. REMAFKS. ELEVATION. SOURCE OF OATA - LASIN6S REt90YED. CASIN.�'i.S DEP.fOPJ�TED, ETC.� �.. �12. GRUUTIqG lNFOR7�ATION� 1[�Neat Ler.enc 2�3antonite � Grvut maLerla7 �Ort1c3.Tld from QCo� ft. cu. yCs�l �13. (;i:��tEST SOURCES f COkTAMIN117I011 � Z�� Fett ,. � �, Qtre[t10n I�e type IWzll d151nf�cted Defore seslfng? � Yes 14. YllfaP [�Rea�ved �Not Present � 7y�t: 1[�Su�.::rsible �L.S. Turbine �Reciprocating 2�det �]Centr/fugal 6(] 15. EXiSTIHC, MELLS (Pla�s• sketth locattons of abandone6 and acLive relis 10 rena�tS sectton or nn dack,) Ottier itnu;aQ •all(s) on propertyt (�Yes � Yo ab�ndoaed: �i Pernan¢nt �Tea�porary (]Nnt saaled �17. �i:4TER wELL COfITRAL70RS LERTIFICA7ION � � � Tni; �11 was sealtd under my jurisdiction and th5s report ��,8 is true to tha best of my knowledge and belief. ___�B r�ersorr�aswell Inc. 270� Llcensre Bu3lness Nae�e Lfcensa Ro. �,115 ��,�,�rr;al Sr_reet Address —��"�-:�- A'IIV 55359 si9��a_ C'.K -� o,u 1 19 , __ . Ni_cholas Schultz o,t� ? i9,90 FFiCIAL ABAlIOONED YELL RECORO (May be used for Proytrty Tr�ns."er) � N:::e of Dr111�� �orrrawr: rzra MITH DSSD I � ��,�._._e.� J STATE OF MINNESOTA DEPARTMENT OF HEALTH � -- WATER WELL RECORD M/NNESOTA UN/QU6'WELL NO. Ccunty t'vame� Ja.Wa��Sa■.p/e 4 6?� � �J ��E,nne ln Mi��aom S�arrics(56A01-.08 Townah�p Name�� ownsh�p Num Range Number Sectan No. Frxuon G. WELL DEPTH immpkted) Date o(ComD�etron Orono 117 S 23 w 18 NE �' NE� Sk'�h 68 r�. 1/19/90 Numencal Sticet Address and City of Well L.oca[ion or D�s[ance from Road Imersecuon. 5. DRILLING METHOD � ❑Cable7ocd ❑Reverse ❑[hrvm O DuQ n � ow exact bcatan d well m sectan gnd wnh"X." Sketch maD d well lonf an. O HollowKod O Air O Bored ❑ N � i Addiuon Name $1 Rotary OJetted p Power Au�{er --r- t -1 1- 6. DRILLINGFLUID i ' ' � � Bentoriite ._�- --- �_ �_ BbckNumbrr W � i E 7 USE -1- -1 � I�[bmestic ❑Mon�tonng ❑Hcat Pump I � � La Number ❑Irr.gatan O Pubhc O Industn ' � 4.,rni. __�_ ; � � � �l-est Well O Munlnpal ❑Commercial 'i- - -r- ❑AvCondiuonmg O I - 1 �Ir—� 8. CASING HOLE DIAM. 2. PHOFERTY OWNER'S NAME Mailing Address if diiferent than propenr�address ❑Black HEIGH7-:Aho�c�Below O Threadcd ind�cated above. Surface (i Scherber Properties P.O. Eox 8 ��a�� ❑Kelded , Dnve Shce. Yes— No-_. i Excelsior, riN 55331 �P�asuc ❑ m.tu ft. Waght IEs.�ft �a io�i. HARDNESti OF 3. FOIiMAT10N L(� COIAR FROM TO _m.to ft. Weight _Ibs.�(t ._�a �o-1t - -_, FORMATION I ----- .. in t„-_..-_... (t. N'e�kht- ---IbsJ(t. �n. tn-�c.! To �oil Black F'rost 0 ? 9.sceFen u����n��� (rem (t.to. ft Make - Yellow Clav Yellow i�]ed. 2 30 TY� �ram — __ siovea�Ze 13 slot ���,n_ Sandv Clc3 � �—(t.and�S�f! FITTINGS Red "ied. 30 33 �'�''w�^— 10 STATIC W'ATER LE'.'EL Clav Gr.av I Med. I 33 5Q 41 _f� o�:�w Gebove DaceMeasured I -'—� j� land surtace v _`__� I !i. PUMFING�\�E��bebw land;uriacei Gravel �Iixed �ft 5C� 52 � � . µl ft.attrr_�hrs.pumpmg--� — R.p.m. ft.a(ter_ hrs.pumying g.p.m � Silt�' Sand Gra�' i Med. 52 �7 IP. HEADW'FLLconsv�e�ion iR.�_ �Pi�less adaptrr manufacturer `�'llt-ehdtei__Model j�i�.� I I S3R�i B�.BCIC 5^ 68 OBasementofiset ❑At least 12"abrwegruund L7 Piasuc casing protecuon -__� 13. WELL GRUUTED? 61 Yes O No I ❑Neat Cement O Bentom!r U— - � Portland 0 30 ' I Grout matenal— irom_ to -(t.cu.yds—�_ Bentonite 30 52 �__ I I4. NFAHEST SOURCES OF POSSIBLE CON7AMINATION �.Sd.L(eet C d�recuon T akP �rvpe Well dis�n�ected eqm completwn'' (�Yes ❑No � I� PUMP � llate mstalled 1/2�/� C Not mstalled Manufacturer's name Cp In(�friS _ Modrl n�mber Gr>>nc�f�S _ �v3,�1�vous )?�'; Length of droP qpe-- �� �t. Capaaty �O g p m � Matenal uf drop p�pr�V�lI11Z� Type: IXSubmersibir ❑L.5 T�rbme L]Heaprocaung UJet ❑Centnlugal ❑ __ __ 16. Af3ANIWNED W�LLS linused well on property' �Yes ❑No Usr o second sheel,i/needed �� � Permanem ❑ 7 empprary ❑ Not seakd 17. REAtARKS.ELE.VATION,SOURCE OF UATA,etc. iH. WATER WELL CONTFiACTOR CERTIF�ICATION 7�his well was drilled under my 7unsdicuon and[his repeMt is trur to the bes�of my knowledgr and behef Ber�erson�'-as�ll Inc. ?7�5� LIfP115PP HNSl�IPSS A'OTP L��eKv hb. Address 5115 In rial Street :`'Ia le � �'�V 55359 �f � �� � S�gntd L^ _�_ Z-v[��1•����'�DatP - 19/7V Authorizrd Hepresentattue Ir3LT�\' SC�IIII1Cit Dace�1� 14nme•ol fJ�t!!Pr IfUPORTANT: , 4 6 21 �' � �, 5%�e� FII F 11!ITH f�FFfl — l4�Fl i (141%nFR C(1PY � z ,.,,.,�,,,,�.._ .,„,�, �;7e�'