well info - Laserfiche WebLink

Home Browse Search

' MINNESOTA UN/QUE WELL WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORWG NO. � County Name WELL AND BORING RECORD 7 8 8 2 3 5 Minnesota Statutes,Chapter 1031 Township N e Township No. Range No. Section No. Fraction WELL'BORING DEPTH(completed) DATE WORK COMPLETED �cono II7 23 03 S� Ng S�i,, Ib3 h ].2—i4-2011 GPS DRILLING METHOD ' LOCATION: Latitude degrees minutes seconds Longitude degrees minutes seconds U Cable Tool Driven � ❑Auger �Rotary House Number,Sheet Name,City,and ZIP Code of Well Location Fire Number ❑Other Gi� FC� St� iJLS7llf! S�JI[J DRILLING FLUID . ��ELL HYDROFRACTURED? C Yes No Show exact location of well/boring in section grid wit " Sketch map of well/boring location. W$�e(� From ft.To ft. Showing property lines, � N roads,buildings,and direction. USE �Domestic _Monitoring ❑Heating/Cooling 4 � __J_.__1____l_. __L_ . �,'.� �Noncommunity PWS ❑Environ.Bore Hole ❑Industry/Commercial �� � � � � . ;Community PWS ❑Irrigation ❑Remedial � � � � --�-----;------�-- --_-- . ,Elevator ❑Dewatering - w , ; ; E T CASING MATERIAL Drive Shoe7 ❑Yes ,�r�No HOLE DIAM. , --- - I ��, „ [J Steel` ❑Threaded ❑WeldEd 'h Miie . �Plastic � ❑ --�--- --T-- ---�----�-- CASING S � iameter Weight Specifications ��Mile-� ��' `,"� 9 in.To�� n. 11 Ibs./R 77L� To__�ft PROPERTY OWNER'S NAME/COMPANY NAME in.To ft. ____Ibs./ft. �in.To��ft VCf7r e �7�7CC:� in.To ft. Ibs./ft. in.To ft � OPEN HOLE Property owner's mailing address if different than well location address indicated above. SCREEN _ Make �� From ft. To ft. Type StRf411.�$$ St�►1 Diam. � SIoUGauze �'��Lengt��'*�� j'� Set between� ft.and i'�� ft. FITTINGS i�� ie STATIC WATER LEVEL Measured from�-q��J��'�� 7� ft.�Below ]Above land surface Date measured i¢�1'* �+ � WELL OWNER'S NAME/COMPANY NAME PUNI�I�LEVEL(below land surface) � y! t 7F.) ��7 ft.after hrs.pumping g.p.m. � Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION ( Pitless/adapter manufacturer �t�ts� Model ❑Casing protection __ __ �72 in.above grade i ❑At-grade ❑Well House ❑Hand Pump GROUTING INFORMATION(specify bentonite,cement-sand,neabcement,concrete,cuttings,or other) Matenal tlCiltVlil�eFrom�To�ft � [J Yds. ,�ags Matenal��$�,___ft£oj,i��To��_ft. [�Yds. ❑Bags HARDNESS OF Matenal From _To ft. U Yds. ❑Bags GEOLOGICALMATERIALS COLOR MATEFIAL FROM TO Drivencasingseal From ___To Bags NEAREST KNOWN SOURCE OF CONTAMINATION C��x br�'W� �i� 0 � �� feet � __direction ��t��__type .�/� t� Well disinfected upon completion? Yes ❑Na ta9e1 b�j �� Jl/ VlJ PUMP I,]Not installed Date�in+s�ta�lle�d_�____��_a" �� � �� U�� ""' Manufacturer's name `�'��C�et � � ��1 rs�� C8 �� t Q� Model Number�. HP } Volts 1 r� Length of drop pipe ft. Capacity g.p.m �� /�� t� ��=l� �nC �c� Type:�Submersible ❑LS.Turbine ❑Reciprocating ❑Jet ❑ V NlClil WJ � qgANDONED WELLS �[iCI (8 �1� �l't I63 Does property have any not in use and not sealed well(s)? ❑Yes �No VARIANCE Was a variance granted from the MDH for[his well? ❑Yes No TN# WELL CONTRACTOR CERTIFICATION This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. The information contained in this report is lrue to the best of my knowledge. Use a second sheet,il needed. REMARKS,ELEVATION,SOURCE OF DATA,etc. D� Stvdola Wel2 Drillin� Co,. inc. 1692 Licensee Business Na Lic.or Reg.No. ' / 12 G7��1 ti e resentative S' a[ Certified Rep.No. Date Mark Stoclola �.�r��`�� 7 8 8 2 3 5 -- - - Name of Driller IC 140-0020 HE-01205-13(Rev.11/10)