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Home My WebLink Aboutwell info tiT�Th�.OF'MINNI-S(7TA Uk�.l'AHIMlNTOI�Hk:ALTH y 1. L(1('ATI(1N()I�WI�.LL Ff/NNFSOTA UNIQUE WE(.L NO. i,,,,,,,YN,�„• WATERWELLRECOR� 403800 � .� .. In.ware,sample Minnriota SfeN�cf/SM1 A.lII�.fIX T��wnship Name Township Numher It�n�c Numher y�c�i�in N�. 1-rai�l��n 3. YROYF;RTY OWNk:R5 NAMt f�fl� ��.� o� �� o� '� � � '6� '' ��+'�.1� �f��+�l�fl3! � I)Islan�'e and It- 11�in fn�m Hn�J Inlrrsecli��ns��r Slnei AJJress an0 C'�1Y o(W<II Lac�ion Addry{ jrE�L'j �i�/�6 O� J .e f� T � ` ,q _'a�a.�^��i � Snnw ea�it Lrcaliun o(ywrll in ucli�in rriJ wilh"X." Ske1cA map o!well I�calion. a.WlLL DEPTH(complet<d) Date of Completion ' n AJJilinn Name ��6 f,. �'�+^��'(j� _ L' __ '`- "ti ii � s ��c,nir�oo� a❑ee.rrse �On��.�� ioOn�e N - - -�- -�-I- , - E e�,Kk N�m�n x❑N��m,wr��u s❑ntr e❑a�rea n❑ ' - - '' -` ��. ��N��tarY 6�Jelled 9OYnwer Aueer - - �- --�- - -�-- 1 Lol Num�er 6. USE I�liimestic 4❑Yu�lie$u00�Y 7[�Induslry S F—1 IRtZI ]�Irriguti��n 5❑Municipal B�Commerti�l 1. lORMATIONLO(: �•p�pH HAltl>NFSSO! F�HUM TO 1()NMqTIVN J�Tr�t Wrll 6❑Air('��ndi�ionini 9❑ q 7.CASING Hti1GHT:AboveJBelow HOLE DIAM '�'�C1 '�� (� Bl�ck a❑ThrcadrJ i' 30(;alv. S�WelAed Sur(ace !t. {wia� � �� ,1G7 P�eStIC 6❑ Drive Shoe? Yes_ No x . �� in.lo �� ft. Weight �� Ibs./ft. —fn.�l�ft. � {[ y��'� Li�W'�►ia � �• in.lo f�. WeigM Ibs./(1. —in.lo_(t. ..f � in.to ft. W<iRhl Ibs.�ft. �n.lo_(t. j• ��r ��j �� =g e.SCRtEj`{�� r open ole . _; Meke� y (rom !t.to ft. ,i II�[iR� i��i�l�i� 1�7 +31J TYV� Sir �'{s1�4� Dis. ';: SI�1/Gauze y �� Length � �tWee�s� �� f'ITTINGS: ;?� �.`�.�� +!{} '� n.,�a «. ft.and fi. 9. STATIC WATlR LEVEL �'�� i18 G�. �i4� �� ^� • � J� �neli�w ❑annve Date Measu�� — land surface f _ 1�� r�� 10.YUMPINGLk;VEL(telowlanOsurface) 1�ai O;f{T.i (I.afler hrs.pumpin6 =� B.p.m. �_��n� w�� !� f�.afler hrs.pumpinH B.p.m. �F i � 11.Wt;LLHEAUCOMYLF:TION — � i'Q.P�uess aaepier,manuracwrer moee� Q'b1L� �1 �� 7❑Bas ment u((sei !❑A��east 12"above Rrade pOiA4 _ 12.WELL GROUTED? �3�.� C�� i �.�.� �C7v� ❑r,o — �❑rvr��c�m<�� aOer�i��n� �O �s�.+�rw't �� Y)� Grout matenal <<om «.cu.Yas. +3Y4�/. w.• 13.NEAREST 60URCES OF P06SIBLE CONTAMINATION �_roe� a�««�o� �rve Well disinfected uDon comple��on? Yes� N��❑ 10. PUMP oa«m:�su�e '3�.3i�.�4: ❑Na��„:�.u<a r:4�.�...�_w,.-... t}r � ('� Manufacluret's Name j�A�� S �(� '�, � Model Number HY�_Volts 6sj3L�_ � i:� Length of drop piPe �� ft.capacitY 1� B.p.m. _J Material of droD p�pe �Y� S+K � � 2 2 �i� irve:��❑suhm�•rcintr �❑L.S.Turbine s�ftec�vroc�i�ng ' 3�1e� 4�('en�rifugul 6❑ , . ' t �r. 1 s s eet �� 16.WATERWELLCONTRACTOR'SCERTIFICATION I5.AEMARKS,ELEVATION,SOUR a ��y_� 'Ihis well was drilled under my jurisCiction and this report is true to � "��+.,,,� Ihe besl of my knowledge and�elief. .�'j�'e�,�nss j�+�1.1 f`.n 2,�,5�31a. Licenree Butineir Name Licenx No. naa.essFi1�1� 41S�V'��, '�,�_�$�� L' ��e'Y��i �`,f� s�aoea� . � , w�e �#-"�s-��$ Auf�orized Represenfalive �.�3J�� :i£E°M@�31� n,« �*„`��'�:1 Name of Drdler I��AL C�PY 4 0 3 8 D 0 sna son+ 7/76 30M 7/78 30M HE-012o5-ot 2/82 tOM